An Act to Maximize Federal Funding in Support of Emergency Medical Services
Maine Legislature, Session 131, LD 1751
Committee: Health and Human Services
Sponsors: CURRY, CYRWAY, FARRIN, JACKSON, MOORE, NANGLE, FAULKINGHAM, SALISBURY, TALBOT ROSS
Amends: 22 MRSA §3174-J

Legislative Document
No. 1751
S.P. 696
In Senate, April 20, 2023
An Act to Maximize Federal Funding in Support of Emergency 
Medical Services
Reference to the Committee on Health and Human Services suggested and ordered printed.
DAREK M. GRANT
Secretary of the Senate
Presented by Senator CURRY of Waldo.
Cosponsored by Representative CYRWAY of Albion and
Senators: FARRIN of Somerset, President JACKSON of Aroostook, LaFOUNTAIN of 
Kennebec, MOORE of Washington, NANGLE of Cumberland, Representatives: 
FAULKINGHAM of Winter Harbor, SALISBURY of Westbrook, Speaker TALBOT ROSS of 
Portland.
Be it enacted by the People of the State of Maine as follows:
Sec. 1.  22 MRSA c. 425 is enacted to read:
CHAPTER 425
AMBULANCE ASSESSMENT
§2150-M.  Definitions
As used in this chapter, unless the context otherwise indicates, the following terms 
have the following meanings.
1.  Ambulance service provider. "Ambulance service provider" means a person that 
holds itself out to be a provider of transportation of ill or injured persons or that routinely 
provides transportation for ill or injured persons and is licensed under Title 32, chapter 2-B. 
"Ambulance service provider" does not include:
A. The Maine Army National Guard, the Maine Air National Guard or the United 
States Armed Forces; 
B. A municipal fire or police department or any other governmental entity that provides 
emergency ambulance services; 
C. An entity that exclusively provides air ambulance services; or
D. An organization that is required to pay any tax under Title 36, Part 4.
2.  Fee. "Fee" means the ambulance service assessment fee authorized by this chapter.
3.  Fund. "Fund" means the ambulance fee fund established in section 2150-O.
4.  Emergency ambulance services.  "Emergency ambulance services" means any 
services delivered by an ambulance service provider.
5.  Net operating revenue. "Net operating revenue" means gross revenue collected by 
an ambulance service provider for the delivery of emergency ambulance services less any 
deducted amounts for bad debts, charity care or payer discounts. 
§2150-N.  Ambulance service assessment fee
1.  Fee established. The department shall charge every ambulance service provider a 
uniform ambulance service assessment fee. The fee must be assessed on each ambulance 
service provider's net operating revenue at a rate determined annually by the department. 
The rate must be calculated in a manner in which the assessment generates the state share 
necessary to fund the payments described in section 2150-O as long as the fee does not 
exceed the maximum limit allowable under 42 Code of Federal Regulations, Section 
433.68(f). The department shall establish each ambulance service provider's fee using the 
most recent data available as determined by the department in consultation with a statewide 
organization representing ambulance service providers and shall update each ambulance 
service provider's fee amount on a periodic basis, but at least annually. All emergency 
ambulance services, regardless of payer, are subject to the fee, including, but not limited 
to, emergency ambulance services provided by ambulance service providers under fee-for-
service and managed care arrangements. An ambulance service provider's liability for the 
fee must, in the case of a transfer of ownership, be assumed by the successor in interest to 
the ambulance service provider. 
2.  Federal approval required.  The department may charge the fee only if the 
department has received approval from the federal Department of Health and Human 
Services, Centers for Medicare and Medicaid Services necessary to authorize the Medicaid 
payments to ambulance service providers in accordance with section 2150-O. 
3.  Deposit of fees.  The funds generated from the fee must be deposited into the fund 
and may be used only in accordance with that section. Funds generated from the fee do not 
revert to the General Fund and must be available for expenditure in subsequent fiscal years.
§2150-O.  Ambulance fee fund
1.  Fund created. The ambulance fee fund is established as a separate nonlapsing fund 
within the department. 
