UtahUtah would set ambulance payment and charge rules
Beginning July 1, 2026, Medicaid, health plans, and workers’ compensation payers would follow specified payment rules for ambulance services.
What it does
Medicaid would pay ambulance providers the highest rate allowed by an approved assessment, subject to the state’s ambulance base and mileage rates.
Health plans and workers’ compensation payers would accept correctly charged ambulance rates and pay providers directly, including when the provider is out of network.
Ambulance and paramedic providers would follow maximum rates for mileage, transport services, and medications, while the bureau would adjust base rates yearly beginning July 1, 2027.
Argument forPatients may face fewer unexpected ambulance bills because providers could not charge above listed rates or balance bill them.
Argument againstAnnual rate adjustments could increase what insurers, employers, and patients owe when ambulance base rates rise with medical inflation.
More detail
The Medicaid division would pay ambulance providers the highest rate allowed by the approved assessment. The rule covers fee-for-service Medicaid payments for ambulance services described in Section 26B-3-804. The assessment must be approved by the Centers for Medicare and Medicaid Services. The payment cannot exceed the applicable ambulance base and mileage rates. The payment rule applies beginning July 1, 2026.
Health plans and workers’ compensation payers would accept correctly charged ambulance mileage, base-rate, and medication amounts and pay providers directly. The rules cover health benefit plans, employers, and workers’ compensation insurers, including payments to out-of-network ambulance providers. The charges must be correctly made under the ambulance-rate law. Health plans would treat the covered amounts as allowable expenses for claims. Workers’ compensation payers would follow the same rule for covered claims. These payment provisions apply beginning July 1, 2026, and the listed sections are scheduled for repeal July 1, 2027.
The emergency medical services bureau would publish adjusted ambulance base rates each year and enforce maximum charges for mileage, base services, and medications. The rules cover ground ambulance and paramedic providers, including transport, supplies, procedures, medications, and mileage. The bureau may adjust the base rate no more than once each calendar year. Beginning July 1, 2027, the annual adjustment would use the medical care consumer price index and rulemaking process. Medication charges would be limited to the lower of the national average drug acquisition cost or Utah’s Medicaid maximum allowable cost. Providers could not charge more than the authorized rates or balance bill a patient. The rate provisions take effect July 1, 2026; annual adjusted base rates begin July 1, 2027, and the rate section is scheduled for repeal July 1, 2027.
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Where it stands
- Introduced
- Passed House
- Passed Senate
- To Governor
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2026
- Mar 26Governor Spencer Cox SignedBecame Law
- Mar 12House/ to GovernorTo Governor
- Mar 12House/ received enrolled bill from PrintingMinor
- Mar 11House/ enrolled bill to Printing
- Mar 11Enrolled Bill Returned to House or SenateMinor
- Mar 7Draft of Enrolled Bill Prepared
- Mar 7Bill Received from House for EnrollingMinor
- Mar 6House/ signed by Speaker/ sent for enrollingMajor
- Vote recorded House/ concurs with Senate amendment. Result: pass.Lower
- Mar 6House/ received from SenateMinor
- Mar 6Senate/ to House
- Mar 6Senate/ signed by President/ returned to HouseMajor
- Mar 6Senate/ received from HouseMinor
- Mar 6House/ to Senate
- Mar 6House/ concurs with Senate amendmentMajor
- Mar 6House/ placed on Concurrence Calendar
- Mar 6House/ received from SenateMinor
- Mar 5Senate/ to House with amendments
- Vote recorded Senate/ passed 2nd & 3rd readings/ suspension. Result: pass.Upper
- Mar 5Senate/ passed 2nd & 3rd readings/ suspensionPassed Senate
- Mar 5Senate/ substituted
- Mar 5Senate/ placed on 2nd Reading Calendar
- Mar 5Senate/ Rules to 2nd Reading Calendar
- Mar 4Senate/ placed back on 3rd Reading Calendar
- Mar 4LFA/ fiscal note publicly available for HB0269S04
- Mar 4LFA/ fiscal note sent to sponsor for HB0269S04
- Mar 4LFA/ bill sent to agencies for fiscal input for HB0269S04
- Mar 4LFA/ bill assigned to staff for fiscal analysis for HB0269S04
- Mar 3LFA/ bill sent to agencies for fiscal input for HB0269S03
- Mar 3LFA/ bill assigned to staff for fiscal analysis for HB0269S03
- Feb 25Senate/ placed on 3rd Reading Calendar table
- Vote recorded Senate/ passed 2nd reading. Result: pass.Upper
- Feb 25Senate/ 3rd readingMinor
- Feb 25Senate/ passed 2nd readingMinor
- Feb 25Senate/ 2nd readingMinor
- Feb 20Senate/ placed on 2nd Reading Calendar
- Feb 20Senate/ committee report favorable [Senate Health and Human Services Committee]Minor
- Feb 19Senate Comm - Favorable Recommendation [Senate Health and Human Services Committee]Minor
- Feb 18Senate/ to standing committee [Senate Health and Human Services Committee]Minor
- Feb 17Senate/ 1st reading (Introduced)Minor
- Feb 13Senate/ received from HouseMinor
- Vote recorded House/ passed 3rd reading. Result: pass.Lower
- Feb 13House/ to Senate
- Feb 13House/ passed 3rd readingPassed House
- Feb 13House/ 3rd readingMinor
- Feb 9LFA/ fiscal note publicly available for HB0269S02
- Feb 6LFA/ fiscal note sent to sponsor for HB0269S02
- Feb 5House/ 2nd readingMinor
- Feb 5House/ comm rpt/ substituted [House Business, Labor, and Commerce Committee]
- Feb 4House Comm - Favorable Recommendation [House Business, Labor, and Commerce Committee]Minor
- Feb 4House Comm - Substitute Recommendation [House Business, Labor, and Commerce Committee]Major
- Feb 4LFA/ bill sent to agencies for fiscal input for HB0269S02
- Feb 4LFA/ bill assigned to staff for fiscal analysis for HB0269S02
- Feb 3LFA/ fiscal note publicly available for HB0269S01
- Feb 3LFA/ fiscal note sent to sponsor for HB0269S01
- Jan 30House Comm - Not Considered [House Business, Labor, and Commerce Committee]
- Jan 29LFA/ bill sent to agencies for fiscal input for HB0269S01
- Jan 29LFA/ bill assigned to staff for fiscal analysis for HB0269S01
- Jan 26House/ to standing committee [House Business, Labor, and Commerce Committee]Minor
- Jan 21House/ received fiscal note from Fiscal AnalystMinor
- Jan 21LFA/ fiscal note publicly available for HB0269
- Jan 20House/ 1st reading (Introduced)Minor
- Jan 20House/ received bill from Legislative ResearchMinor
- Jan 20LFA/ fiscal note sent to sponsor for HB0269
- Jan 15LFA/ bill sent to agencies for fiscal input for HB0269
- Jan 15LFA/ bill assigned to staff for fiscal analysis for HB0269
- Jan 15Numbered Bill Publicly Distributed
- Jan 15Bill Numbered but not DistributedIntroduced
HealthcarePublic SafetyEmergency Management