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Bill

HB 2531

Aligning the quality assurance fee for the ambulance transport fund with federal regulations.

2025-2026 Regular Session Introduced by Zach Hall and 8 co-sponsors

Aligns and finances Washington’s ambulance services by tying the quality assurance fee to federal tax rules and funding higher Medicaid emergency ambulance reimbursements.

Effective date 6/11/2026.
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Bill Summary · HB 2531

Summary of HB 2531 (2025-2026) – Washington

Overview

  • Bill: HB 2531
  • Session: 2025-2026
  • Jurisdiction: Washington
  • Title: Aligning the quality assurance fee for the ambulance transport fund with federal regulations
  • Status: Enacted into law. Effective date: June 11, 2026. Chapter 31, 2026 Laws.

Purpose and Intent

The bill aligns Washington’s quality assurance fee (QAF) framework for ambulance transport with federal health care provider-related tax rules and reinforces how the ambulance transport fund (the Fund) is financed and used. It ensures timely invoicing and payment collection, clarifies administration of QAF revenues, and preserves the add-on payments to Medicaid emergency ambulance services funded by QAFs, while adhering to federal constraints on provider-related taxes.

Key Provisions and Changes

  • Payment Timing Adjustments (Administration of QAF):

    • For each state fiscal year, the authority must send each ambulance transport provider an assessment notice no later than 30 days before the start of the applicable state fiscal quarter.
    • For each state fiscal quarter, the authority must send an invoice to each ambulance transport provider no later than 30 days before the payment due date.
    • Ambulance transport providers must remit payment by a date set by the authority, but no earlier than 15 days after the beginning of the applicable state fiscal quarter.

  • Quality Assurance Fee Structure (QAF):

    • The QAF is imposed on licensed ambulance transport providers that bill and receive patient care revenue for ambulance transports; government-owned providers are exempt.
    • The HCA determines the QAF rate each year.
    • Providers subject to the QAF must report quarterly ambulance transports by payer type and annual gross receipts from ambulance transports to the HCA to calculate the fee.

  • Funding and Uses of the Ambulance Transport Fund:

    • QAF revenues and interest are deposited into the Fund, an appropriated account.
    • Fund uses include: (a) HCA administrative costs related to the QAF, (b) increased payments to ambulance providers subject to the QAF, and (c) recovering erroneous or excessive payments made by hospitals.
    • Payments to ambulance providers subject to the QAF are made for Medicaid emergency ambulance services in lieu of State General Fund moneys.

  • Medicaid Reimbursement Changes:

    • Medicaid emergency ambulance reimbursements are increased via an add-on payment to the Medicaid fee-for-service schedule.
    • The add-on must bring total reimbursement for each emergency ambulance transport to at least 60% of the statewide Medicare rate for an emergency ambulance transport or equivalent service.
    • The add-on payments must be funded from QAFs, interest, federal reimbursements, or other related federal funds, and may not supplant existing funds.

  • Federal Compliance:

    • The bill responds to federal constraints on health care provider-related taxes (no new provider taxes unless already enacted as of June 4, 2025) and maintains hold-harmless protections.
    • If there is a surplus or shortage in the Fund, the HCA must recalculate the QAF to align with add-on payments, but increasing provider-related taxes is prohibited under federal law.

Who Is Affected

  • Ambulance Transport Providers: Subject to the QAF, reporting requirements, and quarterly payments. Government-owned providers are exempt.
  • Health Care Authority (HCA): Administers the QAF, sets annual rate, manages reporting, collects fees, and administers the Fund.
  • Medicaid Beneficiaries Requiring Emergency Ambulance Services: Potentially impacted by higher Medicaid emergency ambulance reimbursements via the add-on payments.
  • Hospitals: May experience adjustments in payments due to the Fund’s use to correct erroneous or excessive hospital payments.

Procedural and Timeline Aspects

  • Notice and Invoicing Schedule: Notices to providers issued up to 30 days before each fiscal quarter; quarterly invoices issued up to 30 days before due dates.
  • Payment Timing: QAF payments due no earlier than 15 days after the start of the quarter.
  • Effective Date: The act becomes law June 11, 2026, with immediate operational implications for the 2026-2027 fiscal year and beyond.

Practical Impacts

  • Clarifies and standardizes payment timelines to improve cash flow management for ambulance providers.
  • Ensures QAF revenues are used to support higher Medicaid emergency ambulance reimbursements, while staying within federal tax rules.
  • Provides a structured mechanism to adjust fees in response to funding surpluses or shortfalls, maintaining federal compliance.

If you’d like, I can add a short Q&A section addressing common questions (e.g., how the 60% Medicare-rate target is calculated, or how the hold-harmless provision applies).

Compiled from official sources — confirm details with the bill’s official record.

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