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1 HOUSE BILL NO. 56
2 INTRODUCED BY E. BUTTREY
3 BY REQUEST OF THE ECONOMIC AFFAIRS INTERIM COMMITTEE
4
5 A BILL FOR AN ACT ENTITLED: “AN ACT ESTABLISHING AN AMBULANCE PROVIDER ASSESSMENT
6 FEE; ESTABLISHING PROCEDURES FOR COLLECTING AND DISTRIBUTING THE ASSESSMENT FEE;
7 ALLOWING AUDITING OF AMBULANCE PROVIDER REPORTS AND PAYMENTS; ALLOWING FOR
8 PENALTIES AND INTEREST; REQUIRING REVENUES GENERATED BY THE ASSESSMENT FEE TO BE
9 USED FOR SUPPLEMENTING AMBULANCE PROVIDER MEDICAID PAYMENTS; PROVIDING
10 DEFINITIONS; PROVIDING RULEMAKING AUTHORITY; PROVIDING A STATUTORY APPROPRIATION;
11 PROVIDING APPROPRIATIONS FOR THE DEPARTMENT OF REVENUE TO IMPLEMENT AND
12 ADMINISTER THE COLLECTION OF THE ASSESSMENT FEE; PROVIDING FOR REIMBURSEMENT TO
13 THE GENERAL FUND FROM THE STATE SPECIAL REVENUE ACCOUNT; AMENDING SECTION 17-7-502,
14 MCA; PROVIDING FOR CONTINGENT VOIDNESS; AND PROVIDING A CONTINGENT EFFECTIVE DATE
15 AND A TERMINATION DATE.”
16
17 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MONTANA:
18
19 NEW SECTION. Section 1. As used in [sections 1 through 13], the following definitions
20 apply:
21 (1)“AIR AMBULANCE SERVICES” MEANS AMBULANCE SERVICES PROVIDED BY AIRCRAFT AS DEFINED IN 50-
22 6-302.
23 (1) (2) (a) "Ambulance provider" means a person licensed pursuant to 50-6-306 to provide ground
24 ambulance transport, including transport for a municipal fire or police department or other government entity.
25 (b) The term does not include:
26 (i) an entity that exclusively provides air ambulance services; or
27 (ii) an entity operated by the United States, an Indian tribe, or any facility authorized under the
28 Indian Health Care Improvement Act; OR - 2025
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1 (III).
2 (2) (3) "Assessment fee" means the ambulance provider assessment fee as provided in [section 2].
3 (3) (4) "Department" means the department of revenue provided for in 2-15-1301.
4 (4) (5) "Emergency ambulance services" means any service delivered by an ambulance provider other
5 than air ambulance services.
6 (5) (6) (a) "Net operating revenue" means gross revenue collected by ambulance providers for the
7 delivery of emergency ambulance services, minus amounts deducted for bad debt, charity care, and payer
8 discounts.
9 (b) The term does not include nonpatient service-related revenue.
10 (7)UBLIC AMBULANCE PROVIDER” MEANS AN AMBULANCE PROVIDER THAT IS INCORPORATED UNDER
11 TITLE 7.
12
13 NEW SECTION. Section 2.
14 shall pay to the department a uniform assessment fee of 5.75% of net operating revenues.
15 (2) The AFTER THE ADMINISTRATION COSTS OF THE DEPARTMENT ARE DEDUCTED, THE department shall
16 deposit the proceeds from collection of the assessment fee in the ambulance provider special
17 revenue account provided for in [section 14].
18
19 NEW SECTION. Section 3. The assessment fee imposed under
20 [section 2] is, in addition to any other taxes and fees, required to be paid by ambulance providers.
21
22 NEW SECTION. Section 4. The department may adopt rules necessary to
23 administer [sections 1 through 13].
24
25 NEW SECTION. Section 5. (1) On or before March
26 31 JUNE 30 each year, an ambulance provider shall file with the department a report of its net operating revenue
27 received during the previous calendar year. The report must be:
28 (a) in the form prescribed by the department; and - 2025
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1 (b) accompanied by a payment in an amount equal to the assessment fee required to be paid
2 under [section 2].
3 (2) Revenue received for all emergency ambulance services provided during the calendar year
4 must be included in the calculation of the ambulance provider's net operating revenue regardless of the source
5 of payment for the services rendered, including services covered under fee-for-service and managed care
6 arrangements.
