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Utah Administrative Code (Current through November 1, 2019) |
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R426. Health, Family Health and Preparedness, Emergency Medical Services |
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R426-8. Emergency Medical Services Ground Ambulance Rates and Charges |
| R426-8-1. Authority and Purpose |
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Latest version.
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(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 in the State of Utah. |
| R426-8-2. Ground Ambulance Transportation Revenues, Rates, and Charges |
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Latest version.
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(1) Licensed ground ambulance providers 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, including subsidies of any type, shall not exceed ten percent of gross revenue. (a) Licensed ground ambulance providers may change rates at their discretion after notifying the Department, provided that the rates do not exceed the maximums specified in this rule. (b) A licensed ground ambulance provider 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 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. (3) Base Rates for ground transport of a patient to a hospital or patient receiving facility are as follows: (a) Ground Ambulance - $772.00 per transport; (b) Advanced EMT Ground Ambulance - $1,018.00 per transport; (c) Advanced EMT Ground Ambulance who was prior to June 30, 2016 licensed as an EMT-IA provider - $1,254.00 per transport; (d) Paramedic Ground Ambulance - $1,490.00 per transport; (e) Ground Ambulance with Paramedic on-board - $1,490.00 per transport if: (i) a designated Emergency Medical Service dispatch center dispatches a licensed paramedic provider to treat the individual; (ii) the licensed paramedic provider has initiated advanced life support; (iii) on-line medical control directs that a paramedic remain with the patient during transport; and (iv) a licensed ground ambulance provider 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 for services provided up to a maximum of $472.00 per transport. (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) 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) 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: (a) Each patient will be assessed the transportation rate; (b) The mileage rate will be computed as specified, the sum to be divided equally between the total number of patients. (7) A round trip may be billed as two one-way trips. A 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. (8) A licensed ground ambulance provider may charge for supplies, providing supplies, medications, and administering medications on a response if: (a) supplies shall be priced fairly and competitively with similar products in the local area; (b) the individual does not refuse services; and (c) the licensed ground ambulance personnel assess or treats the individual. (9) In the event of a temporary escalation of costs, a licensed ground ambulance provider 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. The Department will make a final decision on the proposed surcharge within 30 days of receipt of the petition. (10) The licensed ground ambulance provider shall file with the Department within 90 days of the end of each licensed provider'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. (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. (12) All licensed ground ambulance providers shall submit a written total number of patient transports for each calendar year to the Department for calculating Medicaid assessments. (a) A written patient transport number shall be submitted within 90 days after the end of the calendar year. (b) The submission shall include a written justification when patient transport numbers are not in agreement with patient care reports submitted to the Department as described in R426-7. Written justifications shall include a description of data reporting errors, and a plan to correct future data submission. (c) The Department shall use submitted patient transport numbers to calculate ambulance service providers assessments as described in Utah Code Title 26-37a-104(5). (d) Submitted patient transport numbers and justifications for patient transport numbers not in agreement with patient care report data may be evaluated, corrected, or audited by the Department. If the Department determines that a licensed ground ambulance provider is not in compliance with this rule, the Department may proceed in accordance with Utah Code Title 26-8a-504. |
| R426-8-3. Penalty for Violation of Rule |
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Latest version.
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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. |
| R426-8-100. Authority and Purpose |
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Latest version.
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(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 in the State of Utah. |
| R426-8-200. Ground Ambulance Transportation Revenues, Rates, and Charges |
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Latest version.
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(1) Licensed ground ambulance providers shall not charge more than the rates described in this rule. In addition, the net income of licensed ground ambulance providers, including subsidies of any type, shall not exceed ten percent of gross revenue. (a) Licensed ground ambulance providers may change rates at their discretion provided that the rates do not exceed the maximums specified in this rule. (b) A licensed ground ambulance provider 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 based on financial data as delineated by the Department to be submitted as detailed under R426-8-200(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 a hospital or patient receiving facility are as follows: (a) Ground Ambulance - $795.00 per transport; (b) Advanced EMT Ground Ambulance - $1,049.00 per transport; (c) Advanced EMT Ground Ambulance who was prior to June 30, 2016 licensed as an EMT-IA provider - $1,292.00 per transport; (d) Paramedic Ground Ambulance - $1,535.00 per transport; (e) Ground Ambulance with Paramedic on-board - $1,535.00 per transport if: (i) a designated Emergency Medical Service dispatch center dispatches a licensed paramedic provider to treat the individual; (ii) the licensed paramedic provider has initiated advanced life support; (iii) on-line medical control directs that a paramedic remain with the patient during transport; and (iv) a licensed ground ambulance provider 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 for services provided up to a maximum of $486.00 per transport. (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) 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) 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: (a) Each patient will be assessed the transportation rate; (b) The mileage rate will be computed as specified, the sum to be divided equally between the total number of patients. (7) A round trip may be billed as two one-way trips. A 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. (8) A licensed ground ambulance provider may charge for supplies, providing supplies, medications, and administering medications on a response if: (a) supplies shall be priced fairly and competitively with similar products in the local area; (b) the individual does not refuse services; and (c) the licensed ground ambulance personnel assess or treats the individual. (9) In the event of a temporary escalation of costs, a licensed ground ambulance provider 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. The Department will make a final decision on the proposed surcharge within 30 days of receipt of the petition. (10) The licensed ground ambulance provider shall file with the Department within 6 months of the end of each licensed provider's fiscal year, a fiscal report in accordance with the instructions, guidelines and review criteria as specified by the Department. The Department shall provide a summary of fiscal reports received during the previous state fiscal year to the EMS Committee prior to adjusting maximum base rates for ground ambulance providers. (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. (12) All licensed ground ambulance providers shall submit a written total number of patient transports for each calendar year to the Department for calculating Medicaid assessments. (a) A written patient transport number shall be submitted within 90 days after the end of the calendar year. (b) The submission shall include a written justification when patient transport numbers are not in agreement with patient care reports submitted to the Department as described in R426-7. Written justifications shall include a description of data reporting errors, and a plan to correct future data submission. (c) Submitted patient transport numbers and justifications for patient transport numbers not in agreement with patient care report data may be evaluated, corrected, or audited by the Department. |