Quality assurance fee

AN ACT Relating to aligning the quality assurance fee for the 1
ambulance transport fund with federal regulations; and amending RCW 2
74.70.060, 74.70.050, and 74.70.020. 3
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF WASHINGTON:4
Sec. 1. RCW 74.70.060 and 2020 c 354 s 6 are each amended to 5
read as follows: 6
(1) ((Beginning July 1, 2021, and for )) For each state fiscal 7
year ((thereafter)), reimbursement for emergency ambulance transports 8
provided by ambulance transport providers shall be increased by 9
application of an add-on to the associated medicaid fee-for-service 10
payment schedule. The add-on increase to the fee-for-service payment 11
schedule under this section shall be calculated by ((June 15, 2021, 12
and shall remain the same for later state fiscal years, to the extent 13
the authority determines federal financial participation is 14
available)) the authority annually and be adjusted annually to 15
reflect the available fee amount . The authority shall calculate the 16
projections required by this subsection based on the number of 17
emergency ambulance transports and gross revenue data submitted 18
pursuant to RCW 74.70.040. The fee-for-service add-on shall be equal 19
to the quotient of the available fee amount projected by the 20
authority ((on or before June 15, 2021, for the 2021–22 state )) for 21
H-2969.1
HOUSE BILL 2531
State of Washington 69th Legislature 2026 Regular Session
By Representatives Stuebe, Stonier, Parshley, Ramel, Nance, Thomas,
Hall, Ryu, and Ybarra
Read first time 01/16/26. Referred to Committee on Appropriations.
p. 1 HB 2531
the previous fiscal year, divided by the total medicaid emergency 1
ambulance transports, projected by the authority ((on or before June 2
15, 2021, for the 2021–22 state )) for the previous fiscal year. The 3
resulting fee-for-service payment schedule amounts after the 4
application of this section shall be equal to the sum of the medicaid 5
fee-for-service payment schedule amount and the add-on increase.6
(2) The increased payments required by this section shall be 7
funded solely from the following: 8
(a) The quality assurance fee set forth in RCW 74.70.050, along 9
with any interest or other investment income earned on those funds; 10
and 11
(b) Federal reimbursement and any other related federal funds.12
(3) The proceeds of the quality assurance fee set forth in RCW 13
74.70.050, the matching amount provided by the federal government, 14
and any interest earned on those proceeds shall be used to 15
supplement, and not to supplant, existing funding for emergency 16
ambulance transports provided by ambulance transport providers.17
(4) Notwithstanding any provision of this chapter, the authority 18
may seek federal approval to implement any add-on increase to the 19
fee-for-service payment schedule pursuant to this section for any 20
state fiscal year or years, as applicable, on a time-limited basis 21
for a fixed program period, as determined by the authority.22
Sec. 2. RCW 74.70.050 and 2020 c 354 s 5 are each amended to 23
read as follows: 24
(1) Beginning July 1, 2021, and annually thereafter, the 25
authority shall assess each ambulance transport provider a quality 26
assurance fee. Each ambulance transport provider must pay the quality 27
assurance fee on a quarterly basis. The quarterly quality assurance 28
fee payment shall be based on the annual quality assurance fee rate 29
for the applicable state fiscal year multiplied by the number of 30
emergency ambulance transports provided by the ambulance transport 31
provider in the second quarter preceding the state fiscal quarter for 32
which the fee is assessed. 33
(2)(a) ((For the state fiscal year beginning July 1, 2021, the 34
annual quality assurance fee rate shall be calculated by multiplying 35
the projected total annual gross receipts for all ambulance transport 36
providers by five and one-half percent, which resulting product shall 37
be divided by the projected total annual emergency ambulance 38
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transports by all ambulance transport providers for the state fiscal 1
year. 2
(b))) For state fiscal years beginning July 1, 2022, ((and 3
continuing each state fiscal year thereafter )) until June 30, 2026 , 4
the quality assurance fee rate shall be calculated by a ratio, the 5
numerator of which shall be the product of the projected aggregate 6
fee schedule amount and the state medical assistance percentage , and 7
the denominator of which shall be ninety percent of the projected 8
total annual emergency ambulance transports by all ambulance 9
transport providers. 10
(((c))) (b) If, during a state fiscal year until June 30, 2026 , 11
the actual or projected available fee amount exceeds or is less than 12
