AB 2118: Medi-Cal: emergency medical transportation services.
- Session Year: 2017-2018
- House: Assembly
- Latest Version Date: 2018-06-18
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program program provisions.
Existing law, the Medi-Cal Emergency Medical Transportation Reimbursement Act, commencing July 1, 2018, and subject to federal approval and the availability of federal financial participation, imposes a quality assurance fee for each emergency medical transport provided by an emergency medical transport provider subject to the fee in accordance with a prescribed methodology. Existing law requires the Director of Health Care Services to deposit the collected quality assurance fee into the continuously appropriated Medi-Cal Emergency Medical Transport Fund, for exclusive use 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. Existing law requires each emergency medical transport provider to report to the department data on the number of actual emergency medical transports by payer type and on gross receipts, as defined. The act increases Medi-Cal reimbursement to emergency medical transport providers for emergency medical transports, as specified.
Existing law authorizes a Medi-Cal provider of ground emergency medical transportation services, that is owned or operated by the state, a city, county, city and county, fire protection district, special district, community services district, health care district, or a federally recognized Indian tribe, to receive supplemental Medi-Cal reimbursement in addition to the rate of payment the provider would otherwise receive for those services. Existing law requires the department to develop a modified supplemental reimbursement program, with necessary federal approvals, that would seek to increase the reimbursement to an eligible provider, as specified. Existing law requires the nonfederal share of any supplemental reimbursement provided under the modified program to be derived from voluntary intergovernmental transfers of local funds. Existing law states the Legislatures intent in enacting these provisions to provide the supplemental reimbursement without any expenditure from the General Fund.
This bill would exempt the above-described providers owned or operated by the specified governmental entities from the Medi-Cal Emergency Medical Transportation Reimbursement Act and the quality assurance fee requirements. The bill would require the department to seek approval from the federal Centers for Medicare and Medicaid Services to exempt those providers, as specified.
The bill, subject to any necessary federal approvals, would change the calculation of the supplemental Medi-Cal reimbursement by requiring those governmental entities to participate in a managed care intergovernmental transfer program. The bill would require the combined amounts of payment under the new calculation to equal 100% of projected costs for ground emergency medical transportation services by each qualified provider. The bill would require the department to review and evaluate providers requests for rate changes and make adjustments to those rates, as specified.
The bill would require that the department be reimbursed for costs associated with administering the modified program and for any state revenue not obtained due to government providers being exempted from the quality assurance fee.
The bill would also make technical, nonsubstantive changes to the above-described provisions.
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, and 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, the Medi-Cal Emergency Medical Transportation Reimbursement Act, commencing July 1, 2018, and subject to federal approval and the availability of federal financial participation, imposes a quality assurance fee for each emergency medical transport provided by an emergency medical transport provider subject to the fee in accordance with a prescribed methodology. Existing law requires the Director of Health Care Services to deposit the collected quality assurance fee into the continuously appropriated Medi-Cal Emergency Medical Transport Fund, for exclusive use 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. Existing law requires each emergency medical transport provider to report to the department data on the number of actual emergency medical transports by payer type and on gross receipts, as defined. The act increases Medi-Cal reimbursement to emergency medical transport providers for emergency medical transports, as specified.
Existing law authorizes a Medi-Cal provider of ground emergency medical transportation services, that is owned or operated by the state, a city, county, city and county, fire protection district, special district, community services district, health care district, or a federally recognized Indian tribe, to receive supplemental Medi-Cal reimbursement in addition to the rate of payment the provider would otherwise receive for those services. Existing law requires the department to develop a modified supplemental reimbursement program, with necessary federal approvals, that would seek to increase the reimbursement to an eligible provider, as specified. Existing law requires the nonfederal share of any supplemental reimbursement provided under the modified program to be derived from voluntary intergovernmental transfers of local funds. Existing law states the Legislatures intent in enacting these provisions to provide the supplemental reimbursement without any expenditure from the General Fund.
This bill would exempt the above-described providers owned or operated by the specified governmental entities from the Medi-Cal Emergency Medical Transportation Reimbursement Act and the quality assurance fee requirements. The bill would require the department to seek approval from the federal Centers for Medicare and Medicaid Services to exempt those providers, as specified.
The bill, subject to any necessary federal approvals, would change the calculation of the supplemental Medi-Cal reimbursement by requiring those governmental entities to participate in a managed care intergovernmental transfer program. The bill would require the combined amounts of payment under the new calculation to equal 100% of projected costs for ground emergency medical transportation services by each qualified provider. The bill would require the department to review and evaluate providers requests for rate changes and make adjustments to those rates, as specified.
The bill would require that the department be reimbursed for costs associated with administering the modified program and for any state revenue not obtained due to government providers being exempted from the quality assurance fee.
The bill would also make technical, nonsubstantive changes to the above-described provisions.
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, and 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, the Medi-Cal Emergency Medical Transportation Reimbursement Act, commencing July 1, 2018, and subject to federal approval and the availability of federal financial participation, imposes a quality assurance fee for each emergency medical transport provided by an emergency medical transport provider subject to the fee in accordance with a prescribed methodology. Existing law requires the Director of Health Care Services to deposit the collected quality assurance fee into the continuously appropriated Medi-Cal Emergency Medical Transport Fund, for exclusive use 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. Existing law requires each emergency medical transport provider to report to the department data on the number of actual emergency medical transports by payer type and on gross receipts, as defined. The act increases Medi-Cal reimbursement to emergency medical transport providers for emergency medical transports, as specified.
Existing law authorizes a Medi-Cal provider of ground emergency medical transportation services, that is owned or operated by the state, a city, county, city and county, fire protection district, special district, community services district, health care district, or a federally recognized Indian tribe, to receive supplemental Medi-Cal reimbursement in addition to the rate of payment the provider would otherwise receive for those services. Existing law requires the department to develop a modified supplemental reimbursement program, with necessary federal approvals, that would seek to increase the reimbursement to an eligible provider, as specified. Existing law requires the nonfederal share of any supplemental reimbursement provided under the modified program to be derived from voluntary intergovernmental transfers of local funds. Existing law states the Legislatures intent in enacting these provisions to provide the supplemental reimbursement without any expenditure from the General Fund.
This bill would exempt the above-described providers owned or operated by the specified governmental entities from the Medi-Cal Emergency Medical Transportation Reimbursement Act and the quality assurance fee requirements. The bill would require the department to seek approval from the federal Centers for Medicare and Medicaid Services to exempt those providers, as specified.
The bill, subject to any necessary federal approvals, would change the calculation of the supplemental Medi-Cal reimbursement by requiring those governmental entities to participate in a managed care intergovernmental transfer program. The bill would require the combined amounts of payment under the new calculation to equal 100% of projected costs for ground emergency medical transportation services by each qualified provider. The bill would require the department to review and evaluate providers requests for rate changes and make adjustments to those rates, as specified.
The bill would require that the department be reimbursed for costs associated with administering the modified program and for any state revenue not obtained due to government providers being exempted from the quality assurance fee.
