(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: (A) billing an uninsured individual for services provided; (B) 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; (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). (iii) "Base rate" does not include charges for 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. (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) Subject to adjustments published in rule under Subsection (2)(b), the base rate is as follows: (i) for emergency medical technician ground ambulance transport, $1,257.15; (ii) for advanced emergency medical technician ground ambulance transport, $1,659.66; (iii) for paramedic ground ambulance transport, $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, $2,426.64. (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 for services covered under the base rate. (7) A ground ambulance provider or paramedic provider may not balance bill.
‹ Prev All Utah sections Next ›
Lexace provides legal information, not legal advice, and no attorney–client relationship is created. Statute text is provided for general information and may not reflect the most recent amendments; verify against the official state code.