Montana State Legislature

Study of Air Ambulances

The House Joint Resolution No. 29 study of membership-based medical services is primarily looking at air ambulance services in Montana. See the final report, Appendix C, for the summary of activities on the study.

• Actions Taken:
  • At the Feb. 4, 2016, meeting of the Economic Affairs Interim Committee the members voted to request that the State Auditor's Office work with air ambulance providers, insurers, and selected others to propose solutions that they would report to the Committee. See the letter to the State Auditor's Office and an Options paper for possible solutions. Lien statutes are here. Letter from the State Auditor's Office on working group.
  • The Economic Affairs Interim Committee also voted to send letters to Montana's Congressional delegation to address air ambulance issues from a federal perspective. See a sample of that letter.
  • For Aug. 30-31 Meeting Materials click on this link.
  • The Economic Affairs Interim Committee voted on two committee bills: LC 379 and LC 380.
• Work Group Discussions -- 
  
  AUGUST - Aug. 22 Conference Call;. Revised Draft / Redline Version
  -- Insurer Market Share in Montana for 2015 (individual + small and large groups)
  -- Website Prototype update, Brochure Update
  -- Comment from AMRG Counsel on Membership Reciprocity
  -- Montana Medicaid Claims by Air Ambulance Provider 
  Aug. 8
  -- Agenda
  -- Revised Draft Brochure
  -- Draft Legislation; Transparency Website Prototype
  -- Bill Bryant "What Have We Learned" (presented 8/30/2016 at EAIC)
  -- Letter from America's Health Insurance Plans (AHIP)
  -- Comments: Blue-Cross-Blue-Shield of Montana; MMIA, MHA 
  
  Subworkgroup on transparency
  Materials: Draft Brochure (old) -- Transparency Website Prototype
  
  JULY 
  -- Agenda July 8
  -- Discussion Draft for Possible Legislation
  -- Bill Bryant Slides
  -- Network Adequacy re ERISA and Affordable Care Act DOL Guidelines via Bob Olsen
  
  MAY
  -- Work group May discussion topics ... Airlift NW charges ... AirMethods letter ...Medicare data
  Bill Bryant:handout ... Suggested nonlegislative option -- Ambulance Provider Experience Levels
  
  Allegiance data ... BCBS data... Medicare / Medicaid rates ...Proposed transparency document
  -- Florida balance billing overview ...Florida bill on information/arbitration p. 7/ balance bills p. 10 ... NY regulations on surprise billing
  -- Northeast MT STAT Air data / procedures
  -- Maps for Flight Coverage: A.L.E.R.T., Benefis Mercy Flight, St. V's HELP Flight, ReachAir B, H, US
  Life Flight, Fixed Wing Coverage, Northeast STAT Air Montana - U.S. maps
  -- Wyoming court case
  
  APRIL
  --Work group's April agenda
• Allegiance Air Ambulance Data
• Blue Cross Blue Shield of Montana Air Ambulance Data
• Northeast MT Stat Air Payor Mix
• Pacific Northwest Medicaid rates for air ambulances
• North Dakota court decision
• Updated Survey Table 1 (overview), Table 2 (billing) Table 3 (medical)
  
  MARCH
• Work group March discussion topics

The following topics either have been addressed or were a part of the presentations to the Committee:

• Medical/Air Ambulance Considerations (parts of December and February meetings):
  • Preemption Concerns (also see GAO report, other opinions below)
  • Types of Air Ambulances (Bryant)
• Insurance / Payment Issues (listen to Feb. 4 meeting):
  • NAIC Consumer Information on Air Ambulances
  • Charity Care Guidelines - NW MedStar, A.L.E.R.T form / website
  • Sample Notification about Air Ambulance Balance Billing
  • Memberships: Bryant comment
  • National Council on Compensation Insurance Comparison Data for Workers' Compensation Costs for Air Medical Services
  • Allegiance Presentation
  • Blue Cross Blue Shield of Montana presentation
  • Sierra Health (Bryant) Presentation, Supplement
• Hospital Issues (listen to December 2015 audio), including:
  • the Costs of Affiliation or Service;
  • Montana Protocols for Determining when to Transport or Transfer 
  • Kalispell Regional Medical Center: Background, MembershipInformation
• What Other States Are Doing
  • Arizona - See Pricing Website; Licensing Website
  • North Dakota - HB 1255 Requiring Primary Call Lists and ComplaintsFiled with the North Dakota Insurance Office
    -- Court Decision regarding N.D. case
  • Washington Plan for Emergency Medical/Air Medical Services
  • Alaska Air Ambulance Registration / Membership Regulations

The Economic Affairs Interim Committee sent a survey to air ambulance services licensed in Montana and requested a variety of information. At the December 2015meeting the following materials were discussed or made available:

• Survey Response Summary. Revisions for May 2016: Table 1, Table 2, Table 3, Presentation

Other Material Given or Made Available to the Economic Affairs Committee (some of this material has been updated):

• National Air Ambulance Data 2012-2014 data
• GAO 2010 Report
• Frequently Asked Questions - Affordable Care Act - see balance billing
• National Institutes of Health "Golden Hour" Study
• U.S. Dept. of Transportation (DOT) Helicopter Transport Guidelines
• Texas Attorney General Opinion on Air Ambulance Subscription Services
• HHS Office of Inspector General Opinion on Subscription Services
• Texas Letter Regarding Workers' Compensation; Court Decision
• Article on Oklahoma Class Action Lawsuit by Ambulance Users
• HJR 29 Background Information
• Air Ambulances Operating in Montana
• State Health Benefits Information
• Study Plan - See Work Plan Appendix C