SB 1300: Medi-Cal: emergency medical transport providers: quality assurance fee.
- Session Year: 2015-2016
- House: Senate
- Latest Version Date: 2016-08-29
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law establishes a quality assurance fee program for skilled nursing and intermediate care facilities, as prescribed.
This bill, commencing July 1, 2017, and subject to federal approval, would impose a quality assurance fee for each emergency medical transport provided by an emergency medical transport provider, as defined, subject to the quality assurance fee in accordance with a prescribed methodology. The bill would authorize the director to exempt categories of emergency medical transport providers from the quality assurance fee if necessary to obtain federal approval. The bill would require the Director of Health Care Services to deposit the collected quality assurance fee into the Medi-Cal Emergency Medical Transport Fund, which the bill would create in the State Treasury, to be continuously appropriated, thereby making an appropriation, to the department to be used exclusively in a specified order of priority to enhance federal financial participation for ambulance services under the Medi-Cal program, and to provide additional reimbursement to, and to support quality improvement efforts of, emergency medical transport providers, to pay for state administrative costs, and to provide funding for health care coverage for Californians. The bill, on or before November 15, 2016, would require each emergency medical transport provider to report to the department specified data, including data on gross receipts, as defined, from the provision of emergency medical transports, as specified, in a manner and form prescribed by the department and, commencing on January 1, 2017, and each fiscal quarter thereafter, would require each emergency medical transport provider to report this data to the department. The bill would authorize the department to establish an Internet Web site for the submission of these data reports. The bill would authorize the department to require a certification by each emergency medical transport provider, under penalty of perjury, of the truth of these data reports. By expanding the scope of the crime of perjury, the bill would impose a state-mandated local program. The bill would authorize the department, upon written notice to the emergency medical transport provider, to impose a $100 per day penalty against the provider for each day that the provider fails to make a report within 5 business days of the date upon which the data report was due.
The bill, commencing July 1, 2017, and subject to federal approval, would increase the Medi-Cal reimbursement to emergency medical transport providers for emergency medical transports, including both fee-for-service transports paid by the department and managed care transports paid by Medi-Cal managed care health plans, as specified.
The bill would authorize the department to adopt regulations as necessary to implement these provisions, as specified.
The bill would provide that the provisions of the bill shall cease to be implemented if any of certain conditions, including withdrawal of federal approval, are satisfied.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
This bill would declare that it is to take effect immediately as an urgency statute.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law establishes a quality assurance fee program for skilled nursing and intermediate care facilities, as prescribed.
This bill, commencing July 1, 2017, and subject to federal approval, would impose a quality assurance fee for each transport provided by an emergency medical transport provider, as defined, subject to the quality assurance fee in accordance with a prescribed methodology. The bill would authorize the director to exempt categories of emergency medical transport providers from the quality assurance fee if necessary to obtain federal approval. The bill would require the Director of Health Care Services to deposit the collected quality assurance fee into the Medi-Cal Emergency Medical Transport Fund, which the bill would create in the State Treasury, to be continuously appropriated, thereby making an appropriation, to the department to be used exclusively in a specified order of priority to enhance federal financial participation for ambulance services under the Medi-Cal program, and to provide additional reimbursement to, and to support quality improvement efforts of, emergency medical transport providers, to pay for state administrative costs, and to provide funding for health care coverage for Californians. The bill, on or before November 15, 2016, would require each emergency medical transport provider to report to the department specified data, including data on gross receipts, as defined, from the provision of emergency medical transports, as specified, in a manner and form prescribed by the department and, commencing on January 1, 2017, and each fiscal quarter thereafter, would require each emergency medical transport provider to report this data to the department. The bill would authorize the department to establish an Internet Web site for the submission of these data reports. The bill would authorize the department to require a certification by each emergency medical transport provider, under penalty of perjury, of the truth of these data reports. By expanding the scope of the crime of perjury, the bill would impose a state-mandated local program. The bill would authorize the department, upon written notice to the emergency medical transport provider, to impose a $100 per day penalty against the provider for each day that the provider fails to make a report within 5 business days of the date upon which the data report was due.
The bill, commencing July 1, 2017, and subject to federal approval, would increase the Medi-Cal reimbursement to emergency medical transport providers for emergency medical transports, including both fee-for-service transports paid by the department and managed care transports paid by Medi-Cal managed care health plans, as specified.
The bill would authorize the department to adopt regulations as necessary to implement these provisions, as specified.
The bill would provide that the provisions of the bill shall cease to be implemented if any of certain conditions, including withdrawal of federal approval, are satisfied.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
This bill would declare that it is to take effect immediately as an urgency statute.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law establishes a quality assurance fee program for skilled nursing and intermediate care facilities, as prescribed.
This bill, commencing July 1, 2017, and subject to federal approval, would impose a quality assurance fee for each transport provided by an emergency medical transport provider, as defined, subject to the quality assurance fee in accordance with a prescribed methodology. The bill would authorize the director to exempt categories of emergency medical transport providers from the quality assurance fee if necessary to obtain federal approval. The bill would require the Director of Health Care Services to deposit the collected quality assurance fee into the Medi-Cal Emergency Medical Transport Fund, which the bill would create in the State Treasury, to be continuously appropriated, thereby making an appropriation, to the department to be used exclusively in a specified order of priority to enhance federal financial participation for ambulance services under the Medi-Cal program, and to provide additional reimbursement to, and to support quality improvement efforts of, emergency medical transport providers, to pay for state administrative costs, and to provide funding for health care coverage for Californians. The bill, on or before November 15, 2016, would require each emergency medical transport provider to report to the department specified data, including data on gross receipts, as defined, from the provision of emergency medical transports, as specified, in a manner and form prescribed by the department and, commencing on January 1, 2017, and each fiscal quarter thereafter, would require each emergency medical transport provider to report this data to the department. The bill would authorize the department to establish an Internet Web site for the submission of these data reports. The bill would authorize the department to require a certification by each emergency medical transport provider, under penalty of perjury, of the truth of these data reports. By expanding the scope of the crime of perjury, the bill would impose a state-mandated local program. The bill would authorize the department, upon written notice to the emergency medical transport provider, to impose a $100 per day penalty against the provider for each day that the provider fails to make a report within 5 business days of the date upon which the data report was due.
The bill, commencing July 1, 2017, and subject to federal approval, would increase the Medi-Cal reimbursement to emergency medical transport providers for emergency medical transports, including both fee-for-service transports paid by the department and managed care transports paid by Medi-Cal managed care health plans, as specified.
The bill would authorize the department to adopt regulations as necessary to implement these provisions, as specified.
The bill would provide that the provisions of the bill shall cease to be implemented if any of certain conditions, including withdrawal of federal approval, are satisfied.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
This bill would declare that it is to take effect immediately as an urgency statute.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law establishes a quality assurance fee program for skilled nursing and intermediate care facilities, as prescribed.
This bill, commencing July 1, 2017, and subject to federal approval, would impose a quality assurance fee for each transport provided by an emergency medical transport provider, as defined, subject to the quality assurance fee in accordance with a prescribed methodology. The bill would authorize the director to exempt categories of emergency medical transport providers from the quality assurance fee if necessary to obtain federal approval. The bill would require the Director of Health Care Services to deposit the collected quality assurance fee into the Medi-Cal Emergency Medical Transport Fund, which the bill would create in the State Treasury, to be continuously appropriated, thereby making an appropriation, to the department to be used exclusively in a specified order of priority to enhance federal financial participation for ambulance services under the Medi-Cal program, and to provide additional reimbursement to, and to support quality improvement efforts of, emergency medical transport providers, to pay for state administrative costs, and to provide funding for health care coverage for Californians. The bill, on or before August 15, 2016, November 15, 2016, would require each emergency medical transport provider to report to the department specified data, including data on gross receipts, as defined, from the provision of emergency medical transports, as specified, in a manner and form prescribed by the department and, commencing on October 1, 2016, January 1, 2017, and each fiscal quarter thereafter, would require each emergency medical transport provider to report this data to the department. The bill would authorize the department to establish an Internet Web site for the submission of these data reports. The bill would authorize the department to require a certification by each emergency medical transport provider, under penalty of perjury, of the truth of these data reports. By expanding the scope of the crime of perjury, the bill would impose a state-mandated local program. The bill would authorize the department, upon written notice to the emergency medical transport provider, to impose a $100 per day penalty against the provider for each day that the provider fails to make a report within 5 business days of the date upon which the data report was due. The bill would provide that the failure to make a report under these provisions within 90 days of the date upon which the report was due shall be considered a violation that relates to his or her licensed activities for purposes of a specified section of the Vehicle Code, which authorizes the Commissioner of the California Highway Patrol to suspend, revoke, or take other disciplinary action against a license if the licensee violates any section of the Vehicle Code that relates to his or her licensed activities.
The bill, commencing July 1, 2017, and subject to federal approval, would increase the Medi-Cal reimbursement to emergency medical transport providers for emergency medical transports, including both fee-for-service transports paid by the department and managed care transports paid by Medi-Cal managed care health plans, as specified.
The bill would authorize the department to adopt regulations as necessary to implement these provisions, as specified.
The bill would provide that the provisions of the bill shall cease to be implemented if any of certain conditions, including withdrawal of federal approval, are satisfied.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
This bill would declare that it is to take effect immediately as an urgency statute.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law establishes a quality assurance fee program for skilled nursing and intermediate care facilities, as prescribed.
This bill, commencing July 1, 2017, and subject to federal approval, would impose a quality assurance fee for each transport provided by an emergency medical transport provider, as defined, subject to the quality assurance fee in accordance with a prescribed methodology. The bill would authorize the director to exempt categories of emergency medical transport providers from the quality assurance fee if necessary to obtain federal approval. The bill would require the Director of Health Care Services to deposit the collected quality assurance fee into the Medi-Cal Emergency Medical Transport Fund, which the bill would create in the State Treasury, to be continuously appropriated, thereby making an appropriation, to the department to be used exclusively in a specified order of priority to enhance federal financial participation for ambulance services under the Medi-Cal program, and to provide additional reimbursement to, and to support quality improvement efforts of, emergency medical transport providers, to pay for state administrative costs, and to provide funding for health care coverage for Californians. The bill, on or before August 15, 2016, would require each emergency medical transport provider to report to the department specified data, including data on gross receipts, as defined, from the provision of emergency medical transports, as specified, in a manner and form prescribed by the department and, commencing on October 1, 2016, and each fiscal quarter thereafter, would require each emergency medical transport provider to report this data to the department. The bill would authorize the department to establish an Internet Web site for the submission of these data reports. The bill would authorize the department to require a certification by each emergency medical transport provider, under penalty of perjury, of the truth of these data reports. By expanding the scope of the crime of perjury, the bill would impose a state-mandated local program. The bill would authorize the department, upon written notice to the emergency medical transport provider, to impose a $100 per day penalty against the provider for each day that the provider fails to make a report within 5 business days of the date upon which the data report was due. The bill would provide that the failure to make a report under these provisions within 90 days of the date upon which the report was due shall be considered a violation that relates to his or her licensed activities for purposes of a specified section of the Vehicle Code, which authorizes the Commissioner of the California Highway Patrol to suspend, revoke, or take other disciplinary action against a license if the licensee violates any section of the Vehicle Code that relates to his or her licensed activities.
The bill, commencing July 1, 2017, and subject to federal approval, would increase the Medi-Cal reimbursement to emergency medical transport providers for emergency medical transports, including both fee-for-service transports paid by the department and managed care transports paid by Medi-Cal managed care health plans, as specified.
The bill would authorize the department to adopt regulations as necessary to implement these provisions, as specified.
The bill would provide that the provisions of the bill shall cease to be implemented if any of certain conditions, including continued withdrawal of federal approval, are no longer satisfied.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
This bill would declare that it is to take effect immediately as an urgency statute.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law establishes a quality assurance fee program for skilled nursing and intermediate care facilities, as prescribed.
This bill, commencing July 1, 2017, and subject to federal approval, would impose a quality assurance fee for each transport provided by an emergency medical transport provider, as defined, subject to the quality assurance fee in accordance with a prescribed methodology. The bill would authorize the director to exempt categories of emergency medical transport providers from the quality assurance fee if necessary to obtain federal approval. The bill would require the Director of Health Care Services to deposit the collected quality assurance fee into the Medi-Cal Emergency Medical Transport Fund, which the bill would create in the State Treasury, to be continuously appropriated, thereby making an appropriation, to the department to be used exclusively in a specified order of priority to enhance federal financial participation for ambulance services under the Medi-Cal program, and to provide additional reimbursement to, and to support quality improvement efforts of, emergency medical transport providers, to pay for state administrative costs, and to provide funding for health care coverage for Californians. The bill, on or before August 15, 2016, would require each emergency medical transport provider to report to the department specified data, including data on gross receipts, as defined, from the provision of emergency medical transports, as specified, in a manner and form prescribed by the department and, commencing on October 1, 2016, and each fiscal quarter thereafter, would require each emergency medical transport provider to report this data to the department. The bill would authorize the department to establish an Internet Web site for the submission of these data reports. The bill would authorize the department to require a certification by each emergency medical transport provider, under penalty of perjury, of the truth of these data reports. By expanding the scope of the crime of perjury, the bill would impose a state-mandated local program. The bill would authorize the department, upon written notice to the emergency medical transport provider, to impose a $100 per day penalty against the provider for each day that the provider fails to make a report within 5 business days of the date upon which the data report was due. The bill would provide that the failure to make a report under these provisions within 90 days of the date upon which the report was due shall be considered a violation that relates to his or her licensed activities for purposes of a specified section of the Vehicle Code, which authorizes the Commissioner of the California Highway Patrol to suspend, revoke, or take other disciplinary action against a license if the licensee violates any section of the Vehicle Code that relates to his or her licensed activities.
The bill, commencing July 1, 2017, and subject to federal approval, would increase the Medi-Cal reimbursement to private emergency medical transport providers for emergency medical transports, including both fee-for-service transports paid by the department and managed care transports paid by Medi-Cal managed care health plans, as specified.
The bill would authorize the department to adopt regulations as necessary to implement these provisions, as specified.
The bill would provide that the provisions of the bill shall cease to be implemented if any of certain conditions, including continued federal approval, are no longer satisfied.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
This bill would declare that it is to take effect immediately as an urgency statute.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law establishes a quality assurance fee program for skilled nursing and intermediate care facilities, as prescribed.
This bill, commencing July 1, 2017, and subject to federal approval, would impose a quality assurance fee for each transport provided by an emergency medical transport provider, as defined, subject to the quality assurance fee in accordance with a prescribed methodology. The bill would authorize the director to exempt categories of emergency medical transport providers from the quality assurance fee if necessary to obtain federal approval. The bill would require the Director of Health Care Services to deposit the collected quality assurance fee into the Medi-Cal Emergency Medical Transport Fund, which the bill would create in the State Treasury, to be continuously appropriated, thereby making an appropriation, to the department to be used exclusively in a specified order of priority to enhance federal financial participation for ambulance services under the Medi-Cal program, and to provide additional reimbursement to, and to support quality improvement efforts of, emergency medical transport providers, to pay for state administrative costs, and to provide funding for health care coverage for Californians. The bill, on or before August 15, 2016, would require each emergency medical transport provider to report to the department specified data, including data on gross receipts, as defined, from the provision of emergency medical transports, as specified, in a manner and form prescribed by the department and, commencing on October 1, 2016, and each fiscal quarter thereafter, would require each emergency medical transport provider to report this data to the department. The bill would authorize the department to establish an Internet Web site for the submission of these data reports. The bill would authorize the department to require a certification by each emergency medical transport provider, under penalty of perjury, of the truth of these data reports. By expanding the scope of the crime of perjury, the bill would impose a state-mandated local program. The bill would authorize the department, upon written notice to the emergency medical transport provider, to impose a $100 per day penalty against the provider for each day that the provider fails to make a report within 5 business days of the date upon which the data report was due. The bill would provide that the failure to make a report under these provisions within 90 days of the date upon which the report was due shall be considered a violation that relates to his or her licensed activities for purposes of a specified section of the Vehicle Code, which authorizes the Commissioner of the California Highway Patrol to suspend, revoke, or take other disciplinary action against a license if the licensee violates any section of the Vehicle Code that relates to his or her licensed activities.
The bill, commencing July 1, 2017, and subject to federal approval, would increase the Medi-Cal reimbursement to private emergency medical transport providers for emergency medical transports, including both fee-for-service transports paid by the department and managed care transports paid by Medi-Cal managed care health plans, as specified.
The bill would authorize the department to adopt regulations as necessary to implement these provisions, as specified.
The bill would provide that the provisions of the bill shall cease to be implemented if any of certain conditions, including continued federal approval, are no longer satisfied.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
This bill would declare that it is to take effect immediately as an urgency statute.
Existing law establishes various programs to provide health care coverage to persons with limited financial resources, including the Medi-Cal program and the States Childrens Health Insurance Program. Existing law establishes the California Health Benefit Exchange (Exchange), pursuant to the federal Patient Protection and Affordable Care Act (PPACA), and specifies the duties and powers of the board governing the Exchange relative to determining eligibility for enrollment in the Exchange and arranging for coverage under qualified health plans, and facilitating the purchase of qualified health plans through the Exchange. Existing law, the Health Care Reform Eligibility, Enrollment, and Retention Planning Act, requires the State Department of Social Services in consultation with specified entities, to establish standardized single, accessible, application forms and related renewal procedures for insurance affordability programs, as defined, in accordance with specified requirements relating to the forms and notices developed for these purposes.
This bill would make technical, nonsubstantive changes to those provisions.
Existing law establishes various programs to provide health care coverage to persons with limited financial resources, including the Medi-Cal program and the States Childrens Health Insurance Program. Existing law establishes the California Health Benefit Exchange (Exchange), pursuant to the federal Patient Protection and Affordable Care Act (PPACA), and specifies the duties and powers of the board governing the Exchange relative to determining eligibility for enrollment in the Exchange and arranging for coverage under qualified health plans, and facilitating the purchase of qualified health plans through the Exchange. Existing law, the Health Care Reform Eligibility, Enrollment, and Retention Planning Act, requires the State Department of Social Services in consultation with specified entities, to establish standardized single, accessible, application forms and related renewal procedures for insurance affordability programs, as defined, in accordance with specified requirements relating to the forms and notices developed for these purposes.
This bill would make technical, nonsubstantive changes to those provisions.
The Legislature finds and declares all of the following:
(a)The Legislature recognizes the essential role that emergency medical transport providers play in serving the states Medi-Cal beneficiaries. To that end, it has been and remains the intent of the Legislature to improve funding for emergency medical transport providers and obtain all available federal funds to make supplemental Medi-Cal payments to emergency medical transport providers.
(b)It is the intent of the Legislature to impose a quality assurance fee to be paid by emergency medical transport providers, which will be used to increase federal financial participation in order to increase Medi-Cal payments to emergency medical transport providers.
(c)It is the intent of the Legislature to increase the Medi-Cal emergency medical transport reimbursement in Medi-Cal fee-for-service and Medi-Cal managed care by increasing the fee-for-service payment schedule for emergency medical transports to support quality improvement efforts by emergency medical transport providers, including, but not limited to, the provision of advanced life support services, as defined in Section 1797.52 of the Health and Safety Code.
(d)It is the further intent of the Legislature that the increased fee-for-service and Medi-Cal managed care payment schedule amounts pursuant to this article shall not result in any expenditure from the General Fund.
SEC. 2.Article 3.91 (commencing with Section 14129) is added to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, to read:3.91.Medi-Cal Emergency Medical Transportation Reimbursement Act14129.For purposes of this article, the following definitions shall apply:
(a)Annual quality assurance fee rate means the quality assurance fee assessed on each emergency medical transport applicable to each state fiscal year.
(b)Aggregate fee schedule increase amount means the product of the quotient described in paragraph (2) of subdivision (a) of Section 14129.3 and the Medi-Cal emergency medical transports, including both fee-for-service transports paid by the department and managed care transports paid by Medi-Cal managed care health plans, utilizing the billing codes for emergency medical transport for the state fiscal year.
(c)Available fee amount shall be calculated as the sum of the following:
(1)The amount deposited in the Medi-Cal Emergency Transportation Fund established under Section 14129.2 during the applicable state fiscal year, less the amounts described in subparagraphs (A) and (B) of paragraph (2) of subdivision (f) of Section 14129.2.
(2)Any federal financial participation obtained as a result of the deposit of the amount described in paragraph (1) in the Medi-Cal Emergency Transportation Fund for the applicable fiscal year.
(d)Department means the State Department of Health Care Services.
(e)Director means the Director of Health Care Services.
(f)Effective state medical assistance percentage means a ratio of the aggregate expenditures from state-only sources for the Medi-Cal program divided by the aggregate expenditures from state and federal sources for the Medi-Cal program for a state fiscal year.
(g)Emergency medical transport means the act of transporting an individual from any point of origin to the nearest medical facility capable of meeting the emergency medical needs of the patient by an ambulance licensed, operated, and equipped in accordance with applicable state or local statutes, ordinances, or regulations that are billed with billing codes A0429 BLS Emergency, A0427 ALS Emergency, and A0433 ALS2, and any equivalent, predecessor, or successor billing codes as may be determined by the director. Emergency medical transports shall not include transportation of beneficiaries by passenger car, taxicabs, litter vans, wheelchair vans, or other forms of public or private conveyances, nor shall it include transportation by an air ambulance provider. An emergency medical transport does not occur when, following evaluation of a patient, a transport is not provided.
(h)Gross receipts means gross payments received as patient care revenue for emergency medical transports, determined on a cash basis of accounting. Gross receipts shall include all payments received as patient care revenue for emergency medical transports, including payments for billing codes A0429 BLS Emergency, A0427 ALS Emergency, and A0433 ALS2, and any equivalent, predecessor, or successor billing codes as may be determined by the director, and any other ancillary billing codes associated with emergency medical transport as may be determined by the director. Gross receipts shall not include supplemental amounts received pursuant to Section 14105.94.
(i)Emergency medical transport provider means any provider of emergency medical transports.
(j)Emergency medical transport provider subject to the fee means all emergency medical transport providers that bill and receive patient care revenue from the provision of emergency medical transports, except emergency medical transport providers that are exempt pursuant to subdivision (c) of Section 14129.6.
(k)Medi-Cal managed care health plan means a managed health care plan as that term is defined in subdivision (ab) of Section 14169.51.
14129.1.(a)On or before November 15, 2016, each emergency medical transport provider shall report to the department data on the number of actual emergency medical transports by payor type, including, without limitation, Medi-Cal fee-for-service emergency medical transports and Medi-Cal managed care emergency medical transports, and gross receipts from the provision of emergency medical transports provided in each quarter from July 1, 2015, to October 31, 2016, inclusive, in a manner and format prescribed by the department.
(b)Commencing with the fiscal quarter beginning on January 1, 2017, and each fiscal quarter thereafter, on or before the 45th day of the quarter, each emergency medical transport provider shall report to the department data on the number of actual emergency medical transports by payor type, including, without limitation, Medi-Cal fee-for-service emergency medical transports and Medi-Cal managed care emergency medical transports, and gross receipts from the provision of emergency medical transports provided in the quarter preceding the quarter in which the report is due, in a manner and format prescribed by the department.
(c)The department may establish an Internet Web site for the submission of reports required by this section.
(d)The department may require a certification by each emergency medical transport under penalty of perjury of the truth of the reports required under this section. Upon written notice to an emergency medical transport provider, the department may impose a penalty of one hundred dollars ($100) per day against an emergency medical transport provider for every day that an emergency medical transport provider fails to make a report required by this section within five days of the date upon which the report was due.
14129.2.(a)Commencing with the state fiscal quarter beginning on July 1, 2017, and continuing each state fiscal quarter thereafter, there shall be imposed a quality assurance fee for each emergency medical transport provided by each emergency medical transport provider subject to the fee in accordance with this section.
(b)(1)On or before June 15, 2017, and each June 15 thereafter, the director shall calculate the annual quality assurance fee rate applicable to the following state fiscal year based on the most recently collected data collected from emergency medical transport providers pursuant to Section 14129.1, and publish the annual quality assurance fee rate on its Internet Web site. In no case shall the fees calculated pursuant to this subdivision and collected pursuant to this article exceed the amounts allowable under federal law.
(A)For state fiscal year 201718, the annual quality assurance fee rate shall be calculated by multiplying the projected total annual gross receipts for all emergency medical transport providers subject to the fee by 5.1 percent, which resulting product shall be divided by the projected total annual emergency medical transports by all emergency medical transport providers subject to the fee for the state fiscal year.
(B)For state fiscal years 201819 and thereafter, the annual quality assurance fee rate shall be calculated by a ratio, the numerator of which shall be the sum of the product of the projected aggregate fee schedule amount and the effective state medical assistance percentage, and the amount described in subparagraph (A) of paragraph (2) of subdivision (f), and the denominator of which shall be 90 percent of the projected total annual emergency medical transports by all emergency medical transport providers subject to the fee for the state fiscal year.
(2)On or before June 15, 2017, and each June 15 thereafter, the director shall publish the annual quality assurance fee rate on its Internet Web site.
(3)In no case shall the fees calculated pursuant to this subdivision and collected pursuant to this article exceed the amounts allowable under federal law. If, on or before June 15 of each year, the director makes a determination that the fees collected pursuant to this subdivision exceed the amounts allowable under federal law, the director may reduce the increased fee-for-service payment schedule described in Section 14129.3 only to the extent necessary to reduce the fees calculated pursuant to this subdivision to comply with the amount allowable under federal law.
(4)If, during a state fiscal year, the actual or projected available fee amount exceeds or is less than the actual or projected aggregate fee schedule amount by more than 1 percent, the director shall adjust the annual quality assurance fee rate so that the available fee amount for the state fiscal year will approximately equal the aggregate fee schedule amount for the state fiscal year. The available fee amount for a state fiscal year will be considered to equal the aggregate fee schedule amount for the state fiscal year if the difference between the available fee amount for the state fiscal year and the aggregate fee schedule amount for the state fiscal year constitutes less than 1 percent of the aggregate fee schedule amount for the state fiscal year.
(c)(1)Each emergency medical transport provider subject to the fee shall remit to the department an amount equal to the annual quality assurance fee rate for the 201718 state fiscal year multiplied by the number of transports reported or that should have been reported by the emergency medical transport provider pursuant to subdivision (b) of Section 14129.1 in the quarter commencing April 1, 2017, based on a schedule established by the director. The schedule established by the director for the fee payment described in this paragraph shall require remittance of the fee payment according to the following guidelines:
(A)The director shall require an emergency medical transport provider that rendered 35,000 or more Medi-Cal fee-for-service emergency medical transports during the 2016 calendar year to remit the fee payment described in this paragraph on or after June 20, 2017.
(B)The director shall require an emergency medical transport provider that rendered fewer than 35,000 Medi-Cal fee-for-service emergency medical transports during the 2016 calendar year to remit 50 percent or less of the fee payment described in this paragraph on or after July 1, 2017.
(C)The director shall require an emergency medical transport provider that rendered fewer than 35,000 Medi-Cal fee-for-service emergency medical transports during the 2016 calendar year to remit any remaining fee payment amount described in this paragraph on or after August 15, 2017.
(2)Commencing with the state fiscal quarter beginning on October 1, 2017, and each state fiscal quarter thereafter, on or before the first day of each state fiscal quarter, each emergency medical transport provider subject to the fee shall remit to the department an amount equal to the annual quality assurance fee rate for the applicable state fiscal year multiplied by the number of transports reported or that should have been reported by the emergency medical transport provider pursuant to subdivision (b) of Section 14129.1 in the immediately preceding quarter.
(d)(1)Interest shall be assessed on quality assurance fees not paid on the date due at the greater of 10 percent per annum or the rate at which the department assesses interest on Medi-Cal program overpayments to hospitals that are not repaid when due. Interest shall begin to accrue the day after the date the payment was due and shall be deposited in the Medi-Cal Emergency Medical Transport Fund established in subdivision (f).
(2)In the event that any fee payment is more than 60 days overdue, the department may deduct the unpaid fee and interest owed from any Medi-Cal reimbursement payments owed to the provider until the full amount of the fee, interest, and any penalties assessed under this article are recovered. Any deduction made pursuant to this subdivision shall be made only after the department gives the provider written notification. Any deduction made pursuant to this subdivision may be deducted over a period of time that takes into account the financial condition of the provider.
(3)In the event that any fee payment is more than 60 days overdue, a penalty equal to the interest charge described in paragraph (1) shall be assessed and due for each month for which the payment is not received after 60 days.
(e)The department shall accept an emergency medical transport providers payment even if the payment is submitted in a rate year subsequent to the rate year in which the fee was assessed.
(f)(1)The director shall deposit the quality assurance fee collected pursuant to this section in the Medi-Cal Emergency Medical Transport Fund, which is hereby created in the State Treasury and, notwithstanding Section 13440 of the Government Code, is continuously appropriated without regard to fiscal years to the department for the purposes specified in this article. Notwithstanding Section 16305.7 of the Government Code, the fund shall also include interest and dividends earned on moneys in the fund.
(2)The moneys in the Medi-Cal Emergency Medical Transport Fund, including any interest and dividends earned on money in the fund, shall be available exclusively to enhance federal financial participation for ambulance services under the Medi-Cal program and to provide additional reimbursement to, and to support quality improvement efforts of, emergency medical transport providers, as well as to pay for the states administrative costs and to provide funding for health care coverage for Californians, in the following order of priority:
(A)To pay for the departments staffing and administrative costs directly attributable to implementing this article, not to exceed the following amounts:
(i)For the 201617 fiscal year, one million three thousand dollars ($1,003,000), exclusive of any federal matching funds.
(ii)For the 201718 fiscal year and each fiscal year thereafter, three hundred seventy-four thousand dollars ($374,000), exclusive of any federal matching funds.
(B)To pay for the health care coverage in each fiscal year in the amount of 10 percent of the projected quality assurance fee revenue for that fiscal year, as calculated by the department on or before June 15 preceding that fiscal year, exclusive of any federal matching funds.
(C)To make increased payments to emergency medical transport providers pursuant to this article.
14129.3.(a)Effective July 1, 2017, the Medi-Cal fee-for-service payment schedule governing reimbursement to emergency medical transport providers for emergency medical transports shall be increased. The increase to the fee-for-service payment schedule under this section shall be calculated on or before June 15, 2017, and shall remain the same for later fiscal years. The increase to the fee-for-service payment schedule under this section shall apply only to those billing codes identified in, or any equivalent, predecessor, or successor billing codes as may be determined by the director pursuant to, subdivision (g) of Section 14129. The department shall calculate the projections required by this subdivision based on the data submitted pursuant to Section 14129.1. The resulting fee-for-service payment schedule amounts after the application of this section shall be equal to the sum of both of the following:
(1)The Medi-Cal fee-for-service payment schedule amount for the state fiscal year 201516.
(2)The quotient of the available fee amount projected by the department on or before June 15, 2017, for the state fiscal year 201718, divided by the total Medi-Cal emergency medical transports, including both fee-for-service transports paid by the department and managed care transports paid by Medi-Cal managed care health plans, utilizing these billing codes projected by the department on or before June 15, 2017, for the state fiscal year 201718.
(b)Each Medi-Cal managed care health plan shall satisfy its obligation under Section 438.114(c) of Title 42 of the Code of Federal Regulations for emergency medical transports by providing payment to emergency medical transport providers that is equal to the amount of payment described in Section 1396u-2(b)(2)(D) of Title 42 of the United States Code.
(c)The fee-for-service and Medi-Cal managed care payment schedule increase established pursuant to this section shall be funded solely from the following:
(1)The quality assurance fee set forth in Section 14129.2, along with any interest or other investment income thereon.
(2)Federal reimbursement and any other related federal funds.
(d)The proceeds of the quality assurance fee set forth in Section 14129.2, the matching amount provided by the federal government, and any interest earned on those proceeds shall be used to supplement existing funding for emergency medical transports provided by emergency transport providers and not supplant this funding.
14129.4.If there is a delay in the implementation of this article for any reason, including a delay in any required approval of the quality assurance fee and reimbursement methodology specified by the federal Centers for Medicare and Medicaid Services, all of the following shall apply:
(a)An emergency transport provider subject to the fee may be assessed the amount the provider would be required to pay to the department if the fee-for-service payment schedule increases described in Section 14129.3 were already approved, but shall not be required to pay the fee until the fee-for-service payment schedule increases described in Section 14129.3 are approved. The director shall establish a schedule for payment of retroactive fees pursuant to this subdivision in consultation with emergency medical transport providers to minimize the disruption to the cashflow of emergency medical transport providers.
(b)The department may retroactively increase and make payment of supplemental rates to emergency medical transport providers pursuant to Section 14129.3.
14129.5.(a)The director shall administer this article.
(b)The director may adopt regulations as are necessary to implement this article. These regulations may be adopted as emergency regulations in accordance with the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). For purposes of this article, the first adoption of regulations shall be deemed an emergency and necessary for the immediate preservation of the public peace, health and safety, or general welfare. The regulations shall include, but need not be limited to, any regulations necessary for any of the following purposes:
(1)The administration of this article, including the proper imposition of the quality assurance fee and process for its collection, reporting, and refunds. The costs associated with the administration of this article are not to exceed the amounts reasonably necessary to administer this article.
(2)The development of any forms necessary to obtain required information from providers subject to the quality assurance fee.
(3)The provision of details, definitions, formulas, and other requirements.
(c)As an alternative to subdivision (b), and notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the director may implement this article, in whole or in part, by means of a provider bulletin, or other similar instructions, without taking regulatory action, provided that no such bulletin or other similar instructions shall remain in effect after June 30, 2018. It is the intent of the Legislature that the regulations adopted pursuant to subdivision (b) be adopted on or before June 30, 2018.
(d)The director shall ensure that the quality assurance fee per transport imposed pursuant to this article is collected.
14129.6.(a)The department shall request approval from the federal Centers for Medicare and Medicaid Services for the use of fees collected pursuant to this article for the purpose of receiving federal matching funds.
(b)The director may alter the methodology specified in this article to the extent necessary to meet the requirements of federal law or regulations or to obtain federal approval. If the director, after consulting with affected emergency medical transport providers, determines that an alteration is needed, the director shall execute a declaration stating that this determination has been made. The director shall retain the declaration and provide a copy, within five working days of the execution of the declaration, to the fiscal and appropriate policy committees of the Legislature.
(c)The director may add categories of exempt emergency medical transport providers or apply a nonuniform fee per transport to emergency medical transport providers that are subject to the fee in order to meet requirements of federal law or regulations. The director may exempt categories of emergency medical transport providers from the fee if necessary to obtain federal approval.
14129.7.(a)This article shall be implemented only if, and as long as, all of the following conditions are met:
(1)The federal Centers for Medicare and Medicaid Services does not determine that the quality assurance fee revenues may not be used for the purposes set forth in this article.
(2)The state receives federal approval for the increased fee-for-service payment schedule increases described in subdivision (a) of Section 14129.3.
(3)The state continues its maintenance of effort for the level of state funding of emergency medical transports reimbursement for the 201718 rate year, and for every subsequent rate year, in an amount not less than the amount that the state would have paid for the same number of emergency medical transports under the rate methodology that was in effect on July 31, 2016.
(b)This article shall cease to be implemented if one of the following conditions is satisfied:
(1)The federal Centers for Medicare and Medicaid Services no longer allows the use of the provider assessment provided in this article.
(2)The Medi-Cal fee-for-service payment schedule increase described in subdivision (a) of Section 14129.3 no longer remains in effect.
(3)The quality assurance fee assessed and collected pursuant to this article is no longer available for the purposes specified in this article.
(4)A final judicial determination by the California Supreme Court or any California Court of Appeal that the revenues collected pursuant to this article that are deposited in the Medi-Cal Emergency Medical Transport Fund are either of the following:
(A)General Fund proceeds of taxes appropriated pursuant to Article XIII B of the California Constitution, as used in subdivision (b) of Section 8 of Article XVI of the California Constitution.
(B)Allocated local proceeds of taxes, as used in subdivision (b) of Section 8 of Article XVI of the California Constitution.
