| State of Utah Medicaid | 4/15/2025 | ||||
| Ambulance Assessment | |||||
| R426-8-2(3)(a) | Rate Basis: | ||||
| SFY 2025 | Q3 | Q1 | |||
| Service Dates: | >=7/1/2015 | Q2 | Amount to fund Enhanced Rate | $ 9,301,416.64 | |
| SFY Paid Dates in: | Jan-Mar | Q3 | Federal Share | $ 7,226,642.45 | |
| Q4 | State Share | $ 2,074,774.19 | |||
| Admin Fee (Annual) | $ 20,000.00 | ||||
| Calendar Year Transport Data: | 2023 | Admin Fee (Qtr) | $ 5,000.00 | ||
| Calendar Year (2023) Transports (all payors) | 172,030 | Total Assessment Needed | $ 2,079,774.19 | ||
| SFY | 2025 | Prior Calendar Year Per-Transport Rate | $ 12.09 | ||
| Provider Name | Provider ID | Vendor # | Ground Transports | % of Ground | Invoice Amount |
| AMBULANCE SRVCS OF TOOELE | 102410300 | VC197381 | 3,708 | 2.16% | $ 44,828.24 |
| AMERICAN FORK AMBULANCE | 101056600 | VC197382 | 2,732 | 1.59% | $ 33,028.79 |
| BEAVER AMBULANCE | 102211200 | VC0000180552 | 306 | 0.18% | $ 3,699.42 |
| BLUFFDALE FIRE DEPT | 102677900 | VC197520 | 227 | 0.13% | $ 2,744.34 |
| Box Elder County Ambulance | MedicaidID04 | VC206667 | 10 | 0.01% | $ 120.90 |
| BRIGHAM CITY CORP AMB | 100855200 | VC206653 | 2,198 | 1.28% | $ 26,572.94 |
| Cache County Fire District | 404290501 | VC251740 | 552 | 0.32% | $ 6,673.46 |
| CARBON COUNTY AMBULANCE | 101421900 | VC197384 | 1,386 | 0.81% | $ 16,756.19 |
| Cedar Mountain Fire | 407174701 | VC262525 | 120 | 0.07% | $ 1,450.75 |
| CITY OF ENTERPRISE AMBU | 101391300 | VC197460 | 138 | 0.08% | $ 1,668.37 |
| CITY OF SARATOGA SPRINGS | 100635900 | VC197386 | 816 | 0.47% | $ 9,865.12 |
| CITY OF SOUTH SALT LAKE | 101240500 | VC197387 | 2,945 | 1.71% | $ 35,603.88 |
| Clinton City Fire Department | 102102700 | VC197389 | 513 | 0.30% | $ 6,201.97 |
| CURLEW EMERGENCY MED | 102709000 | VC197463 | 43 | 0.02% | $ 519.85 |
| DRAPER CITY AMBULANCE | 100225100 | VC221541 | 1,565 | 0.91% | $ 18,920.23 |
| EMERY COUNTY AMBULANCE | 100736300 | VC197390 | 560 | 0.33% | $ 6,770.18 |
| EPHRAIM AMBULANCE ASSOC | 102352500 | VC197393 | 287 | 0.17% | $ 3,469.72 |
| FARMINGTON FIRE DEPT AMB | 101880000 | VC197522 | 801 | 0.47% | $ 9,683.77 |
| Fielding Fire Department | MedicaidID01 | VC197468 | 53 | 0.03% | $ 640.75 |
| FLAMING GORGE FIRE AND EMS DISTRICT | MedicaidID06 | (blank) | 37 | 0.02% | $ 447.32 |
| GARFIELD COUNTY AMBULANCE | 102605500 | VC197394 | 373 | 0.22% | $ 4,509.42 |
| GOLD CROSS AMBULANCE | 102031000 | VC197396 | 59,544 | 34.61% | $ 719,863.25 |
