H.B. 269 Ambulance Provider Payment Amendments: transcript

Thank you, Mr. Chair. Uh, HB 2 69 ensures Utah's ambulance providers are paid accurately and predictably for the care they already provide. So emergency services re remain available when utahns need them most. Basically what the bill does is it updates and stabilizes how ambulance services are reimbursed in Utah. It aligns payment rules with how emergency medical care is actually delivered, removes unnecessary statutory instability and maintains strong patient protection already in law. This bill came about when, uh, the chiefs, uh, fire chiefs, uh, came to me and they had, one of the issues they had was, uh, they were having a hard time recouping, uh, expenses from their vehicles. So they'd go and do a emergency call, they'd, uh, uh, help someone in need, and then they would get reimbursed. Uh, and it was getting harder and harder for them to recoup their expenses. So they came to me to see if there's something we can do. And so this, that turned into this bill, which basically increases the, uh, base rate that, uh, these providers can charge to include their service fee, um, their, uh, expenses and also medications, uh, which was, which is one, one of the main things this bill actually does, so that there's only one fee. It makes it easier for them to collect the fees that they need for the service they've provided. Makes it easier for, uh, insurance companies to know what, uh, the, uh, bill's gonna be, and also makes it easier just for the, for the citizens of Utah. So, specifically what the bill does, it aligns the base rate with world real world emergency care, which is what I just went through. It allows for predictable limited annual adjustments. Adjustments. So one of the issues would be the ongoing would be, well, how do we adjust that base rate moving forward due to whatever causes inflation costs, whatever. And so what we did is we, uh, tied it to the, uh, medical CPI consumer price index that will be actually, uh, monitored and done by the Bureau of EMS here in the state of Utah. So they will, uh, once a year look at that rate and see if it, uh, justifies an adjustment and make that adjustment. Um, what the bill also does is, uh, uh, a so what, so what the providers, the ambulance and emergency care services will do is they'll just charge one base rate, um, plus, uh, mileage rate. So the only extra fee above that base rate is a mileage rate, which is important, uh, for them, for them, especially if they're in rural areas, because sometimes those rural areas are, uh, traveling at great lengths. The, the bill also, uh, eliminates balance billing. Uh, so there can be no balanced billing. Everybody knows at this point what the base rate is, and that they can't charge or, uh, pay, uh, or, and the provider, the insurance providers don't have to pay more than the base rate. There are some exceptions to that balance billing based on how an insurance plan may be, uh, uh, set up, or if they're, if someone's uninsured, for example. Uh, and it removes, we had a Sunset on this bill last year, and, uh, we've removed that. We just found that we'd no longer going to need that. So that's the, uh, bill open to any questions?

Fantastic. Thank you, Mr. Chair. Uh, and committee members. Uh, Ben Armstrong. I'm the President of the rural EMS Directors Association of Utah. Uh, we are a, uh, statewide EMS association representing, um, uh, 25 of the, uh, 29 counties in the state now. Um, we, uh, would like to thank, uh, the, uh, bill sponsor for his work on, uh, HB 2 69. Um, he's done a fantastic job of getting, uh, all of the various stakeholders together, um, to work out, uh, solutions that, um, provide, uh, some, some clarity and, uh, certainty to payers and, uh, ambulance services. Um, and, uh, takes the patients out of the middle of any sort of, uh, you know, billing issues or anything. Um, we believe this is a good bill and, uh, we would urge your, uh, support for a favorable recommendation. Thank you.

Uh, good afternoon, Mr. Chair, members of the committee. My name is Clint Smith. I'm the chief of Dr. Draper City Fire Department and also representing the Utah State Fire Chiefs Association. Uh, I'd like to speak in favor of this bill today. Uh, representative Malloy has been fantastic to work with, really over the past two legislative sessions. As, uh, you know, last year we had HB 3 0 1, which was the first steps that he mentioned, uh, as he just started to, uh, describe the changes in this bill. This is really a follow up and a companion bill to what we did last year. And I will tell you that last year as we started this process with all of the stakeholders, again, primarily, uh, the, the providers and the insurance companies, uh, we were, we were really pretty distant in how we viewed, uh, this issue and how we were going to settle it. Um, but through the hard work of Representative Maloy, again, we have come to a point to where we have all stakeholders that, uh, are in favor of this bill. It does provide that payment, uh, certainty, or excuse me, the billing certainty that the insurance is looking for. And it helps to provide some reimbursement certainty for the providers by having one base fee that, uh, has, again, all of the, the associated fees with our supplies and our medications now encompassed in that base rate. And, uh, we encourage support of this bill. And again, thank Representative Maloy for, uh, his, his dedication in helping to get this across the finish line. Thank you very much.