(5)The state does not continue its maintenance of effort for the level of state funding of emergency medical transports reimbursement for the 201718 rate year, or for any subsequent rate year, in an amount not less than the amount that the state would have paid for the same number of emergency medical transports under the rate methodology in effect on July 31, 2016.
(c)If all of the conditions in subdivision (a) are met, this article is implemented. If, subsequently, any one of the conditions in subdivision (b) is met, this article shall become inoperative notwithstanding that the condition or conditions subsequently may be met.
(d)Notwithstanding subdivisions (a), (b), and (c), in the event of a final judicial determination made by any state or federal court that is not appealed, or by a court of appellate jurisdiction that is not further appealed, in any action by any party, or a final determination by the administrator of the federal Centers for Medicare and Medicaid Services, that federal financial participation is not available with respect to any payment made under the methodology implemented pursuant to this article because the methodology is invalid, unlawful, or contrary to any provision of federal law or regulations or of state law, this article shall become inoperative.
SEC. 3.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
SEC. 4.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the Constitution and shall go into immediate effect. The facts constituting the necessity are:
In order to make the necessary changes to increase Medi-Cal payments to emergency ambulance providers and to improve access, at the earliest possible time, to allow this act to be operative as soon as approval from the federal Centers for Medicare and Medicaid Services is obtained by the State Department of Health Care Services, it is necessary that this act take effect immediately.
The Legislature finds and declares all of the following:
(a)The Legislature recognizes the essential role that emergency medical transport providers play in serving the states Medi-Cal beneficiaries. To that end, it has been and remains the intent of the Legislature to improve funding for emergency medical transport providers and obtain all available federal funds to make supplemental Medi-Cal payments to emergency medical transport providers.
(b)It is the intent of the Legislature to impose a quality assurance fee to be paid by emergency medical transport providers, which will be used to increase federal financial participation in order to increase Medi-Cal payments to emergency medical transport providers.
(c)It is the intent of the Legislature to increase the Medi-Cal emergency medical transport reimbursement in Medi-Cal fee-for-service and Medi-Cal managed care by increasing the fee-for-service payment schedule for emergency medical transports to support quality improvement efforts by emergency medical transport providers, including, but not limited to, the provision of advanced life support services, as defined in Section 1797.52 of the Health and Safety Code.
(d)It is the further intent of the Legislature that the increased fee-for-service and Medi-Cal managed care payment schedule amounts pursuant to this article shall not result in any expenditure from the General Fund.
SEC. 2.Article 3.91 (commencing with Section 14129) is added to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, to read:3.91.Medi-Cal Emergency Medical Transportation Reimbursement Act14129.For purposes of this article, the following definitions shall apply:
(a)Annual quality assurance fee rate means the quality assurance fee assessed on each emergency medical transport applicable to each state fiscal year.
(b)Aggregate fee schedule increase amount means the product of the quotient described in paragraph (2) of subdivision (a) of Section 14129.3 and the Medi-Cal emergency medical transports, including both fee-for-service transports paid by the department and managed care transports paid by Medi-Cal managed care health plans, utilizing the billing codes for emergency medical transport for the state fiscal year.
(c)Available fee amount shall be calculated as the sum of the following:
(1)The amount deposited in the Medi-Cal Emergency Transportation Fund established under Section 14129.2 during the applicable state fiscal year, less the amounts described in subparagraphs (A) and (B) of paragraph (2) of subdivision (f) of Section 14129.2.
(2)Any federal financial participation obtained as a result of the deposit of the amount described in paragraph (1) in the Medi-Cal Emergency Transportation Fund for the applicable fiscal year.
(d)Department means the State Department of Health Care Services.
(e)Director means the Director of Health Care Services.
(f)Effective state medical assistance percentage means a ratio of the aggregate expenditures from state-only sources for the Medi-Cal program divided by the aggregate expenditures from state and federal sources for the Medi-Cal program for a state fiscal year.
(g)Emergency medical transport means the act of transporting an individual from any point of origin to the nearest medical facility capable of meeting the emergency medical needs of the patient by an ambulance licensed, operated, and equipped in accordance with applicable state or local statutes, ordinances, or regulations that are billed with billing codes A0429 BLS Emergency, A0427 ALS Emergency, and A0433 ALS2, and any equivalent, predecessor, or successor billing codes as may be determined by the director. Emergency medical transports shall not include transportation of beneficiaries by passenger car, taxicabs, litter vans, wheelchair vans, or other forms of public or private conveyances, nor shall it include transportation by an air ambulance provider. An emergency medical transport does not occur when, following evaluation of a patient, a transport is not provided.
(h)Gross receipts means gross payments received as patient care revenue for emergency medical transports, determined on a cash basis of accounting. Gross receipts shall include all payments received as patient care revenue for emergency medical transports, including payments for billing codes A0429 BLS Emergency, A0427 ALS Emergency, and A0433 ALS2, and any equivalent, predecessor, or successor billing codes as may be determined by the director, and any other ancillary billing codes associated with emergency medical transport as may be determined by the director. Gross receipts shall not include supplemental amounts received pursuant to Section 14105.94.
(i)Emergency medical transport provider means any provider of emergency medical transports.
(j)Emergency medical transport provider subject to the fee means all emergency medical transport providers that bill and receive patient care revenue from the provision of emergency medical transports, except emergency medical transport providers that are exempt pursuant to subdivision (c) of Section 14129.6.
(k)Medi-Cal managed care health plan means a managed health care plan as that term is defined in subdivision (ab) of Section 14169.51.
14129.1.(a)On or before November 15, 2016, each emergency medical transport provider shall report to the department data on the number of actual emergency medical transports by payor type, including, without limitation, Medi-Cal fee-for-service emergency medical transports and Medi-Cal managed care emergency medical transports, and gross receipts from the provision of emergency medical transports provided in each quarter from July 1, 2015, to October 31, 2016, inclusive, in a manner and format prescribed by the department.
(b)Commencing with the fiscal quarter beginning on January 1, 2017, and each fiscal quarter thereafter, on or before the 45th day of the quarter, each emergency medical transport provider shall report to the department data on the number of actual emergency medical transports by payor type, including, without limitation, Medi-Cal fee-for-service emergency medical transports and Medi-Cal managed care emergency medical transports, and gross receipts from the provision of emergency medical transports provided in the quarter preceding the quarter in which the report is due, in a manner and format prescribed by the department.
(c)The department may establish an Internet Web site for the submission of reports required by this section.
(d)The department may require a certification by each emergency medical transport under penalty of perjury of the truth of the reports required under this section. Upon written notice to an emergency medical transport provider, the department may impose a penalty of one hundred dollars ($100) per day against an emergency medical transport provider for every day that an emergency medical transport provider fails to make a report required by this section within five days of the date upon which the report was due.
14129.2.(a)Commencing with the state fiscal quarter beginning on July 1, 2017, and continuing each state fiscal quarter thereafter, there shall be imposed a quality assurance fee for each emergency medical transport provided by each emergency medical transport provider subject to the fee in accordance with this section.
(b)(1)On or before June 15, 2017, and each June 15 thereafter, the director shall calculate the annual quality assurance fee rate applicable to the following state fiscal year based on the most recently collected data collected from emergency medical transport providers pursuant to Section 14129.1, and publish the annual quality assurance fee rate on its Internet Web site. In no case shall the fees calculated pursuant to this subdivision and collected pursuant to this article exceed the amounts allowable under federal law.
(A)For state fiscal year 201718, the annual quality assurance fee rate shall be calculated by multiplying the projected total annual gross receipts for all emergency medical transport providers subject to the fee by 5.1 percent, which resulting product shall be divided by the projected total annual emergency medical transports by all emergency medical transport providers subject to the fee for the state fiscal year.
(B)For state fiscal years 201819 and thereafter, the annual quality assurance fee rate shall be calculated by a ratio, the numerator of which shall be the sum of the product of the projected aggregate fee schedule amount and the effective state medical assistance percentage, and the amount described in subparagraph (A) of paragraph (2) of subdivision (f), and the denominator of which shall be 90 percent of the projected total annual emergency medical transports by all emergency medical transport providers subject to the fee for the state fiscal year.
(2)On or before June 15, 2017, and each June 15 thereafter, the director shall publish the annual quality assurance fee rate on its Internet Web site.
(3)In no case shall the fees calculated pursuant to this subdivision and collected pursuant to this article exceed the amounts allowable under federal law. If, on or before June 15 of each year, the director makes a determination that the fees collected pursuant to this subdivision exceed the amounts allowable under federal law, the director may reduce the increased fee-for-service payment schedule described in Section 14129.3 only to the extent necessary to reduce the fees calculated pursuant to this subdivision to comply with the amount allowable under federal law.
(4)If, during a state fiscal year, the actual or projected available fee amount exceeds or is less than the actual or projected aggregate fee schedule amount by more than 1 percent, the director shall adjust the annual quality assurance fee rate so that the available fee amount for the state fiscal year will approximately equal the aggregate fee schedule amount for the state fiscal year. The available fee amount for a state fiscal year will be considered to equal the aggregate fee schedule amount for the state fiscal year if the difference between the available fee amount for the state fiscal year and the aggregate fee schedule amount for the state fiscal year constitutes less than 1 percent of the aggregate fee schedule amount for the state fiscal year.
(c)(1)Each emergency medical transport provider subject to the fee shall remit to the department an amount equal to the annual quality assurance fee rate for the 201718 state fiscal year multiplied by the number of transports reported or that should have been reported by the emergency medical transport provider pursuant to subdivision (b) of Section 14129.1 in the quarter commencing April 1, 2017, based on a schedule established by the director. The schedule established by the director for the fee payment described in this paragraph shall require remittance of the fee payment according to the following guidelines:
(A)The director shall require an emergency medical transport provider that rendered 35,000 or more Medi-Cal fee-for-service emergency medical transports during the 2016 calendar year to remit the fee payment described in this paragraph on or after June 20, 2017.
(B)The director shall require an emergency medical transport provider that rendered fewer than 35,000 Medi-Cal fee-for-service emergency medical transports during the 2016 calendar year to remit 50 percent or less of the fee payment described in this paragraph on or after July 1, 2017.
(C)The director shall require an emergency medical transport provider that rendered fewer than 35,000 Medi-Cal fee-for-service emergency medical transports during the 2016 calendar year to remit any remaining fee payment amount described in this paragraph on or after August 15, 2017.
(2)Commencing with the state fiscal quarter beginning on October 1, 2017, and each state fiscal quarter thereafter, on or before the first day of each state fiscal quarter, each emergency medical transport provider subject to the fee shall remit to the department an amount equal to the annual quality assurance fee rate for the applicable state fiscal year multiplied by the number of transports reported or that should have been reported by the emergency medical transport provider pursuant to subdivision (b) of Section 14129.1 in the immediately preceding quarter.
(d)(1)Interest shall be assessed on quality assurance fees not paid on the date due at the greater of 10 percent per annum or the rate at which the department assesses interest on Medi-Cal program overpayments to hospitals that are not repaid when due. Interest shall begin to accrue the day after the date the payment was due and shall be deposited in the Medi-Cal Emergency Medical Transport Fund established in subdivision (f).
(2)In the event that any fee payment is more than 60 days overdue, the department may deduct the unpaid fee and interest owed from any Medi-Cal reimbursement payments owed to the provider until the full amount of the fee, interest, and any penalties assessed under this article are recovered. Any deduction made pursuant to this subdivision shall be made only after the department gives the provider written notification. Any deduction made pursuant to this subdivision may be deducted over a period of time that takes into account the financial condition of the provider.
(3)In the event that any fee payment is more than 60 days overdue, a penalty equal to the interest charge described in paragraph (1) shall be assessed and due for each month for which the payment is not received after 60 days.
(e)The department shall accept an emergency medical transport providers payment even if the payment is submitted in a rate year subsequent to the rate year in which the fee was assessed.
(f)(1)The director shall deposit the quality assurance fee collected pursuant to this section in the Medi-Cal Emergency Medical Transport Fund, which is hereby created in the State Treasury and, notwithstanding Section 13440 of the Government Code, is continuously appropriated without regard to fiscal years to the department for the purposes specified in this article. Notwithstanding Section 16305.7 of the Government Code, the fund shall also include interest and dividends earned on moneys in the fund.
(2)The moneys in the Medi-Cal Emergency Medical Transport Fund, including any interest and dividends earned on money in the fund, shall be available exclusively to enhance federal financial participation for ambulance services under the Medi-Cal program and to provide additional reimbursement to, and to support quality improvement efforts of, emergency medical transport providers, as well as to pay for the states administrative costs and to provide funding for health care coverage for Californians, in the following order of priority:
(A)To pay for the departments staffing and administrative costs directly attributable to implementing this article, not to exceed the following amounts:
(i)For the 201617 fiscal year, one million three thousand dollars ($1,003,000), exclusive of any federal matching funds.
(ii)For the 201718 fiscal year and each fiscal year thereafter, three hundred seventy-four thousand dollars ($374,000), exclusive of any federal matching funds.
(B)To pay for the health care coverage in each fiscal year in the amount of 10 percent of the projected quality assurance fee revenue for that fiscal year, as calculated by the department on or before June 15 preceding that fiscal year, exclusive of any federal matching funds.
(C)To make increased payments to emergency medical transport providers pursuant to this article.
14129.3.(a)Effective July 1, 2017, the Medi-Cal fee-for-service payment schedule governing reimbursement to emergency medical transport providers for emergency medical transports shall be increased. The increase to the fee-for-service payment schedule under this section shall be calculated on or before June 15, 2017, and shall remain the same for later fiscal years. The increase to the fee-for-service payment schedule under this section shall apply only to those billing codes identified in, or any equivalent, predecessor, or successor billing codes as may be determined by the director pursuant to, subdivision (g) of Section 14129. The department shall calculate the projections required by this subdivision based on the data submitted pursuant to Section 14129.1. The resulting fee-for-service payment schedule amounts after the application of this section shall be equal to the sum of both of the following:
(1)The Medi-Cal fee-for-service payment schedule amount for the state fiscal year 201516.
(2)The quotient of the projected available fee amount projected by the department on or before June 15, 2017, for the state fiscal year 201718, divided by the total projected Medi-Cal emergency medical transports, including both fee-for-service transports paid by the department and managed care transports paid by Medi-Cal managed care health plans, utilizing these billing codes projected by the department on or before June 15, 2017, for the state fiscal year 201718.
(b)Each Medi-Cal managed care health plan shall satisfy its obligation under Section 438.114(c) of Title 42 of the Code of Federal Regulations for emergency medical transports by providing payment to emergency medical transport providers that is equal to the amount of payment described in Section 1396u-2(b)(2)(D) of Title 42 of the United States Code.
(c)The fee-for-service and Medi-Cal managed care payment schedule increase established pursuant to this section shall be funded solely from the following:
(1)The quality assurance fee set forth in Section 14129.2, along with any interest or other investment income thereon.
(2)Federal reimbursement and any other related federal funds.
(d)The proceeds of the quality assurance fee set forth in Section 14129.2, the matching amount provided by the federal government, and any interest earned on those proceeds shall be used to supplement existing funding for emergency medical transports provided by emergency transport providers and not supplant this funding.
14129.4.If there is a delay in the implementation of this article for any reason, including a delay in any required approval of the quality assurance fee and reimbursement methodology specified by the federal Centers for Medicare and Medicaid Services, all of the following shall apply:
(a)An emergency transport provider subject to the fee may be assessed the amount the provider would be required to pay to the department if the fee-for-service payment schedule increases described in Section 14129.3 were already approved, but shall not be required to pay the fee until the fee-for-service payment schedule increases described in Section 14129.3 are approved. The director shall establish a schedule for payment of retroactive fees pursuant to this subdivision in consultation with emergency medical transport providers to minimize the disruption to the cashflow of emergency medical transport providers.
(b)The department may retroactively increase and make payment of supplemental rates to emergency medical transport providers pursuant to Section 14129.3.
14129.5.(a)The director shall administer this article.
(b)The director may adopt regulations as are necessary to implement this article. These regulations may be adopted as emergency regulations in accordance with the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). For purposes of this article, the first adoption of regulations shall be deemed an emergency and necessary for the immediate preservation of the public peace, health and safety, or general welfare. The regulations shall include, but need not be limited to, any regulations necessary for any of the following purposes:
(1)The administration of this article, including the proper imposition of the quality assurance fee and process for its collection, reporting, and refunds. The costs associated with the administration of this article are not to exceed the amounts reasonably necessary to administer this article.
(2)The development of any forms necessary to obtain required information from providers subject to the quality assurance fee.
(3)The provision of details, definitions, formulas, and other requirements.
(c)As an alternative to subdivision (b), and notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the director may implement this article, in whole or in part, by means of a provider bulletin, or other similar instructions, without taking regulatory action, provided that no such bulletin or other similar instructions shall remain in effect after June 30, 2018. It is the intent of the Legislature that the regulations adopted pursuant to subdivision (b) be adopted on or before June 30, 2018.
(d)The director shall ensure that the quality assurance fee per transport imposed pursuant to this article is collected.
14129.6.(a)The department shall request approval from the federal Centers for Medicare and Medicaid Services for the use of fees collected pursuant to this article for the purpose of receiving federal matching funds.
(b)The director may alter the methodology specified in this article to the extent necessary to meet the requirements of federal law or regulations or to obtain federal approval. If the director, after consulting with affected emergency medical transport providers, determines that an alteration is needed, the director shall execute a declaration stating that this determination has been made. The director shall retain the declaration and provide a copy, within five working days of the execution of the declaration, to the fiscal and appropriate policy committees of the Legislature.
(c)The director may add categories of exempt emergency medical transport providers or apply a nonuniform fee per transport to emergency medical transport providers that are subject to the fee in order to meet requirements of federal law or regulations. The director may exempt categories of emergency medical transport providers from the fee if necessary to obtain federal approval.
14129.7.(a)This article shall be implemented only if, and as long as, both all of the following conditions are met:
(1)The state receives federal approval of the quality assurance fee from the federal Centers for Medicare and Medicaid Services. Services does not determine that the quality assurance fee revenues may not be used for the purposes set forth in this article.
(2)The state receives federal approval for the increased fee-for-service payment schedule increases described in subdivision (a) of Section 14129.3.
(3)The state continues its maintenance of effort for the level of state funding of emergency medical transports reimbursement for the 201718 rate year, and for every subsequent rate year, in an amount not less than the amount that the state would have paid for the same number of emergency medical transports under the rate methodology that was in effect on July 31, 2016.
(b)This article shall cease to be implemented if one of the following conditions is satisfied:
(1)The federal Centers for Medicare and Medicaid Services no longer allows the use of the provider assessment provided in this article.
(2)The Medi-Cal fee-for-service payment schedule increase described in subdivision (a) of Section 14129.3 no longer remains in effect.
(3)The quality assurance fee assessed and collected pursuant to this article is no longer available for the purposes specified in this article.
(4)A final judicial determination by the California Supreme Court or any California Court of Appeal that the revenues collected pursuant to this article that are deposited in the Medi-Cal Emergency Medical Transport Fund are either of the following:
(A)General Fund proceeds of taxes appropriated pursuant to Article XIII B of the California Constitution, as used in subdivision (b) of Section 8 of Article XVI of the California Constitution.
(B)Allocated local proceeds of taxes, as used in subdivision (b) of Section 8 of Article XVI of the California Constitution.
(5)The state does not continue its maintenance of effort for the level of state funding of emergency medical transports reimbursement for the 201718 rate year, or for any subsequent rate year, in an amount not less than the amount that the state would have paid for the same number of emergency medical transports under the rate methodology in effect on July 31, 2016.
(c)If all of the conditions in subdivision (a) are met, this article is implemented. If, subsequently, any one of the conditions in subdivision (b) is met, this article shall become inoperative notwithstanding that the condition or conditions subsequently may be met.
(d)Notwithstanding subdivisions (a), (b), and (c), in the event of a final judicial determination made by any state or federal court that is not appealed, or by a court of appellate jurisdiction that is not further appealed, in any action by any party, or a final determination by the administrator of the federal Centers for Medicare and Medicaid Services, that federal financial participation is not available with respect to any payment made under the methodology implemented pursuant to this article because the methodology is invalid, unlawful, or contrary to any provision of federal law or regulations or of state law, this article shall become inoperative.
SEC. 3.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
SEC. 4.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the Constitution and shall go into immediate effect. The facts constituting the necessity are:
In order to make the necessary changes to increase Medi-Cal payments to emergency ambulance providers and to improve access, at the earliest possible time, to allow this act to be operative as soon as approval from the federal Centers for Medicare and Medicaid Services is obtained by the State Department of Health Care Services, it is necessary that this act take effect immediately.
The Legislature finds and declares all of the following:
(a)The Legislature recognizes the essential role that emergency medical transport providers play in serving the states Medi-Cal beneficiaries. To that end, it has been and remains the intent of the Legislature to improve funding for emergency medical transport providers and obtain all available federal funds to make supplemental Medi-Cal payments to emergency medical transport providers.
(b)It is the intent of the Legislature to impose a quality assurance fee to be paid by emergency medical transport providers, which will be used to increase federal financial participation in order to increase Medi-Cal payments to emergency medical transport providers.
(c)It is the intent of the Legislature to increase the Medi-Cal emergency medical transport reimbursement in Medi-Cal fee-for-service and Medi-Cal managed care by increasing the fee-for-service payment schedule for emergency medical transports to support quality improvement efforts by emergency medical transport providers, including, but not limited to, the provision of advanced life support services, as defined in Section 1797.52 of the Health and Safety Code.
(d)It is the further intent of the Legislature that the increased fee-for-service and Medi-Cal managed care payment schedule amounts pursuant to this article shall not result in any expenditure from the General Fund.
SEC. 2.Article 3.91 (commencing with Section 14129) is added to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, to read:3.91.Medi-Cal Emergency Medical Transportation Reimbursement Act14129.For purposes of this article, the following definitions shall apply:
(a)Annual quality assurance fee rate means the quality assurance fee assessed on each emergency medical transport applicable to each state fiscal year.
(b)Aggregate fee schedule increase amount means the product of the quotient described in paragraph (2) of subdivision (a) of Section 14129.3 and the Medi-Cal emergency medical transports, including both fee-for-service transports paid by the department and managed care transports paid by Medi-Cal managed care health plans, utilizing the billing codes for emergency medical transport for the state fiscal year.
(c)Available fee amount shall be calculated as the sum of the following:
(1)The amount deposited in the Medi-Cal Emergency Transportation Fund established under Section 14129.2 during the applicable state fiscal year, less the amounts described in subparagraphs (A) and (B) of paragraph (2) of subdivision (f) of Section 14129.2.
(2)Any federal financial participation obtained as a result of the deposit of the amount described in paragraph (1) in the Medi-Cal Emergency Transportation Fund for the applicable fiscal year.
(d)Department means the State Department of Health Care Services.
(e)Director means the Director of Health Care Services.
(f)Effective state medical assistance percentage means a ratio of the aggregate expenditures from state-only sources for the Medi-Cal program divided by the aggregate expenditures from state and federal sources for the Medi-Cal program for a state fiscal year.
(g)Emergency medical transport means the act of transporting an individual from any point of origin to the nearest medical facility capable of meeting the emergency medical needs of the patient by an ambulance licensed, operated, and equipped in accordance with applicable state or local statutes, ordinances, or regulations that are billed with billing codes A0429 BLS Emergency, A0427 ALS Emergency, and A0433 ALS2, and any equivalent, predecessor, or successor billing codes as may be determined by the director. Emergency medical transports shall not include transportation of beneficiaries by passenger car, taxicabs, litter vans, wheelchair vans, or other forms of public or private conveyances, nor shall it include transportation by an air ambulance provider. An emergency medical transport does not occur when, following evaluation of a patient, a transport is not provided.
(h)Gross receipts means gross payments received as patient care revenue for emergency medical transports, determined on a cash basis of accounting, excluding accounting. Gross receipts shall include all payments received as patient care revenue for emergency medical transports, including payments for billing codes A0429 BLS Emergency, A0427 ALS Emergency, and A0433 ALS2, and any equivalent, predecessor, or successor billing codes as may be determined by the director, and any other ancillary billing codes associated with emergency medical transport as may be determined by the director. Gross receipts shall not include supplemental amounts received pursuant to Section 14105.94.
(i)Emergency medical transport provider means any provider of emergency medical transports.
(j)Emergency medical transport provider subject to the fee means all emergency medical transport providers that bill and receive patient care revenue from the provision of emergency medical transports, except emergency medical transport providers that are exempt pursuant to subdivision (c) of Section 14129.6.
(k)Medi-Cal managed care health plan means a managed health care plan as that term is defined in subdivision (ab) of Section 14169.51.
14129.1.(a)On or before November 15, 2016, each emergency medical transport provider shall report to the department data on the number of actual emergency medical transports by payor type, including, without limitation, Medi-Cal fee-for-service emergency medical transports and Medi-Cal managed care emergency medical transports, and gross receipts from the provision of emergency medical transports provided in each quarter from July 1, 2015, to October 31, 2016, inclusive, in a manner and format prescribed by the department.
(b)Commencing with the fiscal quarter beginning on January 1, 2017, and each fiscal quarter thereafter, on or before the 45th day of the quarter, each emergency medical transport provider shall report to the department data on the number of actual emergency medical transports by payor type, including, without limitation, Medi-Cal fee-for-service emergency medical transports and Medi-Cal managed care emergency medical transports, and gross receipts from the provision of emergency medical transports provided in the quarter preceding the quarter in which the report is due, in a manner and format prescribed by the department.
(c)The department may establish an Internet Web site for the submission of reports required by this section.
(d)The department may require a certification by each emergency medical transport under penalty of perjury of the truth of the reports required under this section. Upon written notice to an emergency medical transport provider, the department may impose a penalty of one hundred dollars ($100) per day against an emergency medical transport provider for every day that an emergency medical transport provider fails to make a report required by this section within five days of the date upon which the report was due.
14129.2.(a)Commencing with the state fiscal quarter beginning on July 1, 2017, and continuing each state fiscal quarter thereafter, there shall be imposed a quality assurance fee for each emergency medical transport provided by each emergency medical transport provider subject to the fee in accordance with this section.
(b)(1)On or before June 15, 2017, and each June 15 thereafter, the director shall calculate the annual quality assurance fee rate applicable to the following state fiscal year based on the most recently collected data collected from emergency medical transport providers pursuant to Section 14129.1, and publish the annual quality assurance fee rate on its Internet Web site. In no case shall the fees calculated pursuant to this subdivision and collected pursuant to this article exceed the amounts allowable under federal law.
(A)For state fiscal year 201718, the annual quality assurance fee rate shall be calculated by multiplying the projected total annual gross receipts for all emergency medical transport providers subject to the fee by 5.5 5.1 percent, which resulting product shall be divided by the projected total annual emergency medical transports by all emergency medical transport providers subject to the fee for the state fiscal year.
(B)For state fiscal years 201819 and thereafter, the annual quality assurance fee rate shall be calculated by a ratio, the numerator of which shall be the sum of the product of the projected aggregate fee schedule amount and the effective state medical assistance percentage, and the amount described in subparagraph (A) of paragraph (2) of subdivision (f), and the denominator of which shall be 95 90 percent of the projected total annual emergency medical transports by all emergency medical transport providers subject to the fee for the state fiscal year.
(2)On or before June 15, 2017, and each June 15 thereafter, the director shall publish the annual quality assurance fee rate on its Internet Web site.
(3)In no case shall the fees calculated pursuant to this subdivision and collected pursuant to this article exceed the amounts allowable under federal law. If, on or before June 15 of each year, the director makes a determination that the fees collected pursuant to this subdivision exceed the amounts allowable under federal law, the director may reduce the increased fee-for-service payment schedule described in Section 14129.3 only to the extent necessary to reduce the fees calculated pursuant to this subdivision to comply with the amount allowable under federal law.
(4)If, during a state fiscal year, the actual or projected available fee amount exceeds or is less than the actual or projected aggregate fee schedule amount by more than 1 percent, the director shall adjust the annual quality assurance fee rate so that the available fee amount for the state fiscal year will approximately equal the aggregate fee schedule amount for the state fiscal year. The available fee amount for a state fiscal year will be considered to equal the aggregate fee schedule amount for the state fiscal year if the difference between the available fee amount for the state fiscal year and the aggregate fee schedule amount for the state fiscal year constitutes less than 1 percent of the aggregate fee schedule amount for the state fiscal year.
(c)(1)Each emergency medical transport provider subject to the fee shall remit to the department an amount equal to the annual quality assurance fee rate for the 201718 state fiscal year multiplied by the number of transports reported or that should have been reported by the emergency medical transport provider pursuant to subdivision (b) of Section 14129.1 in the quarter commencing April 1, 2017, based on a schedule established by the director. The schedule established by the director for the fee payment described in this paragraph shall not require payment of any of require remittance of the fee payment prior to July 1, 2017, and shall not require payment of more than 50 percent of the fee payment prior to August 1, 2017. according to the following guidelines:
(A)The director shall require an emergency medical transport provider that rendered 35,000 or more Medi-Cal fee-for-service emergency medical transports during the 2016 calendar year to remit the fee payment described in this paragraph on or after June 20, 2017.
(B)The director shall require an emergency medical transport provider that rendered fewer than 35,000 Medi-Cal fee-for-service emergency medical transports during the 2016 calendar year to remit 50 percent or less of the fee payment described in this paragraph on or after July 1, 2017.
(C)The director shall require an emergency medical transport provider that rendered fewer than 35,000 Medi-Cal fee-for-service emergency medical transports during the 2016 calendar year to remit any remaining fee payment amount described in this paragraph on or after August 15, 2017.
(2)Commencing with the state fiscal quarter beginning on October 1, 2017, and each state fiscal quarter thereafter, on or before the first day of each state fiscal quarter, each emergency medical transport provider subject to the fee shall remit to the department an amount equal to the annual quality assurance fee rate for the applicable state fiscal year multiplied by the number of transports reported or that should have been reported by the emergency medical transport provider pursuant to subdivision (b) of Section 14129.1 in the immediately preceding quarter.
(d)(1)Interest shall be assessed on quality assurance fees not paid on the date due at the greater of 10 percent per annum or the rate at which the department assesses interest on Medi-Cal program overpayments to hospitals that are not repaid when due. Interest shall begin to accrue the day after the date the payment was due and shall be deposited in the Medi-Cal Emergency Medical Transport Fund established in subdivision (f).
(2)In the event that any fee payment is more than 60 days overdue, the department may deduct the unpaid fee and interest owed from any Medi-Cal reimbursement payments owed to the provider until the full amount of the fee and interest fee, interest, and any penalties assessed under this article are recovered. Any deduction made pursuant to this subdivision shall be made only after the department gives the provider written notification. Any deduction made pursuant to this subdivision may be deducted over a period of time that takes into account the financial condition of the provider.
(3)In the event that any fee payment is more than 60 days overdue, a penalty equal to the interest charge described in paragraph (1) shall be assessed and due for each month for which the payment is not received after 60 days.
(e)The department shall accept an emergency medical transport providers payment even if the payment is submitted in a rate year subsequent to the rate year in which the fee was assessed.
(f)(1)The director shall deposit the quality assurance fee collected pursuant to this section in the Medi-Cal Emergency Medical Transport Fund, which is hereby created in the State Treasury and, notwithstanding Section 13440 of the Government Code, is continuously appropriated without regard to fiscal years to the department for the purposes specified in this article. Notwithstanding Section 16305.7 of the Government Code, the fund shall also include interest and dividends earned on moneys in the fund.
(2)The moneys in the Medi-Cal Emergency Medical Transport Fund, including any interest and dividends earned on money in the fund, shall be available exclusively to enhance federal financial participation for ambulance services under the Medi-Cal program and to provide additional reimbursement to, and to support quality improvement efforts of, emergency medical transport providers, as well as to pay for the states administrative costs and to provide funding for health care coverage for Californians, in the following order of priority:
(A)To pay for the departments staffing and administrative costs directly attributable to implementing this article, not to exceed three hundred fifty thousand dollars ($350,000) for each fiscal year, exclusive of any federal matching funds. the following amounts:
(i)For the 201617 fiscal year, one million three thousand dollars ($1,003,000), exclusive of any federal matching funds.
(ii)For the 201718 fiscal year and each fiscal year thereafter, three hundred seventy-four thousand dollars ($374,000), exclusive of any federal matching funds.
(B)To pay for the health care coverage in each fiscal year in the amount of 10 percent of the projected quality assurance fee revenue for that fiscal year, as calculated by the department on or before June 15 preceding that fiscal year, exclusive of any federal matching funds.
(C)To make increased payments to emergency medical transport providers pursuant to this article.
14129.3.(a)Effective July 1, 2017, the Medi-Cal fee-for-service payment schedule governing reimbursement to emergency medical transport providers for emergency medical transports shall be increased. The department shall calculate the projections required by this subdivision based on the data submitted pursuant to Section 14129.1. The resulting fee-for-service payment schedule amounts after the application of this section shall be equal to the sum of both of the following:
(1)The Medi-Cal fee-for-service payment schedule amount for the state fiscal year 201516.
(2)The quotient of the projected available fee amount for the state fiscal year 201718, divided by the total projected Medi-Cal emergency medical transports, including both fee-for-service transports paid by the department and managed care transports paid by Medi-Cal managed care health plans, utilizing these billing codes for the state fiscal year 201718.
(b)Each Medi-Cal managed care health plan shall satisfy its obligation under Section 438.114(c) of Title 42 of the Code of Federal Regulations for emergency medical transports by providing payment to emergency medical transport providers that is equal to the amount of payment described in Section 1396u-2(b)(2)(D) of Title 42 of the United States Code.
(c)The fee-for-service and Medi-Cal managed care payment schedule increase established pursuant to this section shall be funded solely from the following:
(1)The quality assurance fee set forth in Section 14129.2, along with any interest or other investment income thereon.
(2)Federal reimbursement and any other related federal funds.
(d)The proceeds of the quality assurance fee set forth in Section 14129.2, the matching amount provided by the federal government, and any interest earned on those proceeds shall be used to supplement existing funding for emergency medical transports provided by emergency transport providers and not supplant this funding.
14129.4.If there is a delay in the implementation of this article for any reason, including a delay in any required approval of the quality assurance fee and reimbursement methodology specified by the federal Centers for Medicare and Medicaid Services, all of the following shall apply:
(a)An emergency transport provider subject to the fee may be assessed the amount the provider would be required to pay to the department if the fee-for-service payment schedule increases described in Section 14129.3 were already approved, but shall not be required to pay the fee until the fee-for-service payment schedule increases described in Section 14129.3 are approved. The director shall establish a schedule for payment of retroactive fees pursuant to this subdivision in consultation with emergency medical transport providers to minimize the disruption to the cashflow of emergency medical transport providers.
(b)The department may retroactively increase and make payment of supplemental rates to emergency medical transport providers pursuant to Section 14129.3.
14129.5.(a)The director shall administer this article.
(b)The director may adopt regulations as are necessary to implement this article. These regulations may be adopted as emergency regulations in accordance with the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). For purposes of this article, the first adoption of regulations shall be deemed an emergency and necessary for the immediate preservation of the public peace, health and safety, or general welfare. The regulations shall include, but need not be limited to, any regulations necessary for any of the following purposes:
(1)The administration of this article, including the proper imposition of the quality assurance fee and process for its collection, reporting, and refunds. The costs associated with the administration of this article are not to exceed the amounts reasonably necessary to administer this article.
(2)The development of any forms necessary to obtain required information from providers subject to the quality assurance fee.
(3)The provision of details, definitions, formulas, and other requirements.
(c)As an alternative to subdivision (b), and notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the director may implement this article, in whole or in part, by means of a provider bulletin, or other similar instructions, without taking regulatory action, provided that no such bulletin or other similar instructions shall remain in effect after June 30, 2018. It is the intent of the Legislature that the regulations adopted pursuant to subdivision (b) be adopted on or before June 30, 2018.
(d)The director shall ensure that the quality assurance fee per transport imposed pursuant to this article is collected.
