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21
26B-3-804
31A-22-627.1
34A-2-407.1
53-2d-503
63I-1-231
63I-1-234
63I-1-253
0
Ambulance Provider Payment Amendments
2026 GENERAL SESSION
STATE OF UTAH
Chief Sponsor: A. Cory Maloy
Senate Sponsor: Evan J. Vickers
LONG TITLE
General Description:
This bill amends provisions regarding ambulance provider payments.
Highlighted Provisions:
This bill:
adjusts ambulance rates related to Medicaid;
defines terms;
amends provisions related to the base rate;
authorizes the Bureau of Emergency Medical Services to adjust the base rate each year;
amends the base rate to include the cost of medicine;
allows an ambulance provider to collect up to the base rate and mileage rate;
repeals sunset dates; and
makes technical changes.
Money Appropriated in this Bill:
None
Other Special Clauses:
This bill provides a special effective date.
Utah Code Sections Affected:
AMENDS:
26B-3-804
Effective
07/01/26
, as last amended by Laws of Utah 2025, Chapters 340,
470
31A-22-627.1
Effective
07/01/26
Repealed
07/01/27
, as enacted by Laws of Utah
2025, Chapter 241
34A-2-407.1
Effective
07/01/26
Repealed
07/01/27
, as enacted by Laws of Utah
2025, Chapter 241
53-2d-503
Effective
07/01/26
Repealed
07/01/27
, as last amended by Laws of Utah
2025, Chapter 241
63I-1-231
Effective
07/01/26
, as last amended by Laws of Utah 2025, Chapters 241,
473
63I-1-234
Effective
07/01/26
, as last amended by Laws of Utah 2025, Chapter 241
63I-1-253
Effective
07/01/26
, as last amended by Laws of Utah 2025, First Special
Session, Chapter 9
Be it enacted by the Legislature of the state of Utah:
Section 1. Section
26B-3-804
is amended to read:
26B-3-804
Effective
07/01/26
. Medicaid ambulance service provider
adjustment under fee-for-service rates.
(1)
The
Subject to Subsection
(2)
, the
division shall, if the assessment imposed by this
part is approved by the Centers for Medicare and Medicaid Services, for fee-for-service
rates effective on or after July 1, 2015, reimburse an ambulance service provider in an
amount up to the Emergency Medical Services Ambulance Rates adopted annually by
the Department of Public Safety
under Section
53-2d-503
.
(2)
Beginning July 1, 2026, the department shall pay a reimbursement rate for services
described in Subsection
(1)
that is equal to the highest reimbursement rate allowed by
the assessment imposed by this part.
Section 2. Section
31A-22-627.1
is amended to read:
31A-22-627.1
Effective
07/01/26
Repealed
07/01/27
. Ground ambulance
reimbursement.
(1)
As used in this section
:
,
(a)
"Base
"base
rate" means the same as that term is defined in Section
53-2d-503
.
(b)
"Medication maximum cost" means the same as that term is defined in Section
53-2d-503
.
(2)
For a mileage rate established in a rule created under Section
53-2d-503
, a health benefit
plan shall accept a correctly charged mileage rate as an allowable expense for a claim.
(3)
For claims made under Section
53-2d-503
, a health benefit plan shall accept a correctly
charged amount
:
(a)
that is equal to the base rate as an allowable expense
; and
.
(b)
that is equal to the medication maximum cost as an allowable expense for a
provided medication.
(4)
A health benefit plan shall make a payment for claims described in this section directly
to the provider, including an out-of-network provider.
Section 3. Section
34A-2-407.1
is amended to read:
34A-2-407.1
Effective
07/01/26
Repealed
07/01/27
. Ground ambulance
reimbursement.
(1)
As used in this section
:
,
(a)
"Base
"base
rate" means the same as that term is defined in Section
53-2d-503
.
(b)
"Medication maximum cost" means the same as that term is defined in Section
53-2d-503
.
(2)
For a mileage rate established in a rule created under Section
53-2d-503
, an employer or
the employer's workers' compensation insurance carrier, if any, shall accept a correctly
charged mileage rate as an allowable expense for a claim.
(3)
For claims made under Section
53-2d-503
, an employer or the employer's workers'
compensation insurance carrier, if any, shall accept a correctly charged amount
:
(a)
that is equal to the base rate as an allowable expense
; and
.
(b)
that is equal to the medication maximum cost as an allowable expense for a
provided medication.
