ID S1319

Out-of-network freestanding emergency rooms must accept the health plan's in-network allowed amount as payment in full for emergency services, and cannot balance bill patients for amounts exceeding this rate.

Health plans must apply in-network cost-sharing (copays, deductibles) when patients receive emergency care at out-of-network freestanding emergency rooms, and must pay providers directly.

Any consent forms, waivers, or agreements that attempt to allow out-of-network providers to bill patients above the permitted amounts are void and unenforceable.

Self-funded employer health plans (ERISA plans) may voluntarily opt into these protections by providing annual notice to the Department of Insurance; the department will publish a list of participating plans.

Violators are liable for the patient's or health plan's attorney fees and costs, and each improper billing attempt constitutes a separate violation; the act takes effect July 1, 2026.