(a) "Emergency medical services" means the services provided by an emergency medical services provider to an individual experiencing a medical emergency in order to:
(A) Assess, treat and stabilize the individual’s medical condition; or
(B) Prepare and transport the individual to a medical facility.
(b) "Emergency medical services provider" means a nonfederal or nonpublic entity that:
(A) Employs individuals who are licensed by the Oregon Health Authority under ORS chapter 682 to provide emergency medical services; and
(B) Contracts with a local government pursuant to a plan described in ORS 682.062.
(c) "Emergency medical services transport" means an emergency medical services provider’s evaluation of an individual experiencing a medical emergency and the transportation of the individual to the nearest medical facility capable of meeting the needs of the individual.
(d) "Federal financial participation" has the meaning given that term in ORS 413.234.
(e)(A) "Gross receipts" means gross payments received as patient care revenue for emergency medical services transports, determined on a cash basis of accounting.
(B) "Gross receipts" does not include Medicaid supplemental reimbursement pursuant to ORS 413.234.
(f) "Local government" has the meaning given that term in ORS 174.116.
(2) The Oregon Health Authority may request approval from the Centers for Medicare and Medicaid Services to administer the program described in this section. Upon receipt of approval, the authority shall:
(a) Annually assess a quality assurance fee on each emergency medical services transport provided by an emergency medical services provider licensed in this state in an amount equal to the lesser of the amount permitted by federal law and five percent of the projected total gross receipts for the following 12-month period, divided by the projected number of emergency medical services transports in the same 12-month period. The projections must be based on the data reported under paragraph (h) of this subsection.
(b) Prescribe the manner and due dates for the assessment and collection of quality assurance fees under this section.
(c) Modify or make adjustments to any methodology, fee amount or other provision specified in this section to the extent necessary to meet the requirements of federal law or to ensure federal financial participation in the costs of emergency medical services transports reimbursed by the authority.
(d) Assess interest on quality assurance fees not paid by the date due at 10 percent per annum, beginning on the day after the date the payment was due.
(e) Assess a penalty equal to the interest charged under paragraph (d) of this subsection for each month for which the payment is more than 60 days overdue.
(f) Deduct the amount of any unpaid fee, interest or penalty assessed under this section from any fee-for-service medical assistance reimbursement owed to the emergency medical services provider until the full amount of the fee, interest or penalty is recovered. The authority may not make a deduction pursuant to this paragraph until after the authority gives the emergency medical services provider written notification. The authority may permit the amount owed to be deducted over a period of time that takes into account the financial condition of the emergency medical services provider.
(g) Establish the reimbursement to be paid to an emergency medical services provider for an emergency medical services transport in an amount that is equal to the amount of quality assurance fees, interest and penalties assessed by the authority under this section and the associated federal financial participation less any costs incurred by the authority to administer this section. An emergency medical services provider shall use a portion of the funds to increase wages and benefits for employees. The reimbursement established under this paragraph:
(A) May not exceed the costs for the emergency medical services transport, determined in accordance with standards established by the authority, less the amount of reimbursement that the emergency medical services provider is eligible to receive from all public and private sources.
(B) Shall be paid only from federal financial participation in the costs of emergency medical services transports and the Emergency Medical Services Fund established under ORS 682.403.
(C) May not be used to supplant existing funding for emergency medical services transports and the Emergency Medical Services Fund established under ORS 682.403.
(D) Shall be required and payable only for periods in which emergency medical services providers are required to pay quality assurance fees.
(E) May be reduced by the authority to provide grants to emergency medical services providers for innovative ambulance programs.
(h) Prescribe the form and manner for an emergency medical services provider to report the data necessary to administer this section, including information about the portion of funds that the emergency medical services provider used to increase wages and benefits for employees, and may require a certification by each emergency medical services provider under penalty of perjury of the truth of the data reported under this paragraph.
(i) Require a medical services provider to report to the authority the number of emergency medical services transports it provided in each 12-month period, by payer type.
(j) Require an emergency medical services provider to report to the authority its gross receipts for each 12-month period.
(k) Require an emergency medical services provider to report to the authority the provider’s costs for emergency medical services transports.
(3) All quality assurance fees and interest collected under this section shall be deposited into the Emergency Medical Services Fund established in ORS 682.403.
(4) The authority may waive a portion or all of the interest or penalties, or both, assessed under subsection (2) of this section if the authority determines that the imposition of the full amount of the quality assurance fee in accordance with the due dates established under subsection (2) of this section is likely to impose an undue financial hardship on the emergency medical services provider. The waiver must be conditioned on the emergency medical services provider’s agreement to pay the quality assurance fees on an alternative schedule developed by the authority.
(5) In the event of a merger, acquisition or similar transaction involving an emergency medical services provider that has outstanding quality assurance fees, interest or penalties due, the successor emergency medical services provider is responsible for paying to the authority the full amount of outstanding quality assurance fees, interest and penalties that are due on the effective date of the merger, acquisition or transaction.
(6) The authority shall modify the method for calculating or paying the reimbursement under subsection (2) of this section if the modification is necessary to ensure that the expenditures for emergency medical services transports qualify for federal financial participation.
(7) The authority shall administer this section in a manner that is consistent with:
(a) ORS 413.234 and 413.235; and
(b) Federal law, including the terms and conditions of agreements with the Centers for Medicare and Medicaid Services.
(8) An emergency medical services provider shall report the data required by subsection (2)(h) of this section within five days after the date upon which the report is due. After sending written notice to an emergency medical services provider, the authority may impose a penalty of $100 per day against an emergency medical services provider for every day that the report is overdue. Any funds resulting from a penalty imposed under this subsection shall be deposited in the General Fund to be available for general governmental purposes. [2021 c.623 §1]
Note: 682.400 and 682.403 were enacted into law by the Legislative Assembly but were not added to or made a part of ORS chapter 682 or any series therein by legislative action. See Preface to Oregon Revised Statutes for further explanation.