# WAC 284-43B-027: WAC 284-43B-027. Payments to nonparticipating ground ambulance services organizations > Washington · Regulations · In force URL: https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_027 ## Section - **Citation:** WAC 284-43B-027 - **Heading:** WAC 284-43B-027. Payments to nonparticipating ground ambulance services organizations - **Jurisdiction:** Washington - **Kind:** Regulations - **Status:** In force - **Text as of:** August 14, 2026 - **Source:** Compiled text - **Location:** Washington Administrative Code / Title 284 / Chapter 284-43B / Section 284-43B-027 ## Text (1) Except for mutual aid transports as provided in subsection (2) of this section, until December 31, 2027, the allowed amount paid to a nonparticipating ground ambulance services organization for covered ground ambulance services under a health plan issued by a carrier must be one of the following amounts: (a)(i) 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 and submitted to the office of the insurance commissioner; or (ii) 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 submitted to the office of the insurance commissioner; (b) If a rate has not been established under (a) of this subsection, the lesser of: (i) 325 percent of the current published rate for ambulance services as established by the federal Centers for Medicare and Medicaid Services under Title XVIII of the Social Security Act for the same service provided in the same geographic area; or (ii) The ground ambulance services organization's billed charges. (2) Until December 31, 2027, when a ground ambulance services organization provides a ground ambulance transport outside of their primary geographic service area, also referred to as mutual aid, the rate paid is: (a) The locally set rate for the ground ambulance services organization that provided the transport; or (b) If there is no locally set rate, the lesser of: organization's billed charges. (2) Until December 31, 2027, when a ground ambulance services organization provides a ground ambulance transport outside of their primary geographic service area, also referred to as mutual aid, the rate paid is: (a) The locally set rate for the ground ambulance services organization that provided the transport; or (b) If there is no locally set rate, the lesser of: (i) 325 percent of the current published rate for ambulance services as established by the federal Centers for Medicare and Medicaid Services under Title XVIII of the Social Security Act for the same service provided in the same geographic area; or (ii) The ground ambulance services organization's billed charges. (3) A carrier may rely in good faith upon the applicable locally set rate submitted to the insurance commissioner under WAC 284-43B-029 . Except to the extent provided otherwise in WAC 284-43B-029 (4)(b), if a local governmental entity's updated rates are not submitted 60 days in advance of the effective date of the updated rate, as provided in WAC 284-43B-029 , the carrier may rely upon the most recent previous rate submission by that local governmental entity for a period of 60 days following the date the updated rate is published in the insurance commissioner's publicly accessible database. (4) A carrier shall make payments for ground ambulance services provided by nonparticipating ground ambulance services organizations directly to the organization, rather than the enrollee. (5) The allowed amount established under this section 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 section. lee. (5) The allowed amount established under this section 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 section. (6) For purposes of this section "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. ## Nearby sections - [WAC 284-43B-010 WAC 284-43B-010. Definitions](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_010.md) - [WAC 284-43B-015 WAC 284-43B-015. Coverage of emergency services](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_015.md) - [WAC 284-43B-020 WAC 284-43B-020. Balance billing prohibition and consumer cost-sharing](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_020.md) - [WAC 284-43B-025 WAC 284-43B-025. Balance billing prohibition and consumer cost-sharing for ground ambulance services](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_025.md) - [WAC 284-43B-027 WAC 284-43B-027. Payments to nonparticipating ground ambulance services organizations](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_027.md) - [WAC 284-43B-029 WAC 284-43B-029. Local governmental entity rate reporting to the insurance commissioner](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_029.md) - [WAC 284-43B-030 WAC 284-43B-030. Out-of-network claim payment and placing a claim into dispute](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_030.md) - [WAC 284-43B-032 WAC 284-43B-032. Applicable dispute resolution system](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_032.md) - [WAC 284-43B-035 WAC 284-43B-035. Arbitration initiation and selection of arbitrator](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_035.md) - [WAC 284-43B-037 WAC 284-43B-037. Arbitration proceedings](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_037.md) - [WAC 284-43B-040 WAC 284-43B-040. Determining whether an enrollee's health plan is subject to the requirements of the act](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_040.md) - [WAC 284-43B-050 WAC 284-43B-050. Notice of consumer rights and transparency](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_050.md) - [WAC 284-43B-060 WAC 284-43B-060. Enforcement](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_060.md) - [WAC 284-43B-070 WAC 284-43B-070. Self-funded group health plan opt in](https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_070.md) --- Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_WA_ADC_284_43B_027. Check the current official text before relying on it. Not legal advice.