HB182ENGROSSED
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HB182
HGW1E86-2
By Representative Reynolds
RFD: Ways and Means General Fund
First Read: 05-Feb-25
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First Read: 05-Feb-25
A BILL
TO BE ENTITLED
AN ACT
Relating to emergency medical transport providers; to
amend Sections 40-26B-90 and 40-26B-93, Code of Alabama 1975
and Sections 40-26B-91, 40-26B-94, 40-26B-95, and 40-26B-99,
Code of Alabama 1975, as last amended by Act 2024-214, 2024
Regular Session; to extend the assessment on emergency medical
providers through the fiscal quarter ending July 1, 2028.
BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:
Section 1. Sections 40-26B-90 and 40-26B-93, Code of
Alabama 1975, and Sections 40-26B-91, 40-26B-94, 40-26B-95,
and 40-26B-99, Code of Alabama 1975, as last amended by Act
2024-214, 2024 Regular Session, are amended to read as
follows:
"§40-26B-90
The following words, terms, and phrases, when used in
this article have the meanings ascribed to them in this
section, except where the context clearly indicates a
different meaning:
(1) ASSESSMENT POOL. The total assessments collected
pursuant to this article as of a date determined by the
Commissioner of Alabama Medicaid, which date shall be no later
than the 60th day of a fiscal quarter, that have not been
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than the 60th day of a fiscal quarter, that have not been
expended for the purposes of this article, net of the amounts
specified in subdivision (c)(1) of Section 40-26B-93, plus any
Medicaid federal financial participation.
(2) ASSESSMENT RATE. A monetary amount per emergency
medical transport applied to calculate emergency medical
transport assessments pursuant to this article.
(3) DEPARTMENT. The Department of Revenue of the State
of Alabama.
(4) EMERGENCY MEDICAL TRANSPORT. The act of
transporting an individual from any point of origin to the
nearest medical facility capable of meeting the emergency
medical needs of the patient by an ambulance licensed,
operated, and equipped in accordance with applicable state or
local statutes, ordinances, or regulations. This term shall
only include services that are billable utilizing Healthcare
Common Procedure Coding System (HCPCS) emergency transport
codes A0429 BLS Emergency, A0427 ALS Emergency (Level 1),
A0433 ALS Emergency (Level 2), A0434 Specialty Care Transport,
and A0225 Neonatal Emergency Transport. In consultation with
the Alabama Medicaid Agency, the Department may include
additional HCPCS Codes when approved by the federal
government. "Emergency medical transports" This term shall not
include transportation of beneficiaries by passenger cars,
taxicabs, litter vans, wheelchair vans, or other forms of
public or private conveyances, nor shall it include
transportation by an air ambulance provider or a transport not
paid by any payor .
(5) EMERGENCY MEDICAL TRANSPORT ENHANCEMENT. An
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(5) EMERGENCY MEDICAL TRANSPORT ENHANCEMENT. An
additional Medicaid payment to emergency medical transport
providers authorized by Section 40-26B-95.
(6) EMERGENCY MEDICAL TRANSPORT PROVIDER. A provider of
emergency medical transports licensed by the Alabama
Department of Public Health's Office of Emergency Medical
Services as a transport provider. The term "emergency medical
transport provider" includes both public and private
providers.
(7) FISCAL QUARTER. A state fiscal quarter within a
state fiscal year.
(8) FISCAL YEAR. An accounting period of 12 months
beginning on the first day of the first month of the state
fiscal year.
(9) GROSS RECEIPTS. Gross payments received as patient
care revenue for emergency medical transports, determined on a
cash basis of accounting.
(10) MEDICAID PROGRAM. The medical assistance program
as established in Title XIX of the Social Security Act and as
administered in the State of Alabama by the Alabama Medicaid
Agency pursuant to executive order and Title 560 of the
Alabama Administrative Code.
(11) TRANSPORT ENHANCEMENT RATE. An additional Medicaid
payment per emergency medical transport authorized pursuant to
this article."