Um, thank you, Mr. Chair. I, I apologize. Um, make a motion that we move second, substitute HB 2 69 favorably to the Senate.

Thank you, uh, Mr. Chair and members of the committee. Um, this is a great bill and, uh, I appreciate all the good words that the, the people commented said about me. Um, but I have to give them all a big compliment as well. We had fire chiefs, uh, the association, we had ambulance services, we had the Department of EMS, we had, uh, representatives from the, uh, insurance companies. And, uh, everybody came together. And, uh, there was a comment said that we are all started kind of distant, but we really came together and, uh, crafted this bill. And it's a very, very good bill. And, uh, it's gonna be a great benefit to the citizens of this great state. So, thank you.

Can you hear me okay? Oh, there you are. Thank you. Okay. So, uh, this is a HB 2 69 ambulance provider. Payment amendments HB 2 69 ensures Utah's ambulance providers are paid accurately and predictably for the care they already provide. So, emergency services remain available when utahns need them most. The bill updates and stabilizes how ambulance services are reimbursed in Utah. It aligns payment rules with how emergency medical care is actually delivered, removes unnecessary statutory instability and maintains strong patient protections already in law. Some of the key points to the bill is that it aligns the base rate with real world emergency care. Current law separates medication costs from the base rate, even though medications are an integral part of emergency transport. HB 2 69 includes the cost of medications in the base rate, simplifying billing, and reflecting how EMS actually operates. The bill also allows predictable limited annual adjustments. The bill authorizes the Bureau of EMS to adjust the base rate once per year. Adjustments are tied to the medical consumer price index and are limited to once annually, ensuring modest predictable updates rather than larger sudden changes. This is about stability, not expansion. The bill also clarifies what pro providers may collect. Ambulance providers may collect the base rate and the mileage rate and nothing beyond that structure. The bill, the bill eliminates ambiguity while preventing open-ended or added on charges. I'll also reiterate what I said earlier to that part, which is that the base rate also includes the, the medication costs. The other part of the bill is that it maintains patient protections against balance billing. Balance Billing remains prohibited. Um, it's already prohibited, but it, it, this will keep that in place. Um, uh, there are some narrow exceptions to that in statute which remain unchanged, and that includes including services provided to uninsured individuals. Limited differences when insurers do not allow the full base rate and mileage and services denied because they're not covered under a, uh, insurance plan. HB 2 69 does not expand any of those exceptions. Um, re the, uh, bill also removes an unnecessary Sunset that we had in the policy before. Uh, so that was no longer needed, so we removed it. Um, what the bill does not do is it does not create new taxes, does not appropriate new state funding, does not expand bill balance billing and does not manda mandate utilization and does not allow arbitrary rate setting. Uh, Mr. Vice Chair, I should point out that I've been speaking to the second substitute, which will need to be moved. Okay. Thank you very much.

It does. Okay. Thank you very much.

Thank you, Mr. Thank you, Mr. Chair. Will you speak to the fiscal note?

Yeah, And I'm not sure if the second sub changes that, but I don't know that the second sub at this point changes the, uh, fiscal note. But the, uh, uh, basically it, uh, the, uh, the federal funds for the Department of Health and Human Services is estimated at $702,600. And, uh, so this reflects some of the, uh, funding that comes from the federal government. But, uh, the general fund will, uh, have a, uh, 2002, $202,000, uh, fund to it. And then the Medicaid, uh, part of it will be 41,300. So for the total expenditures as you can see 'em there, so the, the total hit of the fiscal note is 2002, $202,200.

So you'll fi you'll get it funded. Is that the plan?

Yeah, I'm hoping to get it funded. That is the plan.

Thank you. Okay.

Thank you, Mr. Chair. Uh, looking at line 180 3, instead of, uh, extending the Sunset date, the bill just gets rid of the Sunset date, so there would not be a Sunset date on that section.