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, and 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, the Medi-Cal Emergency Medical Transportation Reimbursement Act, commencing July 1, 2018, and subject to federal approval and the availability of federal financial participation, imposes a quality assurance fee for each emergency medical transport provided by an emergency medical transport provider subject to the fee in accordance with a prescribed methodology. Existing law requires the Director of Health Care Services to deposit the collected quality assurance fee into the continuously appropriated Medi-Cal Emergency Medical Transport Fund, for exclusive use 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. Existing law requires each emergency medical transport provider to report to the department data on the number of actual emergency medical transports by payer type and on gross receipts, as defined. The act increases Medi-Cal reimbursement to emergency medical transport providers for emergency medical transports, as specified.
Existing law authorizes a Medi-Cal provider of ground emergency medical transportation services, that is owned or operated by the state, a city, county, city and county, fire protection district, special district, community services district, health care district, or a federally recognized Indian tribe, to receive supplemental Medi-Cal reimbursement in addition to the rate of payment the provider would otherwise receive for those services. Existing law requires the department to develop a modified supplemental reimbursement program, with necessary federal approvals, that would seek to increase the reimbursement to an eligible provider, as specified. Existing law requires the nonfederal share of any supplemental reimbursement provided under the modified program to be derived from voluntary intergovernmental transfers of local funds. Existing law states the Legislatures intent in enacting these provisions to provide the supplemental reimbursement without any expenditure from the General Fund.
This bill would exempt the above-described providers owned or operated by the specified governmental entities from the Medi-Cal Emergency Medical Transportation Reimbursement Act and the quality assurance fee requirements. The bill would require the department to seek approval from the federal Centers for Medicare and Medicaid Services to exempt those providers, as specified.
The bill, subject to any necessary federal approvals, would change the calculation of the supplemental Medi-Cal reimbursement by requiring these those governmental entities to participate in a managed care intergovernmental transfer program. The bill would require the combined amounts of payment under the new calculation to equal 100% of projected costs for ground emergency medical transportation services by each qualified provider. The bill would require the department to review and evaluate providers requests for rate changes and make adjustments to those rates, as specified.
The bill would require that the department be reimbursed for costs associated with administering the modified program and for any state revenue not obtained due to government providers being exempted from the quality assurance fee.
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, and 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
Existing law, the Medi-Cal Emergency Medical Transportation Reimbursement Act, commencing July 1, 2018, and subject to federal approval and the availability of federal financial participation, imposes a quality assurance fee for each emergency medical transport provided by an emergency medical transport provider subject to the fee in accordance with a prescribed methodology. Existing law requires the Director of Health Care Services to deposit the collected quality assurance fee into the continuously appropriated Medi-Cal Emergency Medical Transport Fund, for exclusive use 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. Existing law requires each emergency medical transport provider to report to the department data on the number of actual emergency medical transports by payer type and on gross receipts, as defined. The act increases Medi-Cal reimbursement to emergency medical transport providers for emergency medical transports, as specified.
Existing law authorizes certain a Medi-Cal provider of ground emergency medical transportation providers services, that is owned or operated by the state, a city, county, city and county, fire protection district, special district, community services district, health care district, or a federally recognized Indian tribe, to receive supplemental Medi-Cal reimbursement in addition to the rate of payment the provider would otherwise receive for those services. Existing law defines an emergency medical transport provider to mean any provider of emergency medical transports. Existing law requires the department to develop a modified supplemental reimbursement program, with necessary federal approvals, that would seek to increase the reimbursement to certain ground emergency medical transportation providers, an eligible provider, as specified. Existing law requires the nonfederal share of any supplemental reimbursement provided under the modified program to be derived from voluntary intergovernmental transfers of local funds. Existing law states the Legislatures intent in enacting these provisions to provide the supplemental reimbursement without any expenditure from the General Fund.
This bill would exclude from the definition of an emergency medical transport provider a county, city, city and county, school district, municipal corporation, district, or political subdivision, or other local agency, as defined.This bill would exempt the above-described providers owned or operated by the specified governmental entities from the Medi-Cal Emergency Medical Transportation Reimbursement Act and the quality assurance fee requirements. The bill would require the department to seek approval from the federal Centers for Medicare and Medicaid Services to exempt those providers, as specified.
The bill, subject to any necessary federal approvals, would change the calculation of the supplemental Medi-Cal reimbursement by requiring these governmental entities to participate in a managed care intergovernmental transfer program. The bill would require the combined amounts of payment under the new calculation to equal 100% of projected costs for ground emergency medical transportation services by each qualified provider. The bill would require the department to review and evaluate providers requests for rate changes and make adjustments to those rates, as specified.
The bill would require that the department be reimbursed for costs associated with administering the modified program and for any state revenue not obtained due to government providers being exempted from the quality assurance fee.
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, and 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 authorizes certain ground emergency medical transportation providers to receive supplemental Medi-Cal reimbursement in addition to the rate of payment the provider would otherwise receive for those services. Existing law defines an emergency medical transport provider to mean any provider of emergency medical transports. Existing law requires the department to develop a modified supplemental reimbursement program, with necessary federal approvals, that would seek to increase the reimbursement to certain ground emergency medical transportation providers, as specified. Existing law states the Legislatures intent in enacting these provisions to provide the supplemental reimbursement without any expenditure from the General Fund.
This bill would make a technical, nonsubstantive change to the statement of the Legislatures intent. exclude from the definition of an emergency medical transport provider a county, city, city and county, school district, municipal corporation, district, or political subdivision, or other local agency, as defined.
Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, and 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 authorizes certain ground emergency medical transportation providers to receive supplemental Medi-Cal reimbursement in addition to the rate of payment the provider would otherwise receive for those services. Existing law requires the department to develop a modified supplemental reimbursement program, with necessary federal approvals, that would seek to increase the reimbursement to certain ground emergency medical transportation providers, as specified. Existing law states the Legislatures intent in enacting these provisions to provide the supplemental reimbursement without any expenditure from the General Fund.
This bill would make a technical, nonsubstantive change to the statement of the Legislatures intent.
(a)An eligible provider, as described in subdivision (b), may, in addition to the rate of payment that the provider would otherwise receive for Medi-Cal ground emergency medical transportation services, receive supplemental Medi-Cal reimbursement to the extent provided in this section.
(b)A provider shall be eligible for supplemental reimbursement only if the provider has all of the following characteristics continuously during a state fiscal year:
(1)Provides ground emergency medical transportation services to Medi-Cal beneficiaries.
(2)Is a provider that is enrolled as a Medi-Cal provider for the period being claimed.
(3)Is owned or operated by the state, a city, county, city and county, fire protection district organized pursuant to Part 2.7 (commencing with Section 13800) of Division 12 of the Health and Safety Code, special district organized pursuant to Chapter 1 (commencing with Section 58000) of Division 1 of Title 6 of the Government Code, community services district organized pursuant to Part 1 (commencing with Section 61000) of Division 3 of Title 6 of the Government Code, health care district organized pursuant to Chapter 1 (commencing with Section 32000) of Division 23 of the Health and Safety Code, or a federally recognized Indian tribe.
