1. An ambulance service that is owned or operated by the state or a state agency, the federal government, a federally recognized Indian tribe, or the Indian Health Service;

2. An ambulance service that is eligible for supplemental Medicaid reimbursement under Section 3242 of Title 63 of the Oklahoma Statutes;

3. An ambulance service that provides air ambulance services only; or

4. An ambulance service that provides nonemergency transports only or a de minimis amount of emergency medical transportation services, as determined by the Authority.

C. 1. The ambulance service provider access payment program fee shall be an assessment imposed on each ambulance service provider, except those exempted under subsection B of this section, for each calendar year in an amount calculated as a percentage of each ambulance service provider's net operating revenue.

2. The assessment rate shall be determined annually based upon the percentage of net operating revenue needed to generate an amount up to the sum of:

In no event shall the assessment rate exceed the maximum rate allowed by federal law or regulation.

3. The assessment rate described in this subsection shall be determined after consultation with the Alliance. The base year for assessment, the method for calculating net operating revenue and related matters not provided for in this section shall be determined by rules promulgated by the Oklahoma Health Care Authority Board.

D. 1. If an ambulance service provider conducts, operates or maintains more than one licensed ambulance service, the ambulance service provider shall pay the ambulance service provider access payment program fee for each ambulance service separately. However, if the ambulance service provider operates more than one ambulance service under one Medicaid provider number, the ambulance service provider may pay the fee for the ambulance services in the aggregate.

2. Notwithstanding any other provision of this section, if an ambulance service provider subject to the ambulance service provider access payment fee operates or conducts business only for a portion of a year, the assessment for the year shall be adjusted by multiplying the annual assessment by a fraction, the numerator of which is the number of days in the year during which the ambulance service operates and the denominator of which is three hundred sixty-five (365). Immediately upon ceasing to operate, the ambulance service provider shall pay the assessment for the year as so adjusted, to the extent not previously paid.

3. The Authority shall determine the assessment for new ambulance services and ambulance services that undergo a change of ownership, in accordance with this section, using the best available information, as determined by the Authority.

E. 1. In the event that federal financial participation pursuant to Title XIX of the Social Security Act is not available to the state Medicaid program for purposes of matching expenditures from the Ambulance Service Provider Access Payment Program Fund at the approved federal medical assistance percentage for the applicable year, the ambulance service provider access payment program fee shall be null and void as of the date of the nonavailability of such federal funding through and during any period of nonavailability.

2. In the event of an invalidation of the Ambulance Service Provider Access Payment Program by any court of last resort, the program shall be null and void as of the effective date of that invalidation.

3. In the event that the Ambulance Service Provider Access Payment Program is determined to be null and void for any of the reasons described in this subsection, any ambulance service provider access payment program fee assessed and collected for any period to which such invalidation applies shall be returned in full within forty-five (45) days by the Authority to the ambulance service from which it was collected.

1. Submit the ambulance service provider access payment program fee;

2. Submit the fee in a timely manner;

3. Submit reports as required by the Authority; or

4. Submit reports timely.