14129.6.(a)The department shall request approval from the federal Centers for Medicare and Medicaid Services for the use of fees collected pursuant to this article for the purpose of receiving federal matching funds.
(b)The director may alter the methodology specified in this article to the extent necessary to meet the requirements of federal law or regulations or to obtain federal approval. If the director, after consulting with affected emergency medical transport providers, determines that an alteration is needed, the director shall execute a declaration stating that this determination has been made. The director shall retain the declaration and provide a copy, within five working days of the execution of the declaration, to the fiscal and appropriate policy committees of the Legislature.
(c)The director may add categories of exempt emergency medical transport providers or apply a nonuniform fee per transport to emergency medical transport providers that are subject to the fee in order to meet requirements of federal law or regulations. The director may exempt categories of emergency medical transport providers from the fee if necessary to obtain federal approval.
14129.7.(a)This article shall be implemented only if, and as long as, both of the following conditions are met:
(1)The state receives federal approval of the quality assurance fee from the federal Centers for Medicare and Medicaid Services.
(2)The state receives federal approval for the increased fee-for-service payment schedule increases described in subdivision (a) of Section 14129.3.
(b)This article shall cease to be implemented if one of the following conditions is satisfied:
(1)The federal Centers for Medicare and Medicaid Services no longer allows the use of the provider assessment provided in this article.
(2)The Medi-Cal fee-for-service payment schedule increase described in subdivision (a) of Section 14129.3 no longer remains in effect.
(3)The quality assurance fee assessed and collected pursuant to this article is no longer available for the purposes specified in this article.
(4)A final judicial determination by the California Supreme Court or any California Court of Appeal that the revenues collected pursuant to this article that are deposited in the Medi-Cal Emergency Medical Transport Fund are either of the following:
(A)General Fund proceeds of taxes appropriated pursuant to Article XIII B of the California Constitution, as used in subdivision (b) of Section 8 of Article XVI of the California Constitution.
(B)Allocated local proceeds of taxes, as used in subdivision (b) of Section 8 of Article XVI of the California Constitution.
(c)If all of the conditions in subdivision (a) are met, this article is implemented. If, subsequently, any one of the conditions in subdivision (b) is met, this article shall become inoperative notwithstanding that the condition or conditions subsequently may be met.
(d)Notwithstanding subdivisions (a), (b), and (c), in the event of a final judicial determination made by any state or federal court that is not appealed, or by a court of appellate jurisdiction that is not further appealed, in any action by any party, or a final determination by the administrator of the federal Centers for Medicare and Medicaid Services, that federal financial participation is not available with respect to any payment made under the methodology implemented pursuant to this article because the methodology is invalid, unlawful, or contrary to any provision of federal law or regulations or of state law, this article shall become inoperative.
SEC. 3.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
SEC. 4.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the Constitution and shall go into immediate effect. The facts constituting the necessity are:
In order to make the necessary changes to increase Medi-Cal payments to emergency ambulance providers and to improve access, at the earliest possible time, to allow this act to be operative as soon as approval from the federal Centers for Medicare and Medicaid Services is obtained by the State Department of Health Care Services, it is necessary that this act take effect immediately.
The Legislature finds and declares all of the following:
(a)The Legislature recognizes the essential role that emergency medical transport providers play in serving the states Medi-Cal beneficiaries. To that end, it has been and remains the intent of the Legislature to improve funding for emergency medical transport providers and obtain all available federal funds to make supplemental Medi-Cal payments to emergency medical transport providers.
(b)It is the intent of the Legislature to impose a quality assurance fee to be paid by emergency medical transport providers, which will be used to increase federal financial participation in order to increase Medi-Cal payments to emergency medical transport providers.
(c)It is the intent of the Legislature to increase the Medi-Cal emergency medical transport reimbursement in Medi-Cal fee-for-service and Medi-Cal managed care by increasing the fee-for-service payment schedule for emergency medical transports to support quality improvement efforts by emergency medical transport providers, including, but not limited to, the provision of advanced life support services, as defined in Section 1797.52 of the Health and Safety Code.
(d)It is the further intent of the Legislature that the increased fee-for-service and Medi-Cal managed care payment schedule amounts pursuant to this article shall not result in any expenditure from the General Fund.
SEC. 2.Article 3.91 (commencing with Section 14129) is added to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, to read:3.91.Medi-Cal Emergency Medical Transportation Reimbursement Act14129.For purposes of this article, the following definitions shall apply:
(a)Annual quality assurance fee rate means the quality assurance fee assessed on each emergency medical transport applicable to each state fiscal year.
(b)Aggregate fee schedule increase amount means the product of the quotient described in paragraph (2) of subdivision (a) of Section 14129.3 and the Medi-Cal emergency medical transports, including both fee-for-service transports paid by the department and managed care transports paid by Medi-Cal managed care health plans, utilizing the billing codes for emergency medical transport for the state fiscal year.
(c)Available fee amount shall be calculated as the sum of the following:
(1)The amount deposited in the Medi-Cal Emergency Transportation Fund established under Section 14129.2 during the applicable state fiscal year, less the amounts described in subparagraphs (A) and (B) of paragraph (2) of subdivision (f) of Section 14129.2.
(2)Any federal financial participation obtained as a result of the deposit of the amount described in paragraph (1) in the Medi-Cal Emergency Transportation Fund for the applicable fiscal year.
(d)Department means the State Department of Health Care Services.
(e)Director means the Director of Health Care Services.
(f)Effective state medical assistance percentage means a ratio of the aggregate expenditures from state-only sources for the Medi-Cal program divided by the aggregate expenditures from state and federal sources for the Medi-Cal program for a state fiscal year.
(g)Emergency medical transport means the act of transporting an individual from any point of origin to the nearest medical facility capable of meeting the emergency medical needs of the patient by an ambulance licensed, operated, and equipped in accordance with applicable state or local statutes, ordinances, or regulations that are billed with billing codes A0429 BLS Emergency, A0427 ALS Emergency, and A0433 ALS2, and any equivalent, predecessor, or successor billing codes as may be determined by the director. Emergency medical transports shall not include transportation of beneficiaries by passenger car, taxicabs, litter vans, wheelchair vans, or other forms of public or private conveyances, nor shall it include transportation by an air ambulance provider. An emergency medical transport does not occur when, following evaluation of a patient, a transport is not provided.
(h)Gross receipts means gross payments received as patient care revenue for emergency medical transports, determined on a cash basis of accounting, excluding supplemental amounts received pursuant to Section 14105.94.
(i)Emergency medical transport provider means any provider of emergency medical transports.
(j)Emergency medical transport provider subject to the fee means all emergency medical transport providers that bill and receive patient care revenue from the provision of emergency medical transports, except emergency medical transport providers that are exempt pursuant to subdivision (c) of Section 14129.6.
(k)Medi-Cal managed care health plan means a managed health care plan as that term is defined in subdivision (ab) of Section 14169.51.
14129.1.(a)On or before August 15, 2016, November 15, 2016, each emergency medical transport provider shall report to the department data on the number of actual emergency medical transports by payor type, including, without limitation, Medi-Cal fee-for-service emergency medical transports and Medi-Cal managed care emergency medical transports, and gross receipts from the provision of emergency medical transports provided in each quarter from July 1, 2015, to June 30, 2016, October 31, 2016, inclusive, in a manner and format prescribed by the department.
(b)Commencing with the fiscal quarter beginning on October 1, 2016, January 1, 2017, and each fiscal quarter thereafter, on or before the 45th day of the quarter, each emergency medical transport provider shall report to the department data on the number of actual emergency medical transports by payor type, including, without limitation, Medi-Cal fee-for-service emergency medical transports and Medi-Cal managed care emergency medical transports, and gross receipts from the provision of emergency medical transports provided in the quarter preceding the quarter in which the report is due, in a manner and format prescribed by the department.
(c)The department may establish an Internet Web site for the submission of reports required by this section.
(d)The department may require a certification by each emergency medical transport under penalty of perjury of the truth of the reports required under this section. Upon written notice to an emergency medical transport provider, the department may impose a penalty of one hundred dollars ($100) per day against an emergency medical transport provider for every day that an emergency medical transport provider fails to make a report required by this section within five days of the date upon which the report was due. If an emergency medical transport provider has not made a report as required by this section within 90 days of the date upon which the report was due, the failure to make the report shall be considered a violation of a section of the Vehicle Code that relates to the emergency medical transport providers licensed activities for the purposes of Section 2542 of the Vehicle Code.
14129.2.(a)Commencing with the state fiscal quarter beginning on July 1, 2017, and continuing each state fiscal quarter thereafter, there shall be imposed a quality assurance fee for each emergency medical transport provided by each emergency medical transport provider subject to the fee in accordance with this section.
(b)(1)On or before June 15, 2017, and each June 15 thereafter, the director shall calculate the annual quality assurance fee rate applicable to the following state fiscal year based on the most recently collected data collected from emergency medical transport providers pursuant to Section 14129.1, and publish the annual quality assurance fee rate on its Internet Web site. In no case shall the fees calculated pursuant to this subdivision and collected pursuant to this article exceed the amounts allowable under federal law.
(A)For state fiscal year 201718, the annual quality assurance fee rate shall be calculated by multiplying the projected total annual gross receipts for all emergency medical transport providers subject to the fee by 5.5 percent, which resulting product shall be divided by the projected total annual emergency medical transports by all emergency medical transport providers subject to the fee for the state fiscal year.
(B)For state fiscal years 201819 and thereafter, the annual quality assurance fee rate shall be calculated by a ratio, the numerator of which shall be the sum of the product of the projected aggregate fee schedule amount and the effective state medical assistance percentage, and the amount described in subparagraph (A) of paragraph (2) of subdivision (f), and the denominator of which shall be 95 percent of the projected total annual emergency medical transports by all emergency medical transport providers subject to the fee for the state fiscal year.
(2)On or before June 15, 2017, and each June 15 thereafter, the director shall publish the annual quality assurance fee rate on its Internet Web site.
(3)In no case shall the fees calculated pursuant to this subdivision and collected pursuant to this article exceed the amounts allowable under federal law.
(4)If, during a state fiscal year, the actual or projected available fee amount exceeds or is less than the actual or projected aggregate fee schedule amount by more than 1 percent, the director shall adjust the annual quality assurance fee rate so that the available fee amount for the state fiscal year will approximately equal the aggregate fee schedule amount for the state fiscal year. The available fee amount for a state fiscal year will be considered to equal the aggregate fee schedule amount for the state fiscal year if the difference between the available fee amount for the state fiscal year and the aggregate fee schedule amount for the state fiscal year constitutes less than 1 percent of the aggregate fee schedule amount for the state fiscal year.
(c)(1)Each emergency medical transport provider subject to the fee shall remit to the department an amount equal to the annual quality assurance fee rate for the 201718 state fiscal year multiplied by the number of transports reported or that should have been reported by the emergency medical transport provider pursuant to subdivision (b) of Section 14129.1 in the quarter commencing April 1, 2017, based on a schedule established by the director. The schedule established by the director for the fee payment described in this paragraph shall not require payment of any of the fee payment prior to July 1, 2017, and shall not require payment of more than 50 percent of the fee payment prior to August 1, 2017.
(2)Commencing with the state fiscal quarter beginning on October 1, 2017, and each state fiscal quarter thereafter, on or before the first day of each state fiscal quarter, each emergency medical transport provider subject to the fee shall remit to the department an amount equal to the annual quality assurance fee rate for the applicable state fiscal year multiplied by the number of transports reported or that should have been reported by the emergency medical transport provider pursuant to subdivision (b) of Section 14129.1 in the immediately preceding quarter.
(d)(1)Interest shall be assessed on quality assurance fees not paid on the date due at the greater of 10 percent per annum or the rate at which the department assesses interest on Medi-Cal program overpayments to hospitals that are not repaid when due. Interest shall begin to accrue the day after the date the payment was due and shall be deposited in the Medi-Cal Emergency Medical Transport Fund established in subdivision (f).
(2)In the event that any fee payment is more than 60 days overdue, the department may deduct the unpaid fee and interest owed from any Medi-Cal reimbursement payments owed to the provider until the full amount of the fee and interest are recovered. Any deduction made pursuant to this subdivision shall be made only after the department gives the provider written notification. Any deduction made pursuant to this subdivision may be deducted over a period of time that takes into account the financial condition of the provider.
(3)In the event that any fee payment is more than 60 days overdue, a penalty equal to the interest charge described in paragraph (1) shall be assessed and due for each month for which the payment is not received after 60 days.
(e)The department shall accept an emergency medical transport providers payment even if the payment is submitted in a rate year subsequent to the rate year in which the fee was assessed.
(f)(1)The director shall deposit the quality assurance fee collected pursuant to this section in the Medi-Cal Emergency Medical Transport Fund, which is hereby created in the State Treasury and, notwithstanding Section 13440 of the Government Code, is continuously appropriated without regard to fiscal years to the department for the purposes specified in this article. Notwithstanding Section 16305.7 of the Government Code, the fund shall also include interest and dividends earned on moneys in the fund.
(2)The moneys in the Medi-Cal Emergency Medical Transport Fund, including any interest and dividends earned on money in the fund, shall be available exclusively to enhance federal financial participation for ambulance services under the Medi-Cal program and to provide additional reimbursement to, and to support quality improvement efforts of, emergency medical transport providers, as well as to pay for the states administrative costs and to provide funding for health care coverage for Californians, in the following order of priority:
(A)To pay for the departments staffing and administrative costs directly attributable to implementing this article, not to exceed three hundred fifty thousand dollars ($350,000) for each fiscal year, exclusive of any federal matching funds.
(B)To pay for the health care coverage in each fiscal year in the amount of 10 percent of the projected quality assurance fee revenue for that fiscal year, as calculated by the department on or before June 15 preceding that fiscal year, exclusive of any federal matching funds.
(C)To make increased payments to emergency medical transport providers pursuant to this article.
14129.3.(a)Effective July 1, 2017, the Medi-Cal fee-for-service payment schedule governing reimbursement to emergency medical transport providers for emergency medical transports shall be increased. The department shall calculate the projections required by this subdivision based on the data submitted pursuant to Section 14129.1. The resulting fee-for-service payment schedule amounts after the application of this section shall be equal to the sum of both of the following:
(1)The Medi-Cal fee-for-service payment schedule amount for the state fiscal year 201516.
(2)The quotient of the projected available fee amount for the state fiscal year 201718, divided by the total projected Medi-Cal emergency medical transports, including both fee-for-service transports paid by the department and managed care transports paid by Medi-Cal managed care health plans, utilizing these billing codes for the state fiscal year 201718.
(b)Each Medi-Cal managed care health plan shall satisfy its obligation under Section 438.114(c) of Title 42 of the Code of Federal Regulations for emergency medical transports by providing payment to emergency medical transport providers that is equal to the amount of payment described in Section 1396u-2(b)(2)(D) of Title 42 of the United States Code.
(c)The fee-for-service and Medi-Cal managed care payment schedule increase established pursuant to this section shall be funded solely from the following:
(1)The quality assurance fee set forth in Section 14129.2, along with any interest or other investment income thereon.
(2)Federal reimbursement and any other related federal funds.
(d)The proceeds of the quality assurance fee set forth in Section 14129.2, the matching amount provided by the federal government, and any interest earned on those proceeds shall be used to supplement existing funding for emergency medical transports provided by emergency transport providers and not supplant this funding.
14129.4.If there is a delay in the implementation of this article for any reason, including a delay in any required approval of the quality assurance fee and reimbursement methodology specified by the federal Centers for Medicare and Medicaid Services, all of the following shall apply:
(a)An emergency transport provider subject to the fee may be assessed the amount the provider would be required to pay to the department if the fee-for-service payment schedule increases described in Section 14129.3 were already approved, but shall not be required to pay the fee until the fee-for-service payment schedule increases described in Section 14129.3 are approved. The director shall establish a schedule for payment of retroactive fees pursuant to this subdivision in consultation with emergency medical transport providers to minimize the disruption to the cashflow of emergency medical transport providers.
(b)The department may retroactively increase and make payment of supplemental rates to emergency medical transport providers pursuant to Section 14129.3.
14129.5.(a)The director shall administer this article.
(b)The director may adopt regulations as are necessary to implement this article. These regulations may be adopted as emergency regulations in accordance with the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). For purposes of this article, the first adoption of regulations shall be deemed an emergency and necessary for the immediate preservation of the public peace, health and safety, or general welfare. The regulations shall include, but need not be limited to, any regulations necessary for any of the following purposes:
(1)The administration of this article, including the proper imposition of the quality assurance fee and process for its collection, reporting, and refunds. The costs associated with the administration of this article are not to exceed the amounts reasonably necessary to administer this article.
(2)The development of any forms necessary to obtain required information from providers subject to the quality assurance fee.
(3)The provision of details, definitions, formulas, and other requirements.
(c)As an alternative to subdivision (b), and notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the director may implement this article, in whole or in part, by means of a provider bulletin, or other similar instructions, without taking regulatory action, provided that no such bulletin or other similar instructions shall remain in effect after June 30, 2018. It is the intent of the Legislature that the regulations adopted pursuant to subdivision (b) be adopted on or before June 30, 2018.
(d)The director shall ensure that the quality assurance fee per transport imposed pursuant to this article is collected.
14129.6.(a)The department shall request approval from the federal Centers for Medicare and Medicaid Services for the use of fees collected pursuant to this article for the purpose of receiving federal matching funds.
(b)The director may alter the methodology specified in this article to the extent necessary to meet the requirements of federal law or regulations or to obtain federal approval. If the director, after consulting with affected emergency medical transport providers, determines that an alteration is needed, the director shall execute a declaration stating that this determination has been made. The director shall retain the declaration and provide a copy, within five working days of the execution of the declaration, to the fiscal and appropriate policy committees of the Legislature.
(c)The director may add categories of exempt emergency medical transport providers or apply a nonuniform fee per transport to emergency medical transport providers that are subject to the fee in order to meet requirements of federal law or regulations. The director may exempt categories of emergency medical transport providers from the fee if necessary to obtain federal approval.
14129.7.(a)This article shall be implemented only if, and as long as, both of the following conditions are met:
(1)The state receives federal approval of the quality assurance fee from the federal Centers for Medicare and Medicaid Services.
(2)The state receives federal approval for the increased fee-for-service payment schedule increases described in subdivision (a) of Section 14129.3.
(b)This article shall cease to be implemented if one of the following conditions is satisfied:
(1)The federal Centers for Medicare and Medicaid Services no longer allows the use of the provider assessment provided in this article.
(2)The Medi-Cal fee-for-service payment schedule increase described in subdivision (a) of Section 14129.3 no longer remains in effect.
(3)The quality assurance fee assessed and collected pursuant to this article is no longer available for the purposes specified in this article.
(4)A final judicial determination by the California Supreme Court or any California Court of Appeal that the revenues collected pursuant to this article that are deposited in the Medi-Cal Emergency Medical Transport Fund are either of the following:
(A)General Fund proceeds of taxes appropriated pursuant to Article XIII B of the California Constitution, as used in subdivision (b) of Section 8 of Article XVI of the California Constitution.
(B)Allocated local proceeds of taxes, as used in subdivision (b) of Section 8 of Article XVI of the California Constitution.
(c)If all of the conditions in subdivision (a) are met, this article is implemented. If, subsequently, any one of the conditions in subdivision (b) is met, this article shall become inoperative notwithstanding that the condition or conditions subsequently may be met.
(d)Notwithstanding subdivisions (a), (b), and (c), in the event of a final judicial determination made by any state or federal court that is not appealed, or by a court of appellate jurisdiction that is not further appealed, in any action by any party, or a final determination by the administrator of the federal Centers for Medicare and Medicaid Services, that federal financial participation is not available with respect to any payment made under the methodology implemented pursuant to this article because the methodology is invalid, unlawful, or contrary to any provision of federal law or regulations or of state law, this article shall become inoperative.
SEC. 3.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
SEC. 4.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the Constitution and shall go into immediate effect. The facts constituting the necessity are:
In order to make the necessary changes to increase Medi-Cal payments to emergency ambulance providers and to improve access, at the earliest possible time, to allow this act to be operative as soon as approval from the federal Centers for Medicare and Medicaid Services is obtained by the State Department of Health Care Services, it is necessary that this act take effect immediately.
The Legislature finds and declares all of the following:
(a)The Legislature recognizes the essential role that emergency medical transport providers play in serving the states Medi-Cal beneficiaries. To that end, it has been and remains the intent of the Legislature to improve funding for emergency medical transport providers and obtain all available federal funds to make supplemental Medi-Cal payments to emergency medical transport providers.
(b)It is the intent of the Legislature to impose a quality assurance fee to be paid by emergency medical transport providers, which will be used to increase federal financial participation in order to increase Medi-Cal payments to emergency medical transport providers.
(c)It is the intent of the Legislature to increase the Medi-Cal emergency medical transport reimbursement in Medi-Cal fee-for-service and Medi-Cal managed care by increasing the fee-for-service payment schedule for emergency medical transports to support quality improvement efforts by emergency medical transport providers, including, but not limited to, the provision of advanced life support services, as defined in Section 1797.52 of the Health and Safety Code.
(d)It is the further intent of the Legislature that the increased fee-for-service and Medi-Cal managed care payment schedule amounts pursuant to this article shall not result in any expenditure from the General Fund.
SECTION 1.SEC. 2.Article 3.91 (commencing with Section 14129) is added to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, to read:3.91.Medi-Cal Emergency Medical Transportation Reimbursement Act14129.The Legislature finds and declares all of the following:
(a)The Legislature recognizes the essential role that emergency medical transport providers play in serving the states Medi-Cal beneficiaries. To that end, it has been and remains the intent of the Legislature to improve funding for emergency medical transport providers and obtain all available federal funds to make supplemental Medi-Cal payments to emergency medical transport providers.
(b)It is the intent of the Legislature to impose a quality assurance fee to be paid by emergency medical transport providers, which will be used to increase federal financial participation in order to increase Medi-Cal payments to emergency medical transport providers.
(c)It is the intent of the Legislature to increase the Medi-Cal emergency medical transport reimbursement in Medi-Cal fee-for-service and Medi-Cal managed care by increasing the fee-for-service payment schedule for emergency medical transports to support quality improvement efforts by emergency medical transport providers, including, but not limited to, the provision of advanced life support services, as defined in Section 1797.52 of the Health and Safety Code.
(d)It is the further intent of the Legislature that the increased fee-for-service and Medi-Cal managed care payment schedule amounts pursuant to this article shall not result in any expenditure from the General Fund.
14129.1.14129.For purposes of this article, the following definitions shall apply:
(a)Annual quality assurance fee rate means the quality assurance fee assessed on each emergency medical transport applicable to each state fiscal year.
(b)Aggregate fee schedule increase amount means the product of the quotient described in paragraph (2) of subdivision (a) of Section 14129.4 14129.3 and the Medi-Cal emergency medical transports, including both fee-for-service transports paid by the department and managed care transports paid by Medi-Cal managed care health plans, utilizing the billing codes for emergency medical transport for the state fiscal year.
(c)Available fee amount shall be calculated as the sum of the following:
(1)The amount deposited in the Medi-Cal Emergency Transportation Fund established under Section 14129.3 14129.2 during the applicable state fiscal year, less the amounts described in subparagraphs (A) and (B) of paragraph (2) of subdivision (f) of Section 14129.3. 14129.2.
(2)Any federal financial participation obtained as a result of the deposit of the amount described in paragraph (1) in the Medi-Cal Emergency Transportation Fund for the applicable fiscal year.
(d)Department means the State Department of Health Care Services.
(e)Director means the Director of Health Care Services.
(f)Effective state medical assistance percentage means a ratio of the aggregate expenditures from state-only sources for the Medi-Cal program divided by the aggregate expenditures from state and federal sources for the Medi-Cal program for a state fiscal year.
(g)Emergency medical transport means the act of transporting an individual from any point of origin to the nearest medical facility capable of meeting the emergency medical needs of the patient by an ambulance licensed, operated, and equipped in accordance with applicable state or local statutes, ordinances, or regulations that are billed with billing codes A0429 BLS Emergency, A0427 ALS Emergency, and A0433 ALS2, and any equivalent, predecessor, or successor billing codes as may be determined by the director. Emergency medical transports shall not include transportation of beneficiaries by passenger car, taxicabs, litter vans, wheelchair vans, or other forms of public or private conveyances, nor shall it include transportation by an air ambulance provider. An emergency medical transport does not occur when, following evaluation of a patient, a transport is not provided.
(h)Gross receipts means gross payments received as patient care revenue for emergency medical transports, determined on a cash basis of accounting, excluding supplemental amounts received pursuant to Section 14105.94.
(i)Emergency medical transport provider means any provider of emergency medical transports.
(j)Emergency medical transport provider subject to the fee means all emergency medical transport providers that bill and receive patient care revenue from the provision of emergency medical transports, except emergency medical transport providers that are exempt pursuant to subdivision (c) of Section 14129.7. 14129.6.
(k)Medi-Cal managed care health plan means a managed health care plan as that term is defined in subdivision (ab) of Section 14169.51.
14129.2.14129.1.(a)On or before August 15, 2016, each emergency medical transport provider shall report to the department data on the number of actual emergency medical transports by payor type, including, without limitation, Medi-Cal fee-for-service emergency medical transports and Medi-Cal managed care emergency medical transports, and gross receipts from the provision of emergency medical transports provided in each quarter from July 1, 2015, through to June 30, 2016, inclusive, in a manner and format prescribed by the department.
(b)Commencing with the fiscal quarter beginning on October 1, 2016, and each fiscal quarter thereafter, on or before the 45th day of the quarter, each emergency medical transport provider shall report to the department data on the number of actual emergency medical transports by payor type, including, without limitation, Medi-Cal fee-for-service emergency medical transports and Medi-Cal managed care emergency medical transports, and gross receipts from the provision of emergency medical transports provided in the quarter preceding the quarter in which the report is due, in a manner and format prescribed by the department.
(c)The department may establish an Internet Web site for the submission of reports required by this section.
(d)The department may require a certification by each emergency medical transport under penalty of perjury of the truth of the reports required under this section. Upon written notice to an emergency medical transport provider, the department may impose a penalty of one hundred dollars ($100) per day against an emergency medical transport provider for every day that an emergency medical transport provider fails to make a report required by this section within five days of the date upon which the report was due. If an emergency medical transport provider has not made a report as required by this section within 90 days of the date upon which the report was due, the failure to make the report shall be considered a violation of a section of the Vehicle Code that relates to the emergency medical transport providers licensed activities for the purposes of Section 2542 of the Vehicle Code.
14129.3.14129.2.(a)Commencing with the state fiscal quarter beginning on July 1, 2017, and continuing each state fiscal quarter thereafter, there shall be imposed a quality assurance fee for each emergency medical transport provided by each emergency medical transport provider subject to the fee in accordance with this section.
(b)(1)On or before June 15, 2017, and each June 15 thereafter, the director shall calculate the annual quality assurance fee rate applicable to the following state fiscal year based on the most recently collected data collected from emergency medical transport providers pursuant to Section 14129.2, 14129.1, and publish the annual quality assurance fee rate on its Internet Web site. In no case shall the fees calculated pursuant to this subdivision and collected pursuant to this article exceed the amounts allowable under federal law.
(A)For state fiscal year 201718, the annual quality assurance fee rate shall be calculated by multiplying the projected total annual gross receipts for all emergency medical transport providers subject to the fee by 5.5 percent, which resulting product shall be divided by the projected total annual emergency medical transports by all emergency medical transport providers subject to the fee for the state fiscal year.
(B)For state fiscal years 201819 and thereafter, the annual quality assurance fee rate shall be calculated by a ratio, the numerator of which shall be the sum of the product of the projected aggregate fee schedule amount and the effective state medical assistance percentage, and the amount described in subparagraph (A) of paragraph (2) of subdivision (f), and the denominator of which shall be 95 percent of the projected total annual emergency medical transports by all emergency medical transport providers subject to the fee for the state fiscal year.
(2)On or before June 15, 2017, and each June 15 thereafter, the director shall publish the annual quality assurance fee rate on its Internet Web site.
(3)In no case shall the fees calculated pursuant to this subdivision and collected pursuant to this article exceed the amounts allowable under federal law.
(4)If, during a state fiscal year, the actual or projected available fee amount exceeds or is less than the actual or projected aggregate fee schedule amount by more than 1 percent, the director shall adjust the annual quality assurance fee rate so that the available fee amount for the state fiscal year will approximately equal the aggregate fee schedule amount for the state fiscal year. The available fee amount for a state fiscal year will be considered to equal the aggregate fee schedule amount for the state fiscal year if the difference between the available fee amount for the state fiscal year and the aggregate fee schedule amount for the state fiscal year constitutes less than 1 percent of the aggregate fee schedule amount for the state fiscal year.
(c)(1)Each emergency medical transport provider subject to the fee shall remit to the department an amount equal to the annual quality assurance fee rate for the 201718 state fiscal year multiplied by the number of transports reported or that should have been reported by the emergency medical transport provider pursuant to subdivision (b) of Section 14129.2 14129.1 in the quarter commencing April 1, 2017, based on a schedule established by the director. The schedule established by the director for the fee payment described in this paragraph shall not require payment of any of the fee payment prior to July 1, 2017, and shall not require payment of more than 50 percent of the fee payment prior to August 1, 2017.
(2)Commencing with the state fiscal quarter beginning on October 1, 2017, and each state fiscal quarter thereafter, on or before the first day of each state fiscal quarter, each emergency medical transport provider subject to the fee shall remit to the department an amount equal to the annual quality assurance fee rate for the applicable state fiscal year multiplied by the number of transports reported or that should have been reported by the emergency medical transport provider pursuant to subdivision (b) of Section 14129.2 14129.1 in the immediately preceding quarter.
(d)(1)Interest shall be assessed on quality assurance fees not paid on the date due at the greater of 10 percent per annum or the rate at which the department assesses interest on Medi-Cal program overpayments to hospitals that are not repaid when due. Interest shall begin to accrue the day after the date the payment was due and shall be deposited in the Medi-Cal Emergency Medical Transport Fund established in subdivision (f).
(2)In the event that any fee payment is more than 60 days overdue, the department may deduct the unpaid fee and interest owed from any Medi-Cal reimbursement payments owed to the provider until the full amount of the fee and interest are recovered. Any deduction made pursuant to this subdivision shall be made only after the department gives the provider written notification. Any deduction made pursuant to this subdivision may be deducted over a period of time that takes into account the financial condition of the provider.
(3)In the event that any fee payment is more than 60 days overdue, a penalty equal to the interest charge described in paragraph (1) shall be assessed and due for each month for which the payment is not received after 60 days.
(e)The department shall accept an emergency medical transport providers payment even if the payment is submitted in a rate year subsequent to the rate year in which the fee was assessed.
(f)(1)The director shall deposit the quality assurance fee collected pursuant to this section in the Medi-Cal Emergency Medical Transport Fund, which is hereby created in the State Treasury and, notwithstanding Section 13440 of the Government Code, is continuously appropriated without regard to fiscal years to the department for the purposes specified in this article. Notwithstanding Section 16305.7 of the Government Code, the fund shall also include interest and dividends earned on moneys in the fund.
(2)The moneys in the Medi-Cal Emergency Medical Transport Fund, including any interest and dividends earned on money in the fund, shall be available exclusively to enhance federal financial participation for ambulance services under the Medi-Cal program and to provide additional reimbursement to, and to support quality improvement efforts of, emergency medical transport providers, as well as to pay for the states administrative costs and to provide funding for health care coverage for Californians, in the following order of priority:
(A)To pay for the departments staffing and administrative costs directly attributable to implementing this article, not to exceed three hundred fifty thousand dollars ($350,000) for each fiscal year, exclusive of any federal matching funds.
(B)To pay for the health care coverage in each fiscal year in the amount of 5 10 percent of the projected quality assurance fee revenue for that fiscal year, as calculated by the department on or before June 15 preceding that fiscal year, exclusive of any federal matching funds.
(C)To make increased payments to emergency medical transport providers pursuant to this article.
(D)To provide additional support for health care coverage of Californians.
14129.4.14129.3.(a)Effective July 1, 2017, the Medi-Cal fee-for-service payment schedule governing reimbursement to emergency medical transport providers for emergency medical transports shall be increased. The department shall calculate the projections required by this subdivision based on the data submitted pursuant to Section 14129.2. 14129.1. The resulting fee-for-service payment schedule amounts after the application of this section shall be equal to the sum of both of the following:
(1)The Medi-Cal fee-for-service payment schedule amount for the state fiscal year 201516.
(2)The quotient of the projected available fee amount for the state fiscal year 201718, divided by the total projected Medi-Cal emergency medical transports, including both fee-for-service transports paid by the department and managed care transports paid by Medi-Cal managed care health plans, utilizing these billing codes for the state fiscal year 201718.
(b)Each Medi-Cal managed care health plan shall satisfy its obligation under Section 438.114(c) of Title 42 of the Code of Federal Regulations for emergency medical transports by providing payment to emergency medical transport providers that is equal to the amount of payment described in Section 1396u-2(b)(2)(D) of Title 42 of the United States Code.
(c)The fee-for-service and Medi-Cal managed care payment schedule increase established pursuant to this section shall be funded solely from the following:
(1)The quality assurance fee set forth in Section 14129.3, 14129.2, along with any interest or other investment income thereon.
(2)Federal reimbursement and any other related federal funds.
(d)The proceeds of the quality assurance fee set forth in Section 14129.3, 14129.2, the matching amount provided by the federal government, and any interest earned on those proceeds shall be used to supplement existing funding for emergency medical transports provided by emergency transport providers and not supplant this funding.
14129.5.14129.4.If there is a delay in the implementation of this article for any reason, including a delay in any required approval of the quality assurance fee and reimbursement methodology specified by the federal Centers for Medicare and Medicaid Services, all of the following shall apply:
(a)An emergency transport provider subject to the fee may be assessed the amount the provider would be required to pay to the department if the fee-for-service payment schedule increases described in Section 14129.4 14129.3 were already approved, but shall not be required to pay the fee until the fee-for-service payment schedule increases described in Section 14129.4 14129.3 are approved. The director shall establish a schedule for payment of retroactive fees pursuant to this subdivision in consultation with emergency medical transport providers to minimize the disruption to the cashflow of emergency medical transport providers.
(b)The department may retroactively increase and make payment of supplemental rates to emergency medical transport providers pursuant to Section 14129.4. 14129.3.
14129.6.14129.5.(a)The director shall administer this article.
(b)The director may adopt regulations as are necessary to implement this article. These regulations may be adopted as emergency regulations in accordance with the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). For purposes of this article, the first adoption of regulations shall be deemed an emergency and necessary for the immediate preservation of the public peace, health and safety, or general welfare. The regulations shall include, but need not be limited to, any regulations necessary for any of the following purposes:
(1)The administration of this article, including the proper imposition of the quality assurance fee and process for its collection, reporting, and refunds. The costs associated with the administration of this article are not to exceed the amounts reasonably necessary to administer this article.
(2)The development of any forms necessary to obtain required information from providers subject to the quality assurance fee.
(3)The provision of details, definitions, formulas, and other requirements.
(c)As an alternative to subdivision (b), and notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the director may implement this article, in whole or in part, by means of a provider bulletin, or other similar instructions, without taking regulatory action, provided that no such bulletin or other similar instructions shall remain in effect after June 30, 2018. It is the intent of the Legislature that the regulations adopted pursuant to subdivision (b) be adopted on or before June 30, 2018.
(d)The director shall ensure that the quality assurance fee per transport imposed pursuant to this article is collected.
14129.7.14129.6.(a)The department shall request approval from the federal Centers for Medicare and Medicaid Services for the use of fees collected pursuant to this article for the purpose of receiving federal matching funds.
(b)The director may alter the methodology specified in this article to the extent necessary to meet the requirements of federal law or regulations or to obtain federal approval. If the director, after consulting with affected emergency medical transport providers, determines that an alteration is needed, the director shall execute a declaration stating that this determination has been made. The director shall retain the declaration and provide a copy, within five working days of the execution of the declaration, to the fiscal and appropriate policy committees of the Legislature.
