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2021 - 2022 LEGISLATURE
ASSEMBLY SUBSTITUTE AMENDMENT 1,
TO ASSEMBLY BILL 874
February 21, 2022 - Offered by Representative Loudenbeck.
AB874-ASA1,1,3 1An Act to create 25.17 (1) (aj), 25.776, 49.45 (3) (em), 49.45 (15r) and 256.23 of
2the statutes; relating to: emergency medical transportation services under
3Medical Assistance program.
Analysis by the Legislative Reference Bureau
This bill implements an ambulance service provider assessment on private
ambulance service providers for supplemental reimbursements under the Medical
Assistance program and a supplemental reimbursement under the Medical
Assistance program to public ambulance service providers though certified public
expenditures. Currently, the Department of Health Services administers the
Medical Assistance program, which is a joint federal and state program that provides
health services to individuals who have limited financial resources. Generally, under
the Medical Assistance program, the state provides its share of the funding for
benefits and the federal government then contributes its designated share of
funding, also known as federal financial participation.
The bill imposes on each private ambulance service provider a fee for the
privilege of doing business in Wisconsin. The fee, as established by DHS is a
percentage of the ambulance service provider's net patient revenues from ground
emergency ambulance transports such that the total fee for a fiscal year is no less
than one quarter of 1 percent lower than the maximum limit for a provider fee under
federal regulation. The bill prohibits those ambulance service providers from

increasing rates they charge for their services because of the imposition of the fee.
DHS must obtain approval from the federal government, if necessary, to obtain
matching funds, and if federal approval is required, is prohibited from collecting the
fee until DHS receives that approval. The bill requires DHS to expend the moneys
collected from the fee assessment to supplement reimbursements to ambulance
service providers for services provided on a fee-for-service basis and through
managed care to Medical Assistance program recipients.
The bill also requires DHS to submit a state plan amendment to the federal
government to allow supplemental reimbursements under the Medical Assistance
program to public ambulance service providers for ground emergency medical
transportation through certified public expenditures. In certain circumstances
under the certified public expenditure process under current federal law, a public
provider may certify its costs for providing services to Medical Assistance recipients
that are in excess of the usual Medical Assistance reimbursement for those services
and then receive a supplement to cover otherwise unreimbursed costs.
The people of the state of Wisconsin, represented in senate and assembly, do
enact as follows:
AB874-ASA1,1 1Section 1. 25.17 (1) (aj) of the statutes is created to read:
AB874-ASA1,2,22 25.17 (1) (aj) Ambulance service provider trust fund (s. 25.776);
AB874-ASA1,2 3Section 2. 25.776 of the statutes is created to read:
AB874-ASA1,2,7 425.776 Ambulance service provider trust fund. There is created a
5separate nonlapsible trust fund designated as the ambulance service provider trust
6fund, consisting of all moneys received from fees from ambulance service providers
7under s. 256.23 (2).
AB874-ASA1,3 8Section 3. 49.45 (3) (em) of the statutes is created to read:
AB874-ASA1,3,29 49.45 (3) (em) The department shall expend moneys collected under s. 256.23
10(2) to supplement reimbursement for eligible ambulance service providers, as
11defined in s. 256.23 (1) (a), for services provided under the Medical Assistance
12program under this subchapter, including services reimbursed on a fee-for-service
13basis and provided under managed care, by eligible ambulance service providers.
14Health plans shall be indemnified and held harmless for any errors made by the

