Health, Health Systems Improvement, Emergency Medical Services

Rule R426-16

Emergency Medical Services Ambulance Rates and Charges

Notice of 120-Day (Emergency) Rule

DAR File No.: 34213
Filed: 11/02/2010 09:15:19 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

Although this rule has not been amended since 2006, the Department of Health by order has authorized agencies to adjust rates according to the agency's fiscal data as reviewed by the Department of Health. For the past four years, the Department of Health has issued these orders on July 1 with the exception of one issued on 01/01/2009. Due to the Order issued by the Department of Health, the published ambulance rates in the rule are not the current rates which ambulance agencies charge. Rule R426-16 is revised to reflect the 07/01/2010 revised ambulance rates issued by an Order by the Department of Health. As all agencies are billing this rate, there is not an increase in cost to users.

Summary of the rule or change:

This rule change will end confusion as the published ambulance rates do not match with the current ambulance rates in Rule R426-16. Rates were adjusted annually based on factors set forth in the rule, but the new rates were not published as a rule. Going forward all rate changes will be placed in rule. Ambulance agencies no longer charge for Treat and Release, Emergency Response, and Night surcharges. Rule R426-16 needs to be amended to reflect these changes. (DAR NOTE: A corresponding proposed amendment is under DAR No. 34214 in this issue, December 1, 2010, of the Bulletin.)

Emergency rule reason and justification:

Regular rulemaking procedures would cause an imminent budget reduction because of budget restraints or federal requirements; and place the agency in violation of federal or state law.

Justification: Rule R426-16 needs to be amended to match current Ambulance Rates as listed by the 07/01/2010 Order as issued by the Department of Health, Bureau of Emergency Medical Services (EMS).

State statutory or constitutional authorization for this rule:

• Section 26-8a-403

Anticipated cost or savings to:

the state budget:

State budget will not be impacted, as the current rate that went into effect in July 2010 will not change by this rule.

local governments:

Local government budgets will not be impacted, as the current rate that went into effect in July 2010 will not change by this rule. The rates listed in the rule are increased significantly, but no change in current rates will occur as the rate in the rule had been inflated annually based on factors in the rule.

small businesses:

EMS budgets will not be impacted, as the current rate that went into effect in July 2010 will not change by this rule. The rates listed in the rule are increased significantly, but no change in current rates will occur as the rate in the rule had been inflated annually based on factors in the rule.

persons other than small businesses, businesses, or local governmental entities:

EMS budgets will not be impacted, as the current rate that went into effect in July 2010 will not change by this rule. The rates listed in the rule are increased significantly, but no change in current rates will occur as the rate in the rule had been inflated annually based on factors in the rule.

Compliance costs for affected persons:

EMS agencies are allowed to bill the rates listed in the proposed rule and there are no costs to the agency for compliance.

Comments by the department head on the fiscal impact the rule may have on businesses:

The rate has been annually increased by inflation factors listed in the rule and published in an order. The rule is hereby updated and will be kept current in the future. No direct fiscal impact expected.

David N. Sundwall, MD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Health Systems Improvement, Emergency Medical Services
3760 S HIGHLAND DR
SALT LAKE CITY, UT 84106

Direct questions regarding this rule to:

• Allan Liu at the above address, by phone at 801-273-6664, by FAX at 801-273-4165, or by Internet E-mail at aliu@utah.gov

This rule is effective on:

11/02/2010

Authorized by:

David Sundwall, Executive Director

R426. Health, Health Systems Improvement, Emergency Medical Services.

R426-16. Emergency Medical Services Ambulance Rates and Charges.

R426-16-1. Authority and Purpose.

(1) This rule is established under Title 26, Chapter 8a.

(2) The purpose of this rule is to provide for the establishment of maximum ambulance transportation and rates to be charged by licensed ambulance services in the State of Utah.

 

R426-16-2. Ambulance Transportation Rates and Charges.

(1) Licensed services operating under R426-15 shall not charge more than the rates described is this rule. In addition, the net income of licensed services, including subsidies of any type, shall not exceed the net income limit set by this rule.

(a) The net income limit shall be the greater of eight percent of gross revenue or 14 percent return on average assets.

(b) Licensed Services may change rates at their discretion after notifying the Department, provided that the rates do not exceed the maximums specified in this rule.

(c) An agency may not charge a transportation fee for patients who are not transported.

(2) The initial regulated rates established in this rule shall be adjusted annually on July 1, based on [an annual review of the most recent 12 month percentage change in price levels from the following sources: U.S. Bureau of Labor Statistics Occupational Employment and Wage Data, the National Consumer Pricing Index (CPI), the State of Utah Governor's Office of Planning and Budget economic report; the U.S. Bureau of Labor Statistics seasonally adjusted CPI for Urban Consumers transportation and medical care categories, and the U.S. Bureau of Labor Statistics seasonally adjusted CPI for Urban Wage Earners and Clerical Workers transportation and medical categories. The adjustment shall be made effective and published by order of the Department prior to June 1 of each year and become effective July 1, of each year. All licensed services will collect ]financial data as delineated by the department to be submitted as detailed under R426-[8]16-2([10]9). This data shall then be used as the basis for the annual rate adjustment.

(3) Base Rates for ground transport to care facility -

(a) [Basic]Ground Ambulance - $[400.40]535.00 per transport.

(b) Intermediate Ground Ambulance - $[475.40]707.00 per transport.

(c) Paramedic Ground Ambulance - $[600.50]1,035.00 per transport.