(4)
An employer or the employer's workers' compensation insurance carrier, if any, shall
make a payment for claims described in this section directly to the provider, including
an out-of-network provider.
Section 4. Section
53-2d-503
is amended to read:
53-2d-503
Effective
07/01/26
Repealed
07/01/27
. Establishment of maximum
rates.
(1)
As used in this section:
(a)
(i)
"Balance bill" means the practice of a health care provider billing an individual
for the difference between the individual's billed charges and the amount the
individual's health benefit plan allows for a covered service.
(ii)
"Balance bill" does not include
billing
:
(A)
billing
an uninsured individual for services provided;
(B)
an individual for the difference of the amount allowed by a health benefit
plan for a billed service and the amount paid by the health benefit plan for the
billed service; and
if an individual's health benefit plan or other health
insurance does not allow the total of the base rate and the mileage rate as an
allowable expense, billing the individual for the total of the following:
(I)
the base rate plus the mileage rate; and
(II)
subtracting the amount actually paid by the health benefit plan or other
third party; and
(C)
billing
an individual for a service that was denied by the health benefit plan
because the service was an uncovered service under the health benefit plan.
(b)
(i)
"Base rate" means the rate
described in Subsection
(5)(a)
that
a ground
ambulance provider charges for:
(A)
transporting an individual to a hospital or patient receiving facility;
(B)
supplies used when transporting the individual;
(C)
providing procedures during transport;
and
(D)
administering medications during transport
.
; and
(E)
the cost of medication.
(ii)
"Base rate" includes an adjusted rate published by the bureau in rule in
accordance with Subsection
(2)(b)
.
(ii)
(iii)
"Base rate" does not include charges for
:
mileage.
(A)
the cost of a medication; or
(B)
mileage.
(c)
"Medical care consumer price index" means the unadjusted 12-month medical
services rate published each December by the United States Bureau of Labor
Statistics to measure inflation.
(c)
"Medication maximum cost" means a cost for a medication that equals the lower of
the:
(i)
national average drug acquisition cost; and
(ii)
Utah maximum allowable cost established in the Utah Medicaid program.
(2)
(a)
The bureau shall establish a maximum mileage rate for ground ambulance
providers and paramedic providers that is just and reasonable.
(b)
Beginning July 1, 2027, and in accordance with Title 63G, Chapter 3, Utah
Administrative Rulemaking Act, on or before July 1 of each year, the bureau shall
publish an adjusted base rate for each transport type described in Subsection
(5)(a)
in
rule.
(c)
The bureau shall adjust the base rate published under Subsection
(2)(b)
to be the total
of the currently operative base rate multiplied by the medical care consumer price
index.
(d)
The bureau may not adjust the base rate more than once each calendar year.
(3)
The committee may make recommendations to the bureau on the maximum mileage rate
set under Subsection
(2)
.
(4)
(a)
Ground ambulance providers and paramedic providers may not charge fees for
transporting a patient when the provider does not transport the patient.
(b)
The provisions of Subsection
(4)(a)
do not apply to ambulance providers or
paramedic providers in a geographic service area which contains a town as defined in
Subsection
10-2-301(2)(f)
.
(5)
(a)
The
Subject to adjustments published in rule under Subsection
(2)(b)
, the
base
rate is as follows:
(i)
for emergency medical technician ground ambulance transport,
$1,234.92
$1,257.15
;
(ii)
for advanced emergency medical technician ground ambulance transport,
$1,630.31
$1,659.66
;
(iii)
for paramedic ground ambulance transport,
$2,383.73
$2,426.64
; and
(iv)
subject to Subsection
(5)(b)
, for a transport described in Subsection
(5)(a)(i)
or
(ii) that has a paramedic on board,
$2,383.73
$2,426.64
.
(b)
A ground ambulance provider may charge the rate described in Subsection
(5)(a)(iv)
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.
(6)
(a)
For the mileage rate established in rule under this section, a ground ambulance
provider or paramedic provider may not charge an amount greater than the amount
authorized in the rule setting the mileage rate.
(b)
For the base rate, a ground ambulance provider or paramedic provider may not
charge an amount greater than the base rate
described in Subsection (5)(a) for
transportation
for
services
covered under the base rate
.
(c)
For a medication, a ground ambulance provider or paramedic provider may not
charge an amount greater than the medication maximum cost for a provided
medication.
(7)
A ground ambulance provider or paramedic provider may not balance bill.
