Or. Admin. Code § 410-136-3373

Current through Register Vol. 63, No. 10, October 1, 2024

Section 410-136-3373 - Ground Emergency Medical Transportation - Emergency Medical Services Transport Private Provider Program - Quality Assurance Fee Requirements and Qualifications

(1) Quality Assurance Fee (QAF) assessment for the Ground Emergency Medical Transportation (GEMT) Emergency Medical Services Transport (EMST) private provider program:

(a) The amount of the QAF is assessed at least annually;

(b) The amount of the QAF is five percent (5%) of the gross receipts for the 12-month period for the calendar year. The amount of the QAF collected in calendar year 2022 or until the Coordinated Care Organizations (CCO) portion of the program is established will be less than the 5% to only account for the Fee for Service portion of the total transports. Any projections must be based on the data reported in the data request template;

(c) The eligible GEMT EMST private provider shall file the data request template form approved by the Authority on or before the 45th day following the term in which the assessment is due.

(A) The QAF payment shall be paid at the same time required for filing the data request template form.

(B) The GEMT EMST private provider shall provide all information required on the data request template form when due.

(C) Failure to file or pay when due shall be a delinquency;

(d) GEMT EMST private provider shall report the data in the data request template form five business days after the date upon which the report is due. The Authority shall notify qualified providers not less than thirty days prior to the due date. After sending written notice to GEMT EMST private provider, the Authority may impose a penalty of $100 per day against GEMT EMST private provider for every day that the report is overdue. Any funds resulting from the penalty imposed under this section shall be deposited in the General Fund to be available for general governmental purposes; and

(e) All QAFs and interest collected shall be deposited into the Emergency Medical Services Fund established.

(2) QAF Penalties, Interest, and Fees:

(a) The Authority has the right to assess interest on QAF's not paid by the due date at ten percent (10%), beginning on the day after the date the payment was due;

(b) The Authority has the right to assess a penalty equal to the interest charged under paragraph (a) of this subsection for each month for which the payment is more than sixty days overdue;

(c) The Authority shall deduct the amount of any unpaid fee, interest or penalty assessed under this section from any add on amount owed to the GEMT EMST private provider until the full amount of the fee, interest or penalty is recovered.

(A) The Authority may not make a deduction pursuant to this paragraph until after the Authority gives the GEMT EMST private provider written notification;

(B) The Authority may permit the amount owed to be deducted over a period of time that takes into account the financial condition of the GEMT EMST private provider.

(d) The Authority may waive a portion of or all interest or penalties, or both, assessed under this section if the Authority determines that the imposition of the full amount of the QAF in accordance with the due dates established under this section will impose an undue financial hardship on the GEMT EMST private provider. The waiver must be conditioned on the GEMT EMST private provider's agreement to pay the QAF on an alternative schedule developed by the Authority;

(e) In the event of a merger, acquisition or similar transaction involving the GEMTEMST private provider that has outstanding QAFs, interest or penalties due, the successor GEMT EMST private provider is responsible for paying to the Authority the full amount of outstanding QAFs, interest and penalties that are due on the effective date of the merger, acquisition or transaction.

(3) Data Request Template Form:

(a) The Authority shall approve the data request template form for an eligible GEMT EMST private provider to report the data necessary to administer the QAF, including information about the portion of funds that the GEMT EMST private provider used to increase wages and benefits for employees, and may require a certification by each GEMT EMST private provider under penalty of perjury of the truth of the data reported under this section;

(b) The Authority requires GEMT EMST private provider to report the number of emergency medical services transports it provided in each 12-month period, by insurance payer type;

(c) Requires GEMT EMST private provider to report to the Authority its gross receipts for each 12-month period; and

(d) Requires GEMT EMST private provider to report to the Authority the provider's costs for GEMT emergency medical service transports.

Or. Admin. Code § 410-136-3373

DMAP 50-2023, adopt filed 06/30/2023, effective 7/1/2023

Statutory/Other Authority: ORS 413.234

Statutes/Other Implemented: ORS 413.234