Proposed legislation in Pa. could aid local EMS if passed
A pair of bills working their way through the Pennsylvania General Assembly is aimed at addressing one of the principal problems for emergency service providers in Pennsylvania: stagnant rates of reimbursement from insurance agencies.
Emergency medical service providers cannot survive if their customers routinely fail to reimburse them for services rendered. Yet, EMS providers in Western Pennsylvania say this is a frequent occurrence, causing them to lose thousands of dollars in revenue needed to make ends meet.
During an April seminar for EMS personnel at the Fairview Township Municipal Building, Eric Schmidt, executive director of Shaler Hampton EMS, said his agency charged 233 Highmark Insurance customers $333,740 for service across 2025, but received only $180,000. Schmidt said this discrepancy was due in large part to 105 Highmark customers who failed to reimburse the agency.
“The problem is that Highmark issues the check directly to the patient and the patient keeps the check,” Schmidt said. “It is a really significant issue.”
Although both pieces of legislation have the same general goal, and both intend to amend the same act — the Insurance Company Law of 1921, they seek to accomplish it through different methods.
“Both proposals are related to EMS reimbursement, but that’s where the similarity stops,” said state Rep. Marci Mustello, R-11th. “They differ widely in terms of language and approach.”
One of the proposals, House Bill 1152, was introduced in February 2025 by state Rep. Jill Cooper, R-55th. Sixty-four state representatives have signed on as cosponsors, including Rep. Aaron Bernstine, R-8th, who represents parts of Butler County.
If passed, the bill would require insurance providers to pay 350% of the current ambulance reimbursement rate set by the Center for Medicare and Medicaid Services. This would apply only to state-mandated 911 calls and would apply regardless of whether the EMS provider is in the insurance agency’s network. The proposal would also eliminate the practice of “balance billing,” which requires patients to pay the difference between the total cost of services and the amount paid by the insurance agency.
“This has an impact on all of us,” said Mark Lauer, president of Karns City Regional Ambulance Service. “We take the middle person out of receiving the check and it goes to the agency involved.”
Schmidt said his agency lost money on nearly three-quarters of the calls it responded to in 2025. On average, the agency took in an average of $381 in income per call against $539 in costs, for a net loss of $158 per call. Over the entire year, that added up to a deficit of $872,780.
“Twenty-seven-point-eight percent of our customers reimburse above what it cost to buy the service and 72.2% reimburse less than the cost to provide the service. It’s really, really not a great picture,” Schmidt said at the April seminar. “If we’re dispatched, we must go. No ifs, ands or buts; and we want to. That’s why we’re here. We’re here to take care of people.”
According to official sources, despite the bill’s large number of cosponsors and bipartisan support, no action has occurred on the House bill since it was referred to the Veterans Affairs & Emergency Preparedness Committee in April 2025. However, Mustello said House members have discussed the bill at length whenever possible.
“The chairs and staff of the House Veterans Affairs and Emergency Preparedness Committee have conducted several stakeholder meetings over the past two years with a goal of addressing the public policy implications of the proposed HB 1152,” Mustello said. “The timing of any consideration of HB 1152 in committee is solely at the discretion of the majority chair of the committee.”
The chairman of the Veterans Affairs and Emergency Preparedness Committee is Jared Solomon, D-202nd.
Schmidt urged his fellow EMS providers to contact their local lawmakers and support the passage of the House bill before the end of the General Assembly’s 2025-26 session.
“We’ve got to bring this all together and make it happen before the end of this legislative session,” Schmidt said. “Otherwise, it all starts over again.”
In the state Senate, SB 622 was introduced in February 2025, with Sen. Katie Muth, D-44th, as the primary sponsor. If passed into law, the bill would require insurance agencies to reimburse EMS providers for services provided, regardless of whether the provider is part of the insurance agency’s network.
“Some insurance companies do not reimburse those ambulance companies for out-of-network services,” said state Sen. Scott Hutchinson, R-21st. “If their insurance company doesn’t cover that EMS agency, then the insurers try to say, ‘Well, you’re not a member. You’re not part of our network. We’re not reimbursing you.’ This would say they have to reimburse.”
The Senate bill was referred to the Banking & Insurance Committee in April 2025. Bill 622 is a reintroduction of Senate Bill 1130 from the 2023-24 session, which never advanced to a vote.
“A version of this has been introduced in the House in previous sessions, as well as in the Senate, and they really have not moved quickly,” Hutchinson said. “We certainly should be doing more things to help our emergency service providers, but this one particular concept has been a long time in the making.”