(8)
Subject to prioritization by the Legislative Audit Subcommittee, the Office of the
Legislative Auditor General created in Section
36-12-15
shall conduct an audit of
ground ambulance providers, paramedic providers, and insurance companies regarding
rates and payments described in this section, Section
31A-22-627.1
, and Section
34A-2-407.1
.
Section 5. Section
63I-1-231
is amended to read:
63I-1-231
Effective
07/01/26
. Repeal dates: Title
31A
.
(1)
Section
31A-2-217
, Coordination with other states, is repealed July 1, 2033.
(2)
Subsection
31A-22-650(5)(b)
, regarding the reporting requirement that includes the
number of preauthorizations that were approved and denied, is repealed July 1, 2029.
(3)
Subsection
31A-22-650(8)
, regarding the rulemaking for the preauthorization reporting
requirement, is repealed July 1, 2029.
(4)
Section
31A-22-627.1
, Ground ambulance reimbursement, is repealed July 1, 2027.
Section 6. Section
63I-1-234
is amended to read:
63I-1-234
Effective
07/01/26
. Repeal dates: Titles 34 and 34A.
(1)
Subsection
34A-1-202(2)(b)(i)
, regarding the Workers' Compensation Advisory
Council, is repealed July 1, 2027.
(2)
Subsection
34A-1-202(2)(b)(iii)
, regarding the Coal Miner Certification Panel, is
repealed July 1, 2034.
(3)
Section
34A-2-107
, Appointment of workers' compensation advisory council --
Composition -- Terms of members -- Duties -- Compensation, is repealed July 1, 2027.
(4)
Section
34A-2-202.5
, Offset for occupational health and safety related donations, is
repealed December 31, 2030.
(5)
Section
34A-2-407.1
, Ground ambulance transport, is repealed July 1, 2027.
Section 7. Section
63I-1-253
is amended to read:
63I-1-253
Effective
07/01/26
. Repeal dates: Titles 53 through 53G.
(1)
Section
53-1-122
, Road Rage Awareness and Prevention Restricted Account, is
repealed July 1, 2028.
(2)
Section
53-2a-105
, Emergency Management Administration Council created --
Function -- Composition -- Expenses, is repealed July 1, 2029.
(3)
Section
53-2a-1103
, Search and Rescue Advisory Board -- Members -- Compensation,
is repealed July 1, 2030.
(4)
Section
53-2a-1104
, General duties of the Search and Rescue Advisory Board, is
repealed July 1, 2027.
(5)
Title 53, Chapter 2a, Part 15, Grid Resilience Committee
, is repealed July 1, 2027.
(6)
Section
53-2d-104
, State Emergency Medical Services Committee -- Membership --
Expenses, is repealed July 1, 2029.
(7)
Section
53-2d-503
, Establishment of maximum rates, is repealed July 1, 2027.
(8)
(7)
Section
53-5a-302
, Concealed Firearm Review Board -- Membership --
Compensation -- Terms -- Duties, is repealed July 1, 2029.
(9)
(8)
Section
53-11-104
, Board, is repealed July 1, 2029.
(10)
(9)
Title
53, Chapter 31
, Department Interaction With Local Law Enforcement, is
repealed July 1, 2027.
(11)
(10)
Subsection
53C-3-203
(4)(b)(vii)
, regarding the distribution of money from the
Land Exchange Distribution Account to the Geological Survey for test wells and other
hydrologic studies in the West Desert, is repealed July 1, 2030.
(12)
(11)
Subsection
53E-1-201
(1)(q)
, regarding the Higher Education and Corrections
Council, is repealed July 1, 2027.
(13)
(12)
Subsection
53E-2-304
(6)
, regarding foreclosing a private right of action or
waiver of governmental immunity, is repealed July 1, 2027.
(14)
(13)
Subsection
53E-3-503
(5)
, regarding coordinating councils for youth in care, is
repealed July 1, 2027.
(15)
(14)
Subsection
53E-3-503
(6)
, regarding coordinating councils for youth in care, is
repealed July 1, 2027.
(16)
(15)
Subsection
53E-4-202
(8)(b)
, regarding a standards review committee, is repealed
January 1, 2028.
(17)
(16)
Section
53E-4-203
, Standards review committee, is repealed January 1, 2028.
(18)
(17)
Title 53E, Chapter 6, Part 5, Utah Professional Practices Advisory Commission
,
is repealed July 1, 2033.
(19)
(18)
Subsection
53E-7-207
(7)
, regarding a private right of action or waiver of
governmental immunity, is repealed July 1, 2027.