(c)An eligible providers reimbursement pursuant to this section shall be calculated and paid as follows:
(1)The amount paid to the provider using the established Medi-Cal schedule of maximum allowance rates as may be revised from time to time.
(2)An additional payment to an eligible provider, as described in subdivision (b), that shall be equal to the amount of federal financial participation received as a result of the claims submitted and, if applicable, the amount of intergovernmental transfer funds needed to claim the federal share.
(3)The amount claimed and paid pursuant to paragraph (1), when combined with the amount received pursuant to paragraph (2) or from all other sources of reimbursement from the Medi-Cal program, shall equal 100 percent of projected costs, as determined pursuant to the Medi-Cal State Plan, for ground emergency medical transportation services by each qualified provider. The providers rate as prescribed in paragraph (2) shall be adjusted annually based upon the ground emergency medical transportation services cost report. Providers shall have the ability to annually request a change in their rate as prescribed in paragraph (2) due to either a change in the scope, intensity, or mix of services that the provider provides or due to extraordinary increases in the cost of providing services. The department shall review and evaluate these requests and adjust a providers rate as demonstrated in this review.
(4)The Medi-Cal reimbursement provided by this section shall be distributed exclusively to eligible providers under a payment methodology based on ground emergency medical transportation services provided to Medi-Cal beneficiaries by eligible providers on a per-transport basis or other federally permissible basis. The department shall obtain approval from the federal Centers for Medicare and Medicaid Services for the payment methodology to be utilized, and may not make any payment pursuant to this section prior to obtaining that approval.
(d)(1)It is the Legislatures intent in enacting this section to provide the supplemental reimbursement described in this section without any expenditure from the General Fund. An eligible provider, as a condition of receiving supplemental reimbursement pursuant to this section, shall enter into, and maintain, an agreement with the department for the purposes of implementing this section and reimbursing the department for the costs of administering this section.
(2)The nonfederal share of the reimbursement specified in paragraph (2) of subdivision (c) submitted to the federal Centers for Medicare and Medicaid Services for purposes of claiming federal financial participation shall be paid only with funds from the governmental entities described in paragraph (3) of subdivision (b) and transferred to the state.
(e)Participation in the program by an eligible provider described in this section is voluntary. If an applicable governmental entity elects to seek reimbursement pursuant to paragraph (2) of subdivision (c) on behalf of an eligible provider owned or operated by the entity, as described in paragraph (3) of subdivision (b), the governmental entity shall do all of the following:
(1)Certify, in conformity with the requirements of Section 433.51 of Title 42 of the Code of Federal Regulations, that the claimed expenditures for the ground emergency medical transportation services are eligible for federal financial participation.
(2)Provide evidence supporting the certification as specified by the department.
(3)Submit data as specified by the department to determine the appropriate amounts to claim as expenditures qualifying for federal financial participation.
(4)Keep, maintain, and have readily retrievable, any records specified by the department to fully disclose reimbursement amounts to which the eligible provider is entitled, and any other records required by the federal Centers for Medicare and Medicaid Services.
(5)If applicable, participate in the managed care intergovernmental transfer program established under subdivision (k).
(f)(1)The department shall promptly seek any necessary federal approvals for the implementation of this section. The department may limit the program to those costs that are allowable expenditures under Title XIX of the federal Social Security Act (42 U.S.C. 1396 et seq.). If federal approval is not obtained for implementation of this section, this section shall not be implemented.
(2)The department shall submit claims for federal financial participation for the expenditures for the services described in subdivision (e) that are allowable expenditures under federal law.
(3)The department shall, on an annual basis, submit any necessary materials to the federal government to provide assurances that claims for federal financial participation will include only those expenditures that are allowable under federal law.
(g)(1)If either a final judicial determination is made by any court of appellate jurisdiction or a final determination is made by the administrator of the federal Centers for Medicare and Medicaid Services that the supplemental reimbursement provided for in this section must be made to any provider not described in this section, the director shall execute a declaration stating that the determination has been made and on that date this section shall become inoperative.
(2)The declaration executed pursuant to this subdivision shall be retained by the director, provided to the fiscal and appropriate policy committees of the Legislature, the Secretary of State, the Secretary of the Senate, the Chief Clerk of the Assembly, and the Legislative Counsel, and posted on the departments Internet Web site.
(h)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement and administer this section by means of provider bulletins, or similar instructions, without taking regulatory action.
(i)(1)Upon the effective date of the act that added this subdivision, the department shall develop, in consultation with the providers described in subdivision (b), and seek any necessary federal approvals for, a modified program for the supplemental reimbursement authorized by this section that will seek to provide increased reimbursement to an eligible provider that participates in the program. The nonfederal share of any supplemental reimbursement provided under the modified program shall be derived from voluntary intergovernmental transfers of local funds. The department shall otherwise develop the modified program consistent with the requirements of this section, except for paragraph (3) of subdivision (c), and only to the extent that federal financial participation is available.
(2)The department shall be reimbursed for costs associated with administering the modified program described in paragraph (1) in accordance with subdivision (d) and for any state revenue not obtained due to government providers being exempted from the quality assurance fee pursuant to paragraph (2) of subdivision (i) of Section 14129 and Section 14129.2. The department shall not otherwise assess a percentage fee in connection with any intergovernmental transfer of funds made pursuant to this subdivision.
(3)The department shall not implement the modified program described in paragraph (1) until it obtains all necessary federal approvals. Until those federal approvals are obtained, supplemental reimbursement shall continue to be available pursuant to the provisions of this section that were operative prior to the effective date of the act that added this subdivision.
(j)The department shall not implement the modified program described in paragraph (1) of subdivision (i) unless it determines that the modified program will likely result in an overall increase to the supplemental reimbursement available pursuant to the provisions of this section that were operative prior to the effective date of the act that added this subdivision.
(k)Subdivision (c) creates a new reimbursement rate for government-operated emergency transportation by government providers that is equal to the projected cost for that provider. Consistent with Section 6085 of the federal Deficit Reduction Act of 2005 (P.L. 109-171), also known as the Rogers Amendment, the department shall require Medi-Cal managed care plans to pay noncontracting government emergency transportation providers an amount equal to the rate established in subdivision (c). The nonfederal share of the payment for paragraph (2) of subdivision (c) shall be paid by intergovernmental transfer from the participating government entity.
SEC. 2.Section 14129 of the Welfare and Institutions Code is amended to read:14129.For purposes of this article, the following definitions apply:
(a)Annual quality assurance fee rate means the quality assurance fee assessed on each emergency medical transport during each applicable state fiscal year.
(b)Aggregate fee schedule amount means the product of the fee-for-service add-on described in 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 Medical Transport 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 Medical Transport Fund, created pursuant to Section 14129.2, for the applicable state 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 emergency medical transport provider by means of 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 transport does 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 includes 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 does not include supplemental amounts received pursuant to Section 14105.94.
(i)(1)Emergency medical transport provider means any nonpublic provider of emergency medical transports.
