HB 2531
SignedHouse
Quality assurance fee
Aligning the quality assurance fee for the ambulance transport fund with federal regulations.
How does a bill become law?
- Introduced: The bill is filed and assigned a number.
- Committee: A subject-matter committee holds hearings, takes public testimony, and decides whether to advance the bill.
- Floor Vote: The full chamber (House or Senate) debates and votes on the bill.
- Opposite Chamber: The bill repeats the committee and floor vote process in the other chamber.
- Governor: The Governor reviews the bill and decides whether to sign or veto it.
- Signed: The bill has been signed into law.
AI Analysis
This bill adjusts how Washington reimburses ambulance providers for emergency transports under Medicaid by creating a quality assurance fee to fund increased payments. It changes the fee calculation method, sets a fixed fee rate starting in 2026, and adds enforcement tools for collection.
- Increases Medicaid fee-for-service reimbursement for emergency ambulance transports by adding a quality assurance fee-based supplement to the base payment schedule.
- Requires ambulance providers to pay a quarterly quality assurance fee based on their prior-year transport volume and revenue, calculated annually by the Washington Health Care Authority.
- Sets a fee rate formula for fiscal years 2022–2026 that ties the fee to projected provider costs and federal Medicaid matching rules, and fixes the rate at the 2025 level starting July 1, 2026.
- Allows the state to adjust the fee annually if actual or projected revenue deviates by more than 1% from target levels, and permits time-limited federal program approvals.
- Imposes interest and penalties on late fee payments, allows deduction from Medicaid reimbursements for overdue amounts, and gives providers the option to request fee waivers due to financial hardship.
Who is affected
- Ambulance transport providers — Ambulance companies that provide ground emergency transport services and bill for those services; they must pay quarterly quality assurance fees based on their transport volume and revenue, and may face interest, penalties, or deductions from Medicaid payments if fees are overdue.
- State and federal governments — State and federal governments; the state uses fee revenue and federal matching funds to supplement ambulance provider payments, while the federal government may provide matching funds if the program meets federal requirements.
- Medicaid recipients — Medicaid recipients who rely on ambulance services; they may benefit from more stable provider reimbursement, which could help maintain access to emergency transport services.
- Hospitals and emergency medical facilities — Hospitals and emergency medical facilities that receive timely payments for ambulance services rendered to patients, since providers are better compensated and may be more financially stable.
Pro/Con Analysis
Potential Benefits (5)
By increasing Medicaid reimbursement for emergency ambulance transports, the bill helps stabilize provider participation and may reduce service disruptions or closures, especially in rural or underserved areas where ambulance services operate on narrow margins — thereby improving access to life-saving emergency transport for Medicaid recipients.
Public SafetyPeopleRef: Sec. 1(1)The bill ensures that increased Medicaid payments supplement — rather than replace — existing funding, helping maintain or expand emergency medical services and reducing provider financial risk, which supports continuity of care for vulnerable populations.
HealthcarePeopleRef: Sec. 1(3)The bill includes a hardship waiver provision allowing the state to waive interest and penalties for providers facing financial distress, which may prevent insolvency for some small or struggling providers — though the discretionary nature limits its overall impact.
Business & EmploymentPeopleRef: Sec. 2(4)(d)The fixed fee rate beginning in 2026 provides long-term predictability for providers, reducing annual uncertainty about fee changes and enabling more stable budgeting — though this benefit is offset by the fact that the 2025 rate may already be high.
Business & EmploymentLean peopleRef: Sec. 2(2)(c)The bill allows the state to seek time-limited federal approval for the fee program, which helps ensure federal matching funds are available — supporting broader state and local public health infrastructure by leveraging federal dollars to boost provider payments.
Local GovernmentLean peopleRef: Sec. 1(4)
Potential Concerns (5)
The bill requires ambulance providers to pay a quarterly quality assurance fee based on prior-year transport volume and revenue, which could strain cash flow for small or marginally profitable providers, especially during the transition period before fee adjustments stabilize.
Business & EmploymentRef: Sec. 2(2)(b)The bill authorizes the state to deduct unpaid fees and penalties from Medicaid reimbursements, which could disrupt cash flow for providers already operating on thin margins and may disproportionately impact smaller providers lacking reserves to absorb delays or deductions.
Business & EmploymentLean industryRef: Sec. 2(4)(b)The bill allows the Health Care Authority to waive interest and penalties for providers demonstrating “undue financial hardship,” but the waiver is discretionary and not guaranteed — meaning financially vulnerable providers may still face penalties even if they qualify in principle, while larger providers with legal/finance staff are better positioned to navigate the waiver process.
Business & EmploymentLean industryRef: Sec. 2(4)(d)Starting in 2026, the fee rate is fixed at the 2025 level, but the 2025 rate itself is based on 2024 cost projections — meaning providers who incurred higher-than-expected costs in 2024 will be locked into a disproportionately high fee for years, potentially penalizing growth or recent investment in capacity or quality improvements.
Business & EmploymentIndustryRef: Sec. 2(2)(c)The fee calculation formula ties payments to projected aggregate provider costs and federal matching rules, but the denominator uses only 90% of projected transports — effectively inflating the fee rate and shifting more cost onto providers, especially those with lower-than-expected volume, while larger providers can absorb higher fees more easily due to economies of scale.
Business & EmploymentIndustryRef: Sec. 2(2)(b)
Who Is Most Affected
Small and rural ambulance providers are most at risk of financial strain due to fixed fees based on prior-year revenue and volume, and they lack the scale or reserves to absorb short-term cash flow disruptions or deductions.
Large, for-profit ambulance chains with diversified revenue streams and stronger balance sheets are better positioned to absorb the fee burden and benefit from more stable Medicaid reimbursement, potentially gaining market share as smaller competitors struggle.
Medicaid recipients relying on emergency ambulance services benefit from more reliable provider participation and reduced risk of service gaps, especially in underserved areas.
Hospitals benefit indirectly from more financially stable ambulance providers, reducing delays in patient handoffs and potential uncompensated care costs from transport disruptions.
The state government gains a self-funding mechanism to increase provider payments without tapping general fund resources, while also improving program compliance through enforcement tools like deductions and penalties.