Oklahoma § 63-3242.3 - Access payment program fee

§ 63-3242.3. Access payment program fee

A. For the purpose of assuring access to quality emergency and

nonemergency transports for state Medicaid beneficiaries, the

Oklahoma Health Care Authority shall, after considering input and

recommendations from the Oklahoma Ambulance Alliance, assess

ambulance service providers licensed in Oklahoma, unless exempt

under subsection B of this section, an ambulance service provider

access payment program fee.

B. The following ambulance services shall be exempt from the

ambulance service provider access payment fee:

1. An ambulance service that is owned or operated by the state

or a state agency, the federal government, a federally recognized

Indian tribe, or the Indian Health Service;

2. An ambulance service that is eligible for supplemental

Medicaid reimbursement under Section 3242 of Title 63 of the

Oklahoma Statutes;

3. An ambulance service that provides air ambulance services

only; or

4. An ambulance service that provides nonemergency transports

only or a de minimis amount of emergency medical transportation

services, as determined by the Authority.

C. 1. The ambulance service provider access payment program

fee shall be an assessment imposed on each ambulance service

provider, except those exempted under subsection B of this section,

for each calendar year in an amount calculated as a percentage of

each ambulance service provider's net operating revenue.

2. The assessment rate shall be determined annually based upon

the percentage of net operating revenue needed to generate an amount

up to the sum of:

a.

the nonfederal portion of the upper payment limit gap

for all ambulance service providers eligible to

receive Medicaid ambulance service provider access

payments, plus

b.

the annual fee to be paid to the Authority under

subparagraph b of paragraph 2 of subsection F of

Section 4 of this act, plus

c.

the amount to be transferred by the Authority to the

Medical Payments Cash Management Improvement Act

Programs Disbursing Fund under subparagraph a of

paragraph 2 of subsection F of Section 4 of this act.

In no event shall the assessment rate exceed the maximum rate

allowed by federal law or regulation.

3. The assessment rate described in this subsection shall be

determined after consultation with the Alliance. The base year for

assessment, the method for calculating net operating revenue and

Oklahoma Statutes - Title 63. Public Health and Safety

related matters not provided for in this section shall be determined

by rules promulgated by the Oklahoma Health Care Authority Board.

D. 1. If an ambulance service provider conducts, operates or

maintains more than one licensed ambulance service, the ambulance

service provider shall pay the ambulance service provider access

payment program fee for each ambulance service separately. However,

if the ambulance service provider operates more than one ambulance

service under one Medicaid provider number, the ambulance service

provider may pay the fee for the ambulance services in the

aggregate.

2. Notwithstanding any other provision of this section, if an

ambulance service provider subject to the ambulance service provider

access payment fee operates or conducts business only for a portion

of a year, the assessment for the year shall be adjusted by

multiplying the annual assessment by a fraction, the numerator of

which is the number of days in the year during which the ambulance

service operates and the denominator of which is three hundred

sixty-five (365). Immediately upon ceasing to operate, the

ambulance service provider shall pay the assessment for the year as

so adjusted, to the extent not previously paid.

3. The Authority shall determine the assessment for new

ambulance services and ambulance services that undergo a change of

ownership, in accordance with this section, using the best available

information, as determined by the Authority.

E. 1. In the event that federal financial participation

pursuant to Title XIX of the Social Security Act is not available to

the state Medicaid program for purposes of matching expenditures

from the Ambulance Service Provider Access Payment Program Fund at

the approved federal medical assistance percentage for the

applicable year, the ambulance service provider access payment

program fee shall be null and void as of the date of the

nonavailability of such federal funding through and during any

period of nonavailability.

2. In the event of an invalidation of the Ambulance Service

Provider Access Payment Program by any court of last resort, the

program shall be null and void as of the effective date of that

invalidation.

3. In the event that the Ambulance Service Provider Access

Payment Program is determined to be null and void for any of the

reasons described in this subsection, any ambulance service provider

access payment program fee assessed and collected for any period to

which such invalidation applies shall be returned in full within

forty-five (45) days by the Authority to the ambulance service from

which it was collected.

F. The Oklahoma Health Care Authority Board, after considering

the input and recommendations of the Alliance, shall promulgate

rules for the implementation and enforcement of the ambulance

Oklahoma Statutes - Title 63. Public Health and Safety

service provider access payment program fee. Unless otherwise

provided, the rules promulgated under this subsection shall not

grant any exceptions to or exemptions from the ambulance service

provider access payment program fee imposed under this section.

G. The Authority shall provide for administrative penalties in

the event an ambulance service provider fails to:

1. Submit the ambulance service provider access payment program

fee;

2. Submit the fee in a timely manner;

3. Submit reports as required by the Authority; or

4. Submit reports timely.

H. The Oklahoma Health Care Authority Board shall have the

power to promulgate emergency rules to implement the provisions of

the Ambulance Service Provider Access Payment Program Act.

Added by Laws 2021, c. 540, § 3, eff. Nov. 1, 2021.