(2)Emergency medical transport provider does not include any emergency transport provider owned or operated by the state, a city, county, city and county, fire protection district organized pursuant to Part 2.7 (commencing with Section 13800) of Division 12 of the Health and Safety Code, special district organized pursuant to Chapter 1 (commencing with Section 58000) of Division 1 of Title 6 of the Government Code, community services district organized pursuant to Part 1 (commencing with Section 61000) of Division 3 of Title 6 of the Government Code, health care district organized pursuant to Chapter 1 (commencing with Section 32000) of Division 23 of the Health and Safety Code, or a federally recognized Indian tribe.
(j)Emergency medical transport provider subject to the fee means all emergency medical transport providers, as defined in subdivision (i), 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.
SEC. 3.Section 14129.1 of the Welfare and Institutions Code is amended to read:14129.1.(a)(1)The department shall establish the manner and format for emergency medical transport providers to report the data required pursuant to this section.(2)The department may establish an Internet Web site for the submission of reports required by this section.(3)The department may require a certification by each emergency medical transport provider 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. Any funds resulting from a penalty imposed pursuant to this paragraph shall be deposited in the Medi-Cal Emergency Medical Transport Fund created pursuant to subdivision (f) of Section 14129.2.(b)Each emergency medical transport provider shall report to the department data on the number of actual emergency medical transports by payer type, including, without limitation, Medi-Cal fee-for-service emergency medical transports and Medi-Cal managed care emergency medical transports per quarter, as follows:(1)For each quarter beginning on July 1, 2015, through the quarter beginning on July 1, 2017, inclusive, the data shall be submitted on or before October 15, 2017.(2)For the quarter beginning on October 1, 2017, and continuing each quarter thereafter, the data shall be submitted on or before the 45th day after the last day of the applicable quarter.(c)Each emergency medical transport provider shall report to the department data on the gross receipts received from the provision of emergency medical transports per state fiscal year, as follows:(1)For the state fiscal years beginning on July 1, 2015, and July 1, 2016, the data shall be submitted on or before October 15, 2017.(2)For each state fiscal year beginning on July 1, 2017, and continuing each state fiscal year thereafter, the data shall be submitted on or before the 45th day after the last day of the applicable state fiscal year.SEC. 4.Section 14129.2 of the Welfare and Institutions Code is amended to read:14129.2.(a)(1)Commencing with the state fiscal quarter beginning on July 1, 2018, and continuing each state fiscal quarter thereafter for which this article is implemented, 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.(2)The director shall ensure that the quality assurance fee per emergency medical transport imposed pursuant to this article is collected.(b)(1)On or before June 15, 2018, and continuing each June 15 thereafter for which this article is implemented, the director shall calculate the annual quality assurance fee rate applicable to the following state fiscal year based on the most recently collected data from emergency medical transport providers pursuant to Section 14129.1. The director may correct any identified material or significant errors in the data collected from emergency medical transport providers pursuant to Section 14129.1 for the purposes of calculating the annual quality assurance fee rate. The directors determination whether to exercise his or her discretion to correct any data pursuant to this paragraph shall not be subject to judicial review, except that an emergency medical transport provider may bring a writ of mandate under Section 1085 of the Code of Civil Procedure to rectify an abuse of discretion by the director in correcting that emergency medical transport providers data when that correction results in a greater fee amount for that provider pursuant to this section.(A)For the state fiscal year beginning on July 1, 2018, 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 beginning July 1, 2019, and continuing each state fiscal year thereafter, the annual quality assurance fee rate shall be calculated by a ratio, the numerator of which shall be the sum of: (i) the product of the projected aggregate fee schedule amount and the effective state medical assistance percentage and (ii) the amount described in subparagraph (A) of paragraph (2) of subdivision (f) for the state fiscal year, 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, 2018, and continuing each June 15 thereafter for which this article is implemented, 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 add-on increase to the fee-for-service payment schedule described in Section 14129.3 only to the extent necessary to reflect the amount of fees allowable under federal law in an applicable state fiscal year.(4)If, during a state fiscal year for which this article is operative, 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 shall 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 201819 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 beginning on April 1, 2018, 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 201617 state fiscal year to remit the fee payment described in this paragraph on or after July 1, 2018.(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 201617 state fiscal year to remit 50 percent or less of the fee payment described in this paragraph on or after August 1, 2018.(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 201617 state fiscal year to remit any remaining fee payment amount described in this paragraph on or after August 15, 2018.(2)Commencing with the state fiscal quarter beginning on October 1, 2018, and continuing 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 pursuant to subdivision (h) of Section 14171. 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 emergency medical transport 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 emergency medical transport 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 emergency medical transport 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. Any funds resulting from a penalty imposed pursuant to this paragraph shall be deposited into the Medi-Cal Emergency Medical Transport Fund created pursuant to subdivision (f).(4)The director may waive a portion or all of either the interest or penalties, or both, assessed under this article in the event the director determines, in his or her sole discretion, that the emergency medical transport provider has demonstrated that imposition of the full amount of the quality assurance fee pursuant to the timelines applicable under this article has a high likelihood of creating an undue financial hardship for the provider. Waiver of some or all of the interest or penalties pursuant to this paragraph shall be conditioned on the emergency medical transport providers agreement to make fee payments on an alternative schedule developed by the department.(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 fees collected pursuant to this section in the Medi-Cal Emergency Medical Transport Fund, which is hereby created in the State Treasury and, notwithstanding Section 13340 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, and 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 201819 state fiscal year, one million three thousand dollars ($1,003,000), exclusive of any federal matching funds.(ii)For the 201920 state fiscal year and each state 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 applicable state fiscal year in the amount of 10 percent of the annual quality assurance fee collection amount, exclusive of any federal matching funds.(C)To make increased payments to emergency medical transport providers pursuant to this article.(g)In the event of a merger, acquisition, or similar transaction involving an emergency medical transport provider that has outstanding quality assurance fee payment obligations pursuant to this article, including any interest and penalty amounts owed, the resultant or successor emergency medical transport provider shall be responsible for paying to the department the full amount of outstanding quality assurance fee payments, including any applicable interest and penalties, attributable to the emergency medical transport provider for which it was assessed, upon the effective date of such transaction. An entity considering a merger, acquisition, or similar transaction involving an emergency medical transport provider may submit a request pursuant to Chapter 3.5 (commencing with Section 6250) of Title 1 of the Government Code to ascertain the outstanding quality assurance fee payment obligations of the emergency medical transport provider pursuant to this article as of the date of the departments response to that request.(h)The department shall seek approval from the federal Centers for Medicare and Medicaid Services to exempt those providers identified in paragraph (2) of subdivision (i) of Section 14129 as exempt from the fees specified, including the submission, as may be necessary, of a request for waiver of the broad-based requirement, waiver of the uniform fee requirement, or both, pursuant to paragraphs (1) and (2) of Section 433.68(e) of Title 42 of the Code of Federal Regulations.SEC. 5.Section 14129.3 of the Welfare and Institutions Code is amended to read:14129.3.(a)Commencing July 1, 2018, and for each state fiscal year thereafter for which this article is operative, reimbursement to emergency medical transport providers for emergency medical transports shall be increased by application of an add-on to the associated Medi-Cal fee-for-service payment schedule. The add-on increase to the fee-for-service payment schedule under this section shall be calculated on or before June 15, 2018, and shall remain the same for later state fiscal years for which this article is operative, to the extent the department determines federal financial participation is available and is not otherwise jeopardized. The add-on 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 fee-for-service add-on shall be equal to the quotient of the available fee amount projected by the department on or before June 15, 2018, for the 201819, state fiscal year, 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, 2018, for the 201819 state fiscal year. The resulting fee-for-service payment schedule amounts after the application of this section shall be equal to the sum of the Medi-Cal fee-for-service payment schedule amount for the 201516 state fiscal year and the add-on increase.(b)Each applicable 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 and shall provide payment to noncontract emergency medical transport providers consistent with Section 1396u-2(b)(2)(D) of Title 42 of the United States Code. Effective July 1, 2018, and for each state fiscal year thereafter for which this article is operative, the amounts a noncontract emergency medical transport provider could collect if the beneficiary received medical assistance other than through enrollment in a Medi-Cal managed care health plan pursuant to Section 1396u-2(b)(2)(D) of Title 42 of the United States Code shall be the resulting fee-for-service payment schedule amounts after the application of this section.(c)The increased payments required by 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 earned on those funds.(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 medical transport providers and not to supplant this funding.(e)Notwithstanding any provision of this article, the department may seek federal approval to implement any add-on increase to the fee-for-service payment schedule pursuant to this section for any state fiscal year or years, as applicable, on a time-limited basis for a fixed program period, as determined by the department.(f)Notwithstanding any provision of this article, the add-on increase to the fee-for-service payment schedule pursuant to this section shall only be required and payable for state fiscal years for which a quality assurance fee payment obligation exists for emergency medical transport providers.SEC. 6.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 California Constitution and shall go into immediate effect. The facts constituting the necessity are:
In order to avoid the imposition of quality assurance fees under the Medi-Cal Emergency Medical Transportation Reimbursement Act on the providers exempted pursuant to this act, it is necessary that this act take effect immediately.