(c)The director may add categories of exempt emergency medical transport providers or apply a nonuniform fee per transport to emergency medical transport providers that are subject to the fee in order to meet requirements of federal law or regulations. The director may exempt categories of emergency medical transport providers from the fee if necessary to obtain federal approval.
14129.8.14129.7.(a)This article shall be implemented only if, and as long as, both of the following conditions are met:
(1)The state receives federal approval of the quality assurance fee from the federal Centers for Medicare and Medicaid Services.
(2)The state receives federal approval for the increased fee-for-service payment schedule increases described in subdivision (a) of Section 14129.4. 14129.3.
(b)This article shall cease to be implemented if one of the following conditions is satisfied:
(1)The federal Centers for Medicare and Medicaid Services no longer allows the use of the provider assessment provided in this article.
(2)The Medi-Cal fee-for-service payment schedule increase described in subdivision (a) of Section 14129.4 14129.3 no longer remains in effect.
(3)The quality assurance fee assessed and collected pursuant to this article is no longer available for the purposes specified in this article.
(4)A final judicial determination by the California Supreme Court or any California Court of Appeal that the revenues collected pursuant to this article that are deposited in the Medi-Cal Emergency Medical Transport Fund are either of the following:
(A)General Fund proceeds of taxes appropriated pursuant to Article XIII B of the California Constitution, as used in subdivision (b) of Section 8 of Article XVI of the California Constitution.
(B)Allocated local proceeds of taxes, as used in subdivision (b) of Section 8 of Article XVI of the California Constitution.
(c)If all of the conditions in subdivision (a) are met, this article is implemented. If, subsequently, any one of the conditions in subdivision (b) is met, this article shall become inoperative notwithstanding that the condition or conditions subsequently may be met.
(d)Notwithstanding subdivisions (a), (b), and (c), in the event of a final judicial determination made by any state or federal court that is not appealed, or by a court of appellate jurisdiction that is not further appealed, in any action by any party, or a final determination by the administrator of the federal Centers for Medicare and Medicaid Services, that federal financial participation is not available with respect to any payment made under the methodology implemented pursuant to this article because the methodology is invalid, unlawful, or contrary to any provision of federal law or regulations or of state law, this article shall become inoperative.
SEC. 2.SEC. 3.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
SEC. 3.SEC. 4.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the Constitution and shall go into immediate effect. The facts constituting the necessity are:
In order to make the necessary changes to increase Medi-Cal payments to emergency ambulance providers and to improve access, at the earliest possible time, to allow this act to be operative as soon as approval from the federal Centers for Medicare and Medicaid Services is obtained by the State Department of Health Care Services, it is necessary that this act take effect immediately.
The Legislature finds and declares all of the following:
(a)The Legislature recognizes the essential role that emergency medical transport providers play in serving the states Medi-Cal beneficiaries. To that end, it has been and remains the intent of the Legislature to improve funding for emergency medical transport providers and obtain all available federal funds to make supplemental Medi-Cal payments to emergency medical transport providers.
(b)It is the intent of the Legislature to impose a quality assurance fee to be paid by emergency medical transport providers, which will be used to increase federal financial participation in order to increase Medi-Cal payments to emergency medical transport providers.
(c)It is the intent of the Legislature to increase the Medi-Cal emergency medical transport reimbursement in Medi-Cal fee-for-service and Medi-Cal managed care by increasing the fee-for-service payment schedule for emergency medical transports to support quality improvement efforts by emergency medical transport providers, including, but not limited to, the provision of advanced life support services, as defined in Section 1797.52 of the Health and Safety Code.
(d)It is the further intent of the Legislature that the increased fee-for-service and Medi-Cal managed care payment schedule amounts pursuant to this article shall not result in any expenditure from the General Fund.
14129.1.For purposes of this article, the following definitions shall apply:
(a)Annual quality assurance fee rate means the quality assurance fee assessed on each emergency medical transport applicable to each state fiscal year.
(b)Aggregate fee schedule increase amount means the product of the quotient described in paragraph (2) of subdivision (a) of Section 14129.4 and the Medi-Cal emergency medical transports, including both fee-for-service transports paid by the department and managed care transports paid by Medi-Cal managed care health plans, utilizing the billing codes for emergency medical transport for the state fiscal year.
(c)Available fee amount shall be calculated as the sum of the following:
(1)The amount deposited in the Medi-Cal Emergency Transportation Fund established under Section 14129.3 during the applicable state fiscal year, less the amounts described in subparagraphs (A) and (B) of paragraph (2) of subdivision (f) of Section 14129.3.
(2)Any federal financial participation obtained as a result of the deposit of the amount described in paragraph (1) in the Medi-Cal Emergency Transportation Fund for the applicable fiscal year.
(d)Department means the State Department of Health Care Services.
(e)Director means the Director of Health Care Services.
(f)Effective state medical assistance percentage means a ratio of the aggregate expenditures from state-only sources for the Medi-Cal program divided by the aggregate expenditures from state and federal sources for the Medi-Cal program for a state fiscal year.
(g)Emergency medical transport means the act of transporting an individual from any point of origin to the nearest medical facility capable of meeting the emergency medical needs of the patient by an ambulance licensed, operated, and equipped in accordance with applicable state or local statutes, ordinances, or regulations that are billed with billing codes A0429 BLS Emergency, A0427 ALS Emergency, and A0433 ALS2, and any equivalent, predecessor, or successor billing codes as may be determined by the director. Emergency medical transports shall not include transportation of beneficiaries by passenger car, taxicabs, litter vans, wheelchair vans, or other forms of public or private conveyances, nor shall it include transportation by an air ambulance provider. An emergency medical transport does not occur when, following evaluation of a patient, a transport is not provided.
(h)Gross receipts means gross payments received as patient care revenue for emergency medical transports, determined on a cash basis of accounting. accounting, excluding supplemental amounts received pursuant to Section 14105.94.
(i)Emergency medical transport provider means any provider of emergency medical transports.
(j)Emergency medical transport provider subject to the fee means all emergency medical transport providers that bill and receive patient care revenue from the provision of emergency medical transports, except emergency medical transport providers that are exempt pursuant to subdivision (c) of Section 14129.8. 14129.7.
(k)Medi-Cal managed care health plan means a managed health care plan as that term is defined in subdivision (ab) of Section 14169.51.
14129.2.(a)On or before August 15, 2016, each emergency medical transport provider shall report to the department data on the number of actual emergency medical transports by payor type, including, without limitation, Medi-Cal fee-for-service emergency medical transports and Medi-Cal managed care emergency medical transports, and gross receipts from the provision of emergency medical transports provided in each quarter from July 1, 2015, through June 30, 2016, inclusive, in a manner and format prescribed by the department.
(b)Commencing with the fiscal quarter beginning on October 1, 2016, and each fiscal quarter thereafter, on or before the 45th day of the quarter, each emergency medical transport provider shall report to the department data on the number of actual emergency medical transports by payor type, including, without limitation, Medi-Cal fee-for-service emergency medical transports and Medi-Cal managed care emergency medical transports, and gross receipts from the provision of emergency medical transports provided in the quarter preceding the quarter in which the report is due, in a manner and format prescribed by the department.
(c)The department may establish an Internet Web site for the submission of reports required by this section.
(d)The department may require a certification by each emergency medical transport under penalty of perjury of the truth of the reports required under this section. Upon written notice to an emergency medical transport provider, the department may impose a penalty of one hundred dollars ($100) per day against an emergency medical transport provider for every day that an emergency medical transport provider fails to make a report required by this section within five days of the date upon which the report was due. If an emergency medical transport provider has not made a report as required by this section within 90 days of the date upon which the report was due, the failure to make the report shall be considered a violation of a section of the Vehicle Code that relates to the emergency medical transport providers licensed activities for the purposes of Section 2542 of the Vehicle Code.
14129.3.(a)Commencing with the state fiscal quarter beginning on July 1, 2017, and continuing each fiscal quarter thereafter, there shall be imposed a quality assurance fee for each emergency medical transport provided by each emergency medical transport provider subject to the fee in accordance with this section.
(b)(1)On or before June 15, 2017, and each June 15 thereafter, the director shall calculate the annual quality assurance fee rate applicable to the following state fiscal year based on the most recently collected data collected from emergency medical transport providers pursuant to Section 14129.2, and publish the annual quality assurance fee rate on its Internet Web site. In no case shall the fees calculated pursuant to this subdivision and collected pursuant to this article exceed the amounts allowable under federal law.
(A)For state fiscal year 201718, the annual quality assurance fee rate shall be calculated by multiplying the projected total annual gross receipts for all emergency medical transport providers subject to the fee by 5.5 percent, which resulting product shall be divided by the projected total annual emergency medical transports by all emergency medical transport providers subject to the fee for the state fiscal year.
(B)For state fiscal years 201819 and thereafter, the annual quality assurance fee rate shall be calculated by a ratio, the numerator of which shall be the sum of the product of the projected aggregate fee schedule amount and the effective state medical assistance percentage, and the amount described in subparagraph (A) of paragraph (2) of subdivision (f), and the denominator of which shall be 95 percent of the projected total annual emergency medical transports by all emergency medical transport providers subject to the fee for the state fiscal year.
(2)On or before June 15, 2017, and each June 15 thereafter, the director shall publish the annual quality assurance fee rate on its Internet Web site.
(3)In no case shall the fees calculated pursuant to this subdivision and collected pursuant to this article exceed the amounts allowable under federal law.
(4)If, during a state fiscal year, the actual or projected available fee amount exceeds or is less than the actual or projected aggregate fee schedule amount by more than 1 percent, the director shall adjust the annual quality assurance fee rate so that the available fee amount for the state fiscal year will approximately equal the aggregate fee schedule amount for the state fiscal year. The available fee amount for a state fiscal year will be considered to equal the aggregate fee schedule amount for the state fiscal year if the difference between the available fee amount for the state fiscal year and the aggregate fee schedule amount for the state fiscal year constitutes less than 1 percent of the aggregate fee schedule amount for the state fiscal year.
(c)(1)Each emergency medical transport provider subject to the fee shall remit to the department an amount equal to the annual quality assurance fee rate for the 201718 state fiscal year multiplied by the number of transports reported or that should have been reported by the emergency medical transport provider pursuant to subdivision (b) of Section 14129.2 in the quarter commencing April 1, 2017, based on a schedule established by the director. The schedule established by the director for the fee payment described in this paragraph shall not require payment of any of the fee payment prior to July 1, 2017, and shall not require payment of more than 50 percent of the fee payment prior to August 1, 2017.
(2)Commencing with the state fiscal quarter beginning on October 1, 2017, and each fiscal quarter thereafter, on or before the first day of each state fiscal quarter, each emergency medical transport provider subject to the fee shall remit to the department an amount equal to the annual quality assurance fee rate for the applicable state fiscal year multiplied by the number of transports reported or that should have been reported by the emergency medical transport provider pursuant to subdivision (b) of Section 14129.2 in the immediately preceding quarter.
(d)(1)Interest shall be assessed on quality assurance fees not paid on the date due at the greater of 10 percent per annum or the rate at which the department assesses interest on Medi-Cal program overpayments to hospitals that are not repaid when due. Interest shall begin to accrue the day after the date the payment was due and shall be deposited in the Medi-Cal Emergency Medical Transport Fund established in subdivision (f).
(2)In the event that any fee payment is more than 60 days overdue, the department may deduct the unpaid fee and interest owed from any Medi-Cal reimbursement payments owed to the provider until the full amount of the fee and interest are recovered. Any deduction made pursuant to this subdivision shall be made only after the department gives the provider written notification. Any deduction made pursuant to this subdivision may be deducted over a period of time that takes into account the financial condition of the provider.
(3)In the event that any fee payment is more than 60 days overdue, a penalty equal to the interest charge described in paragraph (1) shall be assessed and due for each month for which the payment is not received after 60 days.
(e)The department shall accept an emergency medical transport providers payment even if the payment is submitted in a rate year subsequent to the rate year in which the fee was assessed.
(f)(1)The director shall deposit the quality assurance fee collected pursuant to this section in the Medi-Cal Emergency Medical Transport Fund, which is hereby created in the State Treasury and, notwithstanding Section 13440 of the Government Code, is continuously appropriated without regard to fiscal years to the department for the purposes specified in this article. Notwithstanding Section 16305.7 of the Government Code, the fund shall also include interest and dividends earned on moneys in the fund.
(2)The moneys in the Medi-Cal Emergency Medical Transport Fund, including any interest and dividends earned on money in the fund, shall be available exclusively to enhance federal financial participation for ambulance services under the Medi-Cal program and to provide additional reimbursement to, and to support quality improvement efforts of, emergency medical transport providers, as well as to pay for the states administrative costs and to provide funding for health care coverage for Californians, in the following order of priority:
(A)To pay for the departments staffing and administrative costs directly attributable to implementing this article, not to exceed three hundred fifty thousand dollars ($350,000) for each fiscal year, exclusive of any federal matching funds.
(B)To pay for the health care coverage in each fiscal year in the amount of 5 percent of the projected quality assurance fee revenue for that fiscal year, as calculated by the department on or before June 15 preceding that fiscal year, exclusive of any federal matching funds.
(C)To make increased payments to emergency medical transport providers pursuant to this article.
(D)To provide additional support for health care coverage of Californians.
14129.4.(a)Effective July 1, 2017, the Medi-Cal fee-for-service payment schedule governing reimbursement to emergency medical transport providers for emergency medical transports shall be increased. The department shall calculate the projections required by this subdivision based on the data submitted pursuant to Section 14129.2. The resulting fee-for-service payment schedule amounts after the application of this section shall be equal to the sum of (1) the both of the following:
(1)The Medi-Cal fee-for-service payment schedule amount for the state fiscal year 201516 and (2) the 201516.
(2)The quotient of the projected available fee amount for the state fiscal year 201718, divided by the total projected Medi-Cal emergency medical transports, including both fee-for-service transports paid by the department and managed care transports paid by Medi-Cal managed care health plans, utilizing these billing codes for the state fiscal year 201617. The department shall calculate the projections required by this subdivision based on the data submitted pursuant to Section 14129.2. 201718.
(b)Each Medi-Cal managed care health plan shall satisfy its obligation under Section 438.114(c) of Title 42 of the Code of Federal Regulations for emergency medical transports by providing payment to emergency medical transport providers that is equal to the amount of payment described in Section 1396u-2(b)(2)(D) of Title 42 of the United States Code.
(c)The fee-for-service and Medi-Cal managed care payment schedule increase established pursuant to this section shall be funded solely from the following:
(1)The quality assurance fee set forth in Section 14129.3, along with any interest or other investment income thereon.
(2)Federal reimbursement and any other related federal funds.
(d)The proceeds of the quality assurance fee set forth in Section 14129.3, the matching amount provided by the federal government, and any interest earned on those proceeds shall be used to supplement existing funding for emergency medical transports provided by emergency transport providers and not supplant this funding.
14129.5.If there is a delay in the implementation of this article for any reason, including a delay in any required approval of the quality assurance fee and reimbursement methodology specified by the federal Centers for Medicare and Medicaid Services, all of the following shall apply:
(a)An emergency transport provider subject to the fee may be assessed the amount the provider would be required to pay to the department if the fee-for-service payment schedule increases described in Section 14129.4 were already approved, but shall not be required to pay the fee until the fee-for-service payment schedule increases described in Section 14129.4 are approved. The director shall establish a schedule for payment of retroactive fees pursuant to this subdivision in consultation with emergency medical transport providers to minimize the disruption to the cashflow of emergency medical transport providers.
(b)The department may retroactively increase and make payment of supplemental rates to emergency medical transport providers pursuant to Section 14129.4.
14129.6.(a)The director shall administer this article.
(b)The director may adopt regulations as are necessary to implement this article. These regulations may be adopted as emergency regulations in accordance with the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). For purposes of this article, the first adoption of regulations shall be deemed an emergency and necessary for the immediate preservation of the public peace, health and safety, or general welfare. The regulations shall include, but need not be limited to, any regulations necessary for any of the following purposes:
(1)The administration of this article, including the proper imposition of the quality assurance fee and process for its collection, reporting, and refunds. The costs associated with the administration of this article are not to exceed the amounts reasonably necessary to administer this article.
(2)The development of any forms necessary to obtain required information from providers subject to the quality assurance fee.
(3)The provision of details, definitions, formulas, and other requirements.
(c)As an alternative to subdivision (b), and notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the director may implement this article, in whole or in part, by means of a provider bulletin, or other similar instructions, without taking regulatory action, provided that no such bulletin or other similar instructions shall remain in effect after June 30, 2018. It is the intent of the Legislature that the regulations adopted pursuant to subdivision (b) be adopted on or before June 30, 2018.
(d)The director shall ensure that the quality assurance fee per transport imposed pursuant to this article is collected.
14129.7.The moneys in the Medi-Cal Emergency Medical Transport Fund, and any federal matching funds, shall be continuously appropriated, notwithstanding Section 13340 of the Government Code, without regard to fiscal years to the department for the purpose of the increased Medi-Cal fee-for-service payment schedule governing reimbursement to emergency medical transport providers for emergency medical transports described in Section 14129.4.
14129.8.14129.7.(a)The department shall request approval from the federal Centers for Medicare and Medicaid Services for the use of fees collected pursuant to this article for the purpose of receiving federal matching funds.
(b)The director may alter the methodology specified in this article to the extent necessary to meet the requirements of federal law or regulations or to obtain federal approval. If the director, after consulting with affected emergency medical transport providers, determines that an alteration is needed, the director shall execute a declaration stating that this determination has been made. The director shall retain the declaration and provide a copy, within five working days of the execution of the declaration, to the fiscal and appropriate policy committees of the Legislature.
(c)The director may add categories of exempt emergency medical transport providers or apply a nonuniform fee per transport to emergency medical transport providers that are subject to the fee in order to meet requirements of federal law or regulations. The director may exempt categories of emergency medical transport providers from the fee if necessary to obtain federal approval.
14129.9.14129.8.(a)This article shall be implemented only if, and as long as, both of the following conditions are met:
(1)The state receives federal approval of the quality assurance fee from the federal Centers for Medicare and Medicaid Services.
(2)The state receives federal approval for the increased fee-for-service payment schedule increases described in subdivision (a) of Section 14129.4.
(b)This article shall cease to be implemented if one of the following conditions is no longer met: satisfied:
(1)The federal Centers for Medicare and Medicaid Services continues to allow no longer allows the use of the provider assessment provided in this article.
(2)The Medi-Cal fee-for-service payment schedule increase described in subdivision (a) of Section 14129.4 no longer remains in effect.
(3)The quality assurance fee assessed and collected pursuant to this article remains is no longer available for the purposes specified in this article.
(c)If all of the conditions in subdivision (a) are met, this article is implemented. If, subsequently, any one of the conditions in subdivision (b) is not met, this article shall become inoperative notwithstanding that the condition or conditions subsequently may be met.
(d)Notwithstanding subdivisions (a), (b), and (c), in the event of a final judicial determination made by any state or federal court that is not appealed, or by a court of appellate jurisdiction that is not further appealed, in any action by any party, or a final determination by the administrator of the federal Centers for Medicare and Medicaid Services, that federal financial participation is not available with respect to any payment made under the methodology implemented pursuant to this article because the methodology is invalid, unlawful, or contrary to any provision of federal law or regulations or of state law, this article shall become inoperative.
SEC. 2.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
SEC. 3.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the Constitution and shall go into immediate effect. The facts constituting the necessity are:
In order to make the necessary changes to increase Medi-Cal payments to emergency ambulance providers and to improve access, at the earliest possible time, to allow this act to be operative as soon as approval from the federal Centers for Medicare and Medicaid Services is obtained by the State Department of Health Care Services, it is necessary that this act take effect immediately.
The Legislature finds and declares all of the following:
(a)The Legislature recognizes the essential role that emergency medical transport providers play in serving the states Medi-Cal beneficiaries. To that end, it has been and remains the intent of the Legislature to improve funding for emergency medical transport providers and obtain all available federal funds to make supplemental Medi-Cal payments to emergency medical transport providers.
(b)It is the intent of the Legislature to impose a quality assurance fee to be paid by emergency medical transport providers, which will be used to increase federal financial participation in order to increase Medi-Cal payments to emergency medical transport providers.
(c)It is the intent of the Legislature to increase the Medi-Cal emergency medical transport reimbursement by increasing the fee-for-service payment schedule for emergency medical transports to support quality improvement efforts by emergency medical transport providers, including, but not limited to, the provision of advanced life support services, as defined in Section 1797.52 of the Health and Safety Code.
(d)It is the further intent of the Legislature that the increased fee-for-service payment schedule amounts pursuant to this article shall not result in any expenditure from the General Fund.
14129.1.For purposes of this article, the following definitions shall apply:
(a)Annual quality assurance fee rate means the quality assurance fee assessed on each emergency medical transport applicable to each state fiscal year.
(b)Aggregate fee schedule increase amount means the product of the quotient described in paragraph (2) of subdivision (a) of Section 14129.4 and the Medi-Cal emergency medical transports, including both fee-for-service transports paid by the department and managed care transports paid by Medi-Cal managed care health plans, utilizing the billing codes for emergency medical transport for the state fiscal year.
(c)Available fee amount shall be calculated as the sum of the following:
(1)The amount deposited in the Medi-Cal Emergency Transportation Fund established under Section 14129.3 during the applicable state fiscal year, less the amounts described in subparagraphs (A) and (B) of paragraph (2) of subdivision (f) of Section 14129.3.
(2)Any federal financial participation obtained as a result of the deposit of the amount described in paragraph (1) in the Medi-Cal Emergency Transportation Fund for the applicable fiscal year.
(d)Department means the State Department of Health Care Services.
(e)Director means the Director of Health Care Services.
(f)Effective state medical assistance percentage means a ratio of the aggregate expenditures from state-only sources for the Medi-Cal program divided by the aggregate expenditures from state and federal sources for the Medi-Cal program for a state fiscal year.
(g)Emergency medical transport means the act of transporting an individual from any point of origin to the nearest medical facility capable of meeting the emergency medical needs of the patient by an ambulance licensed, operated, and equipped in accordance with applicable state or local statutes, ordinances, or regulations that are billed with billing codes A0429 BLS Emergency, A0427 ALS Emergency, and A0433 ALS2, and any equivalent, predecessor, or successor billing codes as may be determined by the director. Emergency medical transports shall not include transportation of beneficiaries by passenger car, taxicabs, litter vans, wheelchair vans, or other forms of public or private conveyances, nor shall it include transportation by an air ambulance provider. An emergency medical transport does not occur when, following evaluation of a patient, a transport is not provided.
(h)Gross receipts means gross payments received as patient care revenue for emergency medical transports, determined on a cash basis of accounting.
(i)Emergency medical transport provider means any provider of emergency medical transports.
(j)Emergency medical transport provider subject to the fee means all emergency medical transport providers that bill and receive patient care revenue from the provision of emergency medical transports, except emergency medical transport providers that are exempt pursuant to subdivision (c) of Section 14129.8.
(k)Medi-Cal managed care health plan means a managed health care plan as that term is defined in subdivision (ab) of Section 14169.51.
14129.2.(a)On or before August 15, 2016, each emergency medical transport provider shall report to the department data on the number of actual emergency medical transports by payor type, including, without limitation, Medi-Cal fee-for-service emergency medical transports and Medi-Cal managed care emergency medical transports, and gross receipts from the provision of emergency medical transports provided in each quarter from July 1, 2015, through June 30, 2016, inclusive, in a manner and format prescribed by the department.
(b)Commencing with the fiscal quarter beginning on October 1, 2016, and each fiscal quarter thereafter, on or before the 45th day of the quarter, each emergency medical transport provider shall report to the department data on the number of actual emergency medical transports by payor type, including, without limitation, Medi-Cal fee-for-service emergency medical transports and Medi-Cal managed care emergency medical transports, and gross receipts from the provision of emergency medical transports provided in the quarter preceding the quarter in which the report is due, in a manner and format prescribed by the department.
(c)The department may establish an Internet Web site for the submission of reports required by this section.
(d)The department may require a certification by each emergency medical transport under penalty of perjury of the truth of the reports required under this section. Upon written notice to an emergency medical transport provider, the department may impose a penalty of one hundred dollars ($100) per day against an emergency medical transport provider for every day that an emergency medical transport provider fails to make a report required by this section within five days of the date upon which the report was due. If an emergency medical transport provider has not made a report as required by this section within 90 days of the date upon which the report was due, the failure to make the report shall be considered a violation of a section of the Vehicle Code that relates to the emergency medical transport providers licensed activities for the purposes of Section 2542 of the Vehicle Code.
14129.3.(a)Commencing with the state fiscal quarter beginning on July 1, 2017, and continuing each fiscal quarter thereafter, there shall be imposed a quality assurance fee for each transport provided by each emergency medical transport provider subject to the fee in accordance with this section.
(b)(1)On or before June 15, 2017, and each June 15 thereafter, the director shall calculate the annual quality assurance fee rate applicable to the following state fiscal year based on the most recently collected data collected from emergency medical transport providers pursuant to Section 14129.2, and publish the annual quality assurance fee rate on its Internet Web site. In no case shall the fees calculated pursuant to this subdivision and collected pursuant to this article exceed the amounts allowable under federal law.
(A)For state fiscal year 201718, the annual quality assurance fee rate shall be calculated by multiplying the projected total annual gross receipts for all emergency medical transport providers subject to the fee by 5.5 percent, which resulting product shall be divided by the projected total annual emergency medical transports by all emergency medical transport providers subject to the fee for the state fiscal year.
(B)For state fiscal years 201819 and thereafter, the annual quality assurance fee rate shall be calculated by a ratio, the numerator of which shall be the sum of the product of the projected aggregate fee schedule amount and the effective state medical assistance percentage, and the amount described in subparagraph (A) of paragraph (2) of subdivision (f), and the denominator of which shall be 95 percent of the projected total annual emergency medical transports by all emergency medical transport providers subject to the fee for the state fiscal year.
(2)On or before June 15, 2017, and each June 15 thereafter, the director shall publish the annual quality assurance fee rate on its Internet Web site.
(3)In no case shall the fees calculated pursuant to this subdivision and collected pursuant to this article exceed the amounts allowable under federal law.
(4)If, during a state fiscal year, the actual or projected available fee amount exceeds or is less than the actual or projected aggregate fee schedule amount by more than 1 percent, the director shall adjust the annual quality assurance fee rate so that the available fee amount for the state fiscal year will approximately equal the aggregate fee schedule amount for the state fiscal year. The available fee amount for a state fiscal year will be considered to equal the aggregate fee schedule amount for the state fiscal year if the difference between the available fee amount for the state fiscal year and the aggregate fee schedule amount for the state fiscal year constitutes less than 1 percent of the aggregate fee schedule amount for the state fiscal year.
(c)(1)Each emergency medical transport provider subject to the fee shall remit to the department an amount equal to the annual quality assurance fee rate for the 201718 state fiscal year multiplied by the number of transports reported or that should have been reported by the emergency medical transport provider pursuant to subdivision (b) of Section 14129.2 in the quarter commencing April 1, 2017, based on a schedule established by the director. The schedule established by the director for the fee payment described in this paragraph shall not require payment of any of the fee payment prior to July 1, 2017, and shall not require payment of more than 50 percent of the fee payment prior to August 1, 2017.
(2)Commencing with the state fiscal quarter beginning on October 1, 2017, and each fiscal quarter thereafter, on or before the first day of each state fiscal quarter, each emergency medical transport provider subject to the fee shall remit to the department an amount equal to the annual quality assurance fee rate for the applicable state fiscal year multiplied by the number of transports reported or that should have been reported by the emergency medical transport provider pursuant to subdivision (b) of Section 14129.2 in the immediately preceding quarter.
(d)(1)Interest shall be assessed on quality assurance fees not paid on the date due at the greater of 10 percent per annum or the rate at which the department assesses interest on Medi-Cal program overpayments to hospitals that are not repaid when due. Interest shall begin to accrue the day after the date the payment was due and shall be deposited in the Medi-Cal Emergency Medical Transport Fund established in subdivision (f).
(2)In the event that any fee payment is more than 60 days overdue, the department may deduct the unpaid fee and interest owed from any Medi-Cal reimbursement payments owed to the provider until the full amount of the fee and interest are recovered. Any deduction made pursuant to this subdivision shall be made only after the department gives the provider written notification. Any deduction made pursuant to this subdivision may be deducted over a period of time that takes into account the financial condition of the provider.
(3)In the event that any fee payment is more than 60 days overdue, a penalty equal to the interest charge described in paragraph (1) shall be assessed and due for each month for which the payment is not received after 60 days.
(e)The department shall accept an emergency medical transport providers payment even if the payment is submitted in a rate year subsequent to the rate year in which the fee was assessed.
(f)(1)The director shall deposit the quality assurance fee collected pursuant to this section in the Medi-Cal Emergency Medical Transport Fund, which is hereby created in the State Treasury and, notwithstanding Section 13440 of the Government Code, is continuously appropriated without regard to fiscal years to the department for the purposes specified in this article. Notwithstanding Section 16305.7 of the Government Code, the fund shall also include interest and dividends earned on moneys in the fund.
(2)The moneys in the Medi-Cal Emergency Medical Transport Fund, including any interest and dividends earned on money in the fund, shall be available exclusively to enhance federal financial participation for ambulance services under the Medi-Cal program and to provide additional reimbursement to, and to support quality improvement efforts of, emergency medical transport providers, as well as to pay for the states administrative costs and to provide funding for health care coverage for Californians, in the following order of priority:
(A)To pay for the departments staffing and administrative costs directly attributable to implementing this article, not to exceed three hundred fifty thousand dollars ($350,000) for each fiscal year, exclusive of any federal matching funds.
(B)To pay for the health care coverage in each fiscal year in the amount of 5 percent of the projected quality assurance fee revenue for that fiscal year, as calculated by the department on or before June 15 preceding that fiscal year, exclusive of any federal matching funds.
(C)To make increased payments to emergency medical transport providers pursuant to this article.
(D)To provide additional support for health care coverage of Californians.
14129.4.(a)Effective July 1, 2017, the Medi-Cal fee-for-service payment schedule governing reimbursement to emergency medical transport providers for emergency medical transports shall be increased. The resulting fee-for-service payment schedule amounts after the application of this section shall be equal to the sum of (1) the Medi-Cal fee-for-service payment schedule amount for the state fiscal year 201516 and (2) the quotient of the projected available fee amount for the state fiscal year 201718, divided by the total projected Medi-Cal emergency medical transports, including both fee-for-service transports paid by the department and managed care transports paid by Medi-Cal managed care health plans, utilizing these billing codes for the state fiscal year 201617. The department shall calculate the projections required by this subdivision based on the data submitted pursuant to Section 14129.2.
(b)Each Medi-Cal managed care health plan shall satisfy its obligation under Section 438.114(c) of Title 42 of the Code of Federal Regulations for emergency medical transports by providing payment to emergency medical transport providers that is equal to the amount of payment described in Section 1396u-2(b)(2)(D) of Title 42 of the United States Code.
(c)The fee-for-service payment schedule increase established pursuant to this section shall be funded solely from the following:
(1)The quality assurance fee set forth in Section 14129.3, along with any interest or other investment income thereon.
(2)Federal reimbursement and any other related federal funds.
(d)The proceeds of the quality assurance fee set forth in Section 14129.3, the matching amount provided by the federal government, and any interest earned on those proceeds shall be used to supplement existing funding for emergency medical transports provided by emergency transport providers and not supplant this funding.
14129.5.If there is a delay in the implementation of this article for any reason, including a delay in any required approval of the quality assurance fee and reimbursement methodology specified by the federal Centers for Medicare and Medicaid Services, all of the following shall apply:
(a)An emergency transport provider subject to the fee may be assessed the amount the provider would be required to pay to the department if the fee-for-service payment schedule increases described in Section 14129.4 were already approved, but shall not be required to pay the fee until the fee-for-service payment schedule increases described in Section 14129.4 are approved. The director shall establish a schedule for payment of retroactive fees pursuant to this subdivision in consultation with emergency medical transport providers to minimize the disruption to the cash flow of emergency medical transport providers.
(b)The department may retroactively increase and make payment of supplemental rates to emergency medical transport providers pursuant to Section 14129.4.
14129.6.(a)The director shall administer this article.
(b)The director may adopt regulations as are necessary to implement this article. These regulations may be adopted as emergency regulations in accordance with the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). For purposes of this article, the first adoption of regulations shall be deemed an emergency and necessary for the immediate preservation of the public peace, health and safety, or general welfare. The regulations shall include, but need not be limited to, any regulations necessary for any of the following purposes:
(1)The administration of this article, including the proper imposition of the quality assurance fee and process for its collection, reporting, and refunds. The costs associated with the administration of this article are not to exceed the amounts reasonably necessary to administer this article.
(2)The development of any forms necessary to obtain required information from providers subject to the quality assurance fee.
(3)The provision of details, definitions, formulas, and other requirements.
(c)As an alternative to subdivision (b), and notwithstanding the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code), the director may implement this article, in whole or in part, by means of a provider bulletin, or other similar instructions, without taking regulatory action, provided that no such bulletin or other similar instructions shall remain in effect after June 30, 2018. It is the intent of the Legislature that the regulations adopted pursuant to subdivision (b) be adopted on or before June 30, 2018.
(d)The director shall ensure that the quality assurance fee per transport imposed pursuant to this article is collected.
14129.7.The moneys in the Medi-Cal Emergency Medical Transport Fund, and any federal matching funds, shall be continuously appropriated, notwithstanding Section 13340 of the Government Code, without regard to fiscal years to the department for the purpose of the increased Medi-Cal fee-for-service payment schedule governing reimbursement to emergency medical transport providers for emergency medical transports described in Section 14129.4.
14129.8.(a)The department shall request approval from the federal Centers for Medicare and Medicaid Services for the use of fees collected pursuant to this article for the purpose of receiving federal matching funds.
(b)The director may alter the methodology specified in this article to the extent necessary to meet the requirements of federal law or regulations or to obtain federal approval. If the director, after consulting with affected emergency medical transport providers, determines that an alteration is needed, the director shall execute a declaration stating that this determination has been made. The director shall retain the declaration and provide a copy, within five working days of the execution of the declaration, to the fiscal and appropriate policy committees of the Legislature.
(c)The director may add categories of exempt emergency medical transport providers or apply a nonuniform fee per transport to emergency medical transport providers that are subject to the fee in order to meet requirements of federal law or regulations. The director may exempt categories of emergency medical transport providers from the fee if necessary to obtain federal approval.
14129.9.(a)This article shall be implemented only if, and as long as, both of the following conditions are met:
(1)The state receives federal approval of the quality assurance fee from the federal Centers for Medicare and Medicaid Services.
(2)The state receives federal approval for the increased fee-for-service payment schedule increases described in subdivision (a) of Section 14129.4.
(b)This article shall cease to be implemented if one of the following conditions is no longer met:
(1)The federal Centers for Medicare and Medicaid Services continues to allow the use of the provider assessment provided in this article.
(2)The Medi-Cal fee-for-service payment schedule increase described in subdivision (a) of Section 14129.4 remains in effect.
(3)The quality assurance fee assessed and collected pursuant to this article remains available for the purposes specified in this article.
(c)If all of the conditions in subdivision (a) are met, this article is implemented. If, subsequently, any one of the conditions in subdivision (b) is not met, this article shall become inoperative notwithstanding that the condition or conditions subsequently may be met.
(d)Notwithstanding subdivisions (a), (b), and (c), in the event of a final judicial determination made by any state or federal court that is not appealed, or by a court of appellate jurisdiction that is not further appealed, in any action by any party, or a final determination by the administrator of the federal Centers for Medicare and Medicaid Services, that federal financial participation is not available with respect to any payment made under the methodology implemented pursuant to this article because the methodology is invalid, unlawful, or contrary to any provision of federal law or regulations or of state law, this article shall become inoperative.
SEC. 2.No reimbursement is required by this act pursuant to Section 6 of Article XIIIB of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIIIB of the California Constitution.
