SB 6102
In CommitteeSenate
Quality assurance fee
Aligning the quality assurance fee for the ambulance transport fund with federal regulations.
This status may be delayed. See Action History below for the latest updates.
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 establishes a new funding mechanism to increase Medicaid payments to ambulance providers for emergency ground transport services, using a fee assessed on those providers. The fee is recalculated annually to ensure it generates enough revenue to cover the added Medicaid payments, with federal matching funds helping to fund the increase.
- Increases Medicaid reimbursement for emergency ambulance transports by adding a fee-based 'add-on' payment on top of the standard fee-for-service rate.
- Requires ambulance providers to pay a quarterly 'quality assurance fee' based on their number of emergency transports and gross revenue, calculated annually by the Health Care Authority.
- Adjusts the fee rate each year to ensure total collected fees match the amount needed to fund the increased Medicaid payments (within 1% tolerance).
- Allows the state to seek federal approval to implement the add-on payments as part of a time-limited program to maintain federal matching funds.
- Imposes interest and penalties on late fee payments, and allows the state to deduct unpaid fees from future Medicaid reimbursements; also allows fee waivers for providers facing financial hardship.
Who is affected
- Ambulance transport providers — Ambulance companies that provide ground emergency transport services and bill for them; they must pay a quarterly fee 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 collects and administers the fee, while the federal government provides matching funds to help cover increased Medicaid payments to ambulance providers.
- Medicaid recipients — Medicaid recipients who rely on ambulance services — they may benefit from more stable reimbursement to providers, potentially improving access and continuity of emergency transport services.
- Hospitals and EMS systems — Hospitals and emergency medical services systems — they rely on timely and adequate ambulance transport, and improved provider reimbursement may reduce delays or disruptions in patient handoffs.
Pro/Con Analysis
Stronger case for benefits
Potential Benefits (5)
Increased Medicaid reimbursement for emergency ambulance services improves provider solvency and reduces service disruptions, enhancing reliability of emergency response — especially critical in rural and underserved areas where ambulance services are already strained.
Public SafetyPeopleRef: Sec. 1(1), (4); Sec. 2(3)Stabilizing ambulance provider reimbursement reduces delays in patient handoffs at hospitals and emergency departments, improving continuity of care and reducing strain on hospital emergency capacity.
HealthcarePeopleRef: Sec. 1(3); Sec. 2(1)By funding the increase through a dedicated fee (not general fund), the bill ensures sustainable, predictable reimbursement without competing with other state budget priorities — this enhances long-term planning for ambulance services.
HealthcarePeopleRef: Sec. 1(2); Sec. 2(2)(a)Annual adjustment of the fee rate to stay within 1% of target revenue improves actuarial fairness and reduces risk of under- or over-collection — this promotes program stability and provider trust in the system.
HealthcareLean peopleRef: Sec. 1(4); Sec. 2(2)(c)Federal matching funds are explicitly used to supplement (not replace) state funding, increasing total available resources for emergency transport — this leverages federal dollars to expand access without raising state taxes.
Public SafetyPeopleRef: Sec. 1(3); Sec. 2(2)(a)
Potential Concerns (5)
Ambulance providers must pay a quarterly fee based on gross revenue and transport volume, with penalties and interest for late payments and possible deduction from Medicaid reimbursements — this creates administrative burden and cash-flow pressure, especially for small providers without large reserves. While waivers exist for financial hardship, the burden falls disproportionately on smaller, less capitalized firms.
Business & EmploymentLean industryRef: Sec. 2(2)(b), (c); Sec. 2(4)(b)The fee structure is regressive in effect: providers with higher gross revenue per transport (e.g., larger, more efficient or urban-based providers) may pay less per transport than smaller, rural, or lower-revenue providers — this distorts competition and may incentivize consolidation or service reduction in underserved areas.
Business & EmploymentIndustryRef: Sec. 2(2)(b), (c); Sec. 2(4)(b)The fee formula ties payment to gross revenue, not profitability — unprofitable or marginally profitable providers (e.g., rural or volunteer-based services) may be forced to cut services or close, reducing geographic access to emergency transport.
Business & EmploymentIndustryRef: Sec. 2(2)(b), (c)The authority may deduct unpaid fees from future Medicaid reimbursements, effectively creating a lien on federal funds — this gives the state strong leverage over providers and may discourage participation in Medicaid if providers fear delayed or clawed-back payments.
Business & EmploymentIndustryRef: Sec. 2(4)(b)Fee waivers for financial hardship are discretionary and unappealable, giving the Health Care Authority sole discretion — this creates uncertainty and may disproportionately impact small or independent providers lacking legal or administrative capacity to negotiate waivers.
Business & EmploymentLean industryRef: Sec. 2(4)(d)
Who Is Most Affected
Small, rural, or volunteer-based ambulance providers face the greatest strain: they often operate on thin margins, have fewer transports per dollar of revenue, and lack the administrative capacity to absorb new fees or navigate waiver requests. Many may reduce service hours, delay equipment upgrades, or exit the market — worsening access in already vulnerable areas.
Larger, for-profit ambulance companies with higher volume and better cash flow may absorb the fee more easily and even benefit from reduced competition — they may also have legal/finance teams to negotiate waivers or structure payments to avoid deductions. Some may consolidate to gain scale advantages.
Medicaid recipients relying on emergency ambulance services stand to benefit from more stable provider participation and reduced service disruptions, especially in underserved areas. However, if provider exits lead to longer response times, access could decline.
Hospitals and emergency departments benefit from more reliable ambulance handoffs, reducing patient boarding and ED crowding. However, they may indirectly bear costs if providers pass on administrative burdens or if service gaps emerge.
The state gains a self-funding mechanism to raise provider reimbursement without tapping general funds, but loses flexibility in budgeting and faces potential legal or administrative challenges if providers contest fee assessments or deductions.