(a)An eligible provider, as described in subdivision (b), may, in addition to the rate of payment that the provider would otherwise receive for Medi-Cal ground emergency medical transportation services, receive supplemental Medi-Cal reimbursement to the extent provided in this section.
(b)A provider shall be eligible for supplemental reimbursement only if the provider has all of the following characteristics continuously during a state fiscal year:
(1)Provides ground emergency medical transportation services to Medi-Cal beneficiaries.
(2)Is a provider that is enrolled as a Medi-Cal provider for the period being claimed.
(3)Is owned or operated by the state, a city, county, city and county, fire protection district organized pursuant to Part 2.7 (commencing with Section 13800) of Division 12 of the Health and Safety Code, special district organized pursuant to Chapter 1 (commencing with Section 58000) of Division 1 of Title 6 of the Government Code, community services district organized pursuant to Part 1 (commencing with Section 61000) of Division 3 of Title 6 of the Government Code, health care district organized pursuant to Chapter 1 (commencing with Section 32000) of Division 23 of the Health and Safety Code, or a federally recognized Indian tribe.
(c)An eligible providers reimbursement pursuant to this section shall be calculated and paid as follows:
(1)The amount paid to the provider using the established Medi-Cal schedule of maximum allowance rates as may be revised from time to time.
(2)An additional payment to an eligible provider, as described in subdivision (b), that shall be equal to the amount of federal financial participation received as a result of the claims submitted and, if applicable, the amount of intergovernmental transfer funds needed to claim the federal share.
(3)The amount claimed and paid pursuant to paragraph (1), when combined with the amount received pursuant to paragraph (2) or from all other sources of reimbursement from the Medi-Cal program, shall equal 100 percent of projected costs, as determined pursuant to the Medi-Cal State Plan, for ground emergency medical transportation services by each qualified provider. The providers rate as prescribed in paragraph (2) shall be adjusted annually based upon the ground emergency medical transportation services cost report. Providers shall have the ability to annually request a change in their rate as prescribed in paragraph (2) due to either a change in the scope, intensity, or mix of services that the provider provides or due to extraordinary increases in the cost of providing services. The department shall review and evaluate these requests and adjust a providers rate as demonstrated in this review.
(4)The Medi-Cal reimbursement provided by this section shall be distributed exclusively to eligible providers under a payment methodology based on ground emergency medical transportation services provided to Medi-Cal beneficiaries by eligible providers on a per-transport basis or other federally permissible basis. The department shall obtain approval from the federal Centers for Medicare and Medicaid Services for the payment methodology to be utilized, and may not make any payment pursuant to this section prior to obtaining that approval.
(d)(1)It is the Legislatures intent in enacting this section to provide the supplemental reimbursement described in this section without any expenditure from the General Fund. An eligible provider, as a condition of receiving supplemental reimbursement pursuant to this section, shall enter into, and maintain, an agreement with the department for the purposes of implementing this section and reimbursing the department for the costs of administering this section.
(2)The nonfederal share of the reimbursement specified in paragraph (2) of subdivision (c) submitted to the federal Centers for Medicare and Medicaid Services for purposes of claiming federal financial participation shall be paid only with funds from the governmental entities described in paragraph (3) of subdivision (b) and transferred to the state.
(e)Participation in the program by an eligible provider described in this section is voluntary. If an applicable governmental entity elects to seek reimbursement pursuant to paragraph (2) of subdivision (c) on behalf of an eligible provider owned or operated by the entity, as described in paragraph (3) of subdivision (b), the governmental entity shall do all of the following:
(1)Certify, in conformity with the requirements of Section 433.51 of Title 42 of the Code of Federal Regulations, that the claimed expenditures for the ground emergency medical transportation services are eligible for federal financial participation.
(2)Provide evidence supporting the certification as specified by the department.
(3)Submit data as specified by the department to determine the appropriate amounts to claim as expenditures qualifying for federal financial participation.
(4)Keep, maintain, and have readily retrievable, any records specified by the department to fully disclose reimbursement amounts to which the eligible provider is entitled, and any other records required by the federal Centers for Medicare and Medicaid Services.
(5)If applicable, participate in the managed care intergovernmental transfer program established under subdivision (k).
(f)(1)The department shall promptly seek any necessary federal approvals for the implementation of this section. The department may limit the program to those costs that are allowable expenditures under Title XIX of the federal Social Security Act (42 U.S.C. 1396 et seq.). If federal approval is not obtained for implementation of this section, this section shall not be implemented.
(2)The department shall submit claims for federal financial participation for the expenditures for the services described in subdivision (e) that are allowable expenditures under federal law.
(3)The department shall, on an annual basis, submit any necessary materials to the federal government to provide assurances that claims for federal financial participation will include only those expenditures that are allowable under federal law.
(g)(1)If either a final judicial determination is made by any court of appellate jurisdiction or a final determination is made by the administrator of the federal Centers for Medicare and Medicaid Services that the supplemental reimbursement provided for in this section must be made to any provider not described in this section, the director shall execute a declaration stating that the determination has been made and on that date this section shall become inoperative.
