1. (1) The allowed amount paid to a ground ambulance services organization for covered ground ambulance services under a health benefit plan must be one of the following amounts:

   1. (a)

      1. (A) The rate established by the local government entity where the covered health care services originated for the provision of ground ambulance services by ground ambulance services organizations owned or operated by the local government entity; or
      2. (B) Where the ground ambulance services were provided by a private ground ambulance services organization under contract with the local government entity where the covered health care services originated, the contracted rate.
   2. (b) The rate pursuant to a written contract between the ground ambulance services organization and the health benefit plan.
   3. (c) If a rate has not been established under (a) or (b) of this subsection, an amount no less than 325 percent of the Medicare rate, as published by the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services (CMS) as of January 1, 2026, and thereafter as published by the department in an annual bulletin and made available on the division’s website at https://dfr.oregon.gov/laws-rules/Pages/bulletins.aspx, or its successor. The bulletin will notify health benefit plans of annual adjustment in the Medicare rate, if any, as published by CMS. The annual adjustment will be effective January 1 of each calendar year.

2. (2) When a ground ambulance services organization provides a ground ambulance transport outside of their primary geographic service area, also referred to as mutual aid transport, the rate paid is one of the following amounts:

   1. (a) The rate established by the local government entity for the ground ambulance services organization that provided the transport.
   2. (b) If a rate has not been established under (a) or (b) of this subsection, an amount no less than 325 percent of the Medicare rate, as published by the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services (CMS) as of January 1, 2026, and thereafter as published by the department in an annual bulletin and made available on the division’s website at https://dfr.oregon.gov/laws-rules/Pages/bulletins.aspx, or its successor. The bulletin will notify health benefit plans of annual adjustment in the Medicare rate, if any, as published by CMS. The annual adjustment will be effective January 1 of each calendar year.
   3. (c) The rate pursuant to a written contract between the ground ambulance services organization and the health benefit plan.
3. (3) Established local rates are reported to the department by ground ambulance service organizations for transparency purposes and may be used as a reference in determining the allowed amount under sections (1) and (2) of this rule, where applicable. For billing purposes, the health benefit plan and ground ambulance services organization will determine the payment amount based on the allowed amount at the time and place of the service pursuant to sections (1) and (2) of this rule.
4. (4) A health benefit plan shall make payments for ground ambulance services provided by ground ambulance services organizations directly to the organization, rather than the enrollee.
5. (5) The allowed amount established under sections (1) and (2) of this rule constitutes payment in full for the services rendered. A ground ambulance services organization may not request or require a patient at any time, for any procedure, service, or supply, to sign or otherwise execute by oral, written, or electronic means, any document that would attempt to avoid, waive, or alter any provision of this rule.
6. (6) For purposes of this rule "contracted rate" means rates established in a contract or contracts between a local government entity and a private ground ambulance services organization to provide ground ambulance services in their geographic service area.
7. (7) This rule applies to a self-funded group health plan, including plans offered by the Public Employees’ Benefit Board or the Oregon Educators Benefit Board, that has elected to participate in the provisions of ORS 743B.292 pursuant to OAR 836-053-0461.

Statutory/Other Authority

ORS 743B.292

Statutes/Other Implemented

ORS 743B.292

History

ID 7-2026, adopt filed 06/24/2026, effective 06/29/2026
ID 15-2025, temporary adopt filed 12/17/2025, effective 01/01/2026 through 06/29/2026