AL
Alabama House Bill HB182

Alabama 2025 Regular Session

Alabama House Bill HB182 Compare Versions

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55 By Representative Reynolds
66 RFD: Ways and Means General Fund
77 First Read: 05-Feb-25
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12-5 HB182 Engrossed
12+5 B5MEQQQ-1 12/17/2024 TEW (L)TEW 2024-3219
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1414 First Read: 05-Feb-25
15+SYNOPSIS:
16+Under current law, emergency medical transport
17+providers pay a quarterly assessment to provide
18+additional Medicaid enhancement payments for
19+maintenance and expansion of emergency medical
20+transport services. The assessment expires at the end
21+of the fiscal quarter starting July 1, 2025.
22+This bill would extend the assessment period
23+through the fiscal quarter starting July 1, 2028.
1524 A BILL
1625 TO BE ENTITLED
1726 AN ACT
1827 Relating to emergency medical transport providers; to
19-amend Sections 40-26B-90 and 40-26B-93, Code of Alabama 1975
20-and Sections 40-26B-91, 40-26B-94, 40-26B-95, and 40-26B-99,
28+amend Sections 40-26B-91, 40-26B-94, 40-26B-95, and 40-26B-99,
2129 Code of Alabama 1975, as last amended by Act 2024-214, 2024
2230 Regular Session; to extend the assessment on emergency medical
2331 providers through the fiscal quarter ending July 1, 2028.
2432 BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:
25-Section 1. Sections 40-26B-90 and 40-26B-93, Code of
26-Alabama 1975, and Sections 40-26B-91, 40-26B-94, 40-26B-95,
33+Section 1. Sections 40-26B-91, 40-26B-94, 40-26B-95,
2734 and 40-26B-99, Code of Alabama 1975, as last amended by Act
28-2024-214, 2024 Regular Session, are amended to read as
29-follows:
30-"§40-26B-90
31-The following words, terms, and phrases, when used in
32-this article have the meanings ascribed to them in this
33-section, except where the context clearly indicates a
34-different meaning:
35-(1) ASSESSMENT POOL. The total assessments collected
36-pursuant to this article as of a date determined by the
37-Commissioner of Alabama Medicaid, which date shall be no later
38-than the 60th day of a fiscal quarter, that have not been
35+2024-214, 2024 Regular Session, are amended as follows:
36+"§40-26B-91
37+To provide further for the availability of indigent
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68-than the 60th day of a fiscal quarter, that have not been
69-expended for the purposes of this article, net of the amounts
70-specified in subdivision (c)(1) of Section 40-26B-93, plus any
71-Medicaid federal financial participation.
72-(2) ASSESSMENT RATE. A monetary amount per emergency
73-medical transport applied to calculate emergency medical
74-transport assessments pursuant to this article.
75-(3) DEPARTMENT. The Department of Revenue of the State
76-of Alabama.
77-(4) EMERGENCY MEDICAL TRANSPORT. The act of
78-transporting an individual from any point of origin to the
79-nearest medical facility capable of meeting the emergency
80-medical needs of the patient by an ambulance licensed,
81-operated, and equipped in accordance with applicable state or
82-local statutes, ordinances, or regulations. This term shall
83-only include services that are billable utilizing Healthcare
84-Common Procedure Coding System (HCPCS) emergency transport
85-codes A0429 BLS Emergency, A0427 ALS Emergency (Level 1),
86-A0433 ALS Emergency (Level 2), A0434 Specialty Care Transport,
87-and A0225 Neonatal Emergency Transport. In consultation with
88-the Alabama Medicaid Agency, the Department may include
89-additional HCPCS Codes when approved by the federal
90-government. "Emergency medical transports" This term shall not
91-include transportation of beneficiaries by passenger cars,
92-taxicabs, litter vans, wheelchair vans, or other forms of
93-public or private conveyances, nor shall it include
94-transportation by an air ambulance provider or a transport not
95-paid by any payor .