2.  Source of funds. Amounts credited to the fund must be expended for payments to 
ambulance service providers under the MaineCare program. The following sources of 
income must be credited to the fund: 
A. All revenues generated from the fee;
B. An amount equal to any federal financial participation revenues claimed and 
received by the State for eligible expenditures made from the fund; 
C. Any revenue from appropriations or allocated by the Legislature and specifically 
designated to be credited to the fund; and 
D. Interest earned on any money in the fund. 
3. Federal funds.  The department shall seek federal funds to achieve the maximum 
amount of federal funding in a manner in which the assessment amount equals the state 
share under section 2150-N, subsection 1. The expenditures from the fund must be made 
by the department in a manner consistent with the requirements and conditions of 42 United 
States Code, Section 1396b(w) and 42 Code of Federal Regulations, Section 433.68 and 
may be made only under federally approved payment methods, consistent with federal 
funding requirements and consistent with all federal payment limits.
4.  Use of funds. Amounts in the fund must be expended exclusively for reimbursing 
ambulance service providers under the MaineCare program and must be used to 
supplement, not supplant, General Fund appropriations to support emergency ambulance 
service reimbursements as of October 1, 2023. Amounts in the fund may not be used to 
replace payment commitments between the ambulance service providers and the State. The 
reimbursement amounts established and distributed under the MaineCare program under 
this section must increase the total reimbursement amount for emergency ambulance 
services up to the average commercial rate to the extent permitted by the amount of funds 
generated from the fee. Reimbursement payments must be made to ambulance service 
providers at least on a quarterly basis. 
5.  Federal approval.  If the federal Department of Health and Human Services, 
Centers for Medicare and Medicaid Services does not authorize or withdraws approval of 
the Medicaid payments made to ambulance service providers in accordance with this 
section, all money in the fund must be returned to ambulance service providers. If the 
department no longer collects the fee, all money in the fund must be returned to ambulance 
service providers.
§2150-P.  Rules
The department shall adopt rules to implement this chapter.  In adopting rules under 
this section, the department shall consult with relevant stakeholders, including a statewide 
organization representing ambulance service providers.
§2150-Q.  Additional funding mechanisms
The department shall implement voluntary programs to increase funding to 
governmental 
ambulance 
service 
providers, 
including, 
but 
not 
limited 
to, 
intragovernmental transfer or certified public expenditure programs, to the extent allowed 
under Section 1903(w)(6) of the United States Social Security Act.
Sec. 2.  22 MRSA §3174-JJ, as amended by PL 2019, c. 530, Pt. B, §1, is further 
amended to read:
§3174-JJ.  MaineCare reimbursement for ambulance services
The department shall reimburse for ambulance services under MaineCare at a level that 
is not less than the average allowable reimbursement rate under Medicare for such services 
or at the highest percent of that level that is possible within resources appropriated for those 
purposes.  Beginning March 1, 2015, the department shall reimburse for ambulance 
services under MaineCare at a level that is not less than 65% of the average allowable 
reimbursement rate under Medicare for such services.  Beginning January 1, 2020, the 
department shall reimburse for ambulance services under MaineCare at a level that is not 
less than the average allowable reimbursement rate under Medicare for such services and 
shall reimburse for neonatal transport services under MaineCare at the average rate for 
critical care transport services under Medicare.  Beginning January 1, 2024, the department 
shall reimburse for:
1.  Ambulance services.  Ambulance services under MaineCare at a level that is not 
less than 200% of the allowable reimbursement rate under Medicare for such services;
2.  Neonatal transport.  Neonatal transport services under MaineCare at the average 
rate for critical care transport services under Medicare, including any adjustments allowed 
by Medicare for ambulance services;
3.  No-transport calls.  Ambulance service no-transport calls when patient contact was 
initiated and assessment or treatment was performed at either the basic life support 
emergency Medicare base rate or advanced life support emergency Medicare base rate, as 
appropriate; and
4.  Community paramedicine.  Community paramedicine visits conducted by 
licensed providers at a rate that is not less than 100% of the average allowable basic life 
support nonemergency Medicare base rate.  As used in this subsection, "community 
paramedicine" has the same meaning as in Title 32, section 84, subsection 4.
Sec. 3.  Federal Medicaid waivers or state plan amendments.  No later than 6 
months after the effective date of this Act, the Department of Health and Human Services 
shall submit to the United States Department of Health and Human Services, Centers for 
Medicare and Medicaid Services any waivers or state plan amendments determined 
necessary in order to accomplish the purposes of this Act. 
SUMMARY
This bill establishes an ambulance service assessment fee on ambulance service 
providers in order to maximize federal funding for reimbursement to ambulance service 
providers under the MaineCare program.  It also increases the reimbursement rates under 
the MaineCare program for ambulance services, neonatal transport, no-transport calls and 
community paramedicine.