(2)The declaration executed pursuant to this subdivision shall be retained by the director, provided to the fiscal and appropriate policy committees of the Legislature, the Secretary of State, the Secretary of the Senate, the Chief Clerk of the Assembly, and the Legislative Counsel, and posted on the departments Internet Web site.
(h)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement and administer this section by means of provider bulletins, or similar instructions, without taking regulatory action.
(i)(1)Upon the effective date of the act that added this subdivision, the department shall develop, in consultation with the providers described in subdivision (b), and seek any necessary federal approvals for, a modified program for the supplemental reimbursement authorized by this section that will seek to provide increased reimbursement to an eligible provider that participates in the program. The nonfederal share of any supplemental reimbursement provided under the modified program shall be derived from voluntary intergovernmental transfers of local funds. The department shall otherwise develop the modified program consistent with the requirements of this section, except for paragraph (3) of subdivision (c), and only to the extent that federal financial participation is available.
(2)The department shall be reimbursed for costs associated with administering the modified program described in paragraph (1) in accordance with subdivision (d) and for any state revenue not obtained due to government providers being exempted from the quality assurance fee pursuant to subdivision (l) paragraph (2) of subdivision (i) of Section 14129 and Section 14129.2. The department shall not otherwise assess a percentage fee in connection with any intergovernmental transfer of funds made pursuant to this subdivision.
(3)The department shall not implement the modified program described in paragraph (1) until it obtains all necessary federal approvals. Until those federal approvals are obtained, supplemental reimbursement shall continue to be available pursuant to the provisions of this section that were operative prior to the effective date of the act that added this subdivision.
(j)The department shall not implement the modified program described in paragraph (1) of subdivision (i) unless it determines that the modified program will likely result in an overall increase to the supplemental reimbursement available pursuant to the provisions of this section that were operative prior to the effective date of the act that added this subdivision.
(k)Subdivision (c) creates a new reimbursement rate for government-operated emergency transportation by government providers that is equal to the projected cost for that provider. Consistent with Section 6085 of the federal Deficit Reduction Act of 2005 (P.L. 109-171), also known as the Rogers Amendment, the department shall require Medi-Cal managed care plans to pay noncontracting government emergency transportation providers an amount equal to the rate established in subdivision (c). The nonfederal share of the payment for paragraph (2) of subdivision (c) shall be paid by intergovernmental transfer from the participating government entity.
SEC. 2.Section 14129 of the Welfare and Institutions Code is amended to read:14129.For purposes of this article, the following definitions apply:
(a)Annual quality assurance fee rate means the quality assurance fee assessed on each emergency medical transport that is not exempt during each applicable state fiscal year.
(b)Aggregate fee schedule increase amount means the product of the quotient described in subdivision (a) of fee-for-service add-on described in Section 14129.3 and the Medi-Cal emergency medical transports that are not exempt, 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 Medical Transport 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 Medical Transport Fund, created pursuant to Section 14129.2, for the applicable state 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 emergency medical transport provider by means of 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 transport does 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 includes 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 does not include supplemental amounts received pursuant to Section 14105.94.
(i)(1)Emergency medical transport provider means any nonpublic provider of emergency medical transports, except for exempt providers described in subdivision (l). transports.
(2)Emergency medical transport provider does not include any emergency transport provider owned or operated by the state, a city, county, city and county, fire protection district organized pursuant to Part 2.7 (commencing with Section 13800) of Division 12 of the Health and Safety Code, special district organized pursuant to Chapter 1 (commencing with Section 58000) of Division 1 of Title 6 of the Government Code, community services district organized pursuant to Part 1 (commencing with Section 61000) of Division 3 of Title 6 of the Government Code, health care district organized pursuant to Chapter 1 (commencing with Section 32000) of Division 23 of the Health and Safety Code, or a federally recognized Indian tribe.
(j)Emergency medical transport provider subject to the fee means all emergency medical transport providers providers, as defined in subdivision (i), 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.
(l)Exempt provider means any emergency transport provider owned or operated by the state, a city, county, city and county, fire protection district organized pursuant to Part 2.7 (commencing with Section 13800) of Division 12 of the Health and Safety Code, special district organized pursuant to Chapter 1 (commencing with Section 58000) of Division 1 of Title 6 of the Government Code, community services district organized pursuant to Part 1 (commencing with Section 61000) of Division 3 of Title 6 of the Government Code, health care district organized pursuant to Chapter 1 (commencing with Section 32000) of Division 23 of the Health and Safety Code, or a federally recognized Indian tribe.SEC. 3.Section 14129.1 of the Welfare and Institutions Code is amended to read:14129.1.(a)(1)The department shall establish the manner and format for emergency medical transport providers that are not exempt to report the data required pursuant to this section.
(2)The department may establish an Internet Web site for the submission of reports required by this section.
(3)The department may require a certification by each emergency medical transport provider 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. Any funds resulting from a penalty imposed pursuant to this paragraph shall be deposited in the Medi-Cal Emergency Medical Transport Fund created pursuant to subdivision (f) of Section 14129.2.
(b)Each emergency medical transport provider shall report to the department data on the number of actual emergency medical transports by payer type, including, without limitation, Medi-Cal fee-for-service emergency medical transports and Medi-Cal managed care emergency medical transports per quarter, as follows:
(1)For each quarter beginning on July 1, 2015, through the quarter beginning on July 1, 2017, inclusive, the data shall be submitted on or before October 15, 2017.
(2)For the quarter beginning on October 1, 2017, and continuing each quarter thereafter, the data shall be submitted on or before the 45th day after the last day of the applicable quarter.
(c)Each emergency medical transport provider shall report to the department data on the gross receipts received from the provision of emergency medical transports per state fiscal year, as follows:
(1)For the state fiscal years beginning on July 1, 2015, and July 1, 2016, the data shall be submitted on or before October 15, 2017.
(2)For each state fiscal year beginning on July 1, 2017, and continuing each state fiscal year thereafter, the data shall be submitted on or before the 45th day after the last day of the applicable state fiscal year.
SEC. 4.Section 14129.2 of the Welfare and Institutions Code is amended to read:14129.2.(a)(1)Commencing with the state fiscal quarter beginning on July 1, 2018, and continuing each state fiscal quarter thereafter for which this article is implemented, there shall be imposed a quality assurance fee for each emergency medical transport provided by each emergency medical transport provider subject to the fee and that is not exempt, in accordance with this section.
(2)The director shall ensure that the quality assurance fee per emergency medical transport imposed pursuant to this article is collected.
(b)(1)On or before June 15, 2018, and continuing each June 15 thereafter for which this article is implemented, the director shall calculate the annual quality assurance fee rate applicable to the following state fiscal year based on the most recently collected data from emergency medical transport providers pursuant to Section 14129.1. The director may correct any identified material or significant errors in the data collected from emergency medical transport providers pursuant to Section 14129.1 for the purposes of calculating the annual quality assurance fee rate. The directors determination whether to exercise his or her discretion to correct any data pursuant to this paragraph shall not be subject to judicial review, except that an emergency medical transport provider may bring a writ of mandate under Section 1085 of the Code of Civil Procedure to rectify an abuse of discretion by the director in correcting that emergency medical transport providers data when that correction results in a greater fee amount for that provider pursuant to this section.
