Committee endorses bill to set state ambulance base rates, cap drug costs and ban balance billing

The House Business, Labor and Commerce Standing Committee recommended HB 301 favorably after sponsors, ambulance providers and insurers described a negotiated second substitute that sets statewide maximum rates for ambulance services, caps medication costs in transports and prohibits balance billing.

Representative Malloy, sponsor of HB 301, said the bill "ensures fair and transparent ambulance pricing in Utah by setting sustainable base rates for transport, mileage, and medications" and would "prevent surprise billings" by requiring insurers to cover established rates and pay providers promptly.

Under the second substitute presented to the committee, the bill increases existing state-authorized base rates by 5% to help providers cover supplies carried and used on calls. Representative Malloy said the 5% increase was built from the current rule-authorized rates and is intended to simplify billing by rolling commonly used supply costs into the base rate.

Darren Bushman, director of the relevant division, explained the tiered base rates by licensure level: an EMT-level ground transport was listed at $1,234.92; an AEMT-level transport at $1,630.31; and paramedic ground transport at $2,383.73. Mileage remains billed separately (the committee heard a figure of roughly $41 per loaded mile). Malloy said the bill requires insurers to base reimbursements on the state-established rates and prohibits providers from balance billing patients for the difference.

Representatives from providers and insurers supported the revised bill at the hearing. Mike Moffett, president of Gold Cross Ambulance, testified: "Gold Cross Ambulance supports the direction this is going, supports the bill 301 S 2." Ben Armstrong of the Utah EMS Structures Association said the measure would "get the patient out of the middle of billing matters." Clint Smith, fire chief of Draper City and president of the Utah State Fire Chiefs Association, said the bill "helps to clarify the rate setting process and the rates, that the maximum rates that can be charged." Regence Blue Cross Blue Shield's Kim Frost said the insurer supported the audit and the anti-balance-billing protections but remained concerned about high rates in Utah relative to other states.

Representative Thurston asked whether the state's single base-rate approach functions like price regulation for a natural monopoly and whether insurers could still negotiate discounts. Sponsors said insurers would base payments on the state-established maximum rates; patient cost-sharing (deductibles, co-pays) would still apply.

The bill also includes a sunset provision and requires a legislative audit within two years to evaluate whether indexation or another durable mechanism should determine future rate adjustments. The sponsor said staff and stakeholders were unable to reach consensus on a single index, so an audit should recommend a path forward.

Committee members voted to adopt the second substitute and then recommended HB 301 favorably; the committee recorded unanimous approval.