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STATE OF OKLAHOMA
1st Session of the 58th Legislature (2021)
SENATE BILL 824 By: Pederson
AS INTRODUCED
An Act relating to ambulance service provid ers;
creating the Ambulance Service Provider Access
Payment Program Act; providing short title; defining
terms; providing for certain assessment; exempting
certain ambulance services; providing assessment
methodology; providing for adjusted a ssessments under
certain conditions; voiding program un der certain
conditions; directing promulgation of rules;
providing for administrative penalties; creating
Ambulance Service Provider Access Payment Program
Fund; providing sour ce of monies; providing for
notice of assessment; requiring quarterly payments;
providing exception for first installment; providing
certain penalty; specifying certain appea ls
procedures; providing assessment for new provider;
providing for ambulance service provider access
payments; specifying date and frequency of payments,
calculation methodology, eligibility, prohibiting
offset of certain payments; requiring refund under
certain condition; directing budgeting and
expenditure of monies; stating allow ed expense;
prohibiting certain use of monies; providing certain
exemption; stipulating certain lack of guar antee;
providing for certain appeals; specifying that monies
are supplemental; prohibiting certain adjust ment of
Medicaid reimbursement; requiring Oklahoma Health
Care Authority to cease collection of fees and refund
providers under certain condition; di recting
Authority to seek ce rtain federal approval; requiring
certain actions if approval denied; providing for
codification; and providing an effective date .
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
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SECTION 1. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 3242.1 of Title 63, unless there
is created a duplication in numbering, reads as follows:
This act shall be known and may be cited as the “Ambulance
Service Provider Access Payment Program Act ”.
SECTION 2. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 3242.2 of Title 63, unless there
is created a duplication in numbering, reads as follows:
As used in the Ambulance Service Provider Access Payment Program
Act:
1. “Air ambulance” means ambulance services provided by fix ed
or rotor wing ambulance services ;
2. “Alliance” means the Oklahoma Ambulance A lliance or its
successor association ;
3. “Ambulance” means a motor vehicle or watercraft that is
primarily used or designated as available to provide transportation
and basic life support or advanced life support ;
4. “Ambulance service” or “ambulance service provider” means
any private firm or governmen tal agency which is or should be
licensed by the State Department of Health to provide levels of
medical care based on certification rules or standards promulgated
by the State Commissioner of Health;
5. “Department” means the State Department of Health ;
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6. “Emergency” or “emergent” means a serious situa tion or
occurrence that happens unexpectedly and demands immediate action ,
such as a medical condition manifesting itself by acute symptoms of
sufficient severity including severe pain such that the absence of
immediate medical attention could reasonably b e expected, by a
reasonable and prudent layperson, to result in placing the patient’s
health in serious jeopardy, serious impairme nt to bodily function or
serious dysfunction of any bodily organ or part ;
7. “Emergency transfer” means the movement of an ac utely ill or
injured patient from the scene to a health care facility or the
movement of an acutely ill or injured patient from one health care
facility to another hea lthcare facility;
8. “Licensure” means the licensing of emergency ambulance
services pursuant to rules and standards promulgated by the State
Commissioner of Health ;
9. “Net operating revenue ” means the gross revenues earned for
providing emergency and n on-emergency transfers in Oklahoma
excluding amounts refunded to or recouped, offset or o therwise
deducted by a patient or payer for ground medical transportat ion;
10. “Non-emergency transfer” means the movement of any patient
in an ambulance other than a n emergency transfer ;
11. “Upper payment limit” means the lesser of the customary
charges of the ambulance service provider or the prevailing charges
in the locality of the ambulance service provider for comparable
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services under comparable circumstances, calculated according to
methodology in an approved state plan amendment for the state
Medicaid program; and
12. “Upper payment limit gap ” means the difference be tween the
upper payment limit of the ambulance service provider and the
Medicaid payments not financed using the ambulance service provider
assessments made to all ambulance service providers, provided that
the upper payment limit gap is calculated separately for ambulance
services and air ambulance services .
SECTION 3. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 3242.3 of Title 63, unless there
is created a duplication in numbering, reads a s follows:
A. For the purpose of assuring access to quality emergency and
non-emergency transfers f or state Medicaid beneficiaries, the
Oklahoma Health Care Authority shall, after considering input and
recommendations from the Oklahoma Ambulance Alliance , assess
ambulance service providers licensed in Oklah oma, unless exempt
under subsection B of this s ection, an ambulance service provider
access payment program fee.
