(1) The commissioner must undertake a process to review the reasonableness of the percentage of the medicare rate established in RCW 48.49.200 and any trends in changes to ground ambulance services rates set by local governmental entities and ground ambulance services organizations' billed charges. In conducting the review, the commissioner should consider the relationship of the rates to the cost of providing ground ambulance services and any impacts on health plan enrollees that may result from health plans increasing in-network consumer cost-sharing for ground ambulance services due to increased rates paid for these services by carriers.

(2) The results of the review must be submitted to the legislature by the earlier of:

(a) October 1, 2026; or

(b) October 1st following any:

(i) Significant trend of increasing rates for ground ambulance services established or contracted for by local governmental entities, increasing billed charges by ground ambulance services organizations, or increasing consumer cost-sharing for ground ambulance services;

(ii) Significant reduction in access to ground ambulance services in Washington state, including in rural or frontier communities; or

(iii) Update in medicare ground ambulance services payment rates by the federal centers for medicare and medicaid services.

(3) The report submitted to the legislature under subsection (2)(a) of this section must include:

(a) Health carrier spending on ground ambulance transports for fully insured health plans and for public and school employee programs administered under chapter 41.05 RCW during plan years 2024 and 2025;

(b) Individual and small group health plan premium trends and cost-sharing trends for ground ambulance services for plan years 2024 and 2025;

(c) Trends in coverage of ground ambulance services for fully insured health plans and for public and school employee programs administered under chapter 41.05 RCW for plan years 2024 and 2025;

(d) A description of current emergency medical services training, equipment, and personnel standards for emergency medical services licensure; and

(e) A description of emergency medical services interfacility transport capabilities in Washington state.