Utah Admin. Code R911-8-200 - Ground Ambulance Transportation Revenues, Rates, and Charges

(1) A licensed ground ambulance provider may not charge more than the rate described pursuant to Subsections R911-8-200(6) through (12) on ambulance transports.

(2) Net income and subsidies for a licensed ground ambulance provider may not exceed 10% of gross revenue.

(3) A licensed ground ambulance provider may lower a rate at their discretion.

(4) A licensed ground ambulance provider may not charge a base rate for transportation to a patient who is not transported.

(5) The department may adjust each rate annually based on financial data received from licensed ground ambulance providers.

(6) Ground ambulance base rates for patient transport to a hospital or patient receiving facility are as follows:

(a) EMT ground ambulance license level - $1,176.11 per transport;

(b) advanced EMT ground ambulance license level -$1,552.68 per transport;

(c) paramedic ground ambulance license level - $2,270.22 per transport; and

(d) any EMT or AEMT level licensed ground ambulance provider with a paramedic on-board - $2,270.22 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) online medical control directs that a paramedic remain with the patient during transport; and

(iv) the licensed ground ambulance provider has a reimbursement for paramedic services agreement with a paramedic licensed provider for the service provided.

(7) A base rate may not include costs for:

(a) providing procedures to an individual; or

(b) administering medications.

(8) A mileage rate may be charged up to a maximum of $42.24 per mile computed from the location of the patient upon ambulance arrival to the destination hospital or patient receiving facility. A fuel fluctuation surcharge of $0.25 per mile may be added when the diesel fuel price exceeds $5.10 per gallon, or the gasoline price exceeds $4.25 per gallon as invoiced.

(9) A surcharge of $1.50 per mile may be assessed if an ambulance is required to travel two or more miles on unpaved roads.

(10) If more than one patient is transported from the location of the patients to the same destination hospital or patient receiving facility, a charge shall be assessed to each patient as follows:

(a) The transportation base rate; and

(b) the mileage rate divided equally between the total number of patients.

(11) A licensed ground ambulance provider may charge separately for a round trip if the following conditions apply:

(a) no charge is billed to the patient for at least 30 minutes at the hospital or a patient receiving facility at the halfway point of the trip; and

(b) no more than $22.05 per quarter hour is charged for time over 30 minutes.

(12) A licensed ground ambulance provider may charge for disposable supplies used and medications administered during patient care, in addition to the base rate and mileage rate if the disposable supplies and medications are priced fairly and competitively with a similar product in the local area.

(13) A licensed ground ambulance provider may charge for supplies, providing supplies, medications, and administering medications on a response if:

(a) supplies and medications are priced fairly and competitively with a similar product in the local area;

(b) the individual does not refuse the service; and

(c) the licensed ground ambulance personnel assess or treats the individual, but does not transport.

(14) A licensed ground ambulance provider may petition the department for a temporary service-specific surcharge when there is a temporary escalation of costs. The petition shall specify the surcharge amount and financial justification. The department will make a final decision on the proposed surcharge within 30 days of receipt of the petition.

(15) A licensed ground ambulance provider shall submit a fiscal report in accordance with the instructions, guidelines, and review criteria as specified by the department.

(a) A fiscal report shall be submitted within six months of the end of their fiscal year.

(b) The department shall provide guidance and a template for a fiscal report. Guidance will be posted on the department's website.

(c) The department shall provide a summary of fiscal reports to the EMS Committee before adjusting a maximum base rate for a licensed ground ambulance provider.

(16) The department may review a licensed ground ambulance provider's fiscal report for compliance. The department may perform financial audits to ensure compliance to reporting requirements.

(17) Each licensed ground ambulance provider shall submit a written total number of billed 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 a patient transport number is not in agreement with patient care data submitted to the department pursuant to Rule R911-7. A written justification shall include a description of each data reporting error and a plan to correct future data submission.

(c) Any submitted patient transport number not in agreement with patient care report data may be evaluated, corrected, or audited by the department.

Notes

Utah Admin. Code R911-8-200

Adopted by Utah State Bulletin Number 2024-14, effective 7/1/2024