Section 21.5070 - Rate Database for Emergency Medical Services Providers(a) Consistent with Insurance Code § 38.006, concerning Emergency Medical Services Provider Balance Billing Rate Database, this section applies to:(1) a political subdivision that sets, controls, or regulates a rate charged for a health care service, supply, or transport provided by an emergency medical services (EMS) provider, other than an air ambulance; and(2) an EMS provider or its designee that provides a health care service, supply, or transport on behalf of a political subdivision that sets, controls, or regulates a rate.(b) A political subdivision or EMS provider subject to this section may not issue a bill for a health care service, supply, or transport that exceeds the amount of the rate set, controlled, or regulated by the political subdivision.(c) A political subdivision that chooses to submit data to the Texas Department of Insurance (TDI) under this section must submit data using the data submission method available at www.tdi.texas.gov and must include at a minimum:(1) the political subdivision's name and contact information;(2) if known, the National Provider Identification (NPI) number of each EMS provider that provides a health care service, supply, or transport that is subject to rates set, controlled, or regulated by the political subdivision;(3) each ZIP code that is subject to the rates set, controlled, or regulated by the political subdivision; and(4) the applicable billing code, code type, and dollar amount for each health care service, supply, or transport rate that is set, controlled, or regulated by the political subdivision.(d) The data submission deadline for a political subdivision that chooses to submit data is 30 days after the date this section becomes effective.(e) TDI will publish data reported by a political subdivision no later than 10 business days after the data reporting deadline specified in subsection (d) of this section.(f) A claim submitted by an EMS provider or its designee for a health care service, supply, or transport provided on behalf of a political subdivision must include the ZIP code in which the health care service, supply, or transport originated.28 Tex. Admin. Code § 21.5070
Adopted by Texas Register, Volume 48, Number 52, December 29, 2023, TexReg 8380, eff. 1/3/2024