B. The following ambulance services shall be exempt from the
ambulance service provider access payment fee:
1. An ambulance service that is owned or operated by the state
or a state agency, the federal government, a federally recognized
Indian tribe, or the Indian Health Service;
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2. An ambulance service that is eligible for supplement al
Medicaid reimbursement under Section 3242 of Title 63 of the
Oklahoma Statutes;
3. An ambulance service that provides air ambulance services
only; or
3. An ambulance service that provides non -emergency transfers
only or a de minimis amount of emergency medical transportation
services, as determined by the Authority .
C. 1. The ambulance service provider access payment program
fee shall be an assessment imposed on e ach ambulance service
provider, except those exempted under subsection B of this section,
for each calendar year in an amount calculated as a percentage of
each ambulance service provider ’s net operating revenue.
2. The assessment rate shall be determined annually based upon
the percentage of net operating revenue needed to generate an amount
up to the sum of:
a. the nonfederal portion of the upper payment limit gap
for all ambulance service prov iders eligible to
receive Medicaid ambulance service provide r access
payments, plus
b. the annual fee to be paid to the Authority under
subparagraph b of paragraph 2 of subsection F o f
Section 4 of this act , plus
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c. the amount to be transferred by the Auth ority to the
Medical Payments Cash Management Improvement Act
Programs Disbursing Fund under subparagraph a of
paragraph 2 of subsection F o f Section 4 of this act .
In no event shall the assessment rate exceed the maximum rate
allowed by federal law or reg ulation.
3. The assessment rate described in this subsection shall be
determined after consultation with the Alliance. The base year for
assessment, the method for calculating net operating revenue and
related matters not provided for in this section shall be determined
by rules promulgated by the Oklahoma Health Care Authority Board.
D. 1. If an ambulance service provider conducts, operates or
maintains more than one licensed ambulance service, the ambul ance
service provider shall pay the ambulance ser vice provider access
payment program fee for each ambulance service separately. However,
if the ambulance service provider operates more than one ambulance
service under one Medicaid provider number, the ambulance service
provider may pay the fee for the ambulance services in the
aggregate.
2. Notwithstanding any other provision of this section, if an
ambulance service provider subject to the ambulance service provider
access payment fee operates or conducts business only for a portion
of a year, the assessment for the year shall be adjusted by
multiplying the annual assessment by a fraction, the numerator of
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which is the number of days in the year during which the ambulance
service operates and the denominator of which is three hundred
sixty-five (365). Immediately upon ceasing to operate, the
ambulance service provider shall pay the assessment for the year as
so adjusted, to the extent not previously paid .
3. The Authority shall determine the assessment for new
ambulance services and ambulance service s that undergo a change of
ownership in accordance with this sec tion, using the best availa ble
information, as determined by the Authority.
E. 1. In the event that federal financial participation
pursuant to Title XIX of the Social Security Act is not available to
the state Medicaid Program for purposes of matching e xpenditures
from the Ambulance Service Provider Access Payment Program Fund at
the approved federal medical assistance percentage for the
applicable year, the ambulance service provider access payment
program fee shall be null and void as of the date of the
nonavailability of su ch federal funding through and during any
period of nonavailability.
2. In the event of an invalidation of the Ambulance Service
Provider Access Payment Program by any co urt of last resort, the
program shall be null and void as of the effective date of t hat
invalidation.
3. In the event that the Ambulance Service Provider Access
Payment Program is determined to be null and void for any of the
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reasons described in this subsection, any ambulance service provide r
access payment program fee assessed and collected for any period to
which such invalidation applies shall be returned in full within
twenty (20) days by the Authority to the ambulance service from
which it was collected.
F. The Oklahoma Health Care Authority Board, after considering
the input and recomm endations of the Alliance, shall promulgate
rules for the implementation and enforcement of the ambulance
service provider access payment program fee. Unless otherwise
provided, the rules promulgated under this subsection shall not
grant any exceptions to or exemptions from the ambulance service
provider access payment program fee imposed under th is section.
G. The Authority shall provide for administrative penalties in
the event an ambulance service prov ider fails to:
1. Submit the ambulance service pro vider access payment program
fee;
2. Submit the fee in a timely manner;
3. Submit reports as required by the Autho rity;
4. Submit reports timely.
J. The Oklahoma Health Care Authority Board shall have the
power to promulgate emergency rules to implement the provisions of
Ambulance Service Provider Access Payment Program Act .