In 10 years, The, uh, the Sunset was, uh, part of the plan to, uh, see how well the, the old way of, uh, adjusting the balance rate, uh, was going to. So we were gonna look at, we wanted to make sure there was a Sunset in case it wasn't working the way we had planned, but we changed it by, uh, associating the, uh, ch the adjustments to the CSI. And so that was no longer needed. So that's why we took it out.

Thank you, Mr. Chair. Okay. Thank you.

Thank you. Uh, Kim Frost. I'm with Regions Blue Cross Blue Shield. We've been working with the representative on this bill we started last year, and we've made refinements this year, and we just wanted to thank him for his leadership on this issue. Um, it's been a good process with all the stakeholders, and we hope that you'll support the bill. Okay.

Thank you. Chair. Uh, Mike Matthew, um, PA, past Fire Chief for Ogden City. Now I represent Gold Cross, uh, in government affairs. Uh, we're very happy with the direction this is going. Very much appreciate Representative Maloy, and as, uh, Kim Frost stated, very much appreciate the collaboration on this and working together on it. Thank You. Thank you very much.

Thank you, Mr. Chair. My name is Clint Smith. I'm the Fire Chief for Draper City Fire Department and also representing the Utah State Fire Chief's Association. Uh, very much like to thank Representative Maloy in his, uh, leadership on this issue. Um, as was already mentioned by, uh, Kim Frost, uh, we began this process with HB 3 0 1 last year. And, uh, you know, through Representative Malloy's leadership, uh, we, we had some pretty, uh, robust, uh, discussions amongst all the stakeholders last year. Um, and I think the continuation of the success of 3 0 1 and now, the changes that are proposed in 2 69 this year, uh, with all of the stakeholders from both, again, EMS agencies and our insurance partners, uh, to both, uh, be here and speaking in favor of this bill today, again, is the testament of the work that we've been able to do. And looking out for, again, the services provided by EMS, um, and the needs of our insurance partners in coming together with, uh, again, these changes in, in 2 69. This really helps to simplify the process and makes it better for our constituents. And so we, I, uh, urge your support of this bill. Thank you for your time.

Here we go. Uh, hi, Ben Armstrong. I'm representing the rural EMS Directors Association of Utah. Um, uh, I would just like to echo the sentiments that have been shared by, uh, uh, chief Smith, uh, Ms. Frost and, uh, Mr. Matthew. Uh, just our thanks to, uh, representative Malloy for the collaboration, um, and really getting, uh, all the interested parties, uh, together in one room. And, and yeah, I think this, uh, this bill does a great job of refining, um, the foundation that was, uh, uh, put in place from, uh, last session. And, uh, really, um, uh, take some additional steps to help, uh, ensure that patients don't get caught in the middle of, uh, uh, ambulance, uh, finance issues. So, uh, we, uh, support this bill and, uh, would urge, uh, you to, uh, give a favorable recommendation. Thank you.

Thanks, Mr. Chair. We have a sub to adopt. Correct. So we, uh, I make the motion that we, uh, adopt second substitute house bill 2 6 9.

No, I think it's a good bill. He's done a lot of work on it. I think we should move forward. Thank you.

And, Alright. Thanks, Mr. Chair. Um, I'll make a motion that we favorably pass out. Second substitute house bill 2 69, ambulance provider payment amendments.

Thank you. Um, I'd like to just summarize by saying that this has been a, a really interesting, uh, bill to run. And, uh, I really want to thank everybody that's been involved. This bill started out, uh, trying to make it, uh, as efficient and easy for our EMS and our firefighter paramedics to go out and serve the people of Utah and take care of them when they needed emergency services. So this bill is a result of that desire to help our citizens and everybody came together, all the stakeholders. It's been just a wonderful experience with everybody working together to make this bill happen. So, very grateful for them. And, uh, uh, we'll get it passed and we'll get it funded and get it out the door. Thank you. Okay.

Madam Reading Clerk Second substitute House Bill 2 69. Ambulance provider Payment amendments by Representative Malloy. This bill was heard in Business and Labor with a vote of 11 0 5.