(A)For the state fiscal year beginning on July 1, 2018, 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 beginning July 1, 2019, and continuing each state fiscal year thereafter, the annual quality assurance fee rate shall be calculated by a ratio, the numerator of which shall be the sum of: (i) the product of the projected aggregate fee schedule amount and the effective state medical assistance percentage and (ii) the amount described in subparagraph (A) of paragraph (2) of subdivision (f) for the state fiscal year, 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, 2018, and continuing each June 15 thereafter for which this article is implemented, 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 add-on increase to the fee-for-service payment schedule described in Section 14129.3 only to the extent necessary to reflect the amount of fees allowable under federal law in an applicable state fiscal year.
(4)If, during a state fiscal year for which this article is operative, 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 shall 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 201819 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 beginning on April 1, 2018, 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 201617 state fiscal year to remit the fee payment described in this paragraph on or after July 1, 2018.
(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 201617 state fiscal year to remit 50 percent or less of the fee payment described in this paragraph on or after August 1, 2018.
(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 201617 state fiscal year to remit any remaining fee payment amount described in this paragraph on or after August 15, 2018.
(2)Commencing with the state fiscal quarter beginning on October 1, 2018, and continuing 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 pursuant to subdivision (h) of Section 14171. 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 emergency medical transport 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 emergency medical transport 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 emergency medical transport 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. Any funds resulting from a penalty imposed pursuant to this paragraph shall be deposited into the Medi-Cal Emergency Medical Transport Fund created pursuant to subdivision (f).
(4)The director may waive a portion or all of either the interest or penalties, or both, assessed under this article in the event the director determines, in his or her sole discretion, that the emergency medical transport provider has demonstrated that imposition of the full amount of the quality assurance fee pursuant to the timelines applicable under this article has a high likelihood of creating an undue financial hardship for the provider. Waiver of some or all of the interest or penalties pursuant to this paragraph shall be conditioned on the emergency medical transport providers agreement to make fee payments on an alternative schedule developed by the department.
(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 fees collected pursuant to this section in the Medi-Cal Emergency Medical Transport Fund, which is hereby created in the State Treasury and, notwithstanding Section 13340 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, and 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 201819 state fiscal year, one million three thousand dollars ($1,003,000), exclusive of any federal matching funds.
(ii)For the 201920 state fiscal year and each state 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 applicable state fiscal year in the amount of 10 percent of the annual quality assurance fee collection amount, exclusive of any federal matching funds.
(C)To make increased payments to emergency medical transport providers pursuant to this article.
(g)In the event of a merger, acquisition, or similar transaction involving an emergency medical transport provider that has outstanding quality assurance fee payment obligations pursuant to this article, including any interest and penalty amounts owed, the resultant or successor emergency medical transport provider shall be responsible for paying to the department the full amount of outstanding quality assurance fee payments, including any applicable interest and penalties, attributable to the emergency medical transport provider for which it was assessed, upon the effective date of such transaction. An entity considering a merger, acquisition, or similar transaction involving an emergency medical transport provider may submit a request pursuant to Chapter 3.5 (commencing with Section 6250) of Title 1 of the Government Code to ascertain the outstanding quality assurance fee payment obligations of the emergency medical transport provider pursuant to this article as of the date of the departments response to that request.
(h)The department shall seek approval from the federal Centers for Medicare and Medicaid Services to exempt those providers identified in subdivision (l) paragraph (2) of subdivision (i) of Section 14129 as exempt from the fees specified, including the submission, as may be necessary, of a request for waiver of the broad-based requirement, waiver of the uniform fee requirement, or both, pursuant to paragraphs (1) and (2) of Section 433.68(e) of Title 42 of the Code of Federal Regulations.
SEC. 5.Section 14129.3 of the Welfare and Institutions Code is amended to read:14129.3.(a)Commencing July 1, 2018, and for each state fiscal year thereafter for which this article is operative, reimbursement to emergency medical transport providers that are not exempt for emergency medical transports shall be increased by application of an add-on to the associated Medi-Cal fee-for-service payment schedule. The add-on increase to the fee-for-service payment schedule under this section shall be calculated on or before June 15, 2018, and shall remain the same for later state fiscal years for which this article is operative, to the extent the department determines federal financial participation is available and is not otherwise jeopardized. The add-on 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 fee-for-service add-on shall be equal to the quotient of the available fee amount projected by the department on or before June 15, 2018, for the 201819, state fiscal year, 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, 2018, for the 201819 state fiscal year. The resulting fee-for-service payment schedule amounts after the application of this section shall be equal to the sum of the Medi-Cal fee-for-service payment schedule amount for the 201516 state fiscal year and the add-on increase.
(b)Each applicable 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 and shall provide payment to noncontract emergency medical transport providers consistent with Section 1396u-2(b)(2)(D) of Title 42 of the United States Code. Effective July 1, 2018, and for each state fiscal year thereafter for which this article is operative, the amounts a noncontract emergency medical transport provider could collect if the beneficiary received medical assistance other than through enrollment in a Medi-Cal managed care health plan pursuant to Section 1396u-2(b)(2)(D) of Title 42 of the United States Code shall be the resulting fee-for-service payment schedule amounts after the application of this section.
(c)The increased payments required by 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 earned on those funds.
(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 medical transport providers and not to supplant this funding.
(e)Notwithstanding any provision of this article, the department may seek federal approval to implement any add-on increase to the fee-for-service payment schedule pursuant to this section for any state fiscal year or years, as applicable, on a time-limited basis for a fixed program period, as determined by the department.
(f)Notwithstanding any provision of this article, the add-on increase to the fee-for-service payment schedule pursuant to this section shall only be required and payable for state fiscal years for which a quality assurance fee payment obligation exists for emergency medical transport providers.
SEC. 6.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 California Constitution and shall go into immediate effect. The facts constituting the necessity are:
In order to avoid the imposition of quality assurance fees under the Medi-Cal Emergency Medical Transportation Reimbursement Act on the providers exempted pursuant to this act, it is necessary that this act take effect immediately.
(a)An eligible provider, as described in subdivision (b), may, in addition to the rate of payment that the provider would otherwise receive for Medi-Cal ground emergency medical transportation services, receive supplemental Medi-Cal reimbursement to the extent provided in this section.
(b)A provider shall be eligible for supplemental reimbursement only if the provider has all of the following characteristics continuously during a state fiscal year:
(1)Provides ground emergency medical transportation services to Medi-Cal beneficiaries.
(2)Is a provider that is enrolled as a Medi-Cal provider for the period being claimed.
(3)Is owned or operated by the state, a city, county, city and county, fire protection district organized pursuant to Part 2.7 (commencing with Section 13800) of Division 12 of the Health and Safety Code, special district organized pursuant to Chapter 1 (commencing with Section 58000) of Division 1 of Title 6 of the Government Code, community services district organized pursuant to Part 1 (commencing with Section 61000) of Division 3 of Title 6 of the Government Code, health care district organized pursuant to Chapter 1 (commencing with Section 32000) of Division 23 of the Health and Safety Code, or a federally recognized Indian tribe.
