(1)As used in this section:
(1)(a) (1)(a)(i) "Balance bill" means the practice of a health care provider billing an individual for the difference between the individual's billed charges and the amount the individual's health benefit plan allows for a covered service.
(1)(a)(ii) "Balance bill" does not include billing:
(1)(a)(ii)(A) an uninsured individual for services provided;
(1)(a)(ii)(B) an individual for the difference of the amount allowed by a health benefit plan for a billed service and the amount paid by the health benefit plan for the billed service; and
(1)(a)(ii)(C) an individual for a service that was denied by the health benefit plan because the service was an uncovered service under the health benefit plan.
(1)(b) (1)(b)(i) "Base rate" means the rate a ground ambulance prov
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(1) As used in this section:
(1)(a) (1)(a)(i) "Balance bill" means the practice of a health care provider billing an individual for the difference between the individual's billed charges and the amount the individual's health benefit plan allows for a covered service.
(1)(a)(ii) "Balance bill" does not include billing:
(1)(a)(ii)(A) an uninsured individual for services provided;
(1)(a)(ii)(B) an individual for the difference of the amount allowed by a health benefit plan for a billed service and the amount paid by the health benefit plan for the billed service; and
(1)(a)(ii)(C) an individual for a service that was denied by the health benefit plan because the service was an uncovered service under the health benefit plan.
(1)(b) (1)(b)(i) "Base rate" means the rate a ground ambulance provider charges for:
(1)(b)(i)(A) transporting an individual to a hospital or patient receiving facility;
(1)(b)(i)(B) supplies used when transporting the individual;
(1)(b)(i)(C) providing procedures during transport; and
(1)(b)(i)(D) administering medications during transport.
(1)(b)(ii) "Base rate" does not include charges for:
(1)(b)(ii)(A) the cost of a medication; or
(1)(b)(ii)(B) mileage.
(1)(c) "Medication maximum cost" means a cost for a medication that equals the lower of the:
(1)(c)(i) national average drug acquisition cost; and
(1)(c)(ii) Utah maximum allowable cost established in the Utah Medicaid program.
(2) The bureau shall establish a maximum mileage rate for ground ambulance providers and paramedic providers that is just and reasonable.
(3) The committee may make recommendations to the bureau on the maximum mileage rate set under Subsection (2).
(4) (4)(a) Ground ambulance providers and paramedic providers may not charge fees for transporting a patient when the provider does not transport the patient.
(4)(b) The provisions of Subsection (4)(a) do not apply to ambulance providers or paramedic providers in a geographic service area which contains a town as defined in Subsection 10-2-301(2)(f).
(5) (5)(a) The base rate is as follows:
(5)(a)(i) for emergency medical technician ground ambulance transport, $1,234.92;
(5)(a)(ii) for advanced emergency medical technician ground ambulance transport, $1,630.31;
(5)(a)(iii) for paramedic ground ambulance transport, $2,383.73; and
(5)(a)(iv) subject to Subsection (5)(b), for a transport described in Subsection (5)(a)(i) or (ii) that has a paramedic on board, $2,383.73.
(5)(b) A ground ambulance provider may charge the rate described in Subsection (5)(a)(iv) if:
(5)(b)(i) a designated emergency medical service dispatch center dispatches a licensed paramedic provider to treat the individual;
(5)(b)(ii) the licensed paramedic provider has initiated advanced life support;
(5)(b)(iii) online medical control directs that a paramedic remain with the patient during transport; and
(5)(b)(iv) the licensed ground ambulance provider has a reimbursement for paramedic services agreement with a paramedic licensed provider for the service provided.
(6) (6)(a) For the mileage rate established in rule under this section, a ground ambulance provider or paramedic provider may not charge an amount greater than the amount authorized in the rule setting the mileage rate.
(6)(b) For the base rate, a ground ambulance provider or paramedic provider may not charge an amount greater than the base rate described in Subsection (5)(a) for transportation services.
(6)(c) For a medication, a ground ambulance provider or paramedic provider may not charge an amount greater than the medication maximum cost for a provided medication.
(7) A ground ambulance provider or paramedic provider may not balance bill.
(8) Subject to prioritization by the Legislative Audit Subcommittee, the Office of the Legislative Auditor General created in Section 36-12-15 shall conduct an audit of ground ambulance providers, paramedic providers, and insurance companies regarding rates and payments described in this section, Section 31A-22-627.1, and Section 34A-2-407.1.