Thank you Mr. Speaker Pro Tam. Uh, I'm really grateful to be here to present this bill. This is a, the second bill we've done, uh, for our ambulance services. And, uh, this one just makes it even better. Basically what it does is it establishes a base rate for our ambulance providers to charge for their services when they're out taking care of us, uh, when we need their help and services. The base, the base rate has been adjusted to cover the expenses, uh, and the medications that are used on these calls. And the reason we needed to do this is, uh, a couple of years ago, there were some real issues as far as, uh, our, our paramedic firefighters getting reimbursed for the, uh, expenses that they used outta their, out of their ambulances. They had to restock the, uh, the items that they used and they were having a hard time collecting the, the, uh, funds that would reimburse them for that. And, uh, that's kind of where it started, and then it kind of went from there. But this has been a great collaborative effort between our ambulance services, our EMS services, our firefighters and paramedics, and, uh, uh, a great collaboration between the insurance industry, the, uh, fire chiefs, uh, and other ambulance services, EM, the DI division of EMS. And what it will do also is, uh, allow the base rate to be adjusted, uh, as it's needed based, uh, under the direction of the Department of EMS. And it'll be tied to the medical consumer index, uh, so that it doesn't, uh, increase too much. It's not increasing because of inflation or profit or anything like that. It's all based on, uh, the metrics that we use, uh, to, uh, in our society. The other thing too is, is it, uh, eliminates balanced billing. So, uh, the providers will not be the, the providers being the ambulance services. They can charge up to the maximum of the base rate that's been established, but they, uh, uh, can't go to the consumer for additional funds, uh, with some exceptions. And those are, except those exceptions are if they're uninsured or if the, uh, the insurance, uh, plan that they have. Uh, is it like a 2080 plan where it doesn't cover 20% or, uh, there's an ERISA kind of plan where there's a contract with, uh, the providers. So those would be the only times that they would, uh, actually ask the consumers to help pay so they could hit that base rate, which is sensitive to them because they need to get their fee and also the reimbursements that they need. It also, the base rate now also includes medications. So if you've ever had an ambulance ride, uh, and they gave you medications, the base rate will now include that instead of having it be billed separately. So that's the bill. It's a good bill. It'll be good for the systems of Utah. It'll be good for all of the players that are involved in, in providing emergency services for our assistance here in the state of Utah. Thank you, Mr. Speaker ProAm. Thank

Thank you. I'll waive Mr. Speaker Pro

Thank you Mr. Uh, president Pro temp. A motion that we table on third second substitute house bill 2 69 for physical impact.

Senator Vickers. Thank

Thank you Mr. President. Uh, you may or may not remember. This is a, a bill that provides an opportunity for ambulance carriers and providers to be paid accurately and predictably. Uh, it updates and stabilizes how ambulance services are reimbursed in Utah. Uh, we're aligning the, the base rate with a, a real world emergency care. But you know, like I say, we are taking some off because of the fiscal note. Allows predictable, limited annual adjustments. It removes unnecessary sunsets, uh, does not expand any. The exceptions that are considered in balanced billing, uh, still allows for that under certain circumstances, but it does not expand those exceptions. Uh, it does not create new taxes, does not appropriate new state funding and it does not expand balance. Billing does not mandate utilization. It does not allow arbitrary rate setting. Um, this is something that they get sponsors been working on for a couple of years and been making incremental work forward going forward, and we really appreciate that work. And with that, I'd be open for any questions.

Thank you. It waives summation to move the four substitute hospital 2 69 under suspension of the rules

Senator Vickers, Baldy Lewin Brammer Bus Comore. Escamia Fillmore Grover Aye. Harper Aye. Kins Ipson Johnson. Kwan McKay. Mikel Milner Musselman Owens Pitcher Plum Rebe Sandal Stevenson Stratton Stickers. Fillmore Aye. Weiler Wilson Winterton Aye. President Adams Aye. Four. Substitute house bill 2 69.

of the President matter Meeting clerk For substitute house bill 2 69. Ambulance provider Payment amendments by Representative Maloy.

Thank. Thank you Mr. Speaker. I would, uh, like to make a motion to concur with the Senate.

Yes, I would. Uh, we were, uh, we had a fiscal note on that bill and we were, uh, able to figure out a way to eliminate the fiscal note with a substitute. So, uh, we put together a substitute and uh, they ran it in the Senate for me and that eliminated the fiscal note. So that's what, that's what the change was.