1department or its agents in calculation of any supplemental reimbursement made
2under this paragraph.
AB874-ASA1,4 3Section 4. 49.45 (15r) of the statutes is created to read:
AB874-ASA1,3,224 49.45 (15r) Emergency medical transportation reimbursement. The
5department shall submit a state plan amendment to the federal department of
6health and human services to allow payment of supplemental reimbursements
7under the Medical Assistance program under this subchapter to public ambulance
8service providers, as defined in s. 256.01 (3), for ground emergency medical
9transportation through certified public expenditures. For purposes of this
10subsection, any ambulance service provider that is owned by any municipality or
11group of municipalities, regardless of whether or not the ambulance service provider
12is organized as a nonprofit corporation, is considered a public ambulance service
13provider. If the state plan amendment under this subsection is approved, the
14department shall pay to an ambulance service provider that complies with a certified
15public expenditure arrangement, as established by the department, a supplemental
16reimbursement equal to the amount of federal financial participation for ground
17emergency medical transportation services in accordance with state and federal law
18and regulations, except that the total reimbursement under the Medical Assistance
19program for the transportation may not exceed the actual cost to the ambulance
20service provider of providing the transportation. If the federal department of health
21and human services disapproves the state plan amendment, the department may not
22pay the supplement under this subsection.
AB874-ASA1,5 23Section 5. 256.23 of the statutes is created to read:
AB874-ASA1,3,24 24256.23 Ambulance service provider fee. (1) In this section:
AB874-ASA1,4,5
1(a) “Eligible ambulance service provider” means any privately owned
2ambulance service provider. “Eligible ambulance service provider” does not include
3any ambulance service provider that is owned by any municipality or group of
4municipalities regardless of whether or not the ambulance service provider is
5organized as a nonprofit corporation.
AB874-ASA1,4,66 (b) “Emergency ambulance transport” means all of the following:
AB874-ASA1,4,107 1. Each ground emergency ambulance transport that requires the delivery of
8life support services, including basic life support or advanced life support, by an
9emergency medical responder or emergency medical services practitioner at any
10practice level.
AB874-ASA1,4,1211 2. Any other ambulance transport that is designated by the department to be
12subject to the fee under sub. (2).
AB874-ASA1,4,22 13(2) For the privilege of doing business in this state, there is imposed on each
14eligible ambulance service provider a fee that is equal to a uniform percentage, as
15determined under sub. (3), of the eligible ambulance service provider's net patient
16revenues from emergency ambulance transports. Except as provided in sub. (4), each
17eligible ambulance service provider shall pay the fee under this subsection in a
18manner determined by the department acting in collaboration with the Professional
19Ambulance Association of Wisconsin, or its successor organization, no more
20frequently than quarterly. An eligible ambulance service provider cannot increase
21rates it charges for its services because of the imposition of the fee under this
22subsection.
AB874-ASA1,5,3 23(3) The department shall establish the uniform percentage of the eligible
24ambulance service provider's net patient revenues so that the total amount of fees
25collected from an eligible ambulance service provider under sub. (2) in a state fiscal

1year is an amount not less than one quarter of 1 percent lower than the maximum
2limit for a provider fee under 42 CFR 433.68 (f) but does not exceed the maximum
3limit.
AB874-ASA1,5,6 4(4) The department may allow an eligible ambulance service provider that is
5unable to make a payment of the fee by the date specified under sub. (2) to make a
6delayed payment.
AB874-ASA1,5,12 7(5) In accordance with s. 20.940, the department shall submit to the federal
8department of health and human services a request for any state plan amendment,
9waiver or other approval that is required to implement this section and s. 49.45 (3)
10(em). If federal approval is required, the department may not implement the
11collection of the fee under sub. (2) until it receives approval from the federal
12government to obtain federal matching funds.
AB874-ASA1,6 13Section 6. Nonstatutory provisions.
AB874-ASA1,5,2114 (1) Budget request; administrative costs. The department of health services
15shall include in its 2023-25 biennial budget request an appropriation to expend the
16moneys in the ambulance service provider trust fund for the purposes under s. 49.45
17(3) (em), including any request to expend the ambulance service provider trust fund
18moneys for the department's costs in administering s. 256.23. Before the passage of
19the 2023-25 biennial budget act, the department of health services may submit to
20the joint committee on finance a request to supplement one of the department's
21appropriation for the purposes of paying administrative costs of s. 256.23.
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