"§40-26B-91
To provide further for the availability of indigent
health care, the operation of the Medicaid Program, and the
maintenance and expansion of emergency medical transport
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maintenance and expansion of emergency medical transport
services:
(1) Commencing no later than the fiscal quarter
starting April 1, 2023, and through and including the fiscal
quarter starting July 1, 20252028, an assessment is imposed on
each emergency medical transport provider based on the number
of emergency medical transports. The quarterly assessment for
each emergency medical transport provider shall be calculated
based on the product of the assessment rate and the total
number ofrevenue received from emergency medical transports
rendered by the emergency medical transport provider from the
previous fiscal quarter.
(2) In consultation with the Alabama Medicaid Agency,
the department shall calculate the assessment rate by
multiplying the projected total gross receipts for all
emergency medical transport providers for a fiscal year by 5.3
percent, which resulting product shall be divided by the
projected total annual number of emergency medical transports
by all emergency medical transport providers for the fiscal
yearset an assessment rate each fiscal quarter. The
assessment rate shall be a maximum of 5.3 percent , subject to
Section 40-26B-98(b). In no case shall the proportion of
assessments collected under this article divided by total
gross receipts, expressed as a percentage, exceed half a
percent less than the maximum percentage of the annual
aggregate net patient revenue for emergency medical transport
providers that is prescribed pursuant to federal law and
regulations. In consultation with the Alabama Medicaid Agency,
the department may change the assessment rate each quarter to
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the department may change the assessment rate each quarter to
reduce the amount of surplus assessments. Any surplus
assessment from a previous quarter may be used to reduce the
assessment rate.
(3) The assessment imposed by this article is in
addition to all other taxes and assessments of any kind now
imposed by law."
"§40-26B-93
(a) The assessment imposed by this article shall be due
and payable to the department on a date determined by the
department, which date shall not be later than the 30th day of
the fiscal quarter for which the assessment is assessed,
except that Section 40-26B-97 shall apply to any fiscal
quarter for which federal approval has not been obtained as of
the first day of the fiscal quarter. Any payment not received
by the 30th day shall be considered delinquent. When
collected, the assessment imposed by the article shall be
deposited to the Alabama Health Care Trust Fund.
(b) Any emergency medical transport provider that fails
to pay the assessment levied by this article by the 30th day
of the fiscal quarter for which the assessment is assessed
within the time required by the department shall pay, in
addition to the assessment, a penalty of 10 percent of the
amount of the assessment due, together with interest thereon
at the rate prescribed by Section 40-1-44, such penalty and
interest to be assessed and collected as part of the
assessment. Provided, however, the department, if a good and
sufficient reason is shown, may waive or remit the penalty of
10 percent or a portion thereof. If the delinquent payment is
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10 percent or a portion thereof. If the delinquent payment is
not received by the 45th day of the quarter in which the
assessment was due, the department shall notify the Alabama
Medicaid Agency which shall determine whether the emergency
medical transport provider is a Medicaid provider, and if so,
shall withhold the payment, interest, and penalty due from any
reimbursement due the provider under the Medicaid Program,
including any emergency medical transport enhancements
authorized by Section 40-26B-95. Any emergency medical
transport provider who submits a delinquent payment shall not
be eligible for medical transport enhancements authorized by
Section 40-26B-95 during that quarter. Delinquent payments
shall be considered a part of the surplus assessment to be
utilized in accordance with Section 40-26B-91. The assessments
levied by this article shall constitute a debt due the State
of Alabama and may be collected by civil action in addition to
the methods provided in this article.
(c) Revenues generated by this assessment shall be made
available exclusively and are continuously appropriated for
the following purposes:
(1) To pay for the state's administrative costs of this
article, the department shall receive one percent of the
assessment per quarter and Medicaid shall receive funding for
expenses and enhancements to health care services with
emphasis on non-emergency transportation in an amount of one
hundred seventy-five thousand dollars ($175,000) per fiscal
quarter, subject to subsection (d) of Section 40-26B-98.
(2) To pay emergency medical transport enhancements to
emergency transport providers pursuant to Section 40-26B-95."
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emergency transport providers pursuant to Section 40-26B-95."