SEC. 3.This act is an urgency statute necessary for the immediate preservation of the public peace, health, or safety within the meaning of Article IV of the Constitution and shall go into immediate effect. The facts constituting the necessity are:
In order to make the necessary changes to increase Medi-Cal payments to emergency ambulance providers and to improve access, at the earliest possible time, to allow this act to be operative as soon as approval from the federal Centers for Medicare and Medicaid Services is obtained by the State Department of Health Care Services, it is necessary that this act take effect immediately.
SECTION 1.Section 15926 of the Welfare and Institutions Code is amended to read:15926.(a)The following definitions apply for purposes of this part:
(1)Accessible means in compliance with Section 11135 of the Government Code, Section 1557 of the PPACA, and regulations or guidance adopted pursuant to these statutes.
(2)Limited-English-proficient means not speaking English as ones primary language and having a limited ability to read, speak, write, or understand English.
(3)Insurance affordability program means a program that is one of the following:
(A)The Medi-Cal program under Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.).
(B)The states childrens health insurance program (CHIP) under Title XXI of the federal Social Security Act (42 U.S.C. Sec. 1397aa et seq.).
(C)A program that makes available to qualified individuals coverage in a qualified health plan through the California Health Benefit Exchange established pursuant to Title 22 (commencing with Section 100500) of the Government Code with advance payment of the premium tax credit established under Section 36B of the Internal Revenue Code.
(4)A program that makes available coverage in a qualified health plan through the California Health Benefit Exchange established pursuant to Title 22 (commencing with Section 100500) of the Government Code with cost-sharing reductions established under Section 1402 of PPACA and any subsequent amendments to that act.
(b)An individual shall have the option to apply for insurance affordability programs in person, by mail, online, by telephone, or by other commonly available electronic means.
(c)(1)A single, accessible, standardized paper, electronic, and telephone application for insurance affordability programs shall be developed by the department in consultation with MRMIB and the board governing the Exchange as part of the stakeholder process described in subdivision (b) of Section 15925. The application shall be used by all entities authorized to make an eligibility determination for any of the insurance affordability programs and by their agents.
(2)The department may develop and require the use of supplemental forms to collect additional information needed to determine eligibility on a basis other than the financial methodologies described in Section 1396a(e)(14) of Title 42 of the United States Code, as added by the federal Patient Protection and Affordable Care Act (Public Law 111-148), and as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152) and any subsequent amendments, as provided under Section 435.907(c) of Title 42 of the Code of Federal Regulations.
(3)The application shall be tested and operational by the date as required by the federal Secretary of Health and Human Services.
(4)The application form shall, to the extent not inconsistent with federal statutes, regulations, and guidance, satisfy all of the following criteria:
(A)The form shall include simple, user-friendly language and instructions.
(B)The form may not ask for information related to a nonapplicant that is not necessary to determine eligibility in the applicants particular circumstances.
(C)The form may require only information necessary to support the eligibility and enrollment processes for insurance affordability programs.
(D)The form may be used for, but shall not be limited to, screening.
(E)The form may ask, or be used otherwise to identify, if the mother of an infant applicant under one year of age had coverage through an insurance affordability program for the infants birth, for the purpose of automatically enrolling the infant into the applicable program without the family having to complete the application process for the infant.
(F)The form may include questions that are voluntary for applicants to answer regarding demographic data categories, including race, ethnicity, primary language, disability status, and other categories recognized by the federal Secretary of Health and Human Services under Section 4302 of the PPACA.
(G)Until January 1, 2016, the department shall instruct counties to not reject an application that was in existence prior to January 1, 2014, but to accept the application and request any additional information needed from the applicant in order to complete the eligibility determination process. The department shall work with counties and consumer advocates to develop the supplemental questions.
(d)Nothing in this section shall preclude the use of a provider-based application form or enrollment procedures for insurance affordability programs or other health programs that differs from the application form described in subdivision (c), and related enrollment procedures. Nothing in this section shall preclude the use of a joint application, developed by the department and the State Department of Social Services, that allows for an application to be made for multiple programs, including, but not limited to, CalWORKs, CalFresh, and insurance affordability programs.
(e)The entity making the eligibility determination shall grant eligibility immediately whenever possible and with the consent of the applicant in accordance with the state and federal rules governing insurance affordability programs.
(f)(1)If the eligibility, enrollment, and retention system has the ability to prepopulate an application form for insurance affordability programs with personal information from available electronic databases, an applicant shall be given the option, with his or her informed consent, to have the application form prepopulated. Before a prepopulated application is submitted to the entity authorized to make eligibility determinations, the individual shall be given the opportunity to provide additional eligibility information and to correct any information retrieved from a database.
(2)All insurance affordability programs may accept self-attestation, instead of requiring an individual to produce a document, for age, date of birth, family size, household income, state residence, pregnancy, and any other applicable criteria needed to determine the eligibility of an applicant or recipient, to the extent permitted by state and federal law.
(3)An applicant or recipient shall have his or her information electronically verified in the manner required by the PPACA and implementing federal regulations and guidance and state law.
(4)Before an eligibility determination is made, the individual shall be given the opportunity to provide additional eligibility information and to correct information.
(5)The eligibility of an applicant shall not be delayed beyond the timeliness standards as provided in Section 435.912 of Title 42 of the Code of Federal Regulations or denied for any insurance affordability program unless the applicant is given a reasonable opportunity, of at least the kind provided for under the Medi-Cal program pursuant to Section 14007.5 and paragraph (7) of subdivision (e) of Section 14011.2, to resolve discrepancies concerning any information provided by a verifying entity.
(6)To the extent federal financial participation is available, an applicant shall be provided benefits in accordance with the rules of the insurance affordability program, as implemented in federal regulations and guidance, for which he or she otherwise qualifies until a determination is made that he or she is not eligible and all applicable notices have been provided. Nothing in this section shall be interpreted to grant presumptive eligibility if it is not otherwise required by state law, and, if so required, then only to the extent permitted by federal law.
(g)The eligibility, enrollment, and retention system shall offer an applicant and recipient assistance with his or her application or renewal for an insurance affordability program in person, over the telephone, by mail, online, or through other commonly available electronic means and in a manner that is accessible to individuals with disabilities and those who are limited-English proficient.
(h)(1)During the processing of an application, renewal, or a transition due to a change in circumstances, an entity making eligibility determinations for an insurance affordability program shall ensure that an eligible applicant and recipient of insurance affordability programs that meets all of the program eligibility requirements and complies with all of the necessary requests for information moves between programs without any breaks in coverage and without being required to provide any forms, documents, or other information or undergo verification that is duplicative or otherwise unnecessary. The individual shall be informed about how to obtain information about the status of his or her application, renewal, or transfer to another program at any time, and the information shall be promptly provided when requested.
(2)The application or case of an individual screened as not eligible for Medi-Cal on the basis of Modified Adjusted Gross Income (MAGI) household income but who may be eligible on the basis of being 65 years of age or older, or on the basis of blindness or disability, shall be forwarded to the Medi-Cal program for an eligibility determination. During the period the application or case is processed for a non-MAGI Medi-Cal eligibility determination, if the applicant or recipient is otherwise eligible for an insurance affordability program, he or she shall be determined eligible for that program.
(3)Renewal procedures shall include all available methods for reporting renewal information, including, but not limited to, face-to-face, telephone, mail, and online renewal or renewal through other commonly available electronic means.
(4)An applicant who is not eligible for an insurance affordability program for a reason other than income eligibility, or for any reason in the case of applicants and recipients residing in a county that offers a health coverage program for individuals with income above the maximum allowed for the Exchange premium tax credits, shall be referred to the county health coverage program in his or her county of residence.
(i)Notwithstanding subdivisions (e), (f), and (j), before an online applicant who appears to be eligible for the Exchange with a premium tax credit or reduction in cost sharing, or both, may be enrolled in the Exchange, both of the following shall occur:
(1)The applicant shall be informed of the overpayment penalties under the federal Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011 (Public Law 112-9), if the individuals annual family income increases by a specified amount or more, calculated on the basis of the individuals current family size and current income, and that penalties are avoided by prompt reporting of income increases throughout the year.
(2)The applicant shall be informed of the penalty for failure to have minimum essential health coverage.
(j)The department shall, in coordination with MRMIB and the Exchange board, streamline and coordinate all eligibility rules and requirements among insurance affordability programs using the least restrictive rules and requirements permitted by federal and state law. This process shall include the consideration of methodologies for determining income levels, assets, rules for household size, citizenship and immigration status, and self-attestation and verification requirements.
(k)(1)Forms and notices developed pursuant to this section shall be accessible and standardized, as appropriate, and shall comply with federal and state laws, regulations, and guidance prohibiting discrimination.
(2)Forms and notices developed pursuant to this section shall be developed using plain language and shall be provided in a manner that affords meaningful access to limited-English-proficient individuals, in accordance with applicable state and federal law, and at a minimum, provided in the same threshold languages as required for Medi-Cal managed care plans.
(l)The department, the California Health and Human Services Agency, MRMIB, and the Exchange board shall establish a process for receiving and acting on stakeholder suggestions regarding the functionality of the eligibility systems supporting the Exchange, including the activities of all entities providing eligibility screening to ensure the correct eligibility rules and requirements are being used. This process shall include consumers and their advocates, be conducted no less than quarterly, and include the recording, review, and analysis of potential defects or enhancements of the eligibility systems. The process shall also include regular updates on the work to analyze, prioritize, and implement corrections to confirmed defects and proposed enhancements, and to monitor screening.
(m)In designing and implementing the eligibility, enrollment, and retention system, the department, MRMIB, and the Exchange board shall ensure that all privacy and confidentiality rights under the PPACA and other federal and state laws are incorporated and followed, including responses to security breaches.
(n)Except as otherwise specified, this section shall be operative on January 1, 2014.
(a)The following definitions apply for purposes of this part:
(1)Accessible means in compliance with Section 11135 of the Government Code, Section 1557 of the PPACA, and regulations or guidance adopted pursuant to these statutes.
(2)Limited-English-proficient means not speaking English as ones primary language and having a limited ability to read, speak, write, or understand English.
(3)Insurance affordability program means a program that is one of the following:
(A)The Medi-Cal program under Title XIX of the federal Social Security Act (42 U.S.C. Sec. 1396 et seq.).
(B)The states childrens health insurance program (CHIP) under Title XXI of the federal Social Security Act (42 U.S.C. Sec. 1397aa et seq.).
(C)A program that makes available to qualified individuals coverage in a qualified health plan through the California Health Benefit Exchange established pursuant to Title 22 (commencing with Section 100500) of the Government Code with advance payment of the premium tax credit established under Section 36B of the Internal Revenue Code.
(4)A program that makes available coverage in a qualified health plan through the California Health Benefit Exchange established pursuant to Title 22 (commencing with Section 100500) of the Government Code with cost-sharing reductions established under Section 1402 of PPACA and any subsequent amendments to that act.
(b)An individual shall have the option to apply for insurance affordability programs in person, by mail, online, by telephone, or by other commonly available electronic means.
(c)(1)A single, accessible, standardized paper, electronic, and telephone application for insurance affordability programs shall be developed by the department in consultation with MRMIB and the board governing the Exchange as part of the stakeholder process described in subdivision (b) of Section 15925. The application shall be used by all entities authorized to make an eligibility determination for any of the insurance affordability programs and by their agents.
(2)The department may develop and require the use of supplemental forms to collect additional information needed to determine eligibility on a basis other than the financial methodologies described in Section 1396a(e)(14) of Title 42 of the United States Code, as added by the federal Patient Protection and Affordable Care Act (Public Law 111-148), and as amended by the federal Health Care and Education Reconciliation Act of 2010 (Public Law 111-152) and any subsequent amendments, as provided under Section 435.907(c) of Title 42 of the Code of Federal Regulations.
(3)The application shall be tested and operational by the date as required by the federal Secretary of Health and Human Services.
(4)The application form shall, to the extent not inconsistent with federal statutes, regulations, and guidance, satisfy all of the following criteria:
(A)The form shall include simple, user-friendly language and instructions.
(B)The form may not ask for information related to a nonapplicant that is not necessary to determine eligibility in the applicants particular circumstances.
(C)The form may require only information necessary to support the eligibility and enrollment processes for insurance affordability programs.
(D)The form may be used for, but shall not be limited to, screening.
(E)The form may ask, or be used otherwise to identify, if the mother of an infant applicant under one year of age had coverage through an insurance affordability program for the infants birth, for the purpose of automatically enrolling the infant into the applicable program without the family having to complete the application process for the infant.
(F)The form may include questions that are voluntary for applicants to answer regarding demographic data categories, including race, ethnicity, primary language, disability status, and other categories recognized by the federal Secretary of Health and Human Services under Section 4302 of the PPACA.
(G)Until January 1, 2016, the department shall instruct counties to not reject an application that was in existence prior to January 1, 2014, but to accept the application and request any additional information needed from the applicant in order to complete the eligibility determination process. The department shall work with counties and consumer advocates to develop the supplemental questions.
(d)Nothing in this section shall preclude the use of a provider-based application form or enrollment procedures for insurance affordability programs or other health programs that differs from the application form described in subdivision (c), and related enrollment procedures. Nothing in this section shall preclude the use of a joint application, developed by the department and the State Department of Social Services, that allows for an application to be made for multiple programs, including, but not limited to, CalWORKs, CalFresh, and insurance affordability programs.
(e)The entity making the eligibility determination shall grant eligibility immediately whenever possible and with the consent of the applicant in accordance with the state and federal rules governing insurance affordability programs.
(f)(1)If the eligibility, enrollment, and retention system has the ability to prepopulate an application form for insurance affordability programs with personal information from available electronic databases, an applicant shall be given the option, with his or her informed consent, to have the application form prepopulated. Before a prepopulated application is submitted to the entity authorized to make eligibility determinations, the individual shall be given the opportunity to provide additional eligibility information and to correct any information retrieved from a database.
(2)All insurance affordability programs may accept self-attestation, instead of requiring an individual to produce a document, for age, date of birth, family size, household income, state residence, pregnancy, and any other applicable criteria needed to determine the eligibility of an applicant or recipient, to the extent permitted by state and federal law.
(3)An applicant or recipient shall have his or her information electronically verified in the manner required by the PPACA and implementing federal regulations and guidance and state law.
(4)Before an eligibility determination is made, the individual shall be given the opportunity to provide additional eligibility information and to correct information.
(5)The eligibility of an applicant shall not be delayed beyond the timeliness standards as provided in Section 435.912 of Title 42 of the Code of Federal Regulations or denied for any insurance affordability program unless the applicant is given a reasonable opportunity, of at least the kind provided for under the Medi-Cal program pursuant to Section 14007.5 and paragraph (7) of subdivision (e) of Section 14011.2, to resolve discrepancies concerning any information provided by a verifying entity.
(6)To the extent federal financial participation is available, an applicant shall be provided benefits in accordance with the rules of the insurance affordability program, as implemented in federal regulations and guidance, for which he or she otherwise qualifies until a determination is made that he or she is not eligible and all applicable notices have been provided. Nothing in this section shall be interpreted to grant presumptive eligibility if it is not otherwise required by state law, and, if so required, then only to the extent permitted by federal law.
(g)The eligibility, enrollment, and retention system shall offer an applicant and recipient assistance with his or her application or renewal for an insurance affordability program in person, over the telephone, by mail, online, or through other commonly available electronic means and in a manner that is accessible to individuals with disabilities and those who are limited-English proficient.
(h)(1)During the processing of an application, renewal, or a transition due to a change in circumstances, an entity making eligibility determinations for an insurance affordability program shall ensure that an eligible applicant and recipient of insurance affordability programs that meets all of the program eligibility requirements and complies with all of the necessary requests for information moves between programs without any breaks in coverage and without being required to provide any forms, documents, or other information or undergo verification that is duplicative or otherwise unnecessary. The individual shall be informed about how to obtain information about the status of his or her application, renewal, or transfer to another program at any time, and the information shall be promptly provided when requested.
(2)The application or case of an individual screened as not eligible for Medi-Cal on the basis of Modified Adjusted Gross Income (MAGI) household income but who may be eligible on the basis of being 65 years of age or older, or on the basis of blindness or disability, shall be forwarded to the Medi-Cal program for an eligibility determination. During the period this the application or case is processed for a non-MAGI Medi-Cal eligibility determination, if the applicant or recipient is otherwise eligible for an insurance affordability program, he or she shall be determined eligible for that program.
(3)Renewal procedures shall include all available methods for reporting renewal information, including, but not limited to, face-to-face, telephone, mail, and online renewal or renewal through other commonly available electronic means.
(4)An applicant who is not eligible for an insurance affordability program for a reason other than income eligibility, or for any reason in the case of applicants and recipients residing in a county that offers a health coverage program for individuals with income above the maximum allowed for the Exchange premium tax credits, shall be referred to the county health coverage program in his or her county of residence.
(i)Notwithstanding subdivisions (e), (f), and (j), before an online applicant who appears to be eligible for the Exchange with a premium tax credit or reduction in cost sharing, or both, may be enrolled in the Exchange, both of the following shall occur:
(1)The applicant shall be informed of the overpayment penalties under the federal Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011 (Public Law 112-9), if the individuals annual family income increases by a specified amount or more, calculated on the basis of the individuals current family size and current income, and that penalties are avoided by prompt reporting of income increases throughout the year.
(2)The applicant shall be informed of the penalty for failure to have minimum essential health coverage.
(j)The department shall, in coordination with MRMIB and the Exchange board, streamline and coordinate all eligibility rules and requirements among insurance affordability programs using the least restrictive rules and requirements permitted by federal and state law. This process shall include the consideration of methodologies for determining income levels, assets, rules for household size, citizenship and immigration status, and self-attestation and verification requirements.
(k)(1)Forms and notices developed pursuant to this section shall be accessible and standardized, as appropriate, and shall comply with federal and state laws, regulations, and guidance prohibiting discrimination.
(2)Forms and notices developed pursuant to this section shall be developed using plain language and shall be provided in a manner that affords meaningful access to limited-English-proficient individuals, in accordance with applicable state and federal law, and at a minimum, provided in the same threshold languages as required for Medi-Cal managed care plans.
(l)The department, the California Health and Human Services Agency, MRMIB, and the Exchange board shall establish a process for receiving and acting on stakeholder suggestions regarding the functionality of the eligibility systems supporting the Exchange, including the activities of all entities providing eligibility screening to ensure the correct eligibility rules and requirements are being used. This process shall include consumers and their advocates, be conducted no less than quarterly, and include the recording, review, and analysis of potential defects or enhancements of the eligibility systems. The process shall also include regular updates on the work to analyze, prioritize, and implement corrections to confirmed defects and proposed enhancements, and to monitor screening.
(m)In designing and implementing the eligibility, enrollment, and retention system, the department, MRMIB, and the Exchange board shall ensure that all privacy and confidentiality rights under the PPACA and other federal and state laws are incorporated and followed, including responses to security breaches.
(n)Except as otherwise specified, this section shall be operative on January 1, 2014.
|
Date
|
Status
|
|---|---|
| Aug 19, 2016 | Ordered to third reading. |
| Jun 2, 2016 | In Assembly. Read first time. Held at Desk. |
| Jun 9, 2016 | Referred to Com. on HEALTH. |
| Jun 29, 2016 | From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 16. Noes 0.) (June 28). |
| Jun 30, 2016 | Read second time and amended. Re-referred to Com. on APPR. |
| Aug 3, 2016 | August 3 set for first hearing. Placed on APPR. suspense file. |
| Aug 12, 2016 | From committee: Do pass as amended. (Ayes 19. Noes 0.) (August 11). |
| Aug 15, 2016 | Read second time and amended. Ordered to second reading. |
| Aug 16, 2016 | Read second time. Ordered to third reading. |
| Jun 1, 2016 | Read third time. Urgency clause adopted. Passed. (Ayes 36. Noes 1.) Ordered to the Assembly. |
| Aug 19, 2016 | Read third time and amended. |
| Aug 19, 2016 | Read third time and amended. (Ayes 73. Noes 0. Page 5964.) |
| Aug 23, 2016 | In Senate. Concurrence in Assembly amendments pending. |
| Aug 23, 2016 | Read third time. Urgency clause adopted. Passed. Ordered to the Senate. |
| Aug 23, 2016 | Read third time. Urgency clause adopted. Passed. (Ayes 76. Noes 1. Page 6095.) Ordered to the Senate. |
| Aug 25, 2016 | Assembly amendments concurred in. (Ayes 37. Noes 1. Page 5407.) Ordered to engrossing and enrolling. |
| Aug 25, 2016 | Assembly amendments concurred in. (Ayes 37. Noes -1.) Ordered to engrossing and enrolling. |
| Aug 31, 2016 | Enrolled and presented to the Governor at 6 p.m. |
| Apr 26, 2016 | Read second time and amended. Re-referred to Com. on APPR. |
| Feb 22, 2016 | From printer. May be acted upon on or after March 23. |
| Feb 22, 2016 | Read first time. |
| Mar 3, 2016 | Referred to Com. on RLS. |
| Apr 5, 2016 | From committee with author's amendments. Read second time and amended. Re-referred to Com. on RLS. |
| Apr 7, 2016 | Re-referred to Com. on HEALTH. |
| Apr 8, 2016 | Set for hearing April 20. |
| Apr 25, 2016 | From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 5. Noes 0. Page 3646.) (April 20). |
| Apr 25, 2016 | From committee: Do pass as amended and re-refer to Com. on APPR. (Ayes 5. Noes 0.) (April 20). |
| Feb 19, 2016 | Introduced. To Com. on RLS. for assignment. To print. |
| May 6, 2016 | Set for hearing May 16. |
| May 16, 2016 | May 16 hearing: Placed on APPR. suspense file. (Ayes 7. Noes 0.) |
| May 20, 2016 | Set for hearing May 27. |
| May 27, 2016 | From committee: Do pass as amended. (Ayes 7. Noes 0. Page 4007.) (May 27). |
| May 27, 2016 | From committee: Do pass as amended. (Ayes 7. Noes 0.) (May 27). |
| May 31, 2016 | Read second time and amended. Ordered to third reading. |
| Jun 1, 2016 | Read third time. Urgency clause adopted. Passed. (Ayes 36. Noes 1. Page 4107.) Ordered to the Assembly. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Aug 25, 2016 | Unfinished Business SB1300 Hernandez Urgency Clause Concurrence | Senate Floor |
Passed |
|
| Aug 23, 2016 | SB 1300 Hernandez Third Reading Urgency By WOOD | Assembly Floor |
Passed |
|
| Aug 19, 2016 | SB 1300 Hernandez Third Reading Urgency By A & A.R. Amendment Set #1 | Assembly Floor |
Passed |
|
| Aug 11, 2016 | Do pass as amended. | Assembly Standing Committee on Appropriations |
Passed |
|
| Jun 28, 2016 | Do pass as amended and be re-referred to the Committee on [Appropriations] | Assembly Standing Committee on Health |
Passed |
|
| Jun 1, 2016 | Senate 3rd Reading SB1300 Hernandez Urgency Clause | Senate Floor |
Passed |
|
| May 27, 2016 | Do pass as amended | Senate Standing Committee on Appropriations |
Passed |
|
| May 16, 2016 | Placed on suspense file | Senate Standing Committee on Appropriations |
Passed |
|
| Apr 20, 2016 | Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations] | Senate Standing Committee on Health |
Passed |
This list shows positions taken on this bill by organizations on the date displayed, which is linked to the original source.
Positions by individuals are not included.
|
Organization
|
Position
|
Date
|
|---|---|---|
| 911 Ambulance Provider's Medi-Cal Alliance | ** Support | Aug 23, 2016 |
| According to the Assembly Appropriations Committee: | ** Support | Aug 23, 2016 |
| According to the Senate Appropriations Committee: | ** Support | Jun 1, 2016 |
| Alameda County Board of Supervisors | ** Support | Jun 28, 2016 |
| American Ambulance | ** Support | Aug 23, 2016 |
| American Association Of University Women California | * Support | Jun 26, 2018 |
| American Civil Liberties Union | * Indeterminate | Jun 26, 2018 |
| American Health Insurance Plans | * Indeterminate | Jun 28, 2016 |
| American Medical Response | ** Support | Aug 23, 2016 |
| California Ambulance Association | * Against | Jun 26, 2018 |
| California Chamber Of Commerce | * Against | Jun 26, 2018 |
| California Employment Lawyers Association | * Support | Jun 26, 2018 |
| California Fire Chiefs and Fire Districts Association | * Indeterminate | Jun 28, 2016 |
| California Fire Chiefs Association | ** Support | Aug 23, 2016 |
| California Labor Federation | * Support | Jun 26, 2018 |
| California Professional Firefighters | ** Support | Aug 23, 2016 |
| California Work and Family Coalition | * Support | Jun 26, 2018 |
| Care Ambulance Service | * Indeterminate | Apr 20, 2016 |
| County of Alameda Board of Supervisors | * Indeterminate | Jun 28, 2016 |
| Department Of Finance | ** Against | Aug 23, 2016 |
| Department of Health Care Services | ** Against | Aug 23, 2016 |
| Emergency Medical Services Administrators Association of California | ** Support | Aug 23, 2016 |
| EMS Administrators | * Indeterminate | Jun 28, 2016 |
| Equal Rights Advocates | * Support | Jun 26, 2018 |
| federal) for DHCS to develop regulations, federal. | ** Support | Aug 23, 2016 |
| federal). The quality assurance fee is projected to | ** Support | Aug 23, 2016 |
| Fire Districts Association Of California | ** Support | Aug 23, 2016 |
| Fresno County Board of Supervisors | ** Support | Aug 23, 2016 |
| Gold Coast Ambulance | ** Support | Aug 23, 2016 |
| Hall Ambulance Service | * Support | Apr 20, 2016 |
| McCormick Ambulance | ** Support | Jun 28, 2016 |
| McCormick Ambulance Service | ** Support | Aug 23, 2016 |
| Mercy Medical Transportation | ** Support | Jun 28, 2016 |
| Napa County Board of Supervisors | ** Support | Aug 23, 2016 |
| Paramedics Plus | ** Support | Aug 23, 2016 |
| SCIU | * Indeterminate | Jun 28, 2016 |
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | SB 1300 |
VETO
Bill No: SB 1300
Amended: 8/19/16
SENATE HEALTH COMMITTEE: 5-0, 4/20/16
AYES: Hernandez, Hall, Mitchell, Monning, Pan
NO VOTE RECORDED: Nguyen, Nielsen, Roth, Wolk
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/27/16
AYES: Lara, Bates, Beall, Hill, McGuire, Mendoza, Nielsen
SENATE FLOOR: 36-1, 6/1/16
AYES: Allen, Anderson, Bates, Beall, Berryhill, Block, Cannella, De León, Fuller, Gaines, Galgiani, Glazer, Hall, Hancock, Hernandez, Hertzberg, Hill, Hueso, Huff, Jackson, Lara, Leno, Leyva, Liu, McGuire, Mendoza, Mitchell, Monning, Morrell, Nielsen, Pan, Pavley, Stone, Vidak, Wieckowski, Wolk
NOES: Nguyen
NO VOTE RECORDED: Moorlach, Roth, Runner
SENATE FLOOR: 37-1, 8/25/16
AYES: Allen, Anderson, Bates, Beall, Berryhill, Block, Cannella, De León, Fuller, Gaines, Galgiani, Glazer, Hall, Hancock, Hernandez, Hertzberg, Hill, Hueso, Huff, Jackson, Lara, Leno, Leyva, Liu, McGuire, Mendoza, Mitchell, Monning, Morrell, Nielsen, Pan, Pavley, Roth, Stone, Vidak, Wieckowski, Wolk
NOES: Nguyen
NO VOTE RECORDED: Moorlach
ASSEMBLY FLOOR: 76-1, 8/23/16 - See last page for vote
SUBJECT: Medi-Cal: emergency medical transport providers: quality assurance fee
SOURCE: 911 Ambulance Provider’s Medi-Cal Alliance
DIGEST: This bill imposes a quality assurance fee on each transport provided by an emergency medical transport provider in accordance with a prescribed methodology. Requires the resulting revenue to be placed in a continuously appropriated fund to be used to provide additional Medi-Cal reimbursement to emergency medical transport providers, to pay for state administrative costs, and to provide funding for health care coverage for Californians.
Existing law:
- Establishes the Medi-Cal program, administered by the Department of Health Care Services (DHCS), which provides health benefits to low-income individuals who meet specified eligibility criteria. Establishes a schedule of benefits under the Medi-Cal program, which includes emergency and non-emergency medical transportation.
- Reduces specified Medi-Cal provider rates (including ground ambulance services), effective June 1, 2011, by 10% for dates of services on and after June 1, 2011, subject to federal approval, federal financial participation (FFP), and the reduction meeting federal Medicaid requirements. The 10% reduction took effect for ambulance providers for dates of service on or after September 5, 2013, but was not applied retroactively back to June 2011.
This bill:
- Imposes, commencing with the state fiscal quarter beginning on July 1, 2017, and continuing each fiscal quarter thereafter, a quality assurance fee (QAF) for each emergency medical transport provided by each emergency medical transport provider.
- Requires the DHCS director, on or before June 15, 2017, and each June 15th thereafter, to calculate the annual QAF rate applicable to the following state fiscal year based on the most recently collected data collected from emergency medical transport providers.
- Establishes, for the 2017-18 fiscal year and the 2019-19 fiscal year and thereafter, different methods for calculating the annual QAF rate. Prohibits the fees calculated and collected from exceeding the amounts allowable under federal law. Permits the director of DHCS to reduce the increased fee-for-service (FFS) payment schedule if the director makes a determination that the fees collected exceeds the amounts allowable under federal law, only to the extent necessary to reduce the fees to comply with the amount allowable under federal law.
- Requires, effective July 1, 2017, the Medi-Cal FFS payment schedule governing reimbursement to emergency medical transport providers for emergency medical transports to be increased pursuant to a methodology established by this bill, using revenue from the QAF. Requires the increase to the FFS payment schedule under this bill to be calculated on or before June 15, 2017, and to remain the same for later fiscal years. Requires the increase to the FFS payment schedule under this bill to apply only to those billing codes identified in, or any equivalent, predecessor, or successor billing codes as may be determined by the director under this bill.
- Requires each Medi-Cal managed care health plan to provide payment to emergency medical transport providers under this bill that is equal to the amount of payment the provider would have received under FFS Medi-Cal, by referencing existing federal law and regulation.
- Requires the DHCS director to deposit the QAF in the Medi-Cal Emergency Medical Transport Fund (Fund) created by this bill. Continuously appropriates the moneys in the Fund, and any federal matching funds to DHCS.
- Requires moneys in the Fund, including any interest and dividends earned on money in the fund, to be available exclusively to enhance federal financial participation for ambulance services under the Medi-Cal program and to provide additional reimbursement to, and to support quality improvement efforts of, emergency medical transport providers, as well as to pay for the state’s administrative costs and to provide funding for health care coverage for Californians, in the following order of priority:
- To pay for DHCS staffing and administrative costs directly attributable to implementing this bill, capped at $1 million for 2016-17 and $374,00 for the 2017-18 and each fiscal year thereafter, exclusive of any federal matching funds;
- To pay for the health care coverage in each fiscal year in the amount of 10% of the projected QAF revenue for that fiscal year, as calculated by the DHCS on or before June 15 preceding that fiscal year, exclusive of any federal matching funds; and,
- To make increased payments to emergency medical transport providers pursuant to this bill.
- Requires the Medi-Cal FFS and Medi-Cal managed care payment schedule increase established under this bill to be funded solely the QAF, along with any interest or other investment income and federal reimbursement and any other related federal funds.
- Requires the proceeds of the QAF, the matching amount provided by the federal government, and any interest earned on those proceeds to be used to supplement existing funding for emergency medical transports provided by emergency transport providers and not to supplant this funding.
- Requires the DHCS director to adjust the annual QAF fee rate so that the available fee amount for the state fiscal year will approximately equal the aggregate Medi-Cal fee schedule amount for the state fiscal year if, during a state fiscal year, the actual or projected available QAF amount exceeds or is less than the actual or projected aggregate fee schedule amount by more than 1%. Requires the available fee amount for a state fiscal year to be considered to equal the aggregate fee schedule amount for the state fiscal year if the difference between the available fee amount for the state fiscal year and the aggregate fee schedule amount for the state fiscal year constitutes less than 1% of the aggregate fee schedule amount for the state fiscal year.
- Requires each emergency medical transport provider to report to DHCS data on the number of actual emergency medical transports by payor type, and gross receipts from the provision of emergency medical transports in a manner and format prescribed by DHCS.
- Permits DHCS to require a certification by each emergency medical transport under penalty of perjury of the truth of the required reports. Permits DHCS to impose a penalty of $100 per day against an emergency medical transport provider for every day that an emergency medical transport provider fails to make a required report within five days of the date upon which the report was due.
- Requires emergency medical transport providers to remit to DHCS annual QAF amounts, as specified. Requires interest to be assessed on QAF not paid on the date due at the greater of 10% per annum or the rate at which DHCS assesses interest on Medi-Cal program overpayments to hospitals that are not repaid when due. Requires interest to begin to accrue the day after the date the payment was due, and to be deposited in the Medi-Cal Emergency Medical Transport Fund established by this bill.
- Permits DHCS to deduct unpaid QAF amounts and interest owed from Medi-Cal reimbursements payments owed to a provider until the full amount of the fee and interest is owed in the event that any fee payment is more than 60 days overdue.
- Requires DHCS to request approval from the federal Centers for Medicare and Medicaid Services (CMS) for the use of fees collected under this bill for the purpose of receiving federal matching funds.
- Permits the DHCS director to alter the methodology specified in this bill to the extent necessary to meet the requirements of federal law or regulations or to obtain federal approval. Requires, if the DHCS director, after consulting with affected emergency medical transport providers, determines that an alteration is needed, the director to execute a declaration stating that this determination has been made, and to provide a copy to the fiscal and appropriate policy committees of the Legislature.
- Permits the DHCS director to add categories of exempt emergency medical transport providers or apply a non-uniform fee per transport to emergency medical transport providers that are subject to the fee in order to meet requirements of federal law or regulations. Permits the DHCS director to exempt categories of emergency medical transport providers from the fee if necessary to obtain federal approval.
- Implements this bill, and continues implementation of this bill, only if certain conditions are met, including federal approval and the state maintaining its existing level of state funding for emergency medical transports in an amount not less than the amount that the state would have paid for the same number of emergency medical transports under the rate methodology that was in effect on July 31, 2016.
- Makes this bill inoperative in the event of a final judicial determination made by any state or federal court that is not appealed, or by a court of appellate jurisdiction that is not further appealed, in any action by any party, or a final determination by the administrator of the CMS, that federal financial participation is not available with respect to any payment made under the methodology implemented under this bill because the methodology is invalid, unlawful, or contrary to any provision of federal law or regulations or of state law.
Comments
- Author’s statement. According to the author, this bill increases Medi-Cal emergency medical transportation rates by levying a QAF on three emergency medical transportation reimbursement codes. The resulting revenue would then be used to draw down additional federal Medicaid funds to increase Medi-Cal emergency transportation rates, without imposing a cost to the state General Fund. In addition, 10% of revenue raised by the QAF would go to the state General Fund. The author argues inadequate Medi-Cal reimbursement for ambulance transport is a long-standing issue and places a strain on the state's emergency medical services (EMS) system. Unlike other Medi-Cal providers, ambulance providers cannot “opt out” or otherwise limit their participation in the Medi-Cal program the way other non-emergency health care providers can to obtain a more favorable payor mix. While the costs to provide essential ambulance services has significantly increased during the past decade, including escalating wages and benefits, and increasing insurance premiums, Medi-Cal reimbursement has not kept pace with these increased costs and has in fact declined to less than the amounts paid in 1999. The QAF proposed by this bill would increase Medi-Cal emergency medical transportation rates by drawing down federal Medicaid dollars, which will flow back to the state to be used by ambulance providers to maintain the high level of care that is expected of the state's EMS and 911 programs.