the actual or projected aggregate fee schedule amount by more than 13
one percent, the authority shall adjust the annual quality assurance 14
fee rate so that the available fee amount for the state fiscal year 15
is approximately equal to the aggregate fee schedule amount for the 16
state fiscal year. The available fee amount for a state fiscal year 17
shall be considered to equal the aggregate fee schedule amount for 18
the state fiscal year if the difference between the available fee 19
amount for the state fiscal year and the aggregate fee schedule 20
amount for the state fiscal year constitutes less than one percent of 21
the aggregate fee schedule amount for the state fiscal year.22
(c) Beginning July 1, 2026, and continuing each state fiscal year 23
thereafter, the annual quality assurance fee rate shall be the rate 24
in effect as of July 4, 2025.25
(d) If, during a state fiscal year after July 1, 2026, the actual 26
or projected available fee amount exceeds or is less than the actual 27
or projected aggregate fee schedule amount by more than one percent, 28
the authority shall adjust the quality assurance add-on rate so that 29
the available fee amount for the state fiscal year is approximately 30
equal to the aggregate fee schedule amount for the state fiscal year. 31
The available fee amount for a state fiscal year shall be considered 32
to equal the aggregate fee schedule amount for the state fiscal year 33
if the difference between the available fee amount for the state 34
fiscal year and the aggregate fee schedule amount for the state 35
fiscal year constitutes less than one percent of the aggregate fee 36
schedule amount for the state fiscal year.37
(3) For each state fiscal year for which the quality assurance 38
fee is assessed, the authority shall send each ambulance transport 39
provider an assessment notice no later than thirty days prior to the 40
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beginning of the applicable state fiscal quarter. For each state 1
fiscal quarter for which the quality assurance fee is assessed, the 2
authority shall send to each ambulance transport provider an invoice 3
of the quarterly quality assurance fee payment due for the quarter no 4
later than thirty days before the payment is due. For each state 5
fiscal quarter for which the quality assurance fee is assessed, the 6
ambulance transport provider shall remit payment to the authority by 7
the date established by the authority, which shall be no earlier than 8
fifteen days after the beginning of the applicable state fiscal 9
quarter. 10
(4)(a) Interest shall be assessed on quality assurance fees not 11
paid on the date due at the rate and in the manner provided in RCW 12
43.20B.695. Interest shall be deposited in the ambulance transport 13
fund established in RCW 74.70.030. 14
(b) In the event that any fee payment is more than sixty days 15
overdue, the authority may deduct the unpaid fee and interest owed 16
from any medicaid reimbursement payments owed to the ambulance 17
transport provider until the full amount of the fee, interest, and 18
any penalties assessed under this chapter are recovered. Any 19
deduction made pursuant to this subsection shall be made only after 20
the authority gives the ambulance transport provider written 21
notification. Any deduction made pursuant to this subsection may be 22
deducted over a period of time that takes into account the financial 23
condition of the ambulance transport provider. 24
(c) In the event that any fee payment is more than sixty days 25
overdue, a penalty equal to the interest charge described in (a) of 26
this subsection shall be assessed and due for each month for which 27
the payment is not received after sixty days. Any funds resulting 28
from a penalty imposed pursuant to this subsection shall be deposited 29
into the ambulance transport fund established in RCW 74.70.030.30
(d) The authority may waive a portion or all of either the 31
interest or penalties, or both, assessed under this chapter in the 32
event the authority determines, in its sole discretion, that the 33
ambulance transport provider has demonstrated that imposition of the 34
full amount of the quality assurance fee pursuant to the timelines 35
applicable under this chapter has a high likelihood of creating an 36
undue financial hardship for the provider. Waiver of some or all of 37
the interest or penalties pursuant to this subsection shall be 38
conditioned on the ambulance transport provider's agreement to make 39
fee payments on an alternative schedule developed by the authority.40
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(5) The authority shall accept an ambulance transport provider's 1
payment even if the payment is submitted in a rate year subsequent to 2
