Guidance on HB301, Ambulance Provider Payment Amendments

BULLETIN 2025-9 4315 South 2700 West, Suite 2300, Taylorsville, Utah 84129 ● Office (801) 957-9200 ● Facsimile (385) 465-6047 ● insurance.utah.gov State of Utah SPENCER J. COX Governor DEIDRE M. HENDERSON Lieutenant Governor Insurance Department JONATHAN T. PIKE Insurance Commissioner To: Insurers Offering a Health Benefit Plan From: Jonathan T. Pike, Insurance Commissioner Date: September 23, 2025 Subject: Guidance on HB301, Ambulance Provider Payment Amendments The Utah Insurance Department issues this Bulletin to provide guidance concerning HB301, Ambulance Provider Payment Amendments, passed during the 2025 General Session. HB301 establishes payment rates for ground ambulance charges by an ambulance provider, defined in Utah Code § 53-2d-101, for an insurer offering a health benefit plan as defined in § 31A-1-301. Neither HB301 nor this bulletin applies to air ambulance charges. Effective May 7, 2025, an insurer's allowable rate for ground ambulance services shall comply with § 31A-22-627.1, which requires an insurer to calculate the allowable amount no less than the base rate, medication maximum cost, and mileage rate established under § 53-2d-503. An insurer should review all policy forms, claims manuals, and payment adjudication standards to ensure ground ambulance claims are processed compliant with Utah laws. If necessary, an insurer is expected to file an amendment to previously filed policy forms. Base Rates The base rates are established in: § 53-2d-503(1)(b) (1)(b)(i) "Base rate" means the rate 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. (ii) "Base rate" does not include charges for: (A) the cost of a medication; or (B) mileage. § 53-2d-503(5) (5)(a) The base rate is as follows: (i) for emergency medical technician ground ambulance transport, $1,234.92; (ii) for advanced emergency medical technician ground ambulance transport, $1,630.31; (iii) for paramedic ground ambulance transport, $2,383.73; 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. (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. Medication Rate The medication maximum cost is established in: § 53-2d-503(1) (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. § 53-2d-503(6) (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. Mileage Rate Utah Code § 53-2d-503(6) states that, "[ ] a ground ambulance provider or paramedic provider may not charge an amount greater than the amount authorized in the rule setting the mileage rate." The mileage rates are established in Utah Admin. Code R911-8-200. As of the date of this Bulletin, the rates are: (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. Patient Responsibility An insurer shall adjust the insured's responsibility to reflect a correct patient responsibility based on § 53-2d-503(7), which prohibits a ground ambulance provider or paramedic provider from balance billing. "Balance bill" is defined as: § 53-2d-503(1) (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) 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 (C) 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. An insurer with questions related to this Bulletin should contact the Health & Life Division at uid.health@utah.gov or (801) 957-9280. DATED this 23rd day of September 2025. ________________________________ Jonathan T. Pike Insurance Commissioner