- Medi-Cal rates for ambulance services. When billing Medi-Cal for a “911 call,” ambulance providers bill a Basic Life Support (BLS) base rate of $106.38. In addition to the base rate, Medi-Cal provides additional funding for additional costs and services, such as mileage, night calls, extra attendants, waiting times, and certain supplies and services. Medi-Cal FFS emergency base ambulance rates were increased in 1997 and 1998 and were last increased in 1999 by 11.7%, to $118.20. Medi-Cal base ambulance rates were reduced in 2008 and again in 2013 (by 10%). The current Medi-Cal base rate is $106.38, a rate that is $11.82 lower than the rate in 1999.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
According to the Assembly Appropriations Committee:
- One-time costs of $1.2 million and ongoing administrative costs of $750,000 annually (Medi-Cal Emergency Medical Transport Fund/GF/federal) for DHCS to develop regulations, gain federal approval, make any necessary system changes, oversee collection of the quality assurance fee, and make increased payments. This bill provides that $350,000 per year must be available to DHCS for administrative costs (the state would be able to draw down additional federal funding to help cover the administrative costs). To the extent that actual administrative costs are higher, those costs would be GF/federal.
- DHCS states it has been unable to independently verify data provided by emergency medical transportation (EMT) providers. However, based on such data, staff assumes costs associated with fee collection and payment as follows:
- Ongoing GF benefit of about $3 million per year through reduced health care spending. This bill provides that 10% of revenue collected (after setting aside administrative funding) is available to the state for health care coverage. Thus, this bill reduces the need for GF support of the Medi-Cal program by an equal amount.
- Additional payments of about $73 million per year for Medi-Cal EMT services (Medi-Cal Emergency Medical Transport Fund/ federal). The quality assurance fee is projected to generate about $30 million per year in revenues (after accounting for administration and state benefits). With federal matching funds, about $73 million per year would be paid in increased reimbursements to providers.
- Unknown GF cost pressure, potentially in the millions annually, to maintain higher ambulance transport rates if QAF revenues are eliminated or changed.
911 Ambulance Provider’s Medi-Cal Alliance (source)
American Ambulance
American Medical Response
California Ambulance Association
California Fire Chiefs Association
California Professional Firefighters
Emergency Medical Services Administrators Association of California
Fire Districts Association of California
Fresno County Board of Supervisors
Paramedics Plus
Gold Coast Ambulance
McCormick Ambulance Service
Mercy Medical Transportation Inc.
Napa County Board of Supervisors
OPPOSITION: (Verified 8/22/16)
Department of Finance
Department of Health Care Services
ARGUMENTS IN SUPPORT: This bill is sponsored by the 911 Provider's Medi-Cal Alliance (911 Alliance), which writes that in 2015, the leadership of six of California's largest private ambulance companies came together to discuss Medi-Cal reimbursement rates for emergency ambulance transports and formed the 911 Ambulance Provider's Medi-Cal Alliance with a mission to work together to help resolve the ongoing issue of low Medi-Cal reimbursement rates. The 911 Alliance writes that emergency ambulance providers have not seen an increase in base rates for emergency transports since 1999, and in those 17 years since the last increase, they have twice seen their Medi-Cal rates decreased. In those 17 years, the cost to deliver emergency ambulance service to all Californians, and this bill addresses 17 years of a growing difference between the cost to provide emergency ambulance service and Medi-Cal ambulance reimbursement.
ARGUMENTS IN OPPOSITION: DHCS writes in opposition that using QAF revenue to increase the Medi-Cal fee schedule for ambulance services, rather than having QAF revenue fund supplemental payments places the General Fund at greater risk of having to maintain the augmented rates if there are any changed circumstance affecting the amount of QAF DHCS can collect. In addition, DHCS states that using projected amounts in calculating the QAF may pose a challenge to obtaining federal approval because it would make the calculation of the fee uncertain, and DHCS is concerned that General Fund may be required if QAF revenue falls short, Medi-Cal ambulance utilization increases, or federal law requires a reduction in QAF fees.
I am returning Senate Bill 1300 without my signature.
This bill creates a new ambulance quality assurance fee to be collected by the Department of Health Care Services. This fee would be used to claim additional federal funding necessary to increase Medi-Cal reimbursements for ambulance services.
I support establishing a quality assurance fee to bring in additional federal funding to support emergency transportation services. However, the structure of the rate increase in this bill is unlike any other fee structure supported by health care related quality assurance fees. I am concerned this structure puts the state general fund at risk for paying the increased rate if the revenue falls short or if the fee is reduced or removed in the future.
I urge the Legislature and ambulance providers to work with the Departments of Health Care Services and Finance to restructure this fee in a way that protects the general fund and allows for an increase in reimbursement for emergency transportation services.
ASSEMBLY FLOOR: 76-1, 8/23/16
AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Grove, Hadley, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Quirk, Ridley-Thomas, Rodriguez, Salas, Santiago, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Rendon
NOES: Harper
NO VOTE RECORDED: Chang, Gray, Steinorth
Prepared by: Scott Bain / HEALTH / (916) 651-4111
10/24/16 11:39:11
**** END ****
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | SB |
UNFINISHED BUSINESS
Bill No: SB 1300
:
SENATE HEALTH COMMITTEE: 5-0, 4/20/16
AYES: Hernandez, Hall, Mitchell, Monning, Pan
NO VOTE RECORDED: Nguyen, Nielsen, Roth, Wolk
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/27/16
AYES: Lara, Bates, Beall, Hill, McGuire, Mendoza, Nielsen
SENATE FLOOR: 36-1, 6/1/16
AYES: Allen, Anderson, Bates, Beall, Berryhill, Block, Cannella, De León, Fuller, Gaines, Galgiani, Glazer, Hall, Hancock, Hernandez, Hertzberg, Hill, Hueso, Huff, Jackson, Lara, Leno, Leyva, Liu, McGuire, Mendoza, Mitchell, Monning, Morrell, Nielsen, Pan, Pavley, Stone, Vidak, Wieckowski, Wolk
NOES: Nguyen
NO VOTE RECORDED: Moorlach, Roth, Runner
ASSEMBLY FLOOR: 76-1, 8/23/16 - See last page for vote
SOURCE: 911 Ambulance Provider’s Medi-Cal Alliance
DIGEST: This bill imposes a quality assurance fee on each transport provided by an emergency medical transport provider in accordance with a prescribed methodology. Requires the resulting revenue to be placed in a continuously appropriated fund to be used to provide additional Medi-Cal reimbursement to emergency medical transport providers, to pay for state administrative costs, and to provide funding for health care coverage for Californians.
Assembly Amendments increase the amount of revenue from the quality assurance fee that goes for Department of Health Care Services (DHCS) administrative costs; decrease the initial fee rate in the 2017-18 from 5.5% to 5.1%; require the increase to the fee-for-service (FFS) Medi-Cal payment ambulance schedule under this bill to remain the same for later fiscal years; add a “maintenance of effort” for the level of state funding of emergency medical transports reimbursement in an amount not less than the amount that the state would have paid for the same number of emergency medical transports under the rate methodology that was in effect on July 31, 2016; expand the definition of “gross receipts” under this bill to include all payments received as patient care revenue for emergency medical transports, including payments for billing codes; establish a staggered payment of the fee based on the number of FFS Medi-Cal transports by the emergency medical transport provider; and delete provisions making the failure to report data on emergency medical transports by payor type a violation of a specified provision of the Vehicle Code.
Existing law:
- Establishes the Medi-Cal program, administered by the DHCS, which provides health benefits to low-income individuals who meet specified eligibility criteria. Establishes a schedule of benefits under the Medi-Cal program, which includes emergency and non-emergency medical transportation.
- Reduces specified Medi-Cal provider rates (including ground ambulance services), effective June 1, 2011, by 10% for dates of services on and after June 1, 2011, subject to federal approval, federal financial participation (FFP), and the reduction meeting federal Medicaid requirements. The 10% reduction took effect for ambulance providers for dates of service on or after September 5, 2013 but was not applied retroactively back to June 2011.
This bill:
- Imposes, commencing with the state fiscal quarter beginning on July 1, 2017, and continuing each fiscal quarter thereafter, a quality assurance fee (QAF) for each emergency medical transport provided by each emergency medical transport provider.
- Requires the DHCS director, on or before June 15, 2017, and each June 15th thereafter, to calculate the annual QAF rate applicable to the following state fiscal year based on the most recently collected data collected from emergency medical transport providers.
- Establishes, for the 2017-18 fiscal year and the 2019-19 fiscal year and thereafter, different methods for calculating the annual QAF rate. Prohibits the fees calculated and collected from exceeding the amounts allowable under federal law. Permits the director of DHCS to reduce the increased FFS payment schedule if the director makes a determination that the fees collected exceeds the amounts allowable under federal law, only to the extent necessary to reduce the fees to comply with the amount allowable under federal law.
- Requires, effective July 1, 2017, the Medi-Cal FFS payment schedule governing reimbursement to emergency medical transport providers for emergency medical transports to be increased pursuant to a methodology established by this bill, using revenue from the QAF. Requires the increase to the FFS payment schedule under this bill to be calculated on or before June 15, 2017, and to remain the same for later fiscal years. Requires the increase to the FFS payment schedule under this bill to apply only to those billing codes identified in, or any equivalent, predecessor, or successor billing codes as may be determined by the director under this bill.
- Requires each Medi-Cal managed care health plan to provide payment to emergency medical transport providers under this bill that is equal to the amount of payment the provider would have received under FFS Medi-Cal, by referencing existing federal law and regulation.
- Requires the DHCS director to deposit the QAF in the Medi-Cal Emergency Medical Transport Fund (Fund) created by this bill. Continuously appropriates the moneys in the Fund, and any federal matching funds to DHCS.
- Requires moneys in the Fund, including any interest and dividends earned on money in the fund, to be available exclusively to enhance federal financial participation for ambulance services under the Medi-Cal program and to provide additional reimbursement to, and to support quality improvement efforts of, emergency medical transport providers, as well as to pay for the state’s administrative costs and to provide funding for health care coverage for Californians, in the following order of priority:
- To pay for DHCS staffing and administrative costs directly attributable to implementing this bill, capped at $1 million for 2016-17 and $374,00 for the 2017-18 and each fiscal year thereafter, exclusive of any federal matching funds;
- To pay for the health care coverage in each fiscal year in the amount of 10% of the projected QAF revenue for that fiscal year, as calculated by the DHCS on or before June 15 preceding that fiscal year, exclusive of any federal matching funds; and,
- To make increased payments to emergency medical transport providers pursuant to this bill.
- Requires the Medi-Cal FFS and Medi-Cal managed care payment schedule increase established under this bill to be funded solely the QAF, along with any interest or other investment income and federal reimbursement and any other related federal funds.
- Requires the proceeds of the QAF, the matching amount provided by the federal government, and any interest earned on those proceeds to be used to supplement existing funding for emergency medical transports provided by emergency transport providers and not to supplant this funding.
- Requires the DHCS director to adjust the annual QAF fee rate so that the available fee amount for the state fiscal year will approximately equal the aggregate Medi-Cal fee schedule amount for the state fiscal year if, during a state fiscal year, the actual or projected available QAF amount exceeds or is less than the actual or projected aggregate fee schedule amount by more than 1%. Requires the available fee amount for a state fiscal year to be considered to equal the aggregate fee schedule amount for the state fiscal year if the difference between the available fee amount for the state fiscal year and the aggregate fee schedule amount for the state fiscal year constitutes less than 1% of the aggregate fee schedule amount for the state fiscal year.
- Requires each emergency medical transport provider to report to DHCS data on the number of actual emergency medical transports by payor type, and gross receipts from the provision of emergency medical transports in a manner and format prescribed by DHCS.
- Permits DHCS to require a certification by each emergency medical transport under penalty of perjury of the truth of the required reports. Permits DHCS to impose a penalty of $100 per day against an emergency medical transport provider for every day that an emergency medical transport provider fails to make a required report within five days of the date upon which the report was due.
- Requires emergency medical transport providers to remit to DHCS annual QAF amounts, as specified. Requires interest to be assessed on QAF not paid on the date due at the greater of 10% per annum or the rate at which DHCS assesses interest on Medi-Cal program overpayments to hospitals that are not repaid when due. Requires interest to begin to accrue the day after the date the payment was due, and to be deposited in the Medi-Cal Emergency Medical Transport Fund established by this bill.
- Permits DHCS to deduct unpaid QAF amounts and interest owed from Medi-Cal reimbursements payments owed to a provider until the full amount of the fee and interest is owed in the event that any fee payment is more than 60 days overdue.
- Requires DHCS to request approval from the federal Centers for Medicare and Medicaid Services (CMS) for the use of fees collected under this bill for the purpose of receiving federal matching funds.
- Permits the DHCS director to alter the methodology specified in this bill to the extent necessary to meet the requirements of federal law or regulations or to obtain federal approval. Requires, if the DHCS director, after consulting with affected emergency medical transport providers, determines that an alteration is needed, the director to execute a declaration stating that this determination has been made, and to provide a copy to the fiscal and appropriate policy committees of the Legislature.
- Permits the DHCS director to add categories of exempt emergency medical transport providers or apply a non-uniform fee per transport to emergency medical transport providers that are subject to the fee in order to meet requirements of federal law or regulations. Permits the DHCS director to exempt categories of emergency medical transport providers from the fee if necessary to obtain federal approval.
- Implements this bill, and continues implementation of this bill, only if certain conditions are met, including federal approval and the state maintaining its existing level of state funding for emergency medical transports in an amount not less than the amount that the state would have paid for the same number of emergency medical transports under the rate methodology that was in effect on July 31, 2016.
- Makes this bill inoperative in the event of a final judicial determination made by any state or federal court that is not appealed, or by a court of appellate jurisdiction that is not further appealed, in any action by any party, or a final determination by the administrator of the CMS, that federal financial participation is not available with respect to any payment made under the methodology implemented under this bill because the methodology is invalid, unlawful, or contrary to any provision of federal law or regulations or of state law.
Comments
- Author’s statement. According to the author, this bill increases Medi-Cal emergency medical transportation rates by levying a QAF on three emergency medical transportation reimbursement codes. The resulting revenue would then be used to draw down additional federal Medicaid funds to increase Medi-Cal emergency transportation rates, without imposing a cost to the state General Fund. In addition, 10% of revenue raised by the QAF would go to the state General Fund. The author argues inadequate Medi-Cal reimbursement for ambulance transport is a long-standing issue and places a strain on the state's emergency medical services (EMS) system. Unlike other Medi-Cal providers, ambulance providers cannot “opt out” or otherwise limit their participation in the Medi-Cal program the way other non-emergency health care providers can to obtain a more favorable payor mix. While the costs to provide essential ambulance services has significantly increased during the past decade, including escalating wages and benefits, and increasing insurance premiums, Medi-Cal reimbursement has not kept pace with these increased costs and has in fact declined to less than the amounts paid in 1999. The QAF proposed by this bill would increase Medi-Cal emergency medical transportation rates by drawing down federal Medicaid dollars, which will flow back to the state to be used by ambulance providers to maintain the high level of care that is expected of the state's EMS and 911 programs.
- Medi-Cal rates for ambulance services. When billing Medi-Cal for a “911 call,” ambulance providers bill a Basic Life Support (BLS) base rate of $106.38. In addition to the base rate, Medi-Cal provides additional funding for additional costs and services, such as mileage, night calls, extra attendants, waiting times, and certain supplies and services. Medi-Cal FFS emergency base ambulance rates were increased in 1997 and 1998 and were last increased in 1999 by 11.7%, to $118.20. Medi-Cal base ambulance rates were reduced in 2008 and again in 2013 (by 10%). The current Medi-Cal base rate is $106.38, a rate that is $11.82 lower than the rate in 1999.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
According to the Assembly Appropriations Committee:
- One-time costs of $1.2 million and ongoing administrative costs of $750,000 annually (Medi-Cal Emergency Medical Transport Fund/GF/federal) for DHCS to develop regulations, gain federal approval, make any necessary system changes, oversee collection of the quality assurance fee, and make increased payments. This bill provides that $350,000 per year must be available to DHCS for administrative costs (the state would be able to draw down additional federal funding to help cover the administrative costs). To the extent that actual administrative costs are higher, those costs would be GF/federal.
- DHCS states it has been unable to independently verify data provided by emergency medical transportation (EMT) providers. However, based on such data, staff assumes costs associated with fee collection and payment as follows:
- Ongoing GF benefit of about $3 million per year through reduced health care spending. This bill provides that 10% of revenue collected (after setting aside administrative funding) is available to the state for health care coverage. Thus, this bill reduces the need for GF support of the Medi-Cal program by an equal amount.
- Additional payments of about $73 million per year for Medi-Cal EMT services (Medi-Cal Emergency Medical Transport Fund/ federal). The quality assurance fee is projected to generate about $30 million per year in revenues (after accounting for administration and state benefits). With federal matching funds, about $73 million per year would be paid in increased reimbursements to providers.
- Unknown GF cost pressure, potentially in the millions annually, to maintain higher ambulance transport rates if QAF revenues are eliminated or changed.
911 Ambulance Provider’s Medi-Cal Alliance (source)
American Ambulance
American Medical Response
California Ambulance Association
California Fire Chiefs Association
California Professional Firefighters
Emergency Medical Services Administrators Association of California
Fire Districts Association of California
Fresno County Board of Supervisors
Paramedics Plus
Gold Coast Ambulance
McCormick Ambulance Service
Mercy Medical Transportation Inc.
Napa County Board of Supervisors
OPPOSITION: (Verified 8/22/16)
Department of Finance
Department of Health Care Services
ARGUMENTS IN SUPPORT: This bill is sponsored by the 911 Provider's Medi-Cal Alliance (911 Alliance), which writes that in 2015, the leadership of six of California's largest private ambulance companies came together to discuss Medi-Cal reimbursement rates for emergency ambulance transports and formed the 911 Ambulance Provider's Medi-Cal Alliance with a mission to work together to help resolve the ongoing issue of low Medi-Cal reimbursement rates. The 911 Alliance writes that emergency ambulance providers have not seen an increase in base rates for emergency transports since 1999, and in those 17 years since the last increase, they have twice seen their Medi-Cal rates decreased. In those 17 years, the cost to deliver emergency ambulance service to all Californians, and this bill addresses 17 years of a growing difference between the cost to provide emergency ambulance service and Medi-Cal ambulance reimbursement.
ARGUMENTS IN OPPOSITION: DHCS writes in opposition that using QAF revenue to increase the Medi-Cal fee schedule for ambulance services, rather than having QAF revenue fund supplemental payments places the General Fund at greater risk of having to maintain the augmented rates if there are any changed circumstance affecting the amount of QAF DHCS can collect. In addition, DHCS states that using projected amounts in calculating the QAF may pose a challenge to obtaining federal approval because it would make the calculation of the fee uncertain, and DHCS is concerned that General Fund may be required if QAF revenue falls short, Medi-Cal ambulance utilization increases, or federal law requires a reduction in QAF fees.
ASSEMBLY FLOOR: 76-1, 8/23/16
AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Grove, Hadley, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Quirk, Ridley-Thomas, Rodriguez, Salas, Santiago, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Rendon
NOES: Harper
NO VOTE RECORDED: Chang, Gray, Steinorth
8/23/16 20:03:02
SENATE THIRD READING
STR Bill Id:SB 1300
Author:(Hernandez)
As Amended Ver:August 19, 2016
2/3 vote. Urgency
SENATE VOTE: 36-1
Committee | Votes | Ayes | Noes |
Health | 16-0 | Wood, Maienschein, Bonilla, Burke, Campos, Chiu, Gomez, Roger Hernández, Lackey, Olsen, Patterson, Ridley-Thomas, Rodriguez, Santiago, McCarty, Waldron | |
Appropriations | 19-0 | Gonzalez, Bigelow, Bloom, Bonilla, Bonta, Calderon, Daly, Eggman, Gallagher, Eduardo Garcia, Holden, Jones, Obernolte, Quirk, Santiago, Wagner, Weber, Wood, McCarty |
SUMMARY: Establishes the Medi-Cal Emergency Medical Transportation Reimbursement Act which assesses an annual quality assurance fee (QAF) on providers of emergency medical transportation (EMT) in accordance with a prescribed methodology beginning on July 1, 2017, and continuing each state fiscal quarter. Applies the QAF to three EMT billing codes. Specifically, this bill:
- Excludes from the definition of EMTs air ambulance providers, or transportation provided by taxicabs, litter vans, wheelchair vans, or other forms of public or private conveyances, as specified.
- Requires each EMT provider, on or before November 15, 2016, to report to the Department of Health Care Services (DHCS) data on the number of actual EMTs by payor type, including, without limitation, Medi-Cal fee-for-service (FFS) EMTs and Medi-Cal managed care (MCMC) EMTs, and gross receipts from the provision of EMTs provided each quarter from July 1, 2015, to October 31, 2016, in a manner prescribed by DHCS.
- Requires each EMT provider, commencing with the fiscal quarter beginning on January 1, 2017, and each fiscal quarter thereafter, on or before the 45th day of the quarter, to report to DHCS data on the number of actual EMTs by payor type, as specified, and gross receipts from the provision of EMTs provided in the quarter preceding the quarter in which the report is due, in an manner and format prescribed by DHCS.
- Authorizes DHCS to establish an Internet Web site for the submission of the required reports specified in 2) and 3) above.
- Permits DHCS to require certification by each EMT under penalty of perjury of the truth of the reports required in 2) and 3) above. Authorizes DHCS, upon written notice to an EMT provider, to impose a penalty of $100 per day that an EMT provider fails to make a report, as specified. Provides that failure to make the report within 90 days of the date upon which the report was due is considered a licensure violation, as specified.
- Requires, on or before June 15, 2017, and each June 15 thereafter, the DHCS Director to calculate the annual QAF rate applicable to the following state fiscal year based on the most recently collected data collected from EMT providers (See 2) and 3) above), and publish the annual QAF rate on its Internet Web site.
- Prohibits the fees calculated and collected from exceeding the amounts allowed under federal law, and authorizes the Director of DHCS to reduce the fees as necessary to comply with the amounts allowable under federal law, as specified. Specifies calculations of the QAF rate as follows:
- Calculate the QAF rate for state fiscal year (FY) 2017-18 by multiplying the projected total annual gross receipts for all EMT providers subject to the fee by 5.1%, the resulting product to be divided by the projected total annual EMTs by all EMT providers subject to the fee for the state FY; and,
- For state FY 2018-19 and thereafter, the QAF shall be calculated by a ratio, the numerator of which shall be the sum of the product of the projected aggregate fee schedule amount and the effective state medical assistance percentage, and the amount of DHCS staffing and administrative costs, as specified, and the denominator of which shall be 90% of the projected total annual EMTs by all EMT providers subject to the fee for the state FY.
- Establishes a staggered schedule for payment of the fee relative to the number of Medi-Cal FFS EMT that is rendered, as specified.
- Requires each EMT provider subject to the fee to remit to DHCS an amount equal to the annual QAF rate on specified timeframes. Authorizes DHCS to assess interest not paid on the due dates at the greater of 10% per annum or the rate at which DHCS assesses interest on Medi-Cal program overpayments to hospitals that are not repaid when due.
- Authorizes DHCS, if any fee is more than 60 days overdue to deduct any unpaid fee and interest owed from any Medi-Cal reimbursement payments owed to the provider until the full amount of the fee, interest and any penalties assessed are recovered. Requires DHCS to give the provider written notification of the deduction which could be deducted over a period of time taking into account the financial condition of the provider. Assesses an additional penalty if a payment is not received after 60 days.
- Establishes the Medi-Cal Emergency Transport Fund for purposes of the QAF raised in this bill and provides funding for health care coverage, in the following order of priority:
- To pay for the DHCS's staffing and administrative costs for implementation of this bill, not to exceed the following: i) $1,0003,000 in 2016-17; and, ii) $374,000 in 2017-18 and annually thereafter;
- To pay for the health care coverage in each FY in the amount of 10% of the projected quality assurance fee revenue for that FY, as calculated by DHCS on or before June 15 preceding that FY, exclusive of any federal matching funds; and,
- To make increased payments to EMT providers.
- Increases, effective July 1, 2017, the Medi-Cal FFS payment schedule governing reimbursement to EMT providers for EMTs. Requires the increase to the FFS payment schedule to: a) be calculated on or before June 15, 2017, and to remain the same for later fiscal years; and, b) apply only to those billing codes identified in, or any equivalent, predecessor, or successor billing codes as may be determined by the Director.
- Requires DHCS to calculate the projections based on data submitted pursuant to 2) and 3) above. Specifies the payment schedule amounts.
- Requires the FFS and MCMC payment schedule increase to be funded solely from the QAF, and federal reimbursement and any other related federal funds.
- Establishes provisions for delayed payment of the QAF if there is a delay in the implementation of this bill for any reason, including a delay in any required approval of the QAF and the reimbursement methodology. Includes in these provisions retroactive fees and the authority for DHCS to make retroactive payment of supplemental rates.
- Authorizes the DHCS Director to adopt regulations as are necessary to implement this bill. Authorizes adoption of regulations as emergency regulations, as specified.
- Requires DHCS to request approval from the federal Centers for Medicare and Medicaid Services (CMS) for the use of fees collected for the purpose of receiving federal matching funds.
- Authorizes the DHCS Director to alter the methodology to the extent necessary to meet the requirements of federal law or to obtain federal approval. Requires the DHCS Director to execute a declaration if an alteration is necessary.
- Authorizes the DHCS Director to add categories of exempt EMT providers or apply a nonuniform fee per transport to EMT providers that are subject to the fee in order to meet requirements of federal law or regulations.
- Implements this bill only if all of the following conditions are met:
- The CMS does not determine that the QAF may not be used for the purposes set forth in this bill;
- The state receives federal approval for the increased FFS payment schedule increases; and,
- The state continues its maintenance of effort for the level of state funding of EMT reimbursement for the 2017-18 rate year, and for every subsequent rate year, in an amount no less than the amount that the state would have paid for the same number of emergency medical transports under the rate methodology that was in effect on July 31, 2016.
- Ceases implementation of this bill if one of the following conditions is satisfied:
- CMS no longer allows the use of the provider assessment;
- The Medi-Cal FFS payment schedule increase no longer remains in effect;
- The QAF assessed and collected is no longer available;
- A final judicial determination by the California Supreme Court or any California Court of Appeal that the revenues collected pursuant to this article that are deposited in the Fund are considered subject to be proceeds of taxes within the meaning of Proposition 98, or,
- The state does not continue its maintenance of effort for the level of state funding of EMT reimbursement for the 2017-18 rate year, and for every subsequent rate year, as specified.
- Makes this bill inoperative in the event of a final judicial determination made by any state or federal court that is not appealed, or by a court of appellate jurisdiction that is not further appealed, in any action by any party, or a final determination by the administrator of the CMS, that federal financial participation (FFP) is not available with respect to any payment made under the methodology implemented under this bill because the methodology is invalid, unlawful, or contrary to any provision of federal law or regulations or of state law.
FISCAL EFFECT: According to the Assembly Appropriations Committee:
- One-time costs of $1.2 million and ongoing administrative costs of $750,000 annually (Medi-Cal Emergency Medical Transport Fund/General Fund (GF)/federal) for DHCS to develop regulations, gain federal approval, make any necessary system changes, oversee collection of the quality assurance fee, and make increased payments.
- DHCS states it has been unable to independently verify data provided by EMT providers. However, based on such data, staff assumes costs associated with fee collection and payment as follows:
- Ongoing GF benefit of about $3 million per year through reduced health care spending. This bill provides that 10% of revenue collected (after setting aside administrative funding) is available to the state for health care coverage. Thus, this bill reduces the need for GF support of the Medi-Cal program by an equal amount.
- Additional payments of about $73 million per year for Medi-Cal EMT services (Medi-Cal Emergency Medical Transport Fund/ federal). The quality assurance fee is projected to generate about $30 million per year in revenues (after accounting for administration and state benefits). With federal matching funds, about $73 million per year would be paid in increased reimbursements to providers.
- Unknown GF cost pressure to maintain higher ambulance transport rates if QAF revenues are eliminated or changed.
COMMENTS: According to the author, this bill increases Medi-Cal EMT rates by levying a QAF on three EMT reimbursement codes. The resulting revenue would then be used to draw down additional federal Medicaid funds to increase Medi-Cal emergency transportation rates, without imposing a cost to the state GF. In addition, 10% of revenue raised by the QAF would go to the state GF. The author argues inadequate Medi-Cal reimbursement for ambulance transport is a long-standing issue and places a strain on the state's emergency medical services system.
This bill assesses a QAF on revenue EMT providers receive from three EMT reimbursement codes (A0429 Basic Life Support Emergency, A0427 Advanced Life Support (ALS1) Emergency, and A0433 ALS 2). A QAF rate of 5.1% is assessed for 2017-18 against the gross revenue of all EMT providers from the three reimbursement codes. After 2017-18, estimates of the QAF rate provided by the 911 Ambulance Provider's Medi-Cal Alliance, the sponsor of this bill, are as follows: for 2018-19 the QAF would be at 5.7%; for 2019-20 it would be 5.8%; and for 2020-21 and beyond, the rate would be at 5.9%. The increase in the QAF rate is needed to account for the reduction in the federal match (known as the Federal Medical Assistance Percentages or FMAP) for certain populations including adults who became eligible for Medi-Cal under the optional expansion enacted under the federal Affordable Care Act.
Analysis Prepared by: Rosielyn Pulmano / HEALTH / (916) 319-2097 FN: 0004567
SENATE THIRD READING
STR Bill Id:SB 1300
Author:(Hernandez)
As Amended Ver:August 15, 2016
2/3 vote. Urgency
SENATE VOTE: 36-1
Committee | Votes | Ayes | Noes |
Health | 16-0 | Wood, Maienschein, Bonilla, Burke, Campos, Chiu, Gomez, Roger Hernández, Lackey, Olsen, Patterson, Ridley-Thomas, Rodriguez, Santiago, McCarty, Waldron | |
Appropriations | 19-0 | Gonzalez, Bigelow, Bloom, Bonilla, Bonta, Calderon, Daly, Eggman, Gallagher, Eduardo Garcia, Holden, Jones, Obernolte, Quirk, Santiago, Wagner, Weber, Wood, McCarty |
|
SUMMARY: Establishes the Medi-Cal Emergency Medical Transportation Reimbursement Act which assesses an annual quality assurance fee (QAF) on providers of emergency medical transportation (EMT) in accordance with a prescribed methodology beginning on July 1, 2017, and continuing each state fiscal quarter. Applies the QAF to three EMT billing codes. Specifically, this bill:
- Excludes from the definition of EMTs air ambulance providers, or transportation provided by taxicabs, litter vans, wheelchair vans, or other forms of public or private conveyances, as specified.
- Requires each EMT provider, on or before November 15, 2016, to report to the Department of Health Care Services (DHCS) data on the number of actual EMTs by payor type, including, without limitation, Medi-Cal fee-for-service (FFS) EMTs and Medi-Cal managed care (MCMC) EMTs, and gross receipts from the provision of EMTs provided each quarter from July 1, 2015, to June 30, 2016, in a manner prescribed by DHCS.
- Requires each EMT provider, commencing with the fiscal quarter beginning on January 1, 2017, and each fiscal quarter thereafter, on or before the 45th day of the quarter, to report to DHCS data on the number of actual EMTs by payor type, as specified, and gross receipts from the provision of EMTs provided in the quarter preceding the quarter in which the report is due, in an manner and format prescribed by DHCS.
- Authorizes DHCS to establish an Internet Web site for the submission of the required reports specified in 2) and 3) above.
- Permits DHCS to require certification by each EMT under penalty of perjury of the truth of the reports required in 2) and 3) above. Authorizes DHCS, upon written notice to an EMT provider, to impose a penalty of $100 per day that an EMT provider fails to make a report, as specified. Provides that failure to make the report within 90 days of the date upon which the report was due is considered a licensure violation, as specified.
- Requires, on or before June 15, 2017, and each June 15 thereafter, the DHCS Director to calculate the annual QAF rate applicable to the following state fiscal year based on the most recently collected data collected from EMT providers (See 2) and 3) above), and publish the annual QAF rate on its Internet Web site.
- Prohibits the fees calculated and collected from exceeding the amounts allowed under federal law, and authorizes the Director of DHCS to reduce the fees as necessary to comply with the amounts allowable under federal law, as specified. Specifies calculations of the QAF rate as follows:
- Calculate the QAF rate for state fiscal year (FY) 2017-18 by multiplying the projected total annual gross receipts for all EMT providers subject to the fee by 5.1%, the resulting product to be divided by the projected total annual EMTs by all EMT providers subject to the fee for the state FY; and,
- For state FY 2018-19 and thereafter, the QAF shall be calculated by a ratio, the numerator of which shall be the sum of the product of the projected aggregate fee schedule amount and the effective state medical assistance percentage, and the amount of DHCS staffing and administrative costs, as specified, and the denominator of which shall be 90% of the projected total annual EMTs by all EMT providers subject to the fee for the state FY.
- Establishes a staggered schedule for payment of the fee relative to the number of Medi-Cal FFS EMT that is rendered, as specified.
- Requires each EMT provider subject to the fee to remit to DHCS an amount equal to the annual QAF rate on specified timeframes. Authorizes DHCS to assess interest not paid on the due dates at the greater of 10% per annum or the rate at which DHCS assesses interest on Medi-Cal program overpayments to hospitals that are not repaid when due.
- Authorizes DHCS, if any fee is more than 60 days overdue to deduct any unpaid fee and interest owed from any Medi-Cal reimbursement payments owed to the provider until the full amount of the fee, interest and any penalties assessed are recovered. Requires DHCS to give the provider written notification of the deduction which could be deducted over a period of time taking into account the financial condition of the provider. Assesses an additional penalty if a payment is not received after 60 days.
- Establishes the Medi-Cal Emergency Transport Fund for purposes of the QAF raised in this bill and provides funding for health care coverage, in the following order of priority:
- To pay for the DHCS's staffing and administrative costs for implementation of this bill, not to exceed the following: i) $1,0003,000 in 2016-17; and, ii) $350,000 in 2017-18 and annually thereafter;
- To pay for the health care coverage in each FY in the amount of 10% of the projected quality assurance fee revenue for that FY, as calculated by DHCS on or before June 15 preceding that FY, exclusive of any federal matching funds; and,
- To make increased payments to EMT providers.
- Increases, effective July 1, 2017, the Medi-Cal FFS payment schedule governing reimbursement to EMT providers for EMTs.
- Requires DHCS to calculate the projections based on data submitted pursuant to 2) and 3) above. Specifies the payment schedule amounts.
- Requires the FFS and MCMC payment schedule increase to be funded solely from the QAF, and federal reimbursement and any other related federal funds.
- Establishes provisions for delayed payment of the QAF if there is a delay in the implementation of this bill for any reason, including a delay in any required approval of the QAF and the reimbursement methodology. Includes in these provisions retroactive fees and the authority for DHCS to make retroactive payment of supplemental rates.
- Authorizes the DHCS Director to adopt regulation as are necessary to implement this bill. Authorizes adoption of regulations as emergency regulations, as specified.
- Requires DHCS to request approval from the federal Centers for Medicare and Medicaid Services (CMS) for the use of fees collected for the purpose of receiving federal matching funds.
- Authorizes the DHCS Director to alter the methodology to the extent necessary to meet the requirements of federal law or to obtain federal approval. Requires the DHCS Director to execute a declaration if an alteration is necessary.
- Authorizes the DHCS Director to add categories of exempt EMT providers or apply a nonuniform fee per transport to EMT providers that are subject to the fee in order to meet requirements of federal law or regulations.
- Implements this bill only under the following conditions:
- The state receives federal approval of the QAF from CMS; and,
- The state receives federal approval for the increased FFS payment schedule increases.
- Ceases implementation of this bill if one of the following conditions is satisfied:
- CMS no longer allows the use of the provider assessment;
- The Medi-Cal FFS payment schedule increase no longer remains in effect;
- The QAF assessed and collected is no longer available; or,
- A final judicial determination by the California Supreme Court or any California Court of Appeal that the revenues collected pursuant to this article that are deposited in the Fund are considered subject to be proceeds of taxes within the meaning of Proposition 98.
