DAR File No. 40324

Health, Family Health and Preparedness, Emergency Medical Services

Rule R426-8

Emergency Medical Services Ambulance Rates and Charges

Notice of Proposed Rule

(Amendment)

DAR File No.: 40324
Filed: 04/15/2016 02:54:10 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The Department, by order, has authorized agencies to adjust rates according to the agency's fiscal data, as reviewed by the Department. Currently, the published ambulance rates in rule need to be adjusted. Rule R426-8 is revised to reflect the 06/21/2016 revised ambulance rates. The last rule change was 07/01/2015.

Summary of the rule or change:

Fiscal Reporting Guides (FRGs) are financial and statistical data collected from all EMS agencies statewide. The data collected showed EMS rates need to be increased at 1.50% so agencies statewide will have closer revenues matching expenses. Rule R426-8 needs to be amended to reflect these ground ambulance transport rate changes.

State statutory or constitutional authorization for this rule:

• Title 26, Chapter 8a

Anticipated cost or savings to:

the state budget:

State budget will not be impacted as this is a user fee.

local governments:

Local government budgets will not be impacted significantly. The rates listed in the rule are increased by 1.50%. The EMS agency billings increase by 1.50% which will offset declining collections, wages increases, and the increased equipment costs.

small businesses:

Emergency Medical Service budgets will not be impacted. The ambulance transport rate increase is 1.50% from current ambulance rates to offset declining collections, wage increases, and the increased equipment costs.

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

Other budgets will not be impacted. The ambulance transport rate increase is 1.50% from current ambulance rates to offset declining collections, wage increases, and the increased equipment costs.

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 rates will have an impact on businesses. Based on accepted accounting measures, the proposed increase is needed to maintain the solvency of ambulance service within Utah. Increase is based on a careful analysis of the cost of doing business. Individuals that use this service will experience an added cost, some of which will be borne by health insurers. Public comment will be carefully evaluated.

Joseph Miner, 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
Family Health and Preparedness, Emergency Medical Services
3760 S HIGHLAND DR
SALT LAKE CITY, UT 84106

Direct questions regarding this rule to:

• Guy Dansie at the above address, by phone at 801-273-6671, by FAX at 801-273-4165, or by Internet E-mail at gdansie@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:

05/31/2016

This rule may become effective on:

06/07/2016

Authorized by:

Joseph Miner, Executive Director

R426. Health, Family Health and Preparedness, Emergency Medical Services.

R426-8. Emergency Medical Services Ground Ambulance Rates and Charges.

R426-8-1. 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 ground ambulance providers[services] in the State of Utah.

 

R426-8-2. Ground Ambulance Transportation Revenues, Rates, and Charges.

(1) Licensed ground ambulance providers[services] operating under R426-3 shall not charge more than the rates described in this rule. In addition, the net income of licensed ground ambulance providers[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]a) Licensed ground ambulance providers[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]b) A licensed ground ambulance provider[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 financial data as delineated by the [d]Department to be submitted as detailed under R426-8-2([9]10). This data shall then be used as the basis for the annual rate adjustment.

(3) Base Rates for ground transport of a patient to [care]a hospital or patient receiving facility are as follows: [facility -]

(a) Ground Ambulance - [$696.00 ]$707.00 per transport[.];

(b) Advanced EMT [and EMT-IA ]Ground Ambulance -[$919.00]$933.00 per transport[.];

(c) Advanced EMT Ground Ambulance who was prior to June 30, 2016 licensed as an EMT-IA provider - $1,149.00 per transport;

([c]d) Paramedic Ground Ambulance - [$1,344.00]$1,365.00 per transport[.];

([d]e) Ground Ambulance with Paramedic on-board - [$1,344.00]$1,365.00 per transport if:

(i) a designated Emergency Medical Service dispatch center[agency] dispatches a licensed paramedic provider[licensee] to treat the individual;

(ii) the licensed paramedic provider[licensee] has initiated advanced life support;

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

(iv) a[n]licensed ground ambulance provider[service that]who interfaces with a licensed paramedic rescue service and has an inter -local or equivalent agreement in place, dealing with reimbursing the paramedic ground ambulance licensed provider[agency] for services provided up to a maximum of $286.68 per transport.

[(4) Mileage Rate-

(a) $31.65 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 exceed $5.10 per gallon or gasoline exceeds $4.25 as invoiced.]

(4) Mileage rates may be charged at a rate of $31.65 per mile or fraction thereof, and computed from the point of patient pick-up to the point of patient delivery. Fuel fluctuation surcharges of $0.25 per mile may be added when diesel fuel prices exceed $5.10 per gallon, or gasoline prices exceed $4.25 per gallon as invoiced.

[(5) Surcharge-

(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.]

(5) A surcharge of $1.50 per mile may be assessed if an ambulance is required to travel ten or more miles on unpaved roads.

(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]a) Each patient will be assessed the transportation rate[.];

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

([b]7) A round trip may be billed as two one-way trips.[

(c)] A n licensed ground ambulance provider 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) Supplies and Medications -

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

(8) A licensed ground ambulance provider may charge for supplies, providing supplies, medications, and administering medications on a response if:

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

([ii]b) the individual does not refuse services; and

([iii]c) the licensed ground ambulance personnel assess or treats the individual.

[(8) Uncontrollable Cost Escalation -

]([a]9) In the event of a temporary escalation of costs, a[n]licensed ground ambulance provider[service] may petition the 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 Department will make a final decision on the proposed surcharge within 30 days of receipt of the petition.

([9]10) [Operating report -

(a) ]The licensed ground ambulance provider[service] shall file with the Department within 90 days of the end of each licensed provider's[service's] fiscal year, an operating report in accordance with the instructions, guidelines and review criteria as specified by the Department. 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.

[(10) Fiscal audits -

(a) Upon receipt of licensed service fiscal reports, the Department shall review them for compliance to standards established.

(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.]

(11) The Department shall review licensed ground ambulance provider fiscal reports for compliance to Department established standards. The Department may perform financial audits as part of the review. If the Department determines that a licensed ground ambulance provider is not in compliance with this rule, the Department shall proceed in accordance with Utah Code Title 26-8a-504.

 

[R426-8-3. Penalty for Violation of Rule.

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: [June 8, 2015]2016

Notice of Continuation: November 10, 2015

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