(20)
(19)
Section
53F-5-215
, Elementary teacher preparation assessment grant, is repealed
July 1, 2028.
(21)
(20)
Section
53F-5-219
, Local Innovations Civics Education Pilot Program, is
repealed July 1, 2026.
(22)
(21)
Title 53F, Chapter 10, Part 2, Capital Projects Evaluation Panel
, is repealed July
1, 2027.
(23)
(22)
Subsection
53G-4-608
(2)(b)
, regarding the Utah Seismic Safety Commission, is
repealed January 1, 2025.
(24)
(23)
Subsection
53G-4-608
(4)(b)
, regarding the Utah Seismic Safety Commission, is
repealed January 1, 2025.
(25)
(24)
Section
53G-9-212
, Drinking water quality in schools, is repealed July 1, 2027.
(26)
(25)
Subsection
53G-9-703(4)
, regarding the parental video presentation concerning
student use of technology, is repealed January 1, 2030.
(27)
(26)
Subsection
53H-1-402(1)(j)
, regarding the Higher Education and Corrections
Council, is repealed July 1, 2027.
(28)
(27)
Section
53H-1-604
, Higher Education and Corrections Council, is repealed July
1, 2027.
(29)
(28)
Subsection
53H-4-210(3)
, regarding the creation of the SafeUT and School
Safety Commission, is repealed January 1, 2030.
(30)
(29)
Subsection
53H-4-210(4)
, regarding the appointment of the members of the
SafeUT and School Safety Commission, is repealed January 1, 2030.
(31)
(30)
Subsection
53H-4-210(5)
, regarding the attorney general designating the chair of
the SafeUT and School Safety Commission, is repealed January 1, 2030.
(32)
(31)
Subsection
53H-4-210(6)
, regarding the quorum requirements of the SafeUT and
School Safety Commission, is repealed January 1, 2030.
(33)
(32)
Subsection
53H-4-210(7)
, regarding a formal action of the SafeUT and School
Safety Commission, is repealed January 1, 2030.
(34)
(33)
Subsection
53H-4-210(8)
, regarding compensation for members of the SafeUT
and School Safety Commission, is repealed January 1, 2030.
(35)
(34)
Subsection
53H-4-210(9)
, regarding the support staff for the SafeUT and School
Safety Commission, is repealed January 1, 2030.
(36)
(35)
Section
53H-4-306.1
, Definitions -- Electrification of Transportation
Infrastructure Research Center, is repealed July 1, 2028.
(37)
(36)
Section
53H-4-306.2
, Electrification of Transportation Infrastructure Research
Center -- Designation -- Duties, is repealed July 1, 2028.
(38)
(37)
Section
53H-4-306.3
, Electrification of Transportation Infrastructure Research
Center -- Steering committee, is repealed July 1, 2028.
(39)
(38)
Section
53H-4-306.4
, Electrification of Transportation Infrastructure Research
Center -- Industry advisory board, is repealed July 1, 2028.
(40)
(39)
Section
53H-4-306.5
, Electrification of Transportation Infrastructure Research
Center -- Duties of the project director, is repealed July 1, 2028.
(41)
(40)
Section
53H-4-306.6
, Electrification of Transportation Infrastructure Research
Center -- Project development and strategic objectives -- Reporting requirements, is
repealed July 1, 2028.
(42)
(41)
Section
53H-4-307.1
, Center for Civic Excellence, is repealed July 1, 2030.
(43)
(42)
Section
53H-4-307.2
, Center for Civic Excellence -- Duties -- Authority, is
repealed July 1, 2030.
(44)
(43)
Section
53H-4-307.3
, Center for Civic Excellence -- Leadership, is repealed July
1, 2030.
(45)
(44)
Section
53H-4-307.4
, Center for Civic Excellence -- Faculty, is repealed July 1,
2030.
(46)
(45)
Section
53H-4-307.5
, Center for Civic Excellence -- Curriculum, is repealed July
1, 2030.
(47)
(46)
Section
53H-4-307.6
, Center for Civic Excellence -- Oversight -- Reporting, is
repealed July 1, 2030.
(48)
(47)
Section
53H-4-313
, Food Security Council, is repealed July 1, 2027.
(49)
(48)
Section
53H-8-305
, Five-year performance goals, is repealed July 1, 2027.
(50)
(49)
Title
53H, Chapter 10, Part 4
, Education Savings Incentive Program, is repealed
July 1, 2028.
Section 8.
Effective Date.
This bill takes effect on
July 1, 2026
.
3-11-26 11:17 AM