- Makes this bill inoperative in the event of a final judicial determination made by any state or federal court that is not appealed, or by a court of appellate jurisdiction that is not further appealed, in any action by any party, or a final determination by the administrator of the CMS, that federal financial participation (FFP) is not available with respect to any payment made under the methodology implemented under this bill because the methodology is invalid, unlawful, or contrary to any provision of federal law or regulations or of state law.
FISCAL EFFECT: According to the Assembly Appropriations Committee:
- One-time costs of $1.2 million and ongoing administrative costs of $750,000 annually (Medi-Cal Emergency Medical Transport Fund/General Fund (GF)/federal) for DHCS to develop regulations, gain federal approval, make any necessary system changes, oversee collection of the quality assurance fee, and make increased payments.
- DHCS states it has been unable to independently verify data provided by EMT providers. However, based on such data, staff assumes costs associated with fee collection and payment as follows:
- Ongoing GF benefit of about $3 million per year through reduced health care spending. This bill provides that 10% of revenue collected (after setting aside administrative funding) is available to the state for health care coverage. Thus, this bill reduces the need for GF support of the Medi-Cal program by an equal amount.
- Additional payments of about $73 million per year for Medi-Cal EMT services (Medi-Cal Emergency Medical Transport Fund/ federal). The quality assurance fee is projected to generate about $30 million per year in revenues (after accounting for administration and state benefits). With federal matching funds, about $73 million per year would be paid in increased reimbursements to providers.
- Unknown GF cost pressure to maintain higher ambulance transport rates if QAF revenues are eliminated or changed.
COMMENTS: According to the author, this bill increases Medi-Cal EMT rates by levying a QAF on three EMT reimbursement codes. The resulting revenue would then be used to draw down additional federal Medicaid funds to increase Medi-Cal emergency transportation rates, without imposing a cost to the state GF. In addition, 10% of revenue raised by the QAF would go to the state GF. The author argues inadequate Medi-Cal reimbursement for ambulance transport is a long-standing issue and places a strain on the state's emergency medical services system.
This bill assesses a QAF on revenue EMT providers receive from three EMT reimbursement codes (A0429 Basic Life Support Emergency, A0427 Advanced Life Support (ALS1) Emergency, and A0433 ALS 2). A QAF rate of 5.1% is assessed for 2017-18 against the gross revenue of all EMT providers from the three reimbursement codes. After 2017-18, estimates of the QAF rate provided by the 911 Ambulance Provider's Medi-Cal Alliance, the sponsor of this bill, are as follows: for 2018-19 the QAF would be at 5.7%; for 2019-20 it would be 5.8%; and for 2020-21 and beyond, the rate would be at 5.9%. The increase in the QAF rate is needed to account for the reduction in the federal match (known as the Federal Medical Assistance Percentages or FMAP) for certain populations including adults who became eligible for Medi-Cal under the optional expansion enacted under the federal Affordable Care Act.
Analysis Prepared by: Rosielyn Pulmano / HEALTH / (916) 319-2097 FN: 0004107
Date of Hearing: August 3, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez, Chair
SBPCA Bill Id:SB 1300
Author:(Hernandez) – As Amended Ver:June 30, 2016
Policy Committee: | Health | Vote: | 16 - 0 |
Urgency: Yes State Mandated Local Program: Yes Reimbursable: No
SUMMARY:
This bill establishes a quality assurance fee (QAF) on providers of emergency medical transportation (EMT, or ambulance) beginning on July 1, 2017, and uses the revenue to raise reimbursement rates for ambulance providers. Specifically, this bill:
- Assesses a fee on EMT providers of 5.5% of total revenue, with some adjustments for future years, and contains numerous details about fee payment, recourse for nonpayment, federal approval, administrative flexibility, and conditions required for implementation.
- Allocates revenues to a newly created Medi-Cal Emergency Medical Transport Fund and continually appropriates funding for designated purposes.
- Specifies revenue must be used for the following, in priority order:
- Up to $350,000 for Department of Health Care Services (DHCS) staffing and administrative costs associated with implementation (such revenue can be matched with federal funds).
- To pay for health care coverage in each fiscal year in the amount of 10 percent of the projected QAF revenue for that fiscal year.
- To make increased payments to EMT providers. Specifically, it requires the fee-for-service payment schedule governing reimbursement to EMT providers be increased by an amount calculated as specified, for both fee-for-service and managed care.
- Requires the department to adopt implementing regulations, and allows non-regulatory guidance to be issued and active until July 1, 2018.
- Includes an urgency clause, in order to implement the QAF as soon as federal approval is obtained.
FISCAL EFFECT:
- One-time costs of $1.2 million and ongoing administrative costs of $750,000 annually (Medi-Cal Emergency Medical Transport Fund/GF/federal) for DHCS to develop regulations, gain federal approval, make any necessary system changes, oversee collection of the quality assurance fee, and make increased payments. This bill provides that $350,000 per year must be available to DHCS for administrative costs (the state would be able to draw down additional federal funding to help cover the administrative costs). To the extent that actual administrative costs are higher, those costs would be GF/federal.
- DHCS states it has been unable to independently verify data provided by EMT providers. However, based on such data, staff assumes costs associated with fee collection and payment as follows:
- Ongoing GF benefit of about $3 million per year through reduced health care spending. This bill provides that 10% of revenue collected (after setting aside administrative funding) is available to the state for health care coverage. Thus, this bill reduces the need for GF support of the Medi-Cal program by an equal amount.
- Additional payments of about $73 million per year for Medi-Cal EMT services (Medi-Cal Emergency Medical Transport Fund/ federal). The quality assurance fee is projected to generate about $30 million per year in revenues (after accounting for administration and state benefits). With federal matching funds, about $73 million per year would be paid in increased reimbursements to providers.
- Unknown GF cost pressure, potentially in the millions annually, to maintain higher ambulance transport rates if QAF revenues are eliminated or changed. See comment 7 (a), below.
COMMENTS:
- Purpose. According to the author, this bill increases Medi-Cal EMT rates by levying a fee on three specific EMT reimbursement codes. The resulting revenue would then be used to draw down additional federal Medicaid funds to increase Medi-Cal emergency transportation rates, without imposing a cost to the state GF. In addition, 10% of revenue raised by the QAF would offset GF costs for state-funded health care coverage. The author argues inadequate Medi-Cal reimbursement for ambulance transport is a longstanding issue and places a strain on the state's emergency medical services (EMS) system. Unlike other Medi-Cal providers, ambulance providers cannot “opt out” or otherwise limit their participation in the Medi-Cal program based on low Medi-Cal reimbursement levels.
- Background. Federal law authorizes states to fund a portion of Medicaid (Medi-Cal in California) through provider fees that meet federal requirements. The fee revenue collected by states is matched through federal financial participation (FFP) and used to increase provider payments, either through supplemental payments or through increased rates. With certain exceptions, state QAF must be broad-based, uniform, and cannot hold a group of providers harmless with respect to fees paid and payments received. In California, QAF mechanisms have been used to fund Medi-Cal managed care, skilled nursing facilities (SNF, nursing homes), intermediate care facilities for the developmentally disabled (ICF-DDs), and hospitals.
- EMT Costs Versus Medi-Cal Payments. Ambulance payment rates in Medi-Cal are poor even compared to Medi-Cal's generally low fee-for-service payment rates, which are generally about 50% of Medicare levels across all types of services. A 2012 GAO study found the median cost per ambulance transport was $429 nationally, whereas the average Medi-Cal payment is $106 before minor add-ons that slightly increase reimbursement.
- Recent Payment Reduction. Pursuant to AB 97 (Committee on Budget), Chapter 3, Statutes of 2011, Medi-Cal provider rates were reduced by 10% for dates of services on and after June 1, 2011, subject to federal approval, and federal financial participation. This rate reduction was blocked by court action for some providers. It took effect for ambulance providers in September 2013, but without retroactive recoupment.
- Prior Legislation.
- AB 2577 (Cooley and Pan) of 2014 authorized governmental entities to make intergovernmental transfers as the non-federal share of expenditures for ground EMT services for purposes of drawing down federal Medicaid matching funds. AB 2577 was vetoed by the Governor, who cited administrative capacity issues and committed to continue work on a funding mechanism.
- SB 1374 (Hernandez) of 2013 and AB 1257 (Gray) of 2015 increased payment rates for ground EMT services. Both were held on the suspense files of their respective house's Appropriations Committees.
- AB 678 (Pan), Chapter 397, Statutes of 2011, establishes a supplemental payment program for governmental entity providers of Medi-Cal EMT services, based on certified public expenditures using state or local governmental entities’ funds as the required federal match.
- Support and Opposition. Ambulance providers support this bill. DHCS has expressed opposition, noting the mechanism to increase payments is a rate increase, which puts the GF at risk of maintaining augmented rates, notwithstanding any subsequent changed circumstances affecting the amount of QAF revenues DHCS may collect.
- Staff Comments.
- Increased Rates versus Supplemental Payments. As noted, there are two main ways to increase reimbursement: providing higher reimbursement rates or providing supplemental payments without adjusting the base rate. DHCS notes that once higher reimbursement rates are approved by the federal government, they may prove difficult to modify or eliminate based on changing circumstances. For instance, if the QAF mechanism were eliminated, or a situation emerged in which the QAF revenue no longer covered the increased costs of the higher rates, the GF would likely shoulder the burden of paying for the rate increase. Supplemental payments appear easier to modify or eliminate.
- Administrative Costs. DHCS notes the $350,000 limit on revenue for administrative costs may not cover the necessary staffing, contract, and other costs the department may incur to implement the bill. To ensure GF neutrality, this bill should be amended to allow for complete administrative cost recovery from the collected revenues.
Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081
Date of Hearing:
ASSEMBLY COMMITTEE ON
, Chair
SBPCA Bill Id:
Author:() – As Ver:
SENATE VOTE:
SUBJECT: .
SUMMARY: Establishes the Medi-Cal Emergency Medical Transportation Reimbursement Act which assesses an annual quality assurance fee (QAF) on providers of emergency medical transportation (EMT) in accordance with a prescribed methodology beginning on July 1, 2017. and continuing each state fiscal quarter. Applies the QAF to three EMT billing codes. Specifically, this bill:
- Excludes from the definition of EMTs air ambulance providers, or transportation provided by taxicabs, litter vans, wheelchair vans, or other forms of public or private conveyances, as specified.
- Requires each EMT provider, on or before August 15, 2016, to report to the Department of Health Care Services (DHCS) data on the number of actual EMTs by payor type, including, without limitation, Medi-Cal fee-for-service (FFS) EMTs and Medi-Cal managed care (MCMC) EMTs, and gross receipts from the provision of EMTs provided each quarter from July 1, 2015, to June 30, 2016, in a manner prescribed by DHCS.
- Requires each EMT provider, commencing with the fiscal quarter beginning on October 1, 2016, and each fiscal quarter thereafter, on or before the 45th day of the quarter, to report to DHCS data on the number of actual EMTs by payor type, as specified, and gross receipts from the provision of EMTs provided in the quarter preceding the quarter in which the report is due, in an manner and format prescribed by DHCS.
- Authorizes DHCS to establish an Internet Website for the submission of the required reports specified in 2) and 3) above.
- Permits DHCS to require certification by each EMT under penalty of perjury of the truth of the reports required in 2) and 3) above. Authorizes DHCS, upon written notice to an EMT provider, to impose a penalty of $100 per day that an EMT provider fails to make a report, as specified. Provides that failure to make the report within 90 days of the date upon which the report was due is considered a licensure violation, as specified.
- Requires, on or before June 15, 2017, and each June 15 thereafter, the DHCS Director to calculate the annual QAF rate applicable to the following state fiscal year based on the most recently collected data collected from EMT providers (See 2) and 3) above), and publish the annual QAF rate on its Internet Website.
- Prohibits the fees calculated and collected from exceeding the amounts allowed under federal law. Specifies calculations of the QAF rate as follows:
- Calculate the QAF rate for state fiscal year (FY) 2017-18 by multiplying the projected total annual gross receipts for all EMT providers subject to the fee by 5.5%, the resulting product to be divided by the projected total annual EMTs by all EMT providers subject to the fee for the state FY; and,
- For state FY 2018-19 and thereafter, the QAF shall be calculated by a ratio, the numerator of which shall be the sum of the product of the projected aggregate fee schedule amount and the effective state medical assistance percentage, and the amount of DHCS staffing and administrative costs not to exceed $350,000, and the denominator of which shall be 95% of the projected total annual EMTs by all EMT providers subject to the fee for the state FY.
- Requires the DHCS Director, on or before June 15, 2017, and each June 15 thereafter, to publish the annual QAF rate on its Internet Website.
- Requires the Director of DHCS to adjust the QAF rate, as specified.
- Requires each EMT provider subject to the fee to remit to DHCS an amount equal to the annual QAF rate on specified timeframes. Authorizes DHCS to assess interest not paid on the due dates at the greater of 10% per annum or the rate at which DHCS assesses interest on Medi-Cal program overpayments to hospitals that are not repaid when due.
- Authorizes DHCS, if any fee is more than 60 days overdue to deduct any unpaid fee and interest owed from any Medi-Cal reimbursement payments owed to the provider until the full amount of the fee and interest are recovered. Requires DHCS to give the provider written notification of the deduction which could be deducted over a period of time taking into account the financial condition of the provider. Assesses an additional penalty if a payment is not received after 60 days.
- Establishes the Medi-Cal Emergency Transport Fund for purposes of the QAF raised in this bill and provides funding for health care coverage, in the following order of priority:
- To pay for the DHCS’s staffing and administrative costs for implementation of this bill, not to exceed $350,000 for each FY, exclusive of any matching funds;
- To pay for the health care coverage in each FY in the amount of 10% of the projected quality assurance fee revenue for that FY, as calculated by DHCS on or before June 15 preceding that FY, exclusive of any federal matching funds; and,
- To make increased payments to EMT providers.
- Increases, effective July 1, 2017, the Medi-Cal FFS payment schedule governing reimbursement to EMT providers for EMTs.
- Requires DHCS to calculate the projections based on data submitted pursuant to 2) and 3) above. Specifies the payment schedule amounts.
- Requires the FFS and MCMC payment schedule increase to be funded solely from the QAF, and federal reimbursement and any other related federal funds.
- Establishes provisions for delayed payment of the QAF if there is a delay in the implementation of this bill for any reason, including a delay in any required approval of the QAF and the reimbursement methodology. Includes in these provisions retroactive fees and the authority for DHCS to make retroactive payment of supplemental rates.
- Authorizes the DHCS Director to adopt regulation as are necessary to implement this bill. Authorizes adoption of regulations as emergency regulations, as specified.
- Requires DHCS to request approval from the federal Centers for Medicare and Medicaid Services (CMS) for the use of fees collected for the purpose of receiving federal matching funds.
- Authorizes the DHCS Director to alter the methodology to the extent necessary to meet the requirements of federal law or to obtain federal approval. Requires the DHCS Director to execute a declaration if an alteration is necessary.
- Authorizes the DHCS Director to add categories of exempt EMT providers or apply a nonuniform fee per transport to EMT providers that are subject to the fee in order to meet requirements of federal law or regulations.
- Implements this bill only under the following conditions:
- The state receives federal approval of the QAF from CMS; and,
- The state receives federal approval for the increased FFS payment schedule increases.
- Ceases implementation of this bill if one of the following conditions is satisfied:
- CMS no longer allows the use of the provider assessment;
- The Medi-Cal FFS payment schedule increase no longer remains in effect;
- The QAF assessed and collected is no longer available; or,
- A final judicial determination by the California Supreme Court or any California Court of Appeal that the revenues collected pursuant to this article that are deposited in the Fund are considered subject to be proceeds of taxes within the meaning of Proposition 98.
- Makes this bill inoperative in the event of a final judicial determination made by any state or federal court that is not appealed, or by a court of appellate jurisdiction that is not further appealed, in any action by any party, or a final determination by the administrator of the CMS, that federal financial participation (FFP) is not available with respect to any payment made under the methodology implemented under this bill because the methodology is invalid, unlawful, or contrary to any provision of federal law or regulations or of state law.
EXISTING LAW:
- Establishes the Medi-Cal program, administered by the DHCS which provides health benefits to low-income individuals who meet specific eligibility criteria.
- Includes EMT and nonemergency medical transport (NEMT) in the Medi-Cal schedule of benefits.
- Reduces specified Medi-Cal provider rates, including ground ambulance services effective June 1, 2011, by 10% for dates of service on and after June 1, 2011, subject to specific requirements. Applies the 10% reduction for ambulance providers for dates of service on or after September 5, 2013, but was not applied retroactively back to June 2011.
FISCAL EFFECT: According to the Senate Appropriations Committee:
- Ongoing administrative costs, likely in the hundreds of thousands to low millions per year for DHCS to develop regulations, gain federal approval, make any necessary system changes, oversee collection of the quality assurance fee, and make supplemental payments (special fund, General Fund (GF), and federal funds). This bill provides that $350,000 per year shall be available to DHCS for administrative costs (the state would be able to draw down additional federal funding to help cover the administrative costs). To the extent that actual administrative costs are higher, those costs would be paid from the GF and federal funds.
- Ongoing GF benefit of about $3 million per year. This bill provides that 10% of revenue collected (after setting aside administrative funding) shall be available to the state for support of the Medi-Cal program. In doing so, this bill reduces the need for GF support of the Medi-Cal program by an equal amount.
- Additional payments of about $77 million per year for EMT in the Medi-Cal program (special fund and federal funds). The quality assurance fee is projected to generate about $30 million per year in revenues (after accounting for administration and state benefits). With federal matching funds, there would be about $77 million per year for increased reimbursements to providers.
COMMENTS:
- PURPOSE OF THIS BILL. According to the author, this bill increases Medi-Cal EMT rates by levying a QAF on three EMT reimbursement codes. The resulting revenue would then be used to draw down additional federal Medicaid funds to increase Medi-Cal emergency transportation rates, without imposing a cost to the state GF. In addition, 10% of revenue raised by the QAF would go to the state GF. The author argues inadequate Medi-Cal reimbursement for ambulance transport is a long-standing issue and places a strain on the state's emergency medical services (EMS) system. Unlike other Medi-Cal providers, ambulance providers cannot “opt out” or otherwise limit their participation in the Medi-Cal program the way other nonemergency health care providers can to obtain a more favorable payor mix.
While the costs to provide essential ambulance services has significantly increased during the past decade, including escalating wages and benefits, and increasing insurance premiums, Medi-Cal reimbursement has not kept pace with these increased costs and has in fact declined to less than the amounts paid in 1999. The QAF proposed by this bill would increase Medi-Cal EMT rates by drawing down federal Medicaid dollars, which will flow back to the state to be used by ambulance providers to maintain the high level of care that is expected of the state's EMS and 911 programs. - BACKGROUND.
- Provider Taxes. Federal Medicaid law authorizes states to impose health care-related provider taxes on certain types of health care services (such as inpatient hospital services, nursing facility services, emergency ambulance services and managed care organization) without affecting federal matching funding. Health care-related taxes are defined as a licensing fees, assessments, or other mandatory payments that are related to the provision of, or payment for, health care services or items. In many states, including California, states collect these payments from health care providers to help finance the nonfederal share of their Medicaid expenditures. To be deemed permissible under federal law, health-care related taxes must be:
- Broad based: imposed on all providers within a specified class of providers;
- Uniform: applied at the same rate for all payers of the tax; and,
- No hold harmless: the state may not provide a direct or indirect guarantee that providers receive their tax payment back, or be “held harmless” from the tax.
- Provider Taxes. Federal Medicaid law authorizes states to impose health care-related provider taxes on certain types of health care services (such as inpatient hospital services, nursing facility services, emergency ambulance services and managed care organization) without affecting federal matching funding. Health care-related taxes are defined as a licensing fees, assessments, or other mandatory payments that are related to the provision of, or payment for, health care services or items. In many states, including California, states collect these payments from health care providers to help finance the nonfederal share of their Medicaid expenditures. To be deemed permissible under federal law, health-care related taxes must be:
Federal rules permit some health care-related taxes that do not meet the definition of being “broad-based” and “uniform.” To obtain permission for such a tax, states must formally request a waiver of the broad-based and uniform requirements from CMS, and within the waiver request, demonstrate that the tax structure is generally redistributive. However, federal law does not allow for any waiver of the no-hold-harmless requirement.
California currently has provider fees on managed care plans, hospitals, skilled nursing facilities and intermediate care facilities for the developmentally disabled.
- Medi-Cal rates for ambulance services. Medi-Cal covers both EMT and NEMT. EMT is provided when necessary to obtain program covered benefits when the beneficiary’s medical/physical condition is acute and severe, necessitating immediate medical diagnosis and treatment in order to prevent death or disability. Such transportation does not require prior authorization and is always by ambulance.
When billing Medi-Cal for a “911 call,” ambulance providers bill a Basic Life Support (BLS) base rate of $106.38. In addition to the base rate, Medi-Cal provides additional funding for additional costs and services, such as mileage, night calls, extra attendants, waiting times, and certain supplies and services. Medi-Cal FFS emergency base ambulance rates were increased in 1997 and 1998 and were last increased in 1999 by 11.7%, to $118.20. Medi-Cal base ambulance rates were reduced in 2008 and again in 2013 (by 10%). The current Medi-Cal base rate is $106.38, a rate that is $11.82 lower than the rate in 1999. - EMT. This bill imposes a QAF on revenue EMT providers receive from three EMT reimbursement codes, as follows:
- A0429 BLS Emergency. BLS vehicles must be staffed by at least two people, at least one of whom must be certified as an emergency medical technician by the State or local authority where the services are being furnished and be legally authorized to operate all lifesaving and life-sustaining equipment on board the vehicle. An emergency response is one that, at the time the ambulance supplier is called, responds immediately or responds as quickly as possible to take the steps necessary to respond to the call.
- A0427 Advanced Life Support (ALS1) Emergency. ALS1 vehicles must be staffed by at least two people, at least one of whom must be certified by the State or local authority as an EMT-Intermediate or an EMT-Paramedic.
- A0433 ALS 2 – ALS2 is the transportation by ground ambulance vehicle and the provision of medically necessary supplies and services including: 1) at least three separate administrations of one or more medications by intravenous push/bolus or by continuous infusion (excluding crystalloid fluids) or 2) ground ambulance transportation and the provision of at least one of the ALS2 procedures: Manual defibrillation/cardioversion; Endotracheal intubation; Central venous line; Cardiac pacing; Chest decompression; Surgical airway; or Intraosseous line.
- A0429 BLS Emergency. BLS vehicles must be staffed by at least two people, at least one of whom must be certified as an emergency medical technician by the State or local authority where the services are being furnished and be legally authorized to operate all lifesaving and life-sustaining equipment on board the vehicle. An emergency response is one that, at the time the ambulance supplier is called, responds immediately or responds as quickly as possible to take the steps necessary to respond to the call.
- QAF rate. This bill assesses a QAF on revenue EMT providers receive from three EMT reimbursement codes as specified above. A QAF rate of 5.5% is assessed for 2017-18 against the gross revenue of all EMT providers from the three reimbursement codes. After 2017-18, estimates of the QAF rate provided by the 911 Ambulance Provider’s Medi-Cal Alliance, the sponsor of this bill, are as follows: for 2018-19 the QAF would be at 5.7%; for 2019-20 it would be 5.8%; and for 2020-21 and beyond, the rate would be at 5.9%. The increase in the QAF rate is needed to account for the reduction in the federal match (known as the Federal Medical Assistance Percentages or FMAP) for certain populations including adults who became eligible for Medi-Cal under the optional expansion enacted under the federal Affordable Care Act.
- Medi-Cal rates for ambulance services. Medi-Cal covers both EMT and NEMT. EMT is provided when necessary to obtain program covered benefits when the beneficiary’s medical/physical condition is acute and severe, necessitating immediate medical diagnosis and treatment in order to prevent death or disability. Such transportation does not require prior authorization and is always by ambulance.
- SUPPORT. The 911 Ambulance Provider’s Medi-Cal Alliance, the sponsor of this bill, and the Emergency Medical Services Administrators Association of California, state that this bill provides financial relief to public and private ambulance providers who have been impacted by 18 years of a growing divide between the cost of providing emergency ambulance services and the cost of providing care to patients.
- RELATED LEGISLATION. AB 1257 (Gray) would have required DHCS to establish payment rates for ground ambulance services based on changes in the Consumer Price Index-Urban and the California weighted average Geographic Practice Cost Index, and would have designated the ambulance cost study conducted by the federal Government Accountability Office as the evidentiary base. AB 1257 was held on the Assembly Appropriations Committee suspense file.
- PREVIOUS LEGISLATION.
- AB 2577 (Cooley and Pan) of 2014 would have authorized governmental entities to make intergovernmental transfers as the non-federal share of expenditures for ground EMT services for purposes of drawing down federal Medicaid matching funds. AB 2577 was vetoed by the Governor.
- SB 1374 (Hernandez) of 2013 would have required DHCS, by July 1, 2015, to adopt regulations establishing the Medi-Cal reimbursement rate for ground ambulance services using one of two specified methodologies. SB 1374 was held on the Senate Appropriations Committee suspense file.
- SB 359 (Hernandez) of 2011, was similar to SB 1374 in that it would have required DHCS, by July 1, 2012, to adopt regulations establishing the Medi-Cal reimbursement rate for ground ambulance services using one of two specified methodologies. SB 359 was held on the Senate Appropriations Committee suspense file and was gutted and amended and used for another purpose.
- AB 678 (Pan), Chapter 397, Statutes of 2011, establishes a supplemental payment program for governmental entity providers of Medi-Cal EMT services, based on certified public expenditures using state or local governmental entities’ funds as the required federal match.
- AB 2173 (Beall), Chapter 547, Statutes of 2010, establishes a $4 penalty on every vehicle code violation. The resulting revenue would be matched by federal funds and used to make supplemental payments for emergency air medical transportation services in the Medi-Cal program.
- AB 1932 (Hernandez) of 2010, in its final form, would have authorized DHCS to utilize certain service levels for purposes of determining billing codes for emergency and nonemergency basic life and advanced life support transportation and specialty care transportation. If DHCS used the service levels to determine billing codes, AB 1932 would have required DHCS to adopt the definitions and Healthcare Common Procedure Coding System codes for those service levels that have been established by CMS, and to determine the above described billing codes in a revenue-neutral manner. AB 1932 was held on the Senate Appropriations suspense file.
- AB 1174 (Hernández) of 2009 would have required Medi-Cal to cover emergency BLS and advanced life support services when a patient reasonably believes that without immediate medical attention, a serious health condition, as specified, could reasonably result. In addition, AB 1174 would have increased and established in statute maximum Medi-Cal reimbursement rates for ambulance transportation services, and would have required the rates be adjusted to reflect changes in the California Consumer Price Index. AB 2257 (Hernandez) of 2008 was similar to AB 1174, except that AB 2257 would have also increased Medi-Cal rates for air ambulance providers. AB 1174 and AB 2257 were both held on the Assembly Appropriations suspense file.
- AB 511 (De La Torre) of 2010 would have imposed, as a condition of participation in the Medi-Cal Program, a QAF on certain ambulance transportation services providers, to be administered by DHCS. The proceeds from the QAF would be required to be deposited into the Medi-Cal Ambulance Transportation Services Providers Fund (Fund). Moneys in the Fund would be available only to enhance FFP for ambulance transportation services under the Medi-Cal program, or to provide additional reimbursement to, and to support quality improvement efforts of, ambulance transportation services providers, including increased reimbursement for and improvement of the quality of the provision of advanced life support services, as defined. AB 511 died in the Senate.
- AB 1153 (Beall) of 2009 would have levied an additional penalty of $3 upon every fine, penalty, or forfeiture imposed and collected by the courts for all offenses involving a vehicle violation, except certain parking offenses, in each county. The resulting revenue would be transferred to the state and continuously appropriated to DHCS solely for the purposes of augmenting Medi-Cal reimbursement paid to emergency air medical transportation services providers. DHCS would be required to use the moneys in the Emergency Air Medical Transportation Act Fund and federal matching funds to increase the Medi-Cal reimbursement or supplemental payments for emergency air medical transportation services in an amount not to exceed normal and customary charges charged by the emergency air ambulance transportation services provider. AB 1153 was held on the Senate Appropriations suspense file.
- AB 2577 (Cooley and Pan) of 2014 would have authorized governmental entities to make intergovernmental transfers as the non-federal share of expenditures for ground EMT services for purposes of drawing down federal Medicaid matching funds. AB 2577 was vetoed by the Governor.
- AMENDMENTS. This bill requires EMT providers to report to DHCS on or before August 15, 2016, data on their transports to be used to calculate the QAF. To give DHCS sufficient time to determine the manner and format of reporting the data, this timeline needs to be adjusted. Additionally, the author is proposing to delete penalty provisions for failure to submit the report.
14129.1.
(a) On or before August 15, 2016 November 15, 2016, each EMT provider shall report to the department data on the number of actual EMTs by payor type, including, without limitation, Medi-Cal fee-for-service EMTs and Medi-Cal managed care EMTs, and gross receipts from the provision of EMTs provided in each quarter from July 1, 2015, through to June 30, 2016 October 31, 2016, inclusive, in a manner and format prescribed by the department.
(b) Commencing with the fiscal quarter beginning on October 1, 2016 January 1, 2017, and each fiscal quarter thereafter, on or before the 45th day of the quarter, each EMT provider shall report to the department data on the number of actual EMTs by payor type, including, without limitation, Medi-Cal fee-for-service EMTs and Medi-Cal managed care EMTs, and gross receipts from the provision of EMTs provided in the quarter preceding the quarter in which the report is due, in a manner and format prescribed by the department.
(c) The department may establish an Internet Web site for the submission of reports required by this section.
(d) The department may require a certification by each EMT under penalty of perjury of the truth of the reports required under this section. Upon written notice to an EMT provider, the department may impose a penalty of one hundred dollars ($100) per day against an EMT provider for every day that an EMT provider fails to make a report required by this section within five days of the date upon which the report was due. If an EMT provider has not made a report as required by this section within 90 days of the date upon which the report was due, the failure to make the report shall be considered a violation of a section of the Vehicle Code that relates to the EMT provider’s licensed activities for the purposes of Section 2542 of the Vehicle Code.
REGISTERED SUPPORT / OPPOSITION:
Support
911 Ambulance Provider's Medi-Cal Alliance (sponsor)
Alameda County Board of Supervisors
American Ambulance
California Fire Chiefs Association
California Professional Firefighters
Emergency Medical Services Administrators Association of California
Fire Districts Association of California
Gold Coast Ambulance
McCormick Ambulance
Mercy Medical Transportation
Napa County Board of Supervisors
Paramedics Plus
Opposition
None on file.
Analysis Prepared by:
Office of Senate Floor Analyses (916) 651-1520 Fax: (916) 327-4478 | SB |
THIRD READING
Bill No: SB 1300
: 5
SENATE HEALTH COMMITTEE: 5-0, 4/20/16
AYES: Hernandez, Hall, Mitchell, Monning, Pan
NO VOTE RECORDED: Nguyen, Nielsen, Roth, Wolk
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/27/16
AYES: Lara, Bates, Beall, Hill, McGuire, Mendoza, Nielsen
SOURCE: 911 Ambulance Provider’s Medi-Cal Alliance
DIGEST: This bill imposes a quality assurance fee on each transport provided by an emergency medical transport provider in accordance with a prescribed methodology. Requires the resulting revenue to be placed in a continuously appropriated fund to be used to provide additional Medi-Cal reimbursement to emergency medical transport providers, to pay for state administrative costs, and to provide funding for health care coverage for Californians.
Existing law:
- Establishes the Medi-Cal program, administered by the Department of Health Care Services (DHCS), which provides health benefits to low-income individuals who meet specified eligibility criteria. Establishes a schedule of benefits under the Medi-Cal program, which includes emergency and non-emergency medical transportation.
- Reduces specified Medi-Cal provider rates (including ground ambulance services), effective June 1, 2011, by 10% for dates of services on and after June 1, 2011, subject to federal approval, federal financial participation (FFP), and the reduction meeting federal Medicaid requirements. The 10% reduction took effect for ambulance providers for dates of service on or after September 5, 2013 but was not applied retroactively back to June 2011.
This bill:
- Imposes, commencing with the state fiscal quarter beginning on July 1, 2017, and continuing each fiscal quarter thereafter, a quality assurance fee (QAF) for each emergency medical transport provided by each emergency medical transport provider.
- Defines an “emergency medical transport” as the act of transporting an individual from any point of origin to the nearest medical facility capable of meeting the emergency medical needs of the patient by an ambulance licensed, operated, and equipped in accordance with applicable state or local statutes, ordinances, or regulations that are billed with one of three billing codes: A0429 Basic Life Support Emergency, A0427 Advanced Life Support Emergency, and A0433 Advanced Life Support 2.
- Requires the DHCS director, on or before June 15, 2017, and each June 15th thereafter, to calculate the annual QAF rate applicable to the following state fiscal year based on the most recently collected data collected from emergency medical transport providers. Requires DHCS to publish the annual QAF rate on its Internet Web site.
- Establishes, for the 2017-18 fiscal year and the 2019-19 fiscal year and thereafter, different methods for calculating the annual QAF rate. Prohibits the fees calculated and collected from exceeding the amounts allowable under federal law.
- Requires, effective July 1, 2017, the Medi-Cal fee-for-service (FFS) payment schedule governing reimbursement to emergency medical transport providers for emergency medical transports to be increased pursuant to a methodology established by this bill, using revenue from the QAF.
- Requires each Medi-Cal managed care health plan to provide payment to emergency medical transport providers under this bill that is equal to the amount of payment the provider would have received under FFS Medi-Cal, by referencing existing federal law and regulation.
- Requires the DHCS director to deposit the QAF in the Medi-Cal Emergency Medical Transport Fund (Fund) created by this bill. Continuously appropriates the moneys in the Fund, and any federal matching funds to DHCS.
- Requires moneys in the Fund, including any interest and dividends earned on money in the fund, to be available exclusively to enhance federal financial participation for ambulance services under the Medi-Cal program and to provide additional reimbursement to, and to support quality improvement efforts of, emergency medical transport providers, as well as to pay for the state’s administrative costs and to provide funding for health care coverage for Californians, in the following order of priority:
- To pay for DHCS staffing and administrative costs directly attributable to implementing this bill, capped at $350,000 for each fiscal year, exclusive of any federal matching funds;
- To pay for the health care coverage in each fiscal year in the amount of 10% of the projected QAF revenue for that fiscal year, as calculated by the DHCS on or before June 15 preceding that fiscal year, exclusive of any federal matching funds; and,
- To make increased payments to emergency medical transport providers pursuant to this bill.
- Requires the Medi-Cal FFS and Medi-Cal managed care payment schedule increase established under this bill to be funded solely the QAF, along with any interest or other investment income and federal reimbursement and any other related federal funds.
- Requires the proceeds of the QAF, the matching amount provided by the federal government, and any interest earned on those proceeds to be used to supplement existing funding for emergency medical transports provided by emergency transport providers and not to supplant this funding.
- Requires the DHCS director to adjust the annual QAF fee rate so that the available fee amount for the state fiscal year will approximately equal the aggregate Medi-Cal fee schedule amount for the state fiscal year if, during a state fiscal year, the actual or projected available QAF amount exceeds or is less than the actual or projected aggregate fee schedule amount by more than 1%. Requires the available fee amount for a state fiscal year to be considered to equal the aggregate fee schedule amount for the state fiscal year if the difference between the available fee amount for the state fiscal year and the aggregate fee schedule amount for the state fiscal year constitutes less than 1% of the aggregate fee schedule amount for the state fiscal year.
- Requires each emergency medical transport provider to report to DHCS data on the number of actual emergency medical transports by payor type, and gross receipts from the provision of emergency medical transports in a manner and format prescribed by DHCS.