96-(5) EMERGENCY MEDICAL TRANSPORT ENHANCEMENT. An
67+To provide further for the availability of indigent
68+health care, the operation of the Medicaid Program, and the
69+maintenance and expansion of emergency medical transport
70+services:
71+(1) Commencing no later than the fiscal quarter
72+starting April 1, 2023, and through and including the fiscal
73+quarter starting July 1, 20252028, an assessment is imposed on
74+each emergency medical transport provider based on the number
75+of emergency medical transports. The quarterly assessment for
76+each emergency medical transport provider shall be calculated
77+based on the product of the assessment rate and the total
78+number of emergency medical transports rendered by the
79+emergency medical transport provider from the previous fiscal
80+quarter.
81+(2) In consultation with the Alabama Medicaid Agency,
82+the department shall calculate the assessment rate by
83+multiplying the projected total gross receipts for all
84+emergency medical transport providers for a fiscal year by 5.3
85+percent, which resulting product shall be divided by the
86+projected total annual number of emergency medical transports
87+by all emergency medical transport providers for the fiscal
88+year, subject to Section 40-26B-98(b). In no case shall the
89+proportion of assessments collected under this article divided
90+by total gross receipts, expressed as a percentage, exceed
91+half a percent less than the maximum percentage of the annual
92+aggregate net patient revenue for emergency medical transport
93+providers that is prescribed pursuant to federal law and
94+regulations.
95+(3) The assessment imposed by this article is in
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126-(5) EMERGENCY MEDICAL TRANSPORT ENHANCEMENT. An
127-additional Medicaid payment to emergency medical transport
128-providers authorized by Section 40-26B-95.
129-(6) EMERGENCY MEDICAL TRANSPORT PROVIDER. A provider of
130-emergency medical transports licensed by the Alabama
131-Department of Public Health's Office of Emergency Medical
132-Services as a transport provider. The term "emergency medical
133-transport provider" includes both public and private
134-providers.
135-(7) FISCAL QUARTER. A state fiscal quarter within a
136-state fiscal year.
137-(8) FISCAL YEAR. An accounting period of 12 months
138-beginning on the first day of the first month of the state
139-fiscal year.
140-(9) GROSS RECEIPTS. Gross payments received as patient
141-care revenue for emergency medical transports, determined on a
142-cash basis of accounting.
143-(10) MEDICAID PROGRAM. The medical assistance program
144-as established in Title XIX of the Social Security Act and as
145-administered in the State of Alabama by the Alabama Medicaid
146-Agency pursuant to executive order and Title 560 of the
147-Alabama Administrative Code.
148-(11) TRANSPORT ENHANCEMENT RATE. An additional Medicaid
149-payment per emergency medical transport authorized pursuant to
150-this article."
151-"§40-26B-91
152-To provide further for the availability of indigent
153-health care, the operation of the Medicaid Program, and the
154-maintenance and expansion of emergency medical transport
125+(3) The assessment imposed by this article is in
126+addition to all other taxes and assessments of any kind now
127+imposed by law."
128+"§40-26B-94
129+(a) Commencing no later than the fiscal quarter
130+starting April 1, 2023, and through and including the fiscal
131+quarter starting July 1, 20252028, on or before the 15th day
132+after the close of each fiscal quarter, every emergency
133+medical transport provider shall file with the department a
134+statement under penalty of perjury on forms prescribed by the
135+department, showing the total number of emergency medical
136+transports, the total amount of gross receipts for the subject
137+fiscal quarter, and other reasonable and necessary information
138+as the department, after consultation with the Alabama
139+Medicaid Agency and adoption of appropriate rules, may require
140+for the proper enforcement of this article.
141+(b) It shall be the duty of each emergency medical
142+transport provider to keep and preserve suitable books and
143+records as may be necessary to determine the amount of
144+assessments for which it is liable under this article. The
145+books and records shall be kept and preserved for a period of
146+not less than three years, and all such books and records
147+shall be open for examination during business hours by the
148+department or its duly authorized agents.
