836-053-0454 Temporary rule language in effect until 06/29/2026. Payments to Ground Ambulance Services Organizations (1) The allowed amount paid to ground ambulance services organization for covered ground ambulance services under a health benefit plan must be one of the following amounts: (a)(A) The rate established by the local governmental 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 governmental entity; or (B) Where the ground ambulance services were provided by a private ground ambulance services organization under contract with the local governmental entity where the covered health care services originated, the contracted rate; (b) If a rate has not been established under (a) 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) 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: (a) The locally set rate for the ground ambulance services organization that provided the transport; or (b) If a rate has not been established under (a) 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) 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. (4) The allowed amount established under section (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. (5) For purposes of this rule "contracted rates" means rates established in a contract or contracts between a local governmental entity and a private ground ambulance services organization to provide ground ambulance services in their geographic service area. (6) 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 Oregon Laws 2025, chapter 614 pursuant to OAR 836-053-0461. Statutory/Other Authority: Or Laws 2025, ch 614 Statutes/Other Implemented: Or Laws 2025, ch 614 History: ID 15-2025, temporary adopt filed 12/17/2025, effective 01/01/2026 through 06/29/2026