Utah Administrative Code

The Utah Administrative Code is the body of all effective administrative rules as compiled and organized by the Division of Administrative Rules (see Subsection 63G-3-102(5); see also Sections 63G-3-701 and 702).

NOTE: For a list of rules that have been made effective since July 1, 2019, please see the codification segue page.

NOTE TO RULEFILING AGENCIES: Use the RTF version for submitting rule changes.


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

Rule R414-507. Ground Ambulance Service Provider Assessments.

As in effect on July 1, 2019

Table of Contents

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

July 1, 2015

Authorizing, Implemented, or Interpreted Law

26-1-5; 26-18-3; 26-37a-102


Additional Information

Contact

For questions regarding the content or application of rules under Title R414, please contact the promulgating agency (Health, Health Care Financing, Coverage and Reimbursement Policy). A list of agencies with links to their homepages is available at http://www.utah.gov/government/agencylist.html or from http://www.rules.utah.gov/contact/agencycontacts.htm.