Political subdivisions were authorized to submit rates set, controlled, or regulated by the political subdivision to TDI for use in payment of emergency medical services (EMS) provider claims under Senate Bill 2476. TDI published these rates on the Texas Open Data Portal for use in EMS claims payment.
This page has the following sections:
- Background information
- Reporting and publication schedule
- Data reporting application
- Data portal
SB 2476 provides that political subdivisions may submit to TDI rate set, controlled, or regulated by the political subdivision for use in EMS payment and that TDI shall publish the rates on its website.
TDI adopted amendments to the independent dispute resolution rules in Title 28, Texas Administrative Code, Chapter 21, Subchapters OO and PP. To implement SB 2476, this adoption:
- Clarified the payment standards for EMS providers; and
- Explained how and when political subdivisions may submit EMS rates to TDI for publication on the publicly accessible database.
Political subdivisions that chose to submit EMS rate data to TDI were required to do so by February 2, 2024.
- 28 TAC Section 21.5070(d) sets the deadline for rate submission to 30 days after the date the rule is effective. The effective date of the rule was January 3, 2024, and the data submission due date was February 2, 2024.
- This was the only opportunity to submit data.
TDI will publish final EMS rate data on the data portal no later than February 16, 2024.
- 28 TAC Section 21.5070(e) sets a deadline of 10 business days after the data reporting deadline.
- TDI made preliminary data available in January 2024 to help health plans process claims that are submitted before the data submission deadline.
Political subdivisions were required to report emergency medical services rate data to TDI via an online portal.
Emergency medical services data reported by political subdivisions is available on the Texas Open Data Portal.
- For contact information for political subdivisions, refer to dataset: Emergency Services Billing Rates - Contact List.
- For National Provider Identifier Standard (NPI) information reported in each political subdivision, refer to dataset: Emergency Services Billing Rates - NPI.
- For ZIP codes within political subdivisions, refer to dataset: Emergency Services Billing Rates - ZIPs.
- For procedure codes rates, refer to dataset: Emergency Services Billing Rates - Code Rates.
When did SB2476 go into effect? What is the impact on claims between January 1, 2024, and the submission deadline of February 2, 2024?
The payment standards established by SB 2476 apply to claims incurred on or after January 1, 2024. TDI published preliminary data in January to help health plans accurately process claims that are submitted before the data submission deadline.
We expect health plans to work in good faith to pay claims consistent with SB 2476. If a provider has not yet submitted data, but plans to do so, they could wait to submit claims for payment until after the data has been published. If a health plan pays a claim incorrectly, the provider should follow the health plan appeal processes. Providers can complain to TDI if they believe health plans are not working in good faith to follow the new payment standards.
For more information, contact: EMSBilling@tdi.texas.gov