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SECTION 4. NEW LAW A new s ection of law to be codified
in the Oklahoma Statutes as Section 3242.4 of Title 63, unless there
is created a duplication in numbe ring, reads as follows:
A. There is hereby created in the State Treasury a revolving
fund to be designated the “Ambulance Service Provider Access Payment
Program Fund”.
B. The fund shall be a continuing fund, not subject to fiscal
year limitations, be in terest bearing and consist of:
1. All monies received by the Oklahoma Health Care Authority
from ambulance services pursuant to the Ambulance Service Provider
Access Payment Program Act and otherwise spec ified or authorized by
law;
2. Any interest or penalties levied and collected in
conjunction with the a dministration of this section; and
3. All interest attributable to investment of money in the
fund.
C. 1. The Authority shall send a notice of assessment to each
ambulance service provider informing t he ambulance service provide r
of the assessment rate, the ambulance service provider ’s net
operating revenue calculation, and the assessment amount owed by the
ambulance service provider for the applicable year.
2. Annual notices of assessment shall be se nt at least thirty
(30) days before the due date for the first quarterly assessment
payment of each year.
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3. The first notice of assessment shall be sent within forty -
five (45) days after receipt by the Authority of notification from
the Centers for Medic are and Medicaid Services that assessments and
payments required under the Ambulance Service Provider Access
Payment Program Act and, if necessary, the wavier granted under 42
C.F.R., Section 433.68 have been approved.
4. The ambulance service provider sh all have thirty (30) days
from the date of its receipt of a notice of assessment to review and
verify the assessment rate, the ambulance service provider ’s net
operating revenue calculation and the assessment amount.
D. 1. The annual assessment imposed u nder Section 3 of this
act shall be due and payable on a quarterly basis. However, the
first installment payment of an assessment imposed by the Ambulance
Service Provider Access Payment Act shall not be due and payable
until:
a. the Authority issues written notice stating that the
assessment and payment methodologies required under
the Ambulance Service Provider Access Payment Act ,
have been approved by Centers for Medicare and
Medicaid Services and the waiver under 42 C.F.R.,
Section 433.68, if necessary , has been granted by the
Centers for Medicare and Medicaid Services ,
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b. the thirty-day verification period required by
paragraph 4 of subsection C of this section has
expired, and
c. the Authority issues a notice giving a due date for
the first payment.
2. After the initial installment of an annual assessment has
been paid under this section, each subsequent quarterly installment
payment shall be due and payable by the fifteenth day of the first
month of the applicable quarter.
3. If an ambulance service provider fails to timely pay the
full amount of a quarterly assessment, the Authority shall add to
the assessment:
a. a penalty assessment equal to five percent (5%) o f the
quarterly amount not paid on or before the due date,
and
b. on the last day of e ach quarter after the due date
until the assessed amount and the penalty imposed
under subparagraph a of this paragraph are paid in
full, an additional five -percent penalty assessment on
any unpaid quarterly and unpaid penalty assessment
amounts.
4. The quarterly assessment including applicable penalties and
interest must be paid regardless of any appeals action requested by
the ambulance provider. If a provider fails to pay the Authority
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the assessment within the time frames noted on the invoice to the
provider, the assessment, applicable penalty and interest shall be
deducted from the provider ’s payment. Any change in payment amount
resulting from an appeals decision w ill be adjusted in future
payments.
5. An ambulance service provider subject to the ass essment
under the Ambulance Service Provider Access Payment Program Act that
has not been previously licensed as an ambulance service in Oklahoma
and that commences ope rations during a year, shall pay the required
assessment computed under Section 3 of this act and shall be
eligible for ambulance service provider access payments under this
section on the date specified in the rules promulgated by the
Authority after consi deration of input and recommendations of the
Oklahoma Ambulance Alliance .
E. 1. To preserve the quality and improve access to ambulance
services rendered on or after the effective date of this act, the
Authority shall make ambulance service provider acce ss payments as
set forth in this sec tion.
2. The Authority shall pay all quarterly ambulance service
provider access payments within ten (10) calendar days of the due
date for quarterly assessment payments established in subsection D
of this section.
3. The Authority shall calculate the am bulance service provider
access payment amount as the balance of the Ambulance Service
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Provider Access Payment Program Fund plus any federal matching funds
earned on the balance, up to but not to exceed the upper payment
limit gap for all ambulance service providers.
4. All ambulance servic e providers shall be eligible for
ambulance service provider access payments each year as set forth in
this subsection except ambulance services excluded or exempted in
subsection B of Section 3 of this act.