149+(c) All information secured pursuant to this article by
150+the department shall be confidential, as prescribed by Section
151+40-2A-10, except that the department may provide such
152+information to the Alabama Medicaid Agency as necessary for
153+the proper administration of the Medicaid Program, or for the
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184-maintenance and expansion of emergency medical transport
185-services:
186-(1) Commencing no later than the fiscal quarter
183+the proper administration of the Medicaid Program, or for the
184+department's proper administration of the assessment levied by
185+this article.
186+(d) The department shall from time to time, as it deems
187+desirable, adopt reasonable rules as necessary to provide for
188+the orderly and efficient administration of the assessment
189+levied by this article."
190+"§40-26B-95
191+(a) Commencing no later than the fiscal quarter
187192 starting April 1, 2023, and through and including the fiscal
188-quarter starting July 1, 20252028, an assessment is imposed on
189-each emergency medical transport provider based on the number
190-of emergency medical transports. The quarterly assessment for
191-each emergency medical transport provider shall be calculated
192-based on the product of the assessment rate and the total
193-number ofrevenue received from emergency medical transports
194-rendered by the emergency medical transport provider from the
195-previous fiscal quarter.
196-(2) In consultation with the Alabama Medicaid Agency,
197-the department shall calculate the assessment rate by
198-multiplying the projected total gross receipts for all
199-emergency medical transport providers for a fiscal year by 5.3
200-percent, which resulting product shall be divided by the
201-projected total annual number of emergency medical transports
202-by all emergency medical transport providers for the fiscal
203-yearset an assessment rate each fiscal quarter. The
204-assessment rate shall be a maximum of 5.3 percent , subject to
205-Section 40-26B-98(b). In no case shall the proportion of
206-assessments collected under this article divided by total
207-gross receipts, expressed as a percentage, exceed half a
208-percent less than the maximum percentage of the annual
209-aggregate net patient revenue for emergency medical transport
210-providers that is prescribed pursuant to federal law and
211-regulations. In consultation with the Alabama Medicaid Agency,
212-the department may change the assessment rate each quarter to
193+quarter starting July 1, 20252028, the Alabama Medicaid Agency
194+shall pay an emergency medical transport enhancement each
195+fiscal quarter to emergency medical transport providers as set
196+forth in this section on or before the last day of the
197+quarter, except that Section 40-26B-97 shall apply to any
198+fiscal quarter for which federal approval has not been
199+obtained as of the first day of the fiscal quarter. The
200+emergency medical transport enhancement shall be paid in
201+addition to any other amounts payable to emergency medical
202+transport providers with respect to those services and shall
203+not affect any other payments to emergency medical transport
204+providers.
205+(b) For each fiscal quarter, the emergency medical
206+transport enhancement to each emergency medical transport
207+provider shall be calculated as the total number of emergency
208+medical transports reimbursed by the Alabama Medicaid Agency
209+as the primary payor in accordance with Chapter 8 of the
210+Medicaid Provider Manual to the emergency medical transport
211+provider in the preceding fiscal quarter multiplied by the
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242-the department may change the assessment rate each quarter to
243-reduce the amount of surplus assessments. Any surplus
244-assessment from a previous quarter may be used to reduce the
245-assessment rate.
246-(3) The assessment imposed by this article is in
247-addition to all other taxes and assessments of any kind now
248-imposed by law."
249-"§40-26B-93
250-(a) The assessment imposed by this article shall be due
251-and payable to the department on a date determined by the
252-department, which date shall not be later than the 30th day of
253-the fiscal quarter for which the assessment is assessed,
254-except that Section 40-26B-97 shall apply to any fiscal
255-quarter for which federal approval has not been obtained as of
256-the first day of the fiscal quarter. Any payment not received
257-by the 30th day shall be considered delinquent. When
258-collected, the assessment imposed by the article shall be
259-deposited to the Alabama Health Care Trust Fund.
