HB 269: Ambulance Provider Payment Amendments - Utah

Substitute #4 → Enrolled · 5 edits · Mar 26, 2026

MODERATE

This bill updates ambulance payment rules to include the cost of medications in the base rate and sets specific reimbursement amounts for different transport levels. It also extends the sunset dates for several related regulations, ensuring they remain in effect longer than previously planned. These changes aim to stabilize funding for ground ambulance services and clarify billing practices for health plans and employers.

Scope change

The bill expands the definition of the 'base rate' to explicitly include medication costs, thereby increasing the allowable reimbursement amount for ambulance providers. It also modifies the entities required to accept these rates, specifically addressing workers' compensation claims.

DEFINITION

The definition of 'base rate' was updated to include the cost of medication, whereas it previously excluded this cost.

FISCAL

Specific reimbursement rates for emergency medical technician, advanced emergency medical technician, and paramedic transport were increased (e.g., EMT rates rose from $1,234.92 to $1,257.15).

ELIGIBILITY

Health benefit plans and workers' compensation carriers are now explicitly required to accept the medication cost as part of the allowable base rate for claims.

TIMELINE

Sunset dates for several sections regarding ambulance reimbursement and related committees were extended, delaying their repeal from 2027 to later dates or removing them entirely.

TECHNICAL

Minor formatting and numbering adjustments were made throughout the text, including renumbering of repeal subsections in Section 7.

Introduced → Substitute #1 · 4 edits

MODERATE

This bill updates ambulance reimbursement rules in Utah, primarily adjusting the effective date of the legislation and clarifying how providers can charge for services. The bill allows ambulance providers to include the cost of medication in their base rate and explicitly permits them to balance bill patients in specific scenarios where insurance plans do not cover the full cost of transport and medication combined. It also updates the timeline for when these new rules take effect.

Scope change

The bill's scope remains focused on ground ambulance and paramedic reimbursement, but the applicability of the balance billing exception has been clarified to allow billing when insurance plans deny coverage for the total cost of transport and medication.

TIMELINE

The effective date for the bill was changed from May 6, 2026, to January 1, 2027, and the repeal dates for related sections were updated accordingly.

REQUIREMENT

The definition of 'balance bill' was expanded to explicitly allow providers to bill patients for the difference between the total cost of transport and medication and the amount paid by insurance, if the insurance plan does not cover the full combined amount.

DEFINITION

Clarified that the 'base rate' includes the cost of medication, ensuring providers can charge for this expense as part of their standard rate.

TECHNICAL

Various formatting inconsistencies and line breaks in the text were corrected to improve readability and standardization.

Substitute #3 → Substitute #4 · 4 edits

MODERATE

This bill updates Utah's ambulance payment rules to clarify how health plans and employers must reimburse providers. It expands the definition of the 'base rate' to explicitly include medication costs and adjusts the definition of 'balance billing' to allow providers to charge the full rate if insurance plans do not cover it. The bill also repeals previous sunset dates, making these payment standards permanent.

Scope change

The bill expands the scope of reimbursable costs by including medication expenses within the base rate and clarifies that balance billing is permitted when insurance plans fail to cover the total allowable rate.

DEFINITION

The definition of 'base rate' was updated to explicitly include the cost of medication administered during transport.

ELIGIBILITY

The definition of 'balance bill' was revised to permit providers to bill patients for the difference between their charges and the amount paid by insurance if the plan does not allow the full base rate and mileage rate as an allowable expense.

TIMELINE

Sunset dates that previously limited the effectiveness of ambulance reimbursement rules were repealed, making the new payment standards permanent.

REQUIREMENT

Reimbursement rules for Medicaid, health benefit plans, and workers' compensation carriers were adjusted to reflect the new base rate definition and balance billing provisions.

Substitute #2 → Substitute #3 · 5 edits

MODERATE

This bill replaces the previous version of the ambulance payment amendments to update Medicaid reimbursement rules, clarify definitions regarding balance billing and medication costs, and adjust the effective dates for repealing sunset clauses. It also adds a new section requiring the Department of Health to adjust Medicaid ambulance rates if federal assessments cannot cover cost increases.

Scope change

The bill's scope now includes a new requirement for the Department of Health to adjust Medicaid reimbursement rates under specific financial conditions, expanding the scope beyond just defining base rates and mileage fees.

FISCAL

Added a new provision (Section 1) requiring the Department of Health to adjust Medicaid ambulance reimbursement rates if the federal assessment cannot cover the rate increase and legislative appropriations are insufficient.

TIMELINE

Changed the effective date for the repeal of sunset dates in related sections from July 1, 2027, to July 1, 2026, accelerating when these provisions expire.

DEFINITION

Modified the definition of 'Balance bill' to explicitly clarify that billing an individual when their insurance does not cover the total of the base rate and mileage rate is not considered balance billing.

Added 'cost of medication' to the definition of 'Base rate' to ensure providers can charge for medication costs included in the base rate calculation.

TECHNICAL

Updated the list of Utah Code sections affected to reflect the new Medicaid adjustment section (26B-3-804) and corrected the effective dates for repeals.

Substitute #1 → Substitute #2 · 5 edits

MODERATE

This bill updates Utah's ground ambulance payment rules to allow providers to charge for medication costs and clarifies when balance billing is prohibited. It also increases the base reimbursement rates for emergency transport services and adjusts the definition of 'balance bill' to prevent providers from charging patients the difference between their billed charges and what insurance allows, except in specific scenarios. The bill repeals previous sunset dates, making these changes permanent.

Scope change

The bill expands the scope of reimbursable costs by explicitly including medication costs in the base rate and broadens the definition of balance billing to cover situations where insurance does not cover the full base rate plus mileage.

DEFINITION

Added 'cost of medication' to the definition of 'base rate' and clarified that 'balance bill' does not include billing for uncovered services or when insurance fails to pay the full base rate and mileage.

FISCAL

Increased the base reimbursement rates for EMT, AEMT, and paramedic transport services from $1,234.92/$1,630.31/$2,383.73 to $1,257.15/$1,659.66/$2,426.64 respectively.

REQUIREMENT

Updated the 'balance bill' exception to allow billing individuals if their health plan does not allow the total of the base rate and mileage rate as an allowable expense.

TIMELINE

Repealed previous sunset dates for the ambulance reimbursement sections, making the new provisions permanent rather than temporary.

TECHNICAL

Corrected formatting and numbering errors in the legislative text, such as misaligned subsections and stray characters.

Ambulance Provider Payment Amendments

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