This bill amends RCW 74.70.060, 74.70.050, and 74.70.020 to create a recurring add-on to Medicaid fee-for-service payments for emergency ground ambulance transports and to establish and revise an ambulance quality assurance fee program to fund those increased payments. The Health Care Authority must calculate an annual fee-for-service add-on equal to the projected available fee amount divided by projected total Medicaid emergency ambulance transports, and must adjust the add-on annually based on transport and revenue data submitted under RCW 74.70.040. Increased payments are funded only from the ambulance quality assurance fee, any interest or investment income on those funds, and associated federal matching funds, and must supplement—not supplant—existing funding for emergency ambulance transports. The authority may seek federal approval to implement any add-on increase on a time-limited basis. The act defines key terms (including emergency ambulance transport, gross receipts, fee-for-service payment schedule, and an effective state medical assistance percentage) and specifies how the annual quality assurance fee rate is calculated for state fiscal years beginning July 1, 2022 through June 30, 2026 (ratio of projected aggregate fee schedule amount times the state medical assistance percentage divided by 90% of projected total annual transports). Beginning July 1, 2026, the annual rate must be the rate in effect as of July 4, 2025. If the available fee amount and the aggregate fee schedule amount differ by more than one percent during a fiscal year, the authority must adjust the fee or add-on so they are approximately equal (defined as less than one percent difference). The fee-for-service payment schedule explicitly excludes this add-on. The bill establishes administrative procedures and collection rules: quarterly assessments and invoices, payment timing (payments due no earlier than 15 days after the start of the fiscal quarter), assessment notices at least 30 days before a quarter, interest on unpaid fees assessed per RCW 43.20B.695, a monthly penalty equal to the interest charge for payments over 60 days past due, and authority to deduct unpaid fees and interest from Medicaid payments after written notice. The authority may waive interest or penalties for undue hardship conditioned on an alternative payment schedule, accepts late payments submitted in later rate years, and makes successor entities responsible for outstanding obligations after mergers or acquisitions. The definition of the "available fee amount" is incomplete in the provided text, and the content of RCW 74.70.040 (the data submission requirements used for projections) is not included, so some components of the funding and calculation methodology cannot be fully verified from the extracted facts.

If enacted, Medicaid payments for emergency ground ambulance rides would be increased each year by an add-on the Health Care Authority calculates from providers’ reported transport counts and gross revenue. To fund those higher Medicaid reimbursements, most private ground ambulance providers (excluding specified government-owned providers, federally recognized tribes, and air ambulance providers) would pay a quarterly quality assurance fee based on their transports; federal matching funds and interest on the fee proceeds would also be used, and the money must supplement—not replace—existing emergency ambulance funding. That means private ambulance companies are likely to see higher Medicaid revenue but will also take on a new recurring cost, quarterly billing and payment responsibilities, and potential interest, penalties, or Medicaid payment offsets if they fall behind; fees carry special rules for mergers and allow the authority to adjust rates if projections are off by more than one percent. Important details that affect how large the add-on and fees will actually be—such as the complete definition of the “available fee amount,” the specific state medical assistance percentage used in the fee formula, and the data reporting rules the authority will use—are not included in the provided facts, so the exact net financial impact on providers is uncertain.