7 (3) In the case of a transfer of ownership, the successor in interest to the ambulance provider
8 assumes the liability for the assessment fee.
9
10 NEW SECTION. Section 6. (1) The department may audit the records and other
11 documents of an ambulance provider to ensure that the proper assessment fee has been collected.
12 (2) The department may require the ambulance provider to provide records and other
13 documentation, including books, ledgers, and registers, necessary for the department to verify the proper
14 amount of the assessment fee paid.
15 (3) An ambulance provider shall maintain and make available for inspection by the department
16 sufficient records and other documentation to demonstrate how the ambulance provider's net operating revenue
17 was calculated. The ambulance provider shall maintain the records for at least 5 years from the date the report
18 is due.
19
20 NEW SECTION. Section 7. (1) Except as otherwise provided in this section, a
21 deficiency may not be assessed or collected with respect to the year for which a report is filed unless the notice
22 of additional fees proposed to be assessed is mailed within 5 years from the date the report was filed. For the
23 purposes of this section, a report filed before the last day prescribed for filing is considered filed on the last day.
24 If, before the expiration of the period prescribed for the assessment of the fees, the ambulance provider
25 consents in writing to an assessment after the 5-year period, the fees may be assessed at any time prior to the
26 expiration of the period agreed on.
27 (2) A refund or credit may not be paid or allowed with respect to the year for which a report is filed
28 after 5 years from the last day prescribed for filing the report or after 1 year from the date of the overpayment, - 2025
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1 whichever period expires later, unless before the expiration of the period, the ambulance provider files a claim
2 or the department has determined the existence of the overpayment and has approved the refund or credit. If
3 the ambulance provider has agreed in writing under the provisions of subsection (1) to extend the time within
4 which the department may propose an additional assessment, the period for filing a claim for a refund or credit
5 or for allowing a refund or credit if no claim is filed, is automatically extended.
6
7 NEW SECTION. Section 8. If an ambulance provider does
8 not pay the required assessment fee on or before the due date of the report as provided in [section 5], penalty
9 and interest, as provided in 15-1-216, must be added to the assessment fee.
10
11 NEW SECTION. Section 9. For the purposes of
12 ascertaining the correctness of any report, the department may:
13 (1) examine or cause to have examined by a designated agent or representative any books,
14 papers, records, or memoranda bearing on the information required to be included in the report;
15 (2) require the attendance of any officer or employee of the ambulance provider making the report
16 or the attendance of any other persons having relevant knowledge; and
17 (3) take testimony and require the production of any other material for its information.
18
19 NEW SECTION. Section 10. (1) (a) If
20 the department determines that the amount of the assessment fee due is greater than the amount disclosed by
21 the report, it shall mail the ambulance provider a notice of the additional fees proposed to be assessed. Within
22 30 days after the mailing of the notice, the ambulance provider may file with the department a written protest
23 against the proposed additional fees stating the grounds on which the protest is based. The ambulance
24 provider may request in its protest an oral hearing or an opportunity to present additional evidence relating to its
25 fee liability.
26 (b) If a protest is not filed, the amount of the additional fees proposed to be assessed becomes
27 final on the expiration of the 30-day period.
28 (c) If a protest is filed, the department shall reconsider the proposed assessment and, if the - 2025
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1 ambulance provider has requested, shall grant the provider an oral hearing. After consideration of the protest
2 and the evidence presented at an oral hearing, the department's action on the protest is final when it mails
3 notice of its action to the ambulance provider.
4 (2) When a deficiency is determined and the fees become final, the department shall mail a notice
5 and demand to the ambulance provider for payment. Penalty and interest may be added to any deficiency
6 assessment as provided in 15-1-216.
7
8 NEW SECTION. Section 11. (1) The director of the department or a person
9 authorized in writing by the director may enter into an agreement with an ambulance provider relating to the
10 liability of the provider in respect to fees imposed by [sections 1 through 13].
11 (2) An agreement under this section is final and conclusive, and, except on a showing of fraud,
12 malfeasance, or misrepresentation of a material fact:
13 (a) the case may not be reopened as to matters agreed on or the agreement modified by an
14 officer, employee, or agent of this state; and
15 (b) in a suit, action, or proceeding under the agreement or a determination, assessment, collection,
16 payment, abatement, refund, or credit made in accordance with the agreement, the agreement may not be
17 annulled, modified, set aside, or disregarded.