5. Access payments shall be made on a quarter ly basis.
6. Ambulance service provider access payments shall not be used
to offset any other payment by Medicaid for services to Medicaid
beneficiaries.
7. If the Centers for Medicare and Medicaid Services finds that
the Authority has made payments to ambulance service providers that
exceed the upper payment limits, ambulance service providers shall
refund to the Authority a share of the recouped federal funds that
is proportionate to the ambulance services’ contribution to the
upper payment limit.
F. 1. All monies accruing to the credit of the Amb ulance
Service Provider Access Payment Program Fund are hereby appropriated
and shall be budgeted and expended by the Authority after
consideration of the input and recommenda tion of the Alliance.
2. Monies in the Ambulance Service Provider Access Payment
Program Fund shall be used only for:
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a. transfers to the Medical Payments Cash Management
Improvement Act Programs Disbursing Fund for the state
share of ambulance service pr ovider access payments
for ambulance service providers that participate in
the assessment,
b. transfers to the Administrative Re volving Fund for the
state share of payment of administrative expenses
incurred by the Auth ority or its agents and employees
in performing the activities authorized by the
Ambulance Service Provider Access Payment Program Act
but not more than Two Hundred Thousand Dollars
($200,000.00) each year, and
c. the reimbursement of monies collected by t he Authority
from ambulance services through error or mistake in
performing the activiti es authorized under the
Ambulance Service Provider Access Payment Pro gram Act.
3. The Authority shall pay from the Ambulance Service Provider
Access Payment Program Fu nd quarterly installment payments to
ambulance service providers of amounts available fo r ambulance
service provider access payments.
4. Monies in the Ambulance Service Provider Access Payment
Program Fund shall not be used to replace other general revenu es
appropriated and funded by the Legislature or other revenues used to
support Medicaid.
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5. The Ambulance Service Provider Access Payment Program Fun d
and the program specified in the Ambulance Service Provider Access
Payment Program Act are exempt from budgetary reductions or
eliminations caused by the lack of general revenue funds or othe r
funds designated for or appropriated to the Authority.
6. No ambulance service provider shall be guaranteed, expressly
or otherwise, that any additional costs reimbu rsed to the provider
will equal or exceed the amount of the ambulance service provider
access payment program fee paid by the ambulance service.
H. After considering input and recommendations from the
Alliance, the Oklahoma Health Care Authority Board shall promulgate
rules that:
1. Allow for an appeal of the annual assessment of the
Ambulance Service Provider Access Payment Program payable under this
act; and
2. Allow for an appeal of an assessment of any fees or
penalties determined.
SECTION 5. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 3242.5 of Title 63, unless there
is created a duplication in numbering, reads as follows:
A. The ambulance service provider access payment program fee is
to supplement, not supplant, appropriatio ns to support ambulance
service provider reimbursem ent. If Medicaid reimbursement rates to
providers are adjusted, ambulance service provider rates shall not
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be adjusted less favorably than the average percentage -rate
reduction or increase applicable to t he majority of other provider
groups.
B. Notwithstanding any other provision of the Ambulance Service
Provider Access Payment Program Act, if, after receipt of
authorization to receive federal matching funds for monies generated
by the Ambulance Service P rovider Access Payment Program Act, the
authorization is withdrawn or changed so that federal matching funds
are no longer available, the Oklahoma Health Care Authority shall
cease collecting the provider fee and shall r epay to the ambulance
services any money received by the Ambulance Service Provider Acc ess
Payment Program that is not subject to federal matching funds.
SECTION 6. NEW LAW A new s ection of law to be codified
in the Oklahoma Statute s as Section 3242.6 of Title 63, unless there
is created a duplication in numbering, re ads as follows:
A. The Oklahoma Health Care Authority shall submit to the
Oklahoma Ambulance Alliance a proposed state plan amendment to
implement the requirements of t he Ambulance Service Provider Access
Payment Program Act including the payment of ambul ance service
provider access payments under Section 4 of this act, no later than
forty-five (45) days after the effective date of this act, and shall
submit the state plan amendment to the Centers for Medi care and
Medicaid Services after consideration of t he input and
recommendations of the Alliance.
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B. If the state plan amendment is not approved by the Centers
for Medicare and Medicaid Services , the Authority shall:
1. Not implement the assessment imposed under the Ambulance
Service Provider Access Payme nt Program Act; and
2. Return any fees to ambulance services that paid the fees if
any such fees have been collected.
SECTION 7. This act shall become effective November 1, 2021.
58-1-1385 DC 1/21/2021 3:38:25 PM