House passes ambulance payment reform to cap surprise billing and set base rates

The Utah House on Feb. 20 passed third substitute House Bill 301, a package of measures intended to reduce surprise ambulance bills, set sustainable base rates for ground transport and create oversight mechanisms for compliance.

Representative Tim Malloy, sponsor, said the bill "ensures fair and transparent ambulance pricing in Utah by setting sustainable base rates for transport, mileage, and medications." He said the measure was negotiated with ambulance providers, insurers and other stakeholders.

Key provisions in the third substitute include a codified base rate for ground ambulance transport (with an initial increase of roughly 5 percent from a stated baseline in committee discussion), a set mileage rate, a medication maximum cost to limit charges for life-saving drugs administered during transport, and a prohibition on balance billing that would prevent patients from receiving surprise charges beyond insurer-approved amounts. The bill also authorizes legislative oversight and audits of providers and insurers to check compliance.

Representative Shelley, speaking for rural concerns, warned the change could be "very detrimental" to some rural ambulance providers; Malloy said the bill includes a provision allowing carriers to pay an amount that covers the difference between an insurer's allowed amount and billed charges in certain circumstances to address rural-provider revenue gaps.

Representative Kristofferson moved and the House adopted a third substitute; the bill passed third reading and will be transmitted to the Senate. The clerk recorded final passage; the roll-call tally reported 66 yes, 0 no on final passage in the transcript.