260-(b) Any emergency medical transport provider that fails
261-to pay the assessment levied by this article by the 30th day
262-of the fiscal quarter for which the assessment is assessed
263-within the time required by the department shall pay, in
264-addition to the assessment, a penalty of 10 percent of the
265-amount of the assessment due, together with interest thereon
266-at the rate prescribed by Section 40-1-44, such penalty and
267-interest to be assessed and collected as part of the
268-assessment. Provided, however, the department, if a good and
269-sufficient reason is shown, may waive or remit the penalty of
270-10 percent or a portion thereof. If the delinquent payment is
241+provider in the preceding fiscal quarter multiplied by the
242+transport enhancement rate.
243+(c) For each fiscal quarter, the Alabama Medicaid
244+Agency shall establish the transport enhancement rate based on
245+the assessment pool divided by the total number of emergency
246+medical transports reimbursed by the Alabama Medicaid Agency
247+as the primary payor to all emergency medical transport
248+providers in the preceding fiscal quarter."
249+"§40-26B-99
250+(a) This article shall cease to be operative on the
251+first day of the fiscal quarter beginning on or after the date
252+one or more of the following conditions is satisfied:
253+(1) Federal financial participation under Title XIX of
254+the Social Security Act is not available to the Alabama
255+Medicaid Program for the purposes of this article at the
256+approved federal medical assistance percentage, established
257+under Section 1905 of the Social Security Act, 42 U.S.C. §
258+1396d, for the applicable fiscal quarter.
259+(2) The state ceases to meet its obligation for the
260+level of state funding not derived from the assessment
261+established by this article as described in Section
262+40-26B-96(b).
263+(b) On the earlier of the occurrence of one or more of
264+the conditions listed in subsection (a) is satisfied on
265+December 1 of each year, 2024, the department shall refund any
266+remaining assessment pool to each provider of ground emergency
267+medical transport services in proportion to the amount paid by
268+the respective provider during the most recently completed
269+quarterly payment period."
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300-10 percent or a portion thereof. If the delinquent payment is
301-not received by the 45th day of the quarter in which the
302-assessment was due, the department shall notify the Alabama
303-Medicaid Agency which shall determine whether the emergency
304-medical transport provider is a Medicaid provider, and if so,
305-shall withhold the payment, interest, and penalty due from any
306-reimbursement due the provider under the Medicaid Program,
307-including any emergency medical transport enhancements
308-authorized by Section 40-26B-95. Any emergency medical
309-transport provider who submits a delinquent payment shall not
310-be eligible for medical transport enhancements authorized by
311-Section 40-26B-95 during that quarter. Delinquent payments
312-shall be considered a part of the surplus assessment to be
313-utilized in accordance with Section 40-26B-91. The assessments
314-levied by this article shall constitute a debt due the State
315-of Alabama and may be collected by civil action in addition to
316-the methods provided in this article.
317-(c) Revenues generated by this assessment shall be made
318-available exclusively and are continuously appropriated for
319-the following purposes:
320-(1) To pay for the state's administrative costs of this
321-article, the department shall receive one percent of the
322-assessment per quarter and Medicaid shall receive funding for
323-expenses and enhancements to health care services with
324-emphasis on non-emergency transportation in an amount of one
325-hundred seventy-five thousand dollars ($175,000) per fiscal
326-quarter, subject to subsection (d) of Section 40-26B-98.
327-(2) To pay emergency medical transport enhancements to
328-emergency transport providers pursuant to Section 40-26B-95."
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358-emergency transport providers pursuant to Section 40-26B-95."
359-"§40-26B-94
360-(a) Commencing no later than the fiscal quarter
361-starting April 1, 2023, and through and including the fiscal
362-quarter starting July 1, 20252028, on or before the 15th day
363-after the close of each fiscal quarter, every emergency
364-medical transport provider shall file with the department a
365-statement under penalty of perjury on forms prescribed by the
366-department, showing the total number of emergency medical
367-transports, the total amount of gross receipts for the subject
368-fiscal quarter, and other reasonable and necessary information
369-as the department, after consultation with the Alabama
370-Medicaid Agency and adoption of appropriate rules, may require
371-for the proper enforcement of this article.