18
19 NEW SECTION. Section 12. (1) If the
20 department determines that the amount of fees, penalty, or interest due for any year is less than the amount
21 paid, the amount of the overpayment must be credited against any fees, penalty, or interest then due from the
22 ambulance provider and the balance must be refunded to the ambulance provider or its successor through
23 reorganization, merger, or consolidation or to its shareholders on dissolution.
24 (2) Except as provided in subsection (3), interest is allowed on overpayments at the same rate as
25 is charged on unpaid taxes, as provided in 15-1-216. Interest is due from the due date of the report or from the
26 date of overpayment, whichever date is later, to the date the department approves refunding or crediting of the
27 overpayment. Interest does not accrue during a period during which the processing of a claim for refund is
28 delayed more than 30 days by reason of failure of the ambulance provider to furnish information requested by - 2025
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1 the department for the purpose of verifying the amount of the overpayment.
2 (3) Interest is not allowed:
3 (a) if the overpayment is refunded within 6 months from the date the report is due or from the date
4 the return is filed, whichever is later; or
5 (b) if the amount of interest is less than $1.
6 (4) A payment not made incident to a discharge of actual ambulance provider assessment fee
7 liability or payment reasonably assumed to be imposed under [sections 1 through 13] is not considered an
8 overpayment with respect to which interest is allowable.
9
10 NEW SECTION. Section 13. If the assessment fee is not paid when due, the
11 department may issue a warrant for distraint as provided in Title 15, chapter 1, part 7.
12
13 NEW SECTION. Section 14.
14 (1) There is an ambulance medicaid reimbursement account in the state special
15 revenue account provided for in 17-2-102 to the credit of the department of public health and human services.
16 (2) The account consists of:
17 (a) money from the assessment fee provided for in [section 2];
18 (b) any penalties and interest on penalties collected pursuant to [sections 1 through 13];
19 (c) other money authorized by the legislature to be credited to the account; and
20 (d) income earned on the account.
21 (3) Money in the account must be used by the department of public health and human services AS
22:
23 (A) REIMBURSE THE GENERAL FUND THROUGH A TRANSFER FROM THIS ACCOUNT TO THE
24 FOR APPROPRIATIONS MADE TO THE DEPARTMENT OF REVENUE TO IMPLEMENT,,
25 THE AMBULANCE PROVIDER ASSESSMENT FEE;
26 (B)[THIS ACT]; AND
27 (C) to provide funding no later than June 30 S30 of each year for increases in medicaid
28 payments to emergency ambulance services up to the average commercial rate for the service and for the cost - 2025
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1 of collection of the fees and other administrative activities associated with the implementation of increases in
2 the medicaid payments to ambulance providers.
3 (4) Money remaining in the account at the end of a fiscal year may not be expended or transferred
4 for any other purpose EXCEPT AS PROVIDED IN SUBSECTION (3)().
5 (5) Money in the account is statutorily appropriated, as provided in 17-7-502, for the purposes
6 provided for in this section.
7
8 Section 17-7-502, MCA, is amended to read:
9 "17-7-502. (1) A statutory
10 appropriation is an appropriation made by permanent law that authorizes spending by a state agency without
11 the need for a biennial legislative appropriation or budget amendment.
12 (2) Except as provided in subsection (4), to be effective, a statutory appropriation must comply with
13 both of the following provisions:
14 (a) The law containing the statutory authority must be listed in subsection (3).
15 (b) The law or portion of the law making a statutory appropriation must specifically state that a
16 statutory appropriation is made as provided in this section.