| Grand County Emergency Medical Services Special Se | 301114900 | VC197397 | 870 | 0.51% | $ 10,517.95 |
| GUNNISON VALLEY HOSP-AMBUL | 102412600 | VC197469 | 480 | 0.28% | $ 5,803.01 |
| HILDALE FIRE DEPARTMENT | 102982100 | VC197470 | 136 | 0.08% | $ 1,644.19 |
| HURRICANE VALLEY FIRE | 102157900 | VC197399 | 2,438 | 1.42% | $ 29,474.45 |
| JUAB COUNTY AMBULANCE | 100854900 | VC197403 | 678 | 0.39% | $ 8,196.75 |
| KANE COUNTY AMBULANCE | 102413700 | VC197405 | 746 | 0.43% | $ 9,018.84 |
| KAYSVILLE CITY FIRE DEPT | 102214900 | VC197406 | 728 | 0.42% | $ 8,801.23 |
| LAYTON CITY FIRE DEPT AMB | 100700900 | VC197407 | 4,588 | 2.67% | $ 55,467.09 |
| LEHI CITY AMBULANCE | 100853400 | VC197526 | 2,507 | 1.46% | $ 30,308.63 |
| Logan City Fire Department | 402785601 | VC251746 | 3,635 | 2.11% | $ 43,945.70 |
| LONE PEAK AMBULANCE | 103021900 | VC197409 | 456 | 0.27% | $ 5,512.86 |
| MANTI AMBULANCE ASSOC | 101706000 | VC197527 | 206 | 0.12% | $ 2,490.46 |
| MAPLETON CITY AMBULANCE | 101501700 | VC197528 | 364 | 0.21% | $ 4,400.62 |
| MILFORD MEM HOSP PHYS GRP | 101268200 | VC197410 | 150 | 0.09% | $ 1,813.44 |
| MILLARD COUNTY AMBULANCE | 100729700 | VC197411 | 718 | 0.42% | $ 8,680.33 |
| MORGAN COUNTY AMBULANCE | 100499000 | VC197473 | 247 | 0.14% | $ 2,986.13 |
| MOUNTAIN WEST INC | 102930500 | VC197474 | 377 | 0.22% | $ 4,557.78 |
| MURRAY CITY FIRE DEPT | 101592700 | VC197412 | 2,500 | 1.45% | $ 30,224.00 |
| North Davis Fire District | 102306300 | VC228626 | 1,570 | 0.91% | $ 18,980.67 |
| North Fork Fire Department | MedicaidID02 | VC197476 | 83 | 0.05% | $ 1,003.44 |
| NORTH SANPETE AMBULANCE | 102040900 | VC197529 | 754 | 0.44% | $ 9,115.56 |
| North Summit Fire District | 426967901 | VC229247 | 167 | 0.10% | $ 2,018.96 |
| NORTH VIEW FIRE AGENCY | 102604500 | VC197413 | 1,564 | 0.91% | $ 18,908.14 |
| Ogden City Corporation | 102439100 | VC197414 | 9,764 | 5.68% | $ 118,042.87 |
| OREM FIRE DEPARTMENT | 102743700 | VC197477 | 2,844 | 1.65% | $ 34,382.83 |
| PARK CITY AMBULANCE | 100426200 | VC197530 | 2,518 | 1.46% | $ 30,441.62 |
| PAYSON AMBULANCE | 102067600 | VC197532 | 1,180 | 0.69% | $ 14,265.73 |
| PIUTE CO AMBULANCE SRVC | 102067700 | VC197415 | 161 | 0.09% | $ 1,946.43 |
| PLEASANT GROVE AMBULANCE | 100695900 | VC197417 | 697 | 0.41% | $ 8,426.45 |
| Plymouth Town Corporation | 100454600 | VC197418 | 64 | 0.04% | $ 773.73 |
| PROVO CITY CORP | 100701500 | VC197419 | 2,413 | 1.40% | $ 29,172.21 |