"§40-26B-94
(a) Commencing no later than the fiscal quarter
starting April 1, 2023, and through and including the fiscal
quarter starting July 1, 20252028, on or before the 15th day
after the close of each fiscal quarter, every emergency
medical transport provider shall file with the department a
statement under penalty of perjury on forms prescribed by the
department, showing the total number of emergency medical
transports, the total amount of gross receipts for the subject
fiscal quarter, and other reasonable and necessary information
as the department, after consultation with the Alabama
Medicaid Agency and adoption of appropriate rules, may require
for the proper enforcement of this article.
(b) It shall be the duty of each emergency medical
transport provider to keep and preserve suitable books and
records as may be necessary to determine the amount of
assessments for which it is liable under this article. The
books and records shall be kept and preserved for a period of
not less than three years, and all such books and records
shall be open for examination during business hours by the
department or its duly authorized agents.
(c) All information secured pursuant to this article by
the department shall be confidential, as prescribed by Section
40-2A-10, except that the department may provide such
information to the Alabama Medicaid Agency as necessary for
the proper administration of the Medicaid Program, or for the
department's proper administration of the assessment levied by
this article.
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this article.
(d) The department shall from time to time, as it deems
desirable, adopt reasonable rules as necessary to provide for
the orderly and efficient administration of the assessment
levied by this article."
"§40-26B-95
(a) Commencing no later than the fiscal quarter
starting April 1, 2023, and through and including the fiscal
quarter starting July 1, 20252028, the Alabama Medicaid Agency
shall pay an emergency medical transport enhancement each
fiscal quarter to emergency medical transport providers as set
forth in this section on or before the last day of the
quarter, except that Section 40-26B-97 shall apply to any
fiscal quarter for which federal approval has not been
obtained as of the first day of the fiscal quarter. The
emergency medical transport enhancement shall be paid in
addition to any other amounts payable to emergency medical
transport providers with respect to those services and shall
not affect any other payments to emergency medical transport
providers.
(b) For each fiscal quarter, the emergency medical
transport enhancement to each emergency medical transport
provider shall be calculated as the total number of emergency
medical transports reimbursed by the Alabama Medicaid Agency
as the primary payor in accordance with Chapter 8 of the
Medicaid Provider Manual to the emergency medical transport
provider in the preceding fiscal quarter multiplied by the
transport enhancement rate. The total emergency medical
transport enhancement to all providers shall not be great than
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transport enhancement to all providers shall not be great than
the assessment pool.
(c) For each fiscal quarter, the Alabama Medicaid
Agency shall establish the transport enhancement rate based on
the assessment pool divided by the total number of emergency
medical transports reimbursed by the Alabama Medicaid Agency
as the primary payor to all emergency medical transport
providers in the preceding fiscal quarter difference between
the Medicaid rate for each emergency medical transport and the
average rate paid by commercial insurers ."
"§40-26B-99
(a) This article shall cease to be operative on the
first day of the fiscal quarter beginning on or after the date
one or more of the following conditions is satisfied:
(1) Federal financial participation under Title XIX of
the Social Security Act is not available to the Alabama
Medicaid Program for the purposes of this article at the
approved federal medical assistance percentage, established
under Section 1905 of the Social Security Act, 42 U.S.C. §
1396d, for the applicable fiscal quarter.
(2) The state ceases to meet its obligation for the
level of state funding not derived from the assessment
established by this article as described in Section
40-26B-96(b).
(b) On the earlier of the occurrence of one or more of
the conditions listed in subsection (a) is satisfied on
December 1 of each year, 2024, the department shall refund any
remaining assessment pool to each provider of ground emergency
medical transport services in proportion to the amount paid by
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medical transport services in proportion to the amount paid by
the respective provider during the most recently completed
quarterly payment period."
Section 2. This act shall become effective on June 1,
2025.
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2025.
House of Representatives
Read for the first time and referred
to the House of Representatives
committee on Ways and Means General
Fund
................05-Feb-25
Read for the second time and placed
on the calendar:
1 amendment
................01-Apr-25
Read for the third time and passed
as amended
Yeas 101
Nays 0
Abstains 0
................03-Apr-25
John Treadwell
Clerk
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