17 (3) The following laws are the only laws containing statutory appropriations: 2-17-105; 5-11-120; 5-
18 11-407; 5-13-403; 5-13-404; 7-4-2502; 7-4-2924; 7-32-236; 10-1-108; 10-1-1202; 10-1-1303; 10-2-603; 10-2-
19 807; 10-3-203; 10-3-310; 10-3-312; 10-3-314; 10-3-316; 10-3-802; 10-3-1304; 10-4-304; 10-4-310; 15-1-121;
20 15-1-142; 15-1-143; 15-1-218; 15-1-2302; 15-31-165; 15-31-1004; 15-31-1005; 15-35-108; 15-36-332; 15-37-
21 117; 15-39-110; 15-65-121; 15-70-128; 15-70-131; 15-70-132; 15-70-433; 16-11-119; 16-11-509; 17-3-106; 17-
22 3-212; 17-3-222; 17-3-241; 17-6-101; 17-6-214; 17-7-133; 17-7-215; 18-11-112; 19-3-319; 19-3-320; 19-6-410;
23 19-9-702; 19-13-604; 19-17-301; 19-18-512; 19-19-305; 19-19-506; 19-20-604; 19-20-607; 19-21-203; 20-3-
24 369; 20-7-1709; 20-8-107; 20-9-250; 20-9-534; 20-9-622; [20-15-328]; 20-26-617; 20-26-1503; 22-1-327; 22-3-
25 116; 22-3-117; [22-3-1004]; 23-4-105; 23-5-306; 23-5-409; 23-5-612; 23-7-301; 23-7-402; 30-10-1004; 37-43-
26 204; 37-50-209; 37-54-113; 39-71-503; 41-5-2011; 42-2-105; 44-4-1101; 44-4-1506; 44-12-213; 44-13-102; 50-
27 1-115; 53-1-109; [section 14]; 53-6-148; 53-9-113; 53-24-108; 53-24-206; 60-5-530; 60-11-115; 61-3-321; 61-3-
28 415; 67-1-309; 69-3-870; 69-4-527; 75-1-1101; 75-5-1108; 75-6-214; 75-11-313; 75-26-308; 76-13-150; 76-13- - 2025
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1 151; 76-13-417; 76-17-103; 77-1-108; 77-2-362; 80-2-222; 80-4-416; 80-11-518; 80-11-1006; 81-1-112; 81-1-
2 113; 81-2-203; 81-7-106; 81-7-123; 81-10-103; 82-11-161; 85-20-1504; 85-20-1505; [85-25-102]; 87-1-603; 87-
3 5-909; 90-1-115; 90-1-205; 90-1-504; 90-6-331; and 90-9-306.
4 (4) There is a statutory appropriation to pay the principal, interest, premiums, and any costs or fees
5 associated with issuing, paying, securing, redeeming, or defeasing all bonds, notes, or other obligations, as due
6 in the ordinary course or when earlier called for redemption or defeased, that have been authorized and issued
7 pursuant to the laws of Montana. Agencies that have entered into agreements authorized by the laws of
8 Montana to pay the state treasurer, for deposit in accordance with 17-2-101 through 17-2-107, as determined
9 by the state treasurer, an amount sufficient to pay the principal and interest as due on the bonds or notes have
10 statutory appropriation authority for the payments. (In subsection (3): pursuant to sec. 10, Ch. 360, L. 1999, the
11 inclusion of 19-20-604 terminates contingently when the amortization period for the teachers' retirement
12 system's unfunded liability is 10 years or less; pursuant to sec. 73, Ch. 44, L. 2007, the inclusion of 19-6-410
13 terminates contingently upon the death of the last recipient eligible under 19-6-709(2) for the supplemental
14 benefit provided by 19-6-709; pursuant to sec. 5, Ch. 383, L. 2015, the inclusion of 85-25-102 is effective on
15 occurrence of contingency; pursuant to sec. 6, Ch. 423, L. 2015, the inclusion of 22-3-116 and 22-3-117
16 terminates June 30, 2025; pursuant to sec. 4, Ch. 122, L. 2017, the inclusion of 10-3-1304 terminates
17 September 30, 2025; pursuant to sec. 1, Ch. 213, L. 2017, the inclusion of 90-6-331 terminates June 30, 2027;
18 pursuant to sec. 10, Ch. 374, L. 2017, the inclusion of 76-17-103 terminates June 30, 2027; pursuant to secs.
19 11, 12, and 14, Ch. 343, L. 2019, the inclusion of 15-35-108 terminates June 30, 2027; pursuant to sec. 1, Ch.
