Pursuant to the authority of C.G.S. 19a-177, the following
regulations are enacted.
means the commissioner of the Connecticut department of health services, acting
through the office of emergency medical services.
(2) "Department" means the Connecticut state
department of health services.
"Certified provider" means a municipal or volunteer ambulance service issued a
certificate of operation by the office of emergency medical services.
(4) "Licensed provider" means a commercial
ambulance service issued a license by the office of emergency medical services
or any volunteer or municipal ambulance service issued a license by the office
of emergency medical services prior to July 1, 1981.
(5) "Basic level ambulance response" means
the transportation of a patient at the basic life support level.
(6) "Intermediate level ambulance response"
means the transportation of a patient requiring definitive medical care by a
service certified to the intravenous level.
(7) "ALS/Paramedic level ambulance response"
means the transportation of a patient requiring definitive medical care by a
service certified to the ALS/Paramedic level.
(8) "Invalid coach response" means a
nonemergency request to transport a wheelchair patient.
(9) "Maximum allowable rate" means the
highest amount which a licensed or certified provider may charge a patient for
a given service in accordance with the appropriate rate schedule.
(10) "Necessary costs" means the costs
directly related to the service provided.
(11) "Reasonable return on gross revenue"
means that percentage of gross revenue which the commissioner allows to be
earned as profits by licensed providers.
(b) The commissioner shall establish maximum
allowable rates for each licensed or certified provider annually on or before
December 15th of each year. Such rate shall take effect on January 1st of the
following year. Certified and licensed providers may render charges which are
less than maximum allowable rates.
The commissioner shall set maximum
allowable rate schedules for any or all of the following classifications of
(1) Basic level ambulance response
by a certified provider;
Intermediate level ambulance response by a certified provider;
(3) ALS/Paramedic ambulance response by a
(4) Basic level
ambulance response by a licensed provider;
(5) Intermediate level ambulance response by
a licensed provider;
ALS/Paramedic level ambulance response by a licensed provider;
(7) Invalid coach response by a licensed
commissioner shall set maximum allowable charges which will allow each provider
to impose the following special charges under the following conditions:
(1) Mileage. The mileage charge may be
applied from the point of origin within the town of movement of a patient to
any final destination other than within the town of origin. Mileage charges are
not allowable when the point of origin and the point of final destination of
the call are within the boundaries of the same town. Mileage shall be
determined from the public utility control authority's official mileage docket
(2) Waiting time. Charges
for waiting time may be assessed on the basis of a minimum of one hour. When
waiting time is in excess of one hour, additional time may be charged in
quarter hour increments;
time. Charges may be assessed for a response between the hours of 7:00 p.m.
through 7:00 a.m. the following morning;
(4) Special Attendants. Charges may be
assessed for use of attendants with characteristics specifically requested by
or on behalf of the patient. Such special characteristics may include, but are
not limited to, special training or experience or an attendant of a specific
gender. There shall be no additional charge if an attendant with the requested
characteristics has already been scheduled by the ambulance provider.
(e) A certified or licensed
provider shall not charge for services which are not specified in the
appropriate rate schedule.
On or before July
15th of each year, all licensed or certified providers shall file with the
department the following financial information based upon the twelve months
immediately preceeding April 30th of the year of the application:
(A) Existing rate schedule;
(B) If the provider requests a rate increase,
the requested rate schedule;
complete financial statement for the twelve months immediately preceeding April
30th of the year of application, including:
(i) a statement of income and expenses on the
forms provided by the department based on an accrual method of
(ii) a balance sheet
indicating the condition of the business as of the close of business on April
30th of the year of application;
(iii) a review financial statement prepared
in accordance with accepted accounting practices.
(D) Financial projections covering all items
in subsection (f) (1) (C) of this section for the fiscal year of application
reflecting the existing and requested rate schedules;
(E) A schedule of real property,
transportation equipment and all other equipment owned or leased by the
provider and currently in use in the provision of ambulance services;
(F) A schedule of planned capital expenditure
over the next three years;
summary by rate classification of trips logged for the immediately preceeding
(H) A schedule of
annual compensation and benefits by job classification, including corporate
officers and all employees;
Numbers, job titles, annual salary ranges and hourly rate ranges of all
corporate officers and employees.
(J) A schedule of any other services provided
by the ambulance service provider under the same business structure;
(K) A sworn statement signed by the provider
or duly authorized representative thereof that to the best of his/her knowledge
the materials submitted in satisfaction of this provision are true, correct and
complete and have been prepared from the books and records of the
service providers shall provide the commission with any additional financial
and operational information which is relevant to the rate setting; is covered
under subdivision (1) of this subsection, and requested by it within fifteen
(15) calendar days of receipt of the request. The request for additional
information shall be made no later than August 31st of each fiscal
Any licensed or certified
provider who fails to file information required by subdivisions (1) and (2)
above by July 15th of each year or within fifteen (15) days of receipt of the
department's request, whichever is later, shall be subject to sanctions as
provided in section 19-73bb(b), C.G.S., and shall have a maximum allowable
rates for all purposes which are the lesser of the following rates:
(A) The rates set in response to the current
(B) The rates set
following the last filing to which the providers were a party, or if none, the
rates in effect at the time these regulations become effective.
(4) The department reserves the
right to conduct or order a provider to conduct a full audit as it deems
necessary to confirm the accuracy of submitted materials.
(g) For the purpose of the regulations, any
application filed in accordance with subsection (f) of this section shall be a
contested case; shall require a hearing and shall be governed by sections
19-2a-35 through 19-2a-41, inclusive of the Regulations of Connecticut State
Waiver of right
The applicant may waive
his/her right to a hearing by filing along with the application a signed
statement which indicates that:
applicant knows of his/her right to a hearing held under the provisions of
sections 19-2a-35 to 19-2a-41, inclusive, of the Regulations of Connecticut
State Agencies; and
applicant willingly waives the right to such hearing.
(2) Notwithstanding subdivision (1) above,
the commissioner may order, not later than August 15th, that a hearing be
information filed by the applicant pursuant to subsections (f), (g) and (h) of
this section shall be treated by the commissioner as a substantially complete
case in support of the application.
Rate Setting Method.
setting the maximum allowable rates for each provider, the commissioner shall
consider the following:
(1) The necessary
costs incurred in providing said service;
(2) Net income after taxes;
(3) Utilization rate of equipment and
(4) Increases or
decreases in the United States Department of Labor consumer price index factors
relevant to ambulance maintenance and operation in Connecticut, and any other
relevant economic inflationary factors;
(5) The anticipated change in cost to the
provider of full compliance with new federal and state laws and
(6) Rate differential
set and paid for by other state agencies and third party payors;
(7) The percentage of cancelled calls of the
total number of calls during the preceeding fiscal year;
(8) A reasonable return on gross revenue;
(9) Any other information the
commissioner may deem relevant to the rate setting process.