DAR File No. 39332

Health, Health Care Financing, Coverage and Reimbursement Policy

Rule R414-507

Ground Ambulance Service Provider Assessments

Notice of Proposed Rule

(New Rule)

DAR File No.: 39332
Filed: 05/01/2015 07:55:31 AM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this rule is to implement the Ambulance Service Provider Assessment Act in accordance with S.B. 172 passed during the 2015 General Session of the Legislature.

Summary of the rule or change:

This new rule outlines ambulance service provider assessments that include audit procedures, notice requirements, payment requirements, and penalties for non-compliance.

State statutory or constitutional authorization for this rule:

• Section 26-37a-102
• Section 26-1-5
• Section 26-18-3

Anticipated cost or savings to:

the state budget:

The Department does not anticipate any impact to the general fund because this change only implements an ambulance provider assessment that will provide necessary matching funds.

local governments:

Ground ambulance providers may see a total increase of about $10,800,000 in revenue.

small businesses:

Ground ambulance providers may see a total increase of about $10,800,000 in revenue.

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

Ground ambulance providers may see a total increase of about $10,800,000 in revenue.

Compliance costs for affected persons:

Compliance costs should be minimal for those participating in this program and insignificant compared to the revenue.

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

This rule will have a positive impact on business in that providers may see an increase in revenue up to $10,800,000.

David Patton, PhD, 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 Care Financing, Coverage and Reimbursement Policy
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

• Craig Devashrayee at the above address, by phone at 801-538-6641, by FAX at 801-538-6099, or by Internet E-mail at cdevashrayee@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

06/15/2015

This rule may become effective on:

07/01/2015

Authorized by:

David Patton, Executive Director

R414. Health, Health Care Financing, Coverage and Reimbursement Policy.

R414-507. Ground Ambulance Service Provider Assessments.

R414-507-1. Introduction and Authority.

This rule defines the scope of the ground ambulance service provider assessment. This rule is authorized under Title 26, Chapter 37a.

 

R414-507-2. Definitions.

The definitions in Section 26-37a-102 apply to this rule.

 

R414-507-3. Change in Ground Ambulance Provider Status.

(1) If a ground ambulance provider's status changes during any given quarter and it no longer falls under the definition of a ground ambulance provider that is subject to the assessment outlined in Section 26-37a-103 or is no longer entitled to Medicaid ground ambulance provider payments, within 30 days of the change in status, the ground ambulance provider must submit in writing to the Division of Medicaid and Health Financing (DMHF) a notice of the status change and the effective date of that change. The notice must be mailed to the correct address, as follows, and is only effective upon receipt by the Reimbursement Unit:

Via United States Postal Service:

Utah Department of Health

DMHF, BCRP

Attn: Reimbursement Unit

P.O. Box 143102

Salt Lake City, UT 84114-3102

Via United Parcel Service, Federal Express, and similar:

Utah Department of Health

DMHF, BCRP

Attn: Reimbursement Unit

288 North 1460 West

Salt Lake City, UT 84116-3231

(2) For any quarter where a ground ambulance provider is no longer subject to the assessment and notice has been given under Subsection R414-507-3(1):

(a) the Department shall require payment of the assessment from that ground ambulance provider for the full quarter in which the status change occurred; and

(b) the ground ambulance provider is exempt from future assessment in the first quarter following the quarter the status changed.

 

R414-507-4. Payments to Ground Ambulance Providers.

(1) Ground ambulance providers shall be reimbursed an enhanced rate for ground emergency medical transports up to the level approved by the Centers for Medicare and Medicaid Services.

(2) The reimbursement rate shall not exceed the ground ambulance rate published and periodically updated in Section R426-8-2 or the provider's usual and customary charge to private pay individuals. Providers shall not bill Medicaid more than the provider's usual and customary charge to private pay individuals.

 

R414-507-5. Quarterly notice -- Collection.

Quarterly assessments imposed by this chapter shall be paid to DMHF within 15 business days after the original invoice date that appears on the invoice issued by DMHF.

 

R414-507-6. Penalties and Interest.

(1) If DMHF audits a ground ambulance provider's records to determine the correct transports for the assessment, DMHF shall fine the ground ambulance provider five percent of its annual calculated assessment. The fine is payable within 30 days of invoice.

(2) If a ground ambulance provider fails to fully pay its assessment on or before the due date, DMHF shall fine the provider five percent of its quarterly calculated assessment. The fine is payable within 30 days of invoice. The Department shall suspend all Medicaid payments to a ground ambulance provider until the provider pays the assessment and fine due in full or until the provider and the Department reach a negotiated settlement.

 

R414-507-7. Rule Repeal.

The Department shall repeal this rule in conjunction with the repeal of the Ambulance Service Provider Assessment Act outlined in Section 26-37a-108.

 

KEY: Medicaid

Date of Enactment or Last Substantive Amendment: 2015

Authorizing, and Implemented or Interpreted Law: 26-1-5; 26-18-3; 26-37a-102