(d)[(i) A basic ambulance licensee may charge a base rate of $720.65 per transport and an intermediate ambulance licensee may charge a base rate of $795.70 per transport if:] Ground Ambulance with Paramedic on-board - $1,035.00 per transport if:

[(A)](i) a dispatch agency dispatches a paramedic licensee to treat the individual;

[(B)](ii) the paramedic licensee has initiated advanced life support[:];

[(C)](iii) on-line medical control directs that a paramedic remain with the patient during transport; and

[(D)](iv) [the ambulance provider pays $210.95 to the paramedic licensee.

(ii) A]an ambulance service that interfaces with a paramedic rescue service [must have]and has an interlocal or equivalent agreement in place, dealing with reimbursing the paramedic agency for services provided up to [the]a maximum of $[210.95]234.71 per transport.

(4) Mileage Rate[s]-

(a) $31.[40]65 per mile or fraction thereof.

(b) In all cases mileage shall be computed from the point of pickup to the point of delivery.

(c) A fuel fluctuation surcharge of $0.25 per mile may be added when diesel fuel prices [are more than $.31]exceed $5.10 per gallon [above the price of record, as established by the Department, on the immediately prior July 1 of each year]or gasoline exceeds $4.25 as invoiced.[ The Department will notify all agencies when this surcharge is available.]

(5) Surcharge[s]-

[(a) A surcharge of $39.75 may be assessed if the response requires the use of emergency lights and siren.

(b) A surcharge of $39.75 may be assessed for ambulance service between the hours of 8:00 p.m. and 8:00 a.m.

(c)] (a) If the ambulance is required to travel for ten miles or more on unpaved roads, a surcharge of $1.50 per mile may be assessed.

(6) Special Provisions -

(a) If more than one patient is transported from the same point of origin to the same point of delivery in the same ambulance, the charges to be assessed to each individual will be determined as follows:

(i) Each patient will be assessed the transportation rate.

(ii) The [emergency surcharge, night surcharge and] mileage rate will be computed as specified, the sum to be divided equally between the total number of patients.

(b) A round trip may be billed as two one-way trips.

(c) An ambulance shall provide 15 minutes of time at no charge at both point of pickup and point of delivery, and may charge $22.05 per quarter hour or fraction thereof thereafter. On round trips, 30 minutes at no charge will be allowed from the time the ambulance reaches the point of delivery until starting the return trip. At the expiration of the 30 minutes, the ambulance service may charge $22.05 per quarter hour or fraction thereof thereafter.

(7) [Treat and Release Rate -

(a) An ambulance licensee may charge a treat and release fee of $200.00 if:

(i) a dispatch agency dispatches the ambulance to provide emergency care to an individual;

(ii) the ambulance personnel assesses or treats the individual;

(iii) the individual does not refuse service; and

(iv) the ambulance does not transport the individual.

(b) An ambulance licensee may charge for supplies and assess surcharges as provided R426-16-2(5) and R426-16-2(8).

(8)] Supplies and Medications -

(a) An ambulance licensee may charge for supplies and providing supplies, medications, and administering medications used on any response if:

(i) [S]supplies shall be priced fairly and competitively with similar products in the local area[.];

(ii) the individual does not refuse services; and

(iii) the ambulance personnel assess or treats the individual.

[(9)](8) Uncontrollable Cost Escalation -

(a) In the event of a temporary escalation of costs, an ambulance service may petition the [EMS Committee]Department for permission to make a temporary service-specific surcharge. The petition shall specify the amount of the proposed surcharge, the reason for the surcharge, and provide sufficient financial data to clearly demonstrate the need for the proposed surcharge. Since this is intended to only provide temporary relief, the petition shall also include a recommended time limit.

(b) [The petition shall be submitted to the Department, which shall within 30 days, notify the ambulance service of the date and time of the next EMS Committee meeting and the disposition of the petition. Prior to the EMS Committee meeting, the Department shall evaluate the petition for reasonableness and prepare a written response for consideration by the EMS Committee. The EMS Committee may reject, modify or adopt the proposed surcharge as a proposed rule and direct the Department to submit a notice of rule change to the Division of Administrative Rules in accordance with the Rulemaking Act. The public comment period shall include a public hearing]The Department will make a final decision on the proposed surcharge within 30 days of receipt of the petition.

[(10)](9) Operating report -

(a) The licensed service shall file with the Department within [five months]60 days of the end of each licensed service's fiscal year, an operating report in accordance with the instructions, guidelines and review criteria as specified by the Department[in the EMS Committee's "Department of Health Uniform Licensed Service Fiscal Reporting Guide"]. The Department shall provide a summary of operating reports received during the previous state fiscal year to the EMS Committee in the October quarterly meeting[, beginning 2001].

[(11)](10) Fiscal audits -

(a) Upon receipt of licensed service fiscal reports, the Department shall review them for compliance to standards established[ in the "Department of Health Uniform Licensed Service Fiscal Reporting Guide." The Department, or its representative, may audit licensed services to verify the information given in the report].

(b) Where the Department determines that the audited service is not in compliance with this rule, the Department shall proceed in accordance with Section 26-8a-504.

 

R426-16-3. Penalty for Violation of Rule.

[Any person who violates any provision of this rule may be assessed a penalty as provided in Section 26-23-6.]As required by Subsection 63G-3-201(5): Any person that violates any provisions of this rule may be assessed a civil money penalty as provided in Section 26-23-6.

 

KEY: emergency medical services

Date of Enactment or Last Substantive Amendment: November 2, 2010

Notice of Continuation: July 28, 2009

Authorizing, and Implemented or Interpreted Law: 26-8a