Ambulance Provider Payment Amendments, the official text

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31A-22-627.1 Effective 07/01/26 Repealed 07/01/27, as enacted by Laws of Utah 2025, Chapter 241
34A-2-407.1 Effective 07/01/26 Repealed 07/01/27, as enacted by Laws of Utah 2025, Chapter 241
53-2d-503 Effective 07/01/26 Repealed 07/01/27, as last amended by Laws of Utah 2025, Chapter 241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31A-22-627.1 Effective 07/01/26 Repealed 07/01/27.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