No. 29392 (Amendment): R426-16. Emergency Medical Services Maximum Ambulance Transportation Rates and Charges

DAR File No.: 29392
Filed: 01/04/2007, 01:48
Received by: NL

RULE ANALYSIS

Purpose of the rule or reason for the change:

H.B. 221, 2006 Legislative Session, requires the Bureau of Emergency Medical Services (EMS) to clarify current language in this rule and redefine nontransportation rates. Additional changes address the issue of fluctuating fuel costs through a fuel fluctuation surcharge, and to update the stated rate, charges, and fees to reflect the current amounts previously established according to statute and rule by Department order. (DAR NOTE: H.B. 221 is found at Chapter 221, Laws of Utah 2006, and was effective 05/01/2006.)

Summary of the rule or change:

The amendments provide that an ambulance service may not charge a transport fee if the patient is not transported. The dollar amount of the rates, charges, and fees have been updated to reflect the current rates as established by prior order. A fuel fluctuation surcharge has been added with provisions governing when the rate becomes effective or is discontinued. The term "Non Transport" has been changed to "Treat and Release". A definition of the new term and establishment of the rate and allowable charges have been added. The rule title has been changed to more accurately reflect the contents of the rule.

State statutory or constitutional authorization for this rule:

Title 26, Chapter 8a

Anticipated cost or savings to:

the state budget:

The changes to this rule do not affect the state budget. There are no new state costs or requirements created by the changes. There will be no costs or savings generated by theses changes because the state does not pay or collect any of the fees that are adjusted by this rule.

local governments:

The changes to this rule will have minimal impact on local governments. The only new costs created by the changes would be the cost of generating new billing forms or changes in billing software language. There are no decreases in fees and rates that have not been offset by surcharges and other rate inclusions. There will be no savings generated by these changes.

other persons:

The changes to this rule will have minimal impact on other persons. The only new costs created by the changes would be the cost of generating new billing forms or changes in billing software language. There are no new costs created by the changes. There are no decreases in fees and rates that have not been offset by surcharges and other rate inclusions. There will be no savings generated by these changes.

Compliance costs for affected persons:

The Bureau estimates that the compliance costs will be minimal and limited to language changes to billing forms or software programs. There are no new costs created by the changes. There are no decreases in fees and rates that have not been offset by surcharges and other rate inclusions. There will be no savings generated by these changes.

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

Although upon initial reading of the changes proposed in this rule, it would be easy to mistakenly assume that significant increases to ambulance rates are being authorized, in reality the rule is just being updated to reflect the annual increases authorized by Subsection R426-16-2(2). A new provision is being added to recognize the recent experience with significant fluctuations in the cost of fuel. If recent moderating trends in fuel costs reverse, this could impact users of ambulance services, but will protect regulated businesses from being unable to recover the cost of these increases in fuel costs. This rule change should be positive for business. 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
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY UT 84116-3231

Direct questions regarding this rule to:

Paul Patrick at the above address, by phone at 801-538-6291, by FAX at 801-538-6808, or by Internet E-mail at [e-mail]

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:

03/05/2007

This rule may become effective on:

03/12/2007

Authorized by:

David N. Sundwall, Executive Director

RULE TEXT

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

R426-16. Emergency Medical Services [Maximum ]Ambulance [Transportation ]Rates and Charges.

R426-16-2. [Maximum ]Ambulance Transportation Rates and Charges.

(1) Licensed services operating under R426-[3]15 shall not charge more than the [maximum]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. [As of the beginning of fiscal year 2000, a]All licensed services will collect financial data as delineated by the department to be submitted as detailed under R426-8-2(10). This data shall then be used as the basis for the annual rate adjustment.[ beginning July 1, 2001.]

(3) Base Rates

(a) Basic [a]Ambulance - $[235.68]400.40 per transport.

(b) Intermediate [a]Ambulance - $[279.88]475.40 per transport.

(c) Paramedic Ambulance [Transfer Service inter-facility transports, and Paramedic Ambulance transports that provide basic life support ]- $[353.54]600.50 per transport.

(d)[ Paramedic ambulance transports that, under physician medical direction, provide basic or intermediate ambulance transports that have paramedics on-board to continue advanced life support initiated by a paramedic rescue service - Basic ambulance service - $424.24 per transport, Intermediate ambulance service - $468.44 per transport.](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:

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

(B) the paramedic licensee has initiated advanced life support:

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

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

(ii) An[y] ambulance service that interfaces with a paramedic rescue service must have an interlocal or equivalent agreement in place, dealing with reimbursing the paramedic agency for services provided up to the maximum of $[147.31]210.95 per transport.

(4) Mileage Rates

(a) $[10.32]31.40 per mile or fraction thereof.[ In all cases mileage shall be computed from the point of pickup to the point of delivery.]

(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 fuel prices are more than $.31 per gallon above the price of record, as established by the Department, on the immediately prior July 1 of each year. The Department will notify all agencies when this surcharge is available.

(5) Surcharges -

(a) A surcharge of $[23.38]39.75 [per transport ]may be assessed [for emergency responses]if the response requires the use of emergency lights and siren.

(b) A surcharge of $[23.38]39.75[ per transport] may be assessed for ambulance service between the hours of 8:00 p.m. and 8:00 a.m.

(c) [Where]If the ambulance is required to travel for ten miles or more on unpaved roads, a surcharge of $[19.48]1.50 per mile [per transport ]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 $[12.99]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 $[12.99]22.05 per quarter hour or fraction thereof thereafter.

(7) [Where an ambulance is summoned to a medical emergency by a dispatch agency, but does not transport, a charge of $194.88 may be assessed.]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 shall be priced fairly and competitively with similar products in the local area.

(9) Uncontrollable Cost Escalation -

(a) In the event of a temporary escalation of costs, an ambulance service may petition the EMS Committee 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.

(10) The licensed service shall file with the Department within five months of the end of each licensed service's fiscal year, an operating report in accordance with the instructions, guidelines and review criteria specified 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) 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. [Paramedic Fees and Charges.

A resource hospital may recover the cost, through the patient billing process for supplies and drugs administered by the Paramedic to patients, if the supplies or drugs were subsequently replaced by the hospital as outlined in the Emergency Medical Services Operational Standards.

 

R426-16-4. ]Penalty for Violation of Rule.

Any person who violates any provision of this rule may be assessed a penalty not to exceed the sum of $5,000 or be punished for violation of a class B misdemeanor for the first violation and for any subsequent similar violation within two years for violation of a class A misdemeanor as provided in Section 26-23-6.

 

KEY: emergency medical services

Date of Enactment or Last Substantive Amendment: [October 4, 1999]2007

Notice of Continuation: October 1, 2004

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