the rate year in which the fee was assessed. 3
(6) In the event of a merger, acquisition, or similar transaction 4
involving an ambulance transport provider that has outstanding 5
quality assurance fee payment obligations pursuant to this chapter, 6
including any interest and penalty amounts owed, the resultant or 7
successor ambulance transport provider shall be responsible for 8
paying to the authority the full amount of outstanding quality 9
assurance fee payments, including any applicable interest and 10
penalties, attributable to the ambulance transport provider for which 11
it was assessed, upon the effective date of such transaction. An 12
entity considering a merger, acquisition, or similar transaction 13
involving an ambulance transport provider may submit a request to the 14
authority to ascertain the outstanding quality assurance fee payment 15
obligations of the ambulance transport provider pursuant to this 16
chapter as of the date of the authority's response to that request.17
Sec. 3. RCW 74.70.020 and 2020 c 354 s 2 are each amended to 18
read as follows: 19
The definitions in this section apply throughout this chapter 20
unless the context clearly requires otherwise. 21
(1) "Aggregate fee schedule amount" means the product of the add-22
on calculated pursuant to RCW 74.70.060(1) multiplied by the number 23
of emergency ambulance transports for the state fiscal year.24
(2) "Ambulance transport provider" means an ambulance transport 25
provider that is licensed under RCW 18.73.140 that bills and receives 26
patient care revenue from the provision of ground emergency ambulance 27
transports. "Ambulance transport provider" does not include a 28
provider that is owned or operated by the state, cities, counties, 29
fire protection districts, regional fire protection service 30
authorities, port districts, public hospital districts, community 31
services districts, health care districts, federally recognized 32
Indian tribes, or any unit of government as defined in 42 C.F.R. Sec. 33
433.50. 34
(3) "Annual quality assurance fee rate" means the quality 35
assurance fee per emergency ambulance transport during each 36
applicable state fiscal year assessed on each ambulance transport 37
provider, which is calculated as a percentage of annual gross revenue 38
for participating ambulance transport providers. 39
p. 5 HB 2531
(4) "Authority" means the Washington state health care authority.1
(5) "Available fee amount" means the sum of the following:2
(a) The amount deposited in the ambulance transport fund 3
established under RCW 74.70.030 during the applicable state fiscal 4
year, less the amounts described in RCW 74.70.030(3)(a); and5
(b) Any federal financial participation obtained as a result of 6
the deposit of the amount described in this subsection, for the 7
applicable state fiscal year. 8
(6) "Effective state medical assistance percentage" means a ratio 9
of the aggregate expenditures from state-only sources for medicaid 10
divided by the aggregate expenditures from state and federal sources 11
for medicaid for a state fiscal year. 12
(7) "Emergency ambulance transport" means the act of transporting 13
an individual by use of an ambulance during which a client receives 14
needed emergency medical services en route to an appropriate medical 15
facility. "Emergency ambulance transport" does not include 16
transportation of beneficiaries by passenger cars, taxicabs, litter 17
vans, wheelchair vans, or other forms of public or private 18
conveyances, nor does it include transportation by an air ambulance 19
provider. An "emergency ambulance transport" does not occur when, 20
following evaluation of a patient, a transport is not provided.21
(8) "Fee-for-service payment schedule" means the payment rates to 22
ambulance transport providers for emergency ambulance transports by 23
the authority without the inclusion of the add-on described in RCW 24
74.70.060. 25
(9) "Gross receipts" means the total amount of payments received 26
as patient care revenue for emergency ambulance transports, 27
determined on a cash basis of accounting. "Gross receipts" includes 28
all payments received as patient care revenue for emergency ambulance 29
transports from medicaid, medicare, commercial insurance, and all 30
other payers as payment for services rendered. 31
(10) "Medicaid" means the medical assistance program and the 32
state children's health insurance program as established in ((Title 33
XIX and Title XXI )) Titles XIX and XXI of the social security act, 34
respectively, and as administered in the state of Washington by the 35
authority. 36
(11) "Program" means the ambulance quality assurance fee program 37
established in this chapter. 38
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