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:  July 1, 2015
Authorizing, and Implemented or Interpreted Law:  26-1-5; 26-18-3; 26-37a-102