- Permits DHCS to require a certification by each emergency medical transport under penalty of perjury of the truth of the required reports. Permits DHCS to impose a penalty of $100 per day against an emergency medical transport provider for every day that an emergency medical transport provider fails to make a required report within five days of the date upon which the report was due.
- Requires the DHCS director, on or before June 15, 2017, and each June 15 thereafter, to publish the annual QAF rate on its Internet Web site.
- Requires emergency medical transport providers to remit to DHCS annual QAF amounts, as specified. Requires interest to be assessed on QAF not paid on the date due at the greater of 10% per annum or the rate at which DHCS assesses interest on Medi-Cal program overpayments to hospitals that are not repaid when due. Requires interest to begin to accrue the day after the date the payment was due, and to be deposited in the Medi-Cal Emergency Medical Transport Fund established by this bill.
- Permits DHCS to deduct unpaid QAF amounts and interest owed from Medi-Cal reimbursements payments owed to a provider until the full amount of the fee and interest is owed in the event that any fee payment is more than 60 days overdue. Requires any deduction to be made only after DHCS gives the provider written notification, and requires any deduction to be deducted over a period of time that takes into account the financial condition of the provider.
- Requires DHCS to accept an emergency medical transport provider’s payment even if the payment is submitted in a rate year subsequent to the rate year in which the fee was assessed.
- Establishes provisions for delayed payment of the QAF if there is a delay in the implementation of this bill for any reason, including a delay in any required approval of the QAF and the reimbursement methodology. These include retroactive fees and the authority for DHCS to make retroactive payment of supplemental rates.
- Permits DHCS to adopt regulations (including one-time emergency regulations) as are necessary to implement this bill, and permits the use of provider bulletin, or other similar instructions, without taking regulatory action, provided that no such bulletin or other similar instructions remains in effect after June 30, 2018.
- Requires DHCS to request approval from the federal Centers for Medicare and Medicaid Services (CMS) for the use of fees collected under this bill for the purpose of receiving federal matching funds.
- Permits the DHCS director to alter the methodology specified in this bill to the extent necessary to meet the requirements of federal law or regulations or to obtain federal approval. Requires, if the DHCS director, after consulting with affected emergency medical transport providers, determines that an alteration is needed, the director to execute a declaration stating that this determination has been made, and to provide a copy to the fiscal and appropriate policy committees of the Legislature.
- Permits the DHCS director to add categories of exempt emergency medical transport providers or apply a non-uniform fee per transport to emergency medical transport providers that are subject to the fee in order to meet requirements of federal law or regulations. Permits the DHCS director to exempt categories of emergency medical transport providers from the fee if necessary to obtain federal approval.
- Implements this bill only if, and as long as, both of the following conditions are met:
- The state receives federal approval of the QAF from the CMS; and,
- The state receives federal approval for the increased Medi-Cal FFS payment schedule increases in this bill.
- Ceases implementation of this bill if any of the following conditions are met:
- The federal CMS no longer allows the use of the QAF in this bill;
- The Medi-Cal FFS payment schedule increase described in this bill no longer remains in effect;
- The QAF assessed and collected under this bill no longer remains available for the purposes specified in this bill; and,
- A final judicial determination by the California Supreme Court or any California Court of Appeal that the revenues collected pursuant to this article that are deposited in the Fund are considered subject to be proceeds of taxes within the meaning of Proposition 98.
- Makes this bill inoperative in the event of a final judicial determination made by any state or federal court that is not appealed, or by a court of appellate jurisdiction that is not further appealed, in any action by any party, or a final determination by the administrator of the CMS, that federal financial participation is not available with respect to any payment made under the methodology implemented under this bill because the methodology is invalid, unlawful, or contrary to any provision of federal law or regulations or of state law.
Comments
- Author’s statement. According to the author, this bill increases Medi-Cal emergency medical transportation rates by levying a QAF on three emergency medical transportation reimbursement codes. The resulting revenue would then be used to draw down additional federal Medicaid funds to increase Medi-Cal emergency transportation rates, without imposing a cost to the state General Fund. In addition, 10% of revenue raised by the QAF would go to the state General Fund. The author argues inadequate Medi-Cal reimbursement for ambulance transport is a long-standing issue and places a strain on the state's emergency medical services (EMS) system. Unlike other Medi-Cal providers, ambulance providers cannot “opt out” or otherwise limit their participation in the Medi-Cal program the way other non-emergency health care providers can to obtain a more favorable payor mix.
While the costs to provide essential ambulance services has significantly increased during the past decade, including escalating wages and benefits, and increasing insurance premiums, Medi-Cal reimbursement has not kept pace with these increased costs and has in fact declined to less than the amounts paid in 1999. The QAF proposed by this bill would increase Medi-Cal emergency medical transportation rates by drawing down federal Medicaid dollars, which will flow back to the state to be used by ambulance providers to maintain the high level of care that is expected of the state's EMS and 911 programs. - Medi-Cal rates for ambulance services. When billing Medi-Cal for a “911 call,” ambulance providers bill a Basic Life Support (BLS) base rate of $106.38. In addition to the base rate, Medi-Cal provides additional funding for additional costs and services, such as mileage, night calls, extra attendants, waiting times, and certain supplies and services. Medi-Cal FFS emergency base ambulance rates were increased in 1997 and 1998 and were last increased in 1999 by 11.7%, to $118.20. Medi-Cal base ambulance rates were reduced in 2008 and again in 2013 (by 10%). The current Medi-Cal base rate is $106.38, a rate that is $11.82 lower than the rate in 1999.
FISCAL EFFECT: Appropriation: Fiscal Com.: Local:
According to the Senate Appropriations Committee:
- Ongoing administrative costs, likely in the hundreds of thousands to low millions per year for DHCS to develop regulations, gain federal approval, make any necessary system changes, oversee collection of the quality assurance fee, and make supplemental payments (special fund, General Fund [GF], and federal funds). This bill provides that $350,000 per year shall be available to DHCS for administrative costs (the state would be able to draw down additional federal funding to help cover the administrative costs). To the extent that actual administrative costs are higher, those costs would be paid from the GF and federal funds.
- Ongoing GF benefit of about $3 million per year. This bill provides that 10% of revenue collected (after setting aside administrative funding) shall be available to the state for support of the Medi-Cal program. In doing so, this bill reduces the need for GF support of the Medi-Cal program by an equal amount.
- Additional payments of about $77 million per year for emergency medical transportation in the Medi-Cal program (special fund and federal funds). The quality assurance fee is projected to generate about $30 million per year in revenues (after accounting for administration and state benefits). With federal matching funds, there would be about $77 million per year for increased reimbursements to providers.
911 Ambulance Provider’s Medi-Cal Alliance (source)
American Ambulance
American Medical Response
California Ambulance Association
California Fire Chiefs Association
California Professional Firefighters
Fire District Association of California
Paramedics Plus
Gold Coast Ambulance
McCormick Ambulance Service
Mercy Medical Transportation Inc
OPPOSITION: (Verified 5/31/16)
None received
ARGUMENTS IN SUPPORT: This bill is sponsored by the 911 Provider's Medi-Cal Alliance (911 Alliance), which writes that in 2015, the leadership of six of California's largest private ambulance companies came together to discuss Medi-Cal reimbursement rates for emergency ambulance transports and formed the 911 Ambulance Provider's Medi-Cal Alliance with a mission to work together to help resolve the ongoing issue of low Medi-Cal reimbursement rates. The 911 Alliance writes that emergency ambulance providers have not seen an increase in base rates for emergency transports since 1999, and in those 17 years since the last increase, they have twice seen their Medi-Cal rates decreased. In those 17 years, the cost to deliver emergency ambulance service to all Californians, and this bill addresses 17 years of a growing difference between the cost to provide emergency ambulance service and Medi-Cal ambulance reimbursement.
5/31/16 22:24:20
**** END ****
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
SB 1300 (Hernandez) - Medi-Cal: emergency medical transport providers: quality assurance fee
Version: April 26, 2016 | Policy Vote: HEALTH 5 - 0 |
Urgency: Yes | Mandate: Yes |
Hearing Date: May 27, 2016 | Consultant: Brendan McCarthy |
Bill Summary:
:
SB 1300 would impose a quality assurance fee on emergency medical transportation. The bill would use the resulting revenue and federal matching funds to increase reimbursement rates paid in the Medi-Cal program for emergency medical transportation.
*********** ANALYSIS ADDENDUM – SUSPENSE FILE ***********
The following information is revised to reflect amendments
adopted by the committee on May 27, 2016
Fiscal Impact:
- Ongoing administrative costs, likely in the hundreds of thousands to low millions per year for the Department of Health Care Services to develop regulations, gain federal approval, make any necessary system changes, oversee collection of the quality assurance fee, and make supplemental payments (special fund, General Fund, and federal funds). The bill provides that $350,000 per year shall be available to the Department for administrative costs (the state would be able to draw down additional federal funding to help cover the administrative costs). To the extent that actual administrative costs are higher, those costs would be paid from the General Fund and federal funds.
- Ongoing General Fund benefit of about $3 million per year. The bill provides that 10% of revenue collected (after setting aside administrative funding) shall be available to the state for support of the Medi-Cal program. In doing so, the bill would reduce the need for General Fund support of the Medi-Cal program by an equal amount.
- Additional payments of about $77 million per year for emergency medical transportation in the Medi-Cal program (special fund and federal funds). The quality assurance fee is projected to generate about $30 million per year in revenues (after accounting for administration and state benefits). With federal matching funds, there would be about $77 million per year for increased reimbursements to providers.
Committee Amendments:
Make the bill inoperative if a court finds that the bill increases the state’s funding obligations for education under the Constitution and increase the state share of the revenue received to 10%.
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SENATE COMMITTEE ON
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
SB 1300 (Hernandez) - Medi-Cal: emergency medical transport providers: quality assurance fee
Version: | Policy Vote: |
Urgency: | Mandate: |
Hearing Date: | Consultant: |
This bill meets the criteria for referral to the Suspense File.
Bill Summary:
SB 1300 would impose a quality assurance fee on emergency medical transportation. The bill would use the resulting revenue and federal matching funds to increase reimbursement rates paid in the Medi-Cal program for emergency medical transportation.
Fiscal Impact:
- Ongoing administrative costs, likely in the hundreds of thousands to low millions per year for the Department of Health Care Services to develop regulations, gain federal approval, make any necessary system changes, oversee collection of the quality assurance fee, and make supplemental payments (special fund, General Fund, and federal funds). The bill provides that $350,000 per year shall be available to the Department for administrative costs. To the extent that actual administrative costs are higher, those costs would be paid from the General Fund and federal funds.
- Ongoing General Fund benefit of about $1.5 million per year. The bill provides that 5% of revenue collected (after setting aside administrative funding) shall be available to the state for support of the Medi-Cal program. In doing so, the bill would reduce the need for General Fund support of the Medi-Cal program by an equal amount.
- Additional payments of about $78 million per year for emergency medical transportation in the Medi-Cal program (special fund and federal funds). The quality assurance fee is projected to generate about $30 million per year in revenues (after accounting for administration and state benefits). Coupled with federal matching funds, there would be about $78 million per year for increased reimbursements to providers.
- Potential increased Proposition 98 funding obligation. The bill may result in additional state funding obligations for education (General Fund). The state constitution generally requires the state to make payments for K-14 education equal to about 50% of annual General Fund revenues. (The actual funding formulas for Proposition 98 are complex and vary from year to year based on economic conditions and state budgeting.) Historically, the state has not counted revenues from quality assurance fees towards the Proposition 98 funding requirement. However, because this measure imposes a new tax, the resulting revenues may be subject to the requirements of Proposition 98. The state could therefore be obligated to increase payments for education on average by about 50% of the resulting revenues – in this case about $15 million per year.
Background:
The Medi-Cal program is a health care program for low-income individuals and families who meet defined eligibility requirements. Medi-Cal coordinates and directs the delivery of health care services to approximately 12 million qualified individuals, including low-income families, seniors and persons with disabilities, children in families with low-incomes or in foster care, pregnant women, low-income people with specific diseases, and, as of January 1, 2014, due to the Affordable Care Act, childless adults up to 138 percent of the federal poverty level.
The reimbursement rates that the Medi-Cal program pays ambulance providers (both private companies and public agencies) have not kept up with increasing costs over the years. In addition, Medi-Cal providers, including ground ambulance providers, are subject to a 10 percent rate reduction pursuant to AB 97 (Committee on Budget, Statutes of 2011). This rate reduction went into effect in September 2013. However, unlike some providers, ground ambulance providers will not be subject to retroactive cuts to recoup the savings that the state did not achieve while AB 97 was under court injunction from 2011 to September 2013.
Federal law allows states to impose quality assurance fees on providers in state Medicaid programs. States are allowed to impose such fees or taxes on providers, use the resulting revenues to draw down additional federal Medicaid funding, and use the combined revenues to pay increased reimbursement rates to providers. The state currently imposes quality assurance fees on hospitals, managed care plans, skilled nursing facilities, and intermediate care facilities for the developmentally disabled.
Proposed Law:
SB 1300 would impose a quality assurance fee on emergency medical transportation. The bill would use the resulting revenue and federal matching funds to increase reimbursement rates paid in the Medi-Cal program for emergency medical transportation.
Specific provisions of the bill would:
- Impose a quality assurance fee for each emergency medical transport, beginning on July 1, 2017 (the quality assurance fee would not apply to all emergency medical transportation, not just those provided to Medi-Cal beneficiaries);
- Require the Department of Health Care Services to calculate the quality assurance fee rate each year;
- Establish the methods for calculating the quality assurance fee (which differ in the first year from subsequent years);
- Require the Medi-Cal fee-for-service reimbursement rate to be increased using the revenue generated and require Medi-Cal managed care plans to pay emergency medical transportation providers based on the increased fee-for-service reimbursement rate;
- Require the quality assurance fee revenues to be deposited in a new special fund and continuously appropriate the moneys in that fund for the purposes of the bill;
- Allocate the revenues generated under the bill: first to pay for administrative costs up to $350,000 per year, second to allocate 5% of revenues to pay for the state costs of operating the Medi-Cal program, third to make increased provider payments, and fourth to provide additional support for health care in the state;
- Require revenue generated from the quality assurance fee and federal matching funds to be used to supplement existing funding;
- Provide for the Department to adjust the fee rate;
- Require emergency medical transport providers to report specified data to the Department;
- Require emergency medical transport providers to remit the quality assurance fee to the Department;
- Require the Department to seek federal approval and to modify the methodology in the bill if necessary to meet federal requirements;
- Make implementation of the bill contingent on federal approval.
This bill is an urgency measure.
Related Legislation:
There have been several bills in recent years that have attempted to raise reimbursement rates for Medi-Cal emergency medical transport providers, by a variety of means. None of those bills have been enacted.
Staff Comments:
Currently, the state pays on average $150 for ground emergency medical transports in the fee-for-service system. (This average includes the base rate of $106 and a variety additional charges for the specific services provided by ambulance providers.) According to the California Ambulance Association, the average cost to provide these services is close to $600. While the rates paid to providers is not publicly available, providers indicate that payments from managed care plans are also significantly below their costs. According to calculations performed by the sponsors of the bill, the quality assurance fee is projected to be about $28 per emergency medical transport (this cost would be assessed on all emergency medical transports, not just those provided under the Medi-Cal program). The quality assurance fee is projected to result in the base emergency medical transport reimbursement rate increasing to about $340.
The only costs that may be incurred by a local agency relate to crimes and infractions. Under the California Constitution, such costs are not reimbursable by the state.
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SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 1300
AUTHOR: | Hernandez | ||
VERSION: | April 5, 2016 | ||
HEARING DATE: | April 20, 2016 | ||
CONSULTANT: | Scott Bain | ||
SUBJECT: Medi-Cal: emergency medical transport providers: quality assurance fee
SUMMARY:
Imposes a quality assurance fee on each transport provided by an emergency medical transport provider in accordance with a prescribed methodology. Requires the resulting revenue to be placed in a continuously appropriated fund to be used to provide additional Medi-Cal reimbursement to emergency medical transport providers, to pay for state administrative costs, and to provide funding for health care coverage for Californians. Would take effect immediately as an urgency bill.
Existing law:
- Establishes the Medi-Cal program, administered by the Department of Health Care Services
(DHCS), which provides health benefits to low-income individuals who meet specified eligibility criteria.
- Establishes a schedule of benefits under the Medi-Cal program, which includes emergency and non-emergency medical transportation. Establishes, through regulation, maximum Medi-Cal reimbursement rates for medical transportation services, and prohibits the amount billed from exceeding charges made to the general public.
- Reduces specified Medi-Cal provider rates (including ground ambulance services), effective June 1, 2011, by 10% for dates of services on and after June 1, 2011, subject to federal approval, federal financial participation (FFP), and the reduction meeting federal Medicaid requirements. If the director of DHCS determines that the payments do not comply with federal Medicaid requirements or that FFP is not available with respect to any payment that is reduced, the director retains the discretion to not implement the particular payment reduction and to adjust the payment as necessary to comply with federal Medicaid requirements. The 10% reduction took effect for ambulance providers for dates of service on or after September 5, 2013 but was not applied retroactively back to June 2011.
This bill:
- Imposes, commencing with the state fiscal quarter beginning on July 1, 2017, and continuing each fiscal quarter thereafter, a quality assurance fee (QAF) for each emergency medical transport provided by each emergency medical transport provider.
- Defines an “emergency medical transport” as the act of transporting an individual from any point of origin to the nearest medical facility capable of meeting the emergency medical needs of the patient by an ambulance licensed, operated, and equipped in accordance with applicable state or local statutes, ordinances, or regulations that are billed with one of three billing codes: A0429 Basic Life Support Emergency, A0427 Advanced Life Support Emergency, and A0433 Advanced Life Support 2.
- Requires the DHCS director, on or before June 15, 2017, and each June 15 thereafter, to calculate the annual QAF rate applicable to the following state fiscal year based on the most recently collected data collected from emergency medical transport providers. Requires DHCS to publish the annual QAF rate on its Internet Web site.
- Establishes, for the 2017-18 fiscal year and the 2019-19 fiscal year and thereafter, different methods for calculating the annual QAF rate. Prohibits the fees calculated and collected from exceeding the amounts allowable under federal law.
- Requires, effective July 1, 2017, the Medi-Cal fee-for-service (FFS) payment schedule governing reimbursement to emergency medical transport providers for emergency medical transports to be increased pursuant to a methodology established by this bill, using revenue from the QAF.
- Requires each Medi-Cal managed care health plan to provide payment to emergency medical transport providers under this bill that is equal to the amount of payment the provider would have received under FFS Medi-Cal, by referencing existing federal law and regulation.
- Requires the DHCS director to deposit the QAF in the Medi-Cal Emergency Medical Transport Fund (Fund) created by this bill. Continuously appropriates the moneys in the Fund, and any federal matching funds to DHCS.
- Requires moneys in the Fund, including any interest and dividends earned on money in the fund, to be available exclusively to enhance federal financial participation for ambulance services under the Medi-Cal program and to provide additional reimbursement to, and to support quality improvement efforts of, emergency medical transport providers, as well as to pay for the state’s administrative costs and to provide funding for health care coverage for Californians, in the following order of priority:
- To pay for DHCS staffing and administrative costs directly attributable to implementing this bill, capped at $350,000 for each fiscal year, exclusive of any federal matching funds;
- To pay for the health care coverage in each fiscal year in the amount of 5% of the projected QAF revenue for that fiscal year, as calculated by the DHCS on or before June 15 preceding that fiscal year, exclusive of any federal matching funds;
- To make increased payments to emergency medical transport providers pursuant to this bill; and,
- To provide additional support for health care coverage of Californians.
- Requires the Medi-Cal FFS payment schedule increase established under this bill to be funded solely from the following:
- The QAF, along with any interest or other investment income; and,
- Federal reimbursement and any other related federal funds.
- Requires the proceeds of the QAF, the matching amount provided by the federal government, and any interest earned on those proceeds to be used to supplement existing funding for emergency medical transports provided by emergency transport providers and not to supplant this funding.
- Requires the DHCS director to adjust the annual QAF fee rate so that the available fee amount for the state fiscal year will approximately equal the aggregate Medi-Cal fee schedule amount for the state fiscal year if, during a state fiscal year, the actual or projected available QAF amount exceeds or is less than the actual or projected aggregate fee schedule amount by more than 1%. Requires the available fee amount for a state fiscal year to be considered to equal the aggregate fee schedule amount for the state fiscal year if the difference between the available fee amount for the state fiscal year and the aggregate fee schedule amount for the state fiscal year constitutes less than 1% of the aggregate fee schedule amount for the state fiscal year.
- Requires each emergency medical transport provider to report to DHCS data on the number of actual emergency medical transports by payor type, and gross receipts from the provision of emergency medical transports in a manner and format prescribed by DHCS.
- Permits DHCS to establish an Internet Web site for the submission of reports required by this bill.
- Permits DHCS to require a certification by each emergency medical transport under penalty of perjury of the truth of the required reports. Permits DHCS to impose a penalty of $100 per day against an emergency medical transport provider for every day that an emergency medical transport provider fails to make a required report within five days of the date upon which the report was due.
- Requires the DHCS director, on or before June 15, 2017, and each June 15 thereafter, to publish the annual QAF rate on its Internet Web site.
- Requires emergency medical transport providers to remit to DHCS annual QAF amounts, as specified.
- Requires interest to be assessed on QAF not paid on the date due at the greater of 10% per annum or the rate at which DHCS assesses interest on Medi-Cal program overpayments to hospitals that are not repaid when due. Requires interest to begin to accrue the day after the date the payment was due, and to be deposited in the Medi-Cal Emergency Medical Transport Fund established by this bill.
- Permits DHCS to deduct unpaid QAF amounts and interest owed from Medi-Cal reimbursements payments owed to a provider until the full amount of the fee and interest is owed in the event that any fee payment is more than 60 days overdue. Requires any deduction to be made only after DHCS gives the provider written notification, and requires any deduction to be deducted over a period of time that takes into account the financial condition of the provider.
- Requires DHCS to accept an emergency medical transport provider’s payment even if the payment is submitted in a rate year subsequent to the rate year in which the fee was assessed.
- Establishes provisions for delayed payment of the QAF if there is a delay in the implementation of this bill for any reason, including a delay in any required approval of the QAF and the reimbursement methodology. These include retroactive fees and the authority for DHCS to make retroactive payment of supplemental rates.
- Permits DHCS to adopt regulations (including one-time emergency regulations) as are necessary to implement this bill, and permits the use of provider bulletin, or other similar instructions, without taking regulatory action, provided that no such bulletin or other similar instructions remains in effect after June 30, 2018.
- Requires DHCS to request approval from the federal Centers for Medicare and Medicaid Services for the use of fees collected under this bill for the purpose of receiving federal matching funds.
- Permits the DHCS director to alter the methodology specified in this bill to the extent necessary to meet the requirements of federal law or regulations or to obtain federal approval. Requires, if the DHCS director, after consulting with affected emergency medical transport providers, determines that an alteration is needed, the director to execute a declaration stating that this determination has been made, and to provide a copy to the fiscal and appropriate policy committees of the Legislature.
- Permits the DHCS director to add categories of exempt emergency medical transport providers or apply a non-uniform fee per transport to emergency medical transport providers that are subject to the fee in order to meet requirements of federal law or regulations. Permits the DHCS director to exempt categories of emergency medical transport providers from the fee if necessary to obtain federal approval.
- Implements this bill only if, and as long as, both of the following conditions are met:
- The state receives federal approval of the QAF from the federal Centers for Medicare and Medicaid Services (CMS); and,
- The state receives federal approval for the increased Medi-Cal FFS payment schedule increases in this bill.
- Continues to implement this bill if all of the following conditions are met:
- The federal CMS continues to allow the use of the QAF in this bill;
- The Medi-Cal FFS payment schedule increase described in this bill remains in effect; and,
- The QAF assessed and collected under this bill remains available for the purposes specified in this bill.
- Makes this bill inoperative in the event of a final judicial determination made by any state or federal court that is not appealed, or by a court of appellate jurisdiction that is not further appealed, in any action by any party, or a final determination by the administrator of the federal Centers for Medicare and Medicaid Services, that federal financial participation is not available with respect to any payment made under the methodology implemented under this bill because the methodology is invalid, unlawful, or contrary to any provision of federal law or regulations or of state law.
- Takes effect immediately as an urgency bill.
FISCAL EFFECT:
This bill has not been analyzed by a fiscal committee.
COMMENTS:
- Author’s statement. According to the author, this bill would increase Medi-Cal emergency medical transportation rates by levying a QAF on three emergency medical transportation reimbursement codes. The resulting revenue would then be used to draw down additional federal Medicaid funds to increase Medi-Cal emergency transportation rates, without imposing a cost to the state General Fund. In addition, 5% of revenue raised by the QAF would go to the state General Fund. The author argues inadequate Medi-Cal reimbursement for ambulance transport is a long-standing issue and places a strain on the state's emergency medical services (EMS) system. Unlike other Medi-Cal providers, ambulance providers cannot “opt out” or otherwise limit their participation in the Medi-Cal program the way other non-emergency health care providers can to obtain a more favorable payor mix.
While the costs to provide essential ambulance services has significantly increased during the past decade, including escalating wages and benefits, and increasing insurance premiums, Medi-Cal reimbursement has not kept pace with these increased costs and has in fact declined to less than the amounts paid in 1999. The QAF proposed by this bill would increase Medi-Cal emergency medical transportation rates by drawing down federal Medicaid dollars, which will flow back to the state to be used by ambulance providers to maintain the high level of care that is expected of the state's EMS and 911 programs. - Medi-Cal rates for ambulance services. Medi-Cal covers emergency medical transportation when necessary to obtain Medi-Cal covered benefits when a beneficiary’s medical or physical condition is acute and severe, necessitating immediate diagnosis and treatment so as to prevent death or disability. When billing Medi-Cal for a “911 call,” ambulance providers bill a Basic Life Support (BLS) base rate of $106.38. In addition to the base rate, Medi-Cal provides additional funding for additional costs and services, such as mileage, night calls, extra attendants, waiting times, and certain supplies and services.
Medi-Cal FFS emergency base ambulance rates were increased in 1997 and 1998 and were last increased in 1999 by 11.7%, to $118.20. Medi-Cal base ambulance rates were reduced in 2008 and again in 2013 (by 10%) pursuant to AB 97 (Committee on Budget, Chapter 3, Statutes of 2011). The ambulance rate reduction was not imposed retroactively but did apply prospectively, beginning on September 5, 2013. The current Medi-Cal base rate is $106.38, a rate that is $11.82 lower than the rate in 1999. - Provider fees. Federal Medicaid law authorizes states to levy fees on health care providers if the fees meet federal requirements. Provider taxes must be broad-based and uniformly imposed (unless waived), and not violate a “hold harmless” prohibition that offsets the tax. Federal regulations allow 19 different classes of health care services on which a provider tax may be imposed, one of which is “emergency ambulance services.” Nearly all states (including California) fund a portion of their share of Medicaid program costs through a fee on health care providers. Under these funding methods, states collect funds (through fees, taxes, or other means) from providers, which are then matched with federal Medicaid funds to provide increased Medicaid (Medi-Cal in California) reimbursement to health care providers. California currently has Medicaid provider fees on managed care plans, hospitals, skilled nursing facilities and intermediate care facilities for the developmentally disabled.
- Calculation of QAF amount owed and Medi-Cal rate increase amounts. This bill levies a per emergency medical transport QAF. This bill establishes how the QAF will be collected in the initial year (2017-18) and then on an on-going basis (2019-19 and thereafter) and how the resulting revenue will be used to fund state administrative costs, 5% for the GF and rate increases for three reimbursement codes for emergency medical transportation providers .
For 2017-18, this bill would asses a QAF at a rate of 5.5% against the gross revenue of all emergency medical transport providers from three reimbursement codes. From this amount, the state cost of administering the bill ($350,000) and the 5% that goes to the GF would be subtracted. The remaining amount would then be matched by federal Medicaid funds to determine the total funds available for the rate increase. This amount would then be divided by the number of emergency medical transports to determine the per transport increase for the three reimbursement codes, and this amount would be added to the existing 2015-16 base rates. The dollar amount of the increase would be the same for each of the three codes, and the increased rate would be fixed for the duration of the bill to address DHCS’ concern that rates could increase at a rate higher than revenue from the QAF, which would result in either a rate reduction or GF cost to maintain the increased rate.
For the 2017-18 fiscal year and thereafter, the QAF amount owed would be calculated differently than the initial 2016-17 fiscal year. The state would determine the total funds amount needed to fund the increased rate for the three billing codes and multiply that by the state share of Medi-Cal costs (referred to as the State Medicaid Assistance Percentage or SMAP). The cost of the state administration ($350,000) would be added to this amount. The resulting amount would be divided by 95% (to account for the 5% that would go to the GF), and then divided by the total transports for the three billing codes to establish the per transport fee.
- GAO report on ambulance rates. A 2007 GAO report on ambulance rates, entitled “Costs and Expected Medicare Margins Vary Greatly,” found that the costs of ground ambulance transports were highly variable across ambulance providers without shared costs, reflecting differences in provider characteristics (an example of an ambulance provider with shared costs would be an ambulance in a fire department, where the cost of the ambulance is part of the overall cost of the fire department). Costs per transport for ambulance providers without shared costs averaged $415, but varied from $99 to $1,218 per transport. The GAO found ambulance providers without shared costs had higher costs per transport typically had fewer transports per year, a greater percentage of transports in which more than a basic medical intervention occurred, more transports in rural counties with lowest population density, lower productivity (measured as number of transports furnished per staffed hour), and a greater percentage of revenues from local tax support.
- Related legislation. AB 1257 (Gray) would have required DHCS to establish payment rates for ground ambulance services based on changes in the Consumer Price Index-Urban and the California weighted average Geographic Practice Cost Index, and would designate the ambulance cost study conducted by the federal GAO as the evidentiary base. AB 1257 was held on the Assembly Appropriations Committee suspense file.
- Prior legislation.
- SB 1374 (Hernandez of 2013) would have required DHCS, by July 1, 2015, to adopt regulations establishing the Medi-Cal reimbursement rate for ground ambulance services using one of two specified methodologies.
- AB 2577 (Cooley and Pan) would have authorized governmental entities to make intergovernmental transfers as the non-federal share of expenditures for ground emergency medical transportation services for purposes of drawing down federal Medicaid matching funds. AB 2577 was vetoed by the Governor.
- SB 359 (Hernandez of 2011), was similar to SB 1374 in that it would have required DHCS, by July 1, 2012, to adopt regulations establishing the Medi-Cal reimbursement rate for ground ambulance services using one of two specified methodologies. SB 359 designated one of the two methodologies as 120% of the Medicare ambulance fee schedule. SB 359 was held on the Senate Appropriations Committee suspense file and was gutted and amended and used for another purpose.
- AB 678 (Pan, Chapter 397, Statutes of 2011) established a supplemental payment program for governmental entity providers of Medi-Cal emergency medical transportation services, based on certified public expenditures using state or local governmental entities’ funds as the required federal match.
- AB 2173 (Beall, Chapter 547, Statutes of 2010) established a $4 penalty on every vehicle code violation. The resulting revenue would be matched by federal funds and used to make supplemental payments for emergency air medical transportation services in the Medi-Cal Program.
- AB 1932 (Hernandez of 2010), in its final form, would have authorized DHCS to utilize certain service levels for purposes of determining billing codes for emergency and non-emergency basic life and advanced life support transportation and specialty care transportation. If DHCS used the service levels to determine billing codes, AB 1932 would have required DHCS to adopt the definitions and Healthcare Common Procedure Coding System codes for those service levels that have been established by CMS, and to determine the above described billing codes in a revenue-neutral manner. AB 1932 was held on the Senate Appropriations suspense file.
- AB 1174 (Hernandez of 2009), would have required Medi-Cal to cover emergency basic life support and advanced life support services when a patient reasonably believes that without immediate medical attention, a serious health condition, as specified, could reasonably result. In addition, AB 1174 would have increased and established in statute maximum Medi-Cal reimbursement rates for ambulance transportation services, and would have required the rates be adjusted to reflect changes in the California Consumer Price Index. AB 2257 (Hernandez) of 2008 was similar to AB 1174, except that AB 2257 also would have also increased Medi-Cal rates for air ambulance providers. AB 1174 and AB 2257 were both held on the Assembly Appropriations suspense file.
- AB 511 (De La Torre of 2010) would have imposed, as a condition of participation in the Medi-Cal Program, a quality assurance fee (QAF) on certain ambulance transportation services providers, to be administered by DHCS. The proceeds from the QAF would be required to be deposited into the Medi-Cal Ambulance Transportation Services Providers Fund (Fund). Moneys in the Fund would be available only to enhance FFP for ambulance transportation services under the Medi-Cal Program, or to provide additional reimbursement to, and to support quality improvement efforts of, ambulance transportation services providers, including increased reimbursement for and improvement of the quality of the provision of advanced life support services, as defined. Held on the Senate Appropriations suspense file; subsequently referred to Senate Health and Senate Revenue and Taxation Committees. At the request of the author, the bill was not heard in a policy committee again.
- AB 1153 (Beall of 2009) would have levied an additional penalty of $3 upon every fine, penalty, or forfeiture imposed and collected by the courts for all offenses involving a vehicle violation, except certain parking offenses, in each county. The resulting revenue would be transferred to the state and continuously appropriated to DHCS solely for the purposes of augmenting Medi-Cal reimbursement paid to emergency air medical transportation services providers. DHCS would be required to use the moneys in the Emergency Air Medical Transportation Act Fund and federal matching funds to increase the Medi-Cal reimbursement or supplemental payments for emergency air medical transportation services in an amount not to exceed normal and customary charges charged by the emergency air ambulance transportation services provider. AB 1153 was held on the Senate Appropriations suspense file.
- Support. This bill is sponsored by the 911 Provider's Medi-Cal Alliance (911 Alliance), which writes that in 2015, the leadership of six of California's largest private ambulance companies (American Ambulance, American Medical Response, Care Ambulance, Hall Ambulance, Paramedics Plus and Rural Metro Ambulance) came together to discuss Medi-Cal reimbursement rates for emergency ambulance transports and formed the 911 Ambulance Provider's Medi-Cal Alliance with a mission to work together to help resolve the ongoing issue of low Medi-Cal reimbursement rates. The 911 Alliance writes that emergency ambulance providers have not seen an increase in base rates for emergency transports since 1999, and in those 17 years since the last increase, they have twice seen their Medi-Cal rates decreased. In those 17 years, employee wages continue to grow, fuel prices have skyrocketed, healthcare costs for employees have grown exponentially, the cost of new technology seems to know no ceiling, and worker's compensation rates have climbed steadily. All this has increased the cost to deliver emergency ambulance service to all Californians. This bill would address 17 years of a growing difference between the cost to provide emergency ambulance service and the reimbursement for caring for Medi-Cal patients needing emergency medical transportation.
- Author’s amendments. The author intends to amend this bill to: (a) clarify that the QAF revenue would fund the Medi-Cal managed care rate increase paid to ambulance providers as the bill currently on refers to the QAF funding the FFS increase; (b) to eliminate duplicate language regarding the Fund; (c) to reword for clarity the “poison pill” language that halts the QAF from operating if CMS approval is withdrawn or if the Medi-Cal rate increase no longer applies; (d) to clarify that the state cost for administering the provisions of this bill and the 5% of fee revenue that goes to the GF is taken into account in determining the QAF rate; (e) to clarify that “transport” means “emergency medical transport” and to correct a cross reference; and (f) to make a correction of the dates at the end of the second-to-last sentence in Section 14129.4(a) (from 2016-17 to 2017-18).
SUPPORT AND OPPOSITION:
Support: 911 Ambulance Provider’s Medi-Cal Alliance (sponsor)
American Medical Response
Oppose: None received
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Discussed in Hearing
18MIN
Assembly Standing Committee on Judiciary
2MIN
Senate Floor
1MIN
Assembly Floor
7MIN
Assembly Standing Committee on Health
2MIN
Senate Floor
7MIN
Senate Standing Committee on Health
Bill Author
Bill Co-Author(s):