20 408, L. 2019, the inclusion of 17-7-215 terminates June 30, 2029; pursuant to secs. 1, 2, 3, Ch. 139, L. 2021,
21 the inclusion of 53-9-113 terminates June 30, 2027; pursuant to sec. 8, Ch. 200, L. 2021, the inclusion of 10-4-
22 310 terminates July 1, 2031; pursuant to secs. 3, 4, Ch. 404, L. 2021, the inclusion of 30-10-1004 terminates
23 June 30, 2027; pursuant to sec. 5, Ch. 548, L. 2021, the inclusion of 50-1-115 terminates June 30, 2025;
24 pursuant to secs. 5 and 12, Ch. 563, L. 2021, the inclusion of 22-3-1004 is effective July 1, 2027; pursuant to
25 sec. 1, Ch. 20, L. 2023, sec. 2, Ch. 20, L. 2023, and sec. 3, Ch. 20, L. 2023, the inclusion of 81-1-112, 81-1-
26 113, and 81-7-106 terminates June 30, 2029; pursuant to sec. 9, Ch. 44, L. 2023, the inclusion of 15-1-142
27 terminates December 31, 2025; pursuant to sec. 10, Ch. 47, L. 2023, the inclusion of 15-1-2302 terminates
28 June 30, 2025; pursuant to sec. 2, Ch. 374, L. 2023, the inclusion of 10-3-802 terminates June 30, 2031; - 2025
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1 pursuant to sec. 12, Ch. 558, L. 2023, the inclusion of 20-9-250 terminates December 31, 2029; pursuant to
2 sec. 4, Ch. 621, L. 2023, the inclusion of 22-1-327 terminates July 1, 2029; pursuant to sec. 24, Ch. 722, L.
3 2023, the inclusion of 17-7-133 terminates June 30, 2027; pursuant to sec. 10, Ch. 758, L. 2023, the inclusion
4 of 44-4-1506 terminates June 30, 2027; and pursuant to sec. 10, Ch. 764, L. 2023, the inclusion of 15-1-143
5 terminates December 31, 2025.)"
6
7 NEW SECTION. Section 16. The legislature directs the
8 department of revenue to delay collection of the assessment fee provided for in [section 2] until the department
9 of public health and human services notifies the department of revenue that the centers for medicare and
10 medicaid services has approved the payments provided for in [section 14].
11
12 NEW SECTION. Section 17. (1) [Sections 1 through 13] are intended to
13 be codified as a new chapter in Title 15, and the provisions of Title 15 apply to [sections 1 through 13].
14 (2) [Section 14] is intended to be codified as an integral part of Title 53, chapter 6, part 1, and the
15 provisions of Title 53, chapter 6, part 1, apply to [section 14].
16
17 NEW SECTION. SECTION 18. PPROPRIATIONS. (1) FJULY 1, 2025,
18$637,828 FROM THE GENERAL FUND TO THE DEPARTMENT OF REVENUE FOR START-UP AND OPERATING
19[].
20 (2) For the FISCAL YEAR BEGINNING JULY 1, 2025, THERE IS APPROPRIATED $131,000
21[THIS ACT].
22 (3) For the FISCAL YEAR BEGINNING JULY 1, 2026, THERE IS APPROPRIATED $131,000
23[THIS ACT].
24 (4) The legislature intends that the appropriations for personal services in this section be
25 considered part of the ongoing base for the next legislative session to be paid from the ambulance medicaid
26 reimbursement account established in [section 14].
27
28 NEW SECTION. Section 19. [This act] is effective on approval by the - 2025
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1 United States department of health and human services of all waivers and approvals necessary to implement
2 the assessment fee and supplemental payments as provided in [sections 1 through 15]. The department of
3 public health and human services shall notify the code commissioner within 15 days of the occurrence of the
4 contingency.
5
6 NEW SECTION. Section 20. (1) [Sections 1 through 15] are void on the date
7 that federal law or policy is amended so that the assessment fee collected pursuant to [sections 1 through 15]
8 may not be considered as the state's share in claiming federal financial participation under the medicaid
9 program. The department of public health and human services shall submit certification of the change in federal
10 law or policy to the code commissioner within 15 days of the occurrence of the contingency.
11 (2) If [sections 1 through 15] are rendered void under the provisions of this section, all fees
12 received or collected by the department of revenue prior to the date on which the act becomes void must be
13 deposited in accordance with [section 2], and a person or party may not receive a refund of any fees received
14 or collected by the department prior to the date on which [sections 1 through 15] become void.
15 (3) If the United States department of health and human services fails to approve the ambulance
16 provider supplemental payments, [sections 1 through 15] are void. The department of public health and human
17 services shall notify the code commissioner within 15 days of the occurrence of the contingency.
18
19 NEW SECTION. SECTION 21. ERMINATION. [THIS ACT] TERMINATES JUNE 30,2033.
20 - END -