372-(b) It shall be the duty of each emergency medical
373-transport provider to keep and preserve suitable books and
374-records as may be necessary to determine the amount of
375-assessments for which it is liable under this article. The
376-books and records shall be kept and preserved for a period of
377-not less than three years, and all such books and records
378-shall be open for examination during business hours by the
379-department or its duly authorized agents.
380-(c) All information secured pursuant to this article by
381-the department shall be confidential, as prescribed by Section
382-40-2A-10, except that the department may provide such
383-information to the Alabama Medicaid Agency as necessary for
384-the proper administration of the Medicaid Program, or for the
385-department's proper administration of the assessment levied by
386-this article.
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416-this article.
417-(d) The department shall from time to time, as it deems
418-desirable, adopt reasonable rules as necessary to provide for
419-the orderly and efficient administration of the assessment
420-levied by this article."
421-"§40-26B-95
422-(a) Commencing no later than the fiscal quarter
423-starting April 1, 2023, and through and including the fiscal
424-quarter starting July 1, 20252028, the Alabama Medicaid Agency
425-shall pay an emergency medical transport enhancement each
426-fiscal quarter to emergency medical transport providers as set
427-forth in this section on or before the last day of the
428-quarter, except that Section 40-26B-97 shall apply to any
429-fiscal quarter for which federal approval has not been
430-obtained as of the first day of the fiscal quarter. The
431-emergency medical transport enhancement shall be paid in
432-addition to any other amounts payable to emergency medical
433-transport providers with respect to those services and shall
434-not affect any other payments to emergency medical transport
435-providers.
436-(b) For each fiscal quarter, the emergency medical
437-transport enhancement to each emergency medical transport
438-provider shall be calculated as the total number of emergency
439-medical transports reimbursed by the Alabama Medicaid Agency
440-as the primary payor in accordance with Chapter 8 of the
441-Medicaid Provider Manual to the emergency medical transport
442-provider in the preceding fiscal quarter multiplied by the
443-transport enhancement rate. The total emergency medical
444-transport enhancement to all providers shall not be great than
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474-transport enhancement to all providers shall not be great than
475-the assessment pool.
476-(c) For each fiscal quarter, the Alabama Medicaid
477-Agency shall establish the transport enhancement rate based on
478-the assessment pool divided by the total number of emergency
479-medical transports reimbursed by the Alabama Medicaid Agency
480-as the primary payor to all emergency medical transport
481-providers in the preceding fiscal quarter difference between
482-the Medicaid rate for each emergency medical transport and the
483-average rate paid by commercial insurers ."
484-"§40-26B-99
485-(a) This article shall cease to be operative on the
486-first day of the fiscal quarter beginning on or after the date
487-one or more of the following conditions is satisfied:
488-(1) Federal financial participation under Title XIX of
489-the Social Security Act is not available to the Alabama
490-Medicaid Program for the purposes of this article at the
491-approved federal medical assistance percentage, established
492-under Section 1905 of the Social Security Act, 42 U.S.C. §
493-1396d, for the applicable fiscal quarter.
494-(2) The state ceases to meet its obligation for the
495-level of state funding not derived from the assessment
496-established by this article as described in Section
497-40-26B-96(b).
498-(b) On the earlier of the occurrence of one or more of
499-the conditions listed in subsection (a) is satisfied on
500-December 1 of each year, 2024, the department shall refund any
501-remaining assessment pool to each provider of ground emergency
502-medical transport services in proportion to the amount paid by
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532-medical transport services in proportion to the amount paid by
533-the respective provider during the most recently completed
534299 quarterly payment period."
535300 Section 2. This act shall become effective on June 1,
536301 2025.
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542-2025.
543-House of Representatives
544-Read for the first time and referred
545-to the House of Representatives
546-committee on Ways and Means General
547-Fund
548-................05-Feb-25
549-Read for the second time and placed
550-on the calendar:
551- 1 amendment
552-................01-Apr-25
553-Read for the third time and passed
554-as amended
555-Yeas 101
556-Nays 0
557-Abstains 0
558-................03-Apr-25
559-John Treadwell
560-Clerk
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