| RICH COUNTY AMBULANCE | 101836400 | VC197420 | 90 | 0.05% | $ 1,088.06 |
| RIVERDALE CITY AMBULANCE | 100685500 | VC197422 | 457 | 0.27% | $ 5,524.95 |
| ROY CITY AMBULANCE | 100027300 | VC197425 | 2,587 | 1.50% | $ 31,275.80 |
| SALEM EMERGENCY MED AMB | 100332500 | VC197479 | 246 | 0.14% | $ 2,974.04 |
| SAN JUAN CO EMERGENCY | 102743400 | VC197427 | 486 | 0.28% | $ 5,875.55 |
| SANDY CITY AMBULANCE | 101016300 | VC197429 | 2,768 | 1.61% | $ 33,464.02 |
| Santa Clara Ivins Fire and Rescue | 301049400 | VC225033 | 601 | 0.35% | $ 7,265.85 |
| SANTAQUIN AMBULANCE | 101120200 | VC197533 | 270 | 0.16% | $ 3,264.19 |
| Scipio Ambulance | MedicaidID03 | VC197534 | 26 | 0.02% | $ 314.33 |
| SEVIER COUNTY AMBULANCE | 100629600 | VC197430 | 1,542 | 0.90% | $ 18,642.17 |
| Smithfield Fire and EMS | 403731502 | VC251747 | 868 | 0.50% | $ 10,493.77 |
| SOUTH DAVIS METRO FIRE | 101736400 | VC197431 | 3,589 | 2.09% | $ 43,389.58 |
| SOUTH JORDAN FIRE DEPT | 101307900 | VC197480 | 3,992 | 2.32% | $ 48,261.69 |
| SOUTH OGDEN CITY FIRE DEPT | 102946200 | VC197434 | 1,237 | 0.72% | $ 14,954.84 |
| SOUTH SUMMIT FIRE PROTECTION DISTRICT | 429295301 | VC0000277580 | 232 | 0.13% | $ 2,804.79 |
| South Weber Fire | 405220401 | VC251066 | 121 | 0.07% | $ 1,462.84 |
| SPANISH FORK AMBULANCE | 100629800 | VC197435 | 2,121 | 1.23% | $ 25,642.05 |
| SPRINGVILLE AMBULANCE SRVC | 101838700 | VC197481 | 849 | 0.49% | $ 10,264.07 |
| St George Regional Hospital | 101078700 | VC197464 | 93 | 0.05% | $ 1,124.33 |
| SUNNYSIDE AMBULANCE SRVC | 100722100 | VC240417 | 187 | 0.11% | $ 2,260.76 |
| SYRACUSE CITY CORPORATION | 100811600 | VC197437 | 538 | 0.31% | $ 6,504.21 |
| TREMONTON CITY CORP | 101533100 | VC197482 | 894 | 0.52% | $ 10,808.10 |
| UINTAH BASIN MED CTR | 102630600 | VC197535 | 1,122 | 0.65% | $ 13,564.53 |
| UNIFIED FIRE AUTHORITY | 100169800 | VC197438 | 12,664 | 7.36% | $ 153,102.72 |
| UTAH NAVAJO HLTH SYST AMB | 101786100 | VC197439 | 459 | 0.27% | $ 5,549.13 |
| UTE TRIBE AMBULANCE | 102782700 | VC197440 | 303 | 0.18% | $ 3,663.15 |
| WASATCH COUNTY FIRE DISTRICT | 101707800 | VC197441 | 1,573 | 0.91% | $ 19,016.94 |
| WAYNE COUNTY AMBULANCE | 100338200 | VC197442 | 135 | 0.08% | $ 1,632.10 |
| WEBER FIRE DISTRICT | 100344100 | VC197518 | 787 | 0.46% | $ 9,514.52 |
| WEST JORDAN FIRE and AMBUL | 101278800 | VC197443 | 2,392 | 1.39% | $ 28,918.33 |
| WEST VALLEY CITY FIRE AMB | 102824900 | VC197458 | 4,284 | 2.49% | $ 51,791.85 |
| Grand Total | 172,030 | 100.00% | $2,079,774.19 |