(c)An eligible providers reimbursement pursuant to this section shall be calculated and paid as follows:
(1)The amount paid to the provider using the established Medi-Cal schedule of maximum allowance rates as may be revised from time to time.
(2)An additional payment to an eligible provider, as described in subdivision (b), that shall be equal to the amount of federal financial participation received as a result of the claims submitted and, if applicable, the amount of intergovernmental transfer funds needed to claim the federal share.
(3)The amount claimed and paid pursuant to paragraph (1), when combined with the amount received pursuant to paragraph (2) or from all other sources of reimbursement from the Medi-Cal program, shall equal 100 percent of projected costs, as determined pursuant to the Medi-Cal State Plan, for ground emergency medical transportation services by each qualified provider. The providers rate as prescribed in paragraph (2) shall be adjusted annually based upon the ground emergency medical transportation services cost report. Providers shall have the ability to annually request a change in their rate as prescribed in paragraph (2) due to either a change in the scope, intensity, or mix of services that the provider provides or due to extraordinary increases in the cost of providing services. The department shall review and evaluate these requests and adjust a providers rate as demonstrated in this review.
(4)The Medi-Cal reimbursement provided by this section shall be distributed exclusively to eligible providers under a payment methodology based on ground emergency medical transportation services provided to Medi-Cal beneficiaries by eligible providers on a per-transport basis or other federally permissible basis. The department shall obtain approval from the federal Centers for Medicare and Medicaid Services for the payment methodology to be utilized, and may not make any payment pursuant to this section prior to obtaining that approval.
(d)(1)It is the Legislatures intent in enacting this section to provide the supplemental reimbursement described in this section without any expenditure from the General Fund. An eligible provider, as a condition of receiving supplemental reimbursement pursuant to this section, shall enter into, and maintain, an agreement with the department for the purposes of implementing this section and reimbursing the department for the costs of administering this section.
(2)The nonfederal share of the reimbursement specified in paragraph (2) of subdivision (c) submitted to the federal Centers for Medicare and Medicaid Services for purposes of claiming federal financial participation shall be paid only with funds from the governmental entities described in paragraph (3) of subdivision (b) and transferred to the state.
(e)Participation in the program by an eligible provider described in this section is voluntary. If an applicable governmental entity elects to seek reimbursement pursuant to paragraph (2) of subdivision (c) on behalf of an eligible provider owned or operated by the entity, as described in paragraph (3) of subdivision (b), the governmental entity shall do all of the following:
(1)Certify, in conformity with the requirements of Section 433.51 of Title 42 of the Code of Federal Regulations, that the claimed expenditures for the ground emergency medical transportation services are eligible for federal financial participation.
(2)Provide evidence supporting the certification as specified by the department.
(3)Submit data as specified by the department to determine the appropriate amounts to claim as expenditures qualifying for federal financial participation.
(4)Keep, maintain, and have readily retrievable, any records specified by the department to fully disclose reimbursement amounts to which the eligible provider is entitled, and any other records required by the federal Centers for Medicare and Medicaid Services.
(5)If applicable, participate in the managed care intergovernmental transfer program established under subdivision (k).
(f)(1)The department shall promptly seek any necessary federal approvals for the implementation of this section. The department may limit the program to those costs that are allowable expenditures under Title XIX of the federal Social Security Act (42 U.S.C. 1396 et seq.). If federal approval is not obtained for implementation of this section, this section shall not be implemented.
(2)The department shall submit claims for federal financial participation for the expenditures for the services described in subdivision (e) that are allowable expenditures under federal law.
(3)The department shall, on an annual basis, submit any necessary materials to the federal government to provide assurances that claims for federal financial participation will include only those expenditures that are allowable under federal law.
(g)(1)If either a final judicial determination is made by any court of appellate jurisdiction or a final determination is made by the administrator of the federal Centers for Medicare and Medicaid Services that the supplemental reimbursement provided for in this section must be made to any provider not described in this section, the director shall execute a declaration stating that the determination has been made and on that date this section shall become inoperative.
(2)The declaration executed pursuant to this subdivision shall be retained by the director, provided to the fiscal and appropriate policy committees of the Legislature, the Secretary of State, the Secretary of the Senate, the Chief Clerk of the Assembly, and the Legislative Counsel, and posted on the departments Internet Web site.
(h)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement and administer this section by means of provider bulletins, or similar instructions, without taking regulatory action.
(i)(1)Upon the effective date of the act that added this subdivision, the department shall develop, in consultation with the providers described in subdivision (b), and seek any necessary federal approvals for, a modified program for the supplemental reimbursement authorized by this section that will seek to provide increased reimbursement to an eligible provider that participates in the program. The nonfederal share of any supplemental reimbursement provided under the modified program shall be derived from voluntary intergovernmental transfers of local funds. The department shall otherwise develop the modified program consistent with the requirements of this section, except for paragraph (3) of subdivision (c), and only to the extent that federal financial participation is available.
(2)The department shall be reimbursed for costs associated with administering the modified program described in paragraph (1) in accordance with subdivision (d) and for any state revenue not obtained due to government providers being exempted from the quality assurance fee pursuant to subdivision (l) of Section 14129 and Section 14129.2. The department shall not otherwise assess a percentage fee in connection with any intergovernmental transfer of funds made pursuant to this subdivision.
(3)The department shall not implement the modified program described in paragraph (1) until it obtains all necessary federal approvals. Until those federal approvals are obtained, supplemental reimbursement shall continue to be available pursuant to the provisions of this section that were operative prior to the effective date of the act that added this subdivision.
(j)The department shall not implement the modified program described in paragraph (1) of subdivision (i) unless it determines that the modified program will likely result in an overall increase to the supplemental reimbursement available pursuant to the provisions of this section that were operative prior to the effective date of the act that added this subdivision.
(k)Subdivision (c) creates a new reimbursement rate for government-operated emergency transportation by government providers that is equal to the projected cost for that provider. Consistent with Section 6085 of the federal Deficit Reduction Act of 2005 (P.L. 109-171), also known as the Rogers Amendment, the department shall require Medi-Cal managed care plans to pay noncontracting government emergency transportation providers an amount equal to the rate established in subdivision (c). The nonfederal share of the payment for paragraph (2) of subdivision (c) shall be paid by intergovernmental transfer from the participating government entity.
SEC. 2.Section 14129 of the Welfare and Institutions Code is amended to read:14129.For purposes of this article, the following definitions apply:
(a)Annual quality assurance fee rate means the quality assurance fee assessed on each emergency medical transport that is not exempt during each applicable state fiscal year.
(b)Aggregate fee schedule increase amount means the product of the quotient described in subdivision (a) of Section 14129.3 and the Medi-Cal emergency medical transports that are not exempt, 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 Medical Transport 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 Medical Transport Fund, created pursuant to Section 14129.2, for the applicable state 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 does 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 includes 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 does not include supplemental amounts received pursuant to Section 14105.94.
(i)Emergency medical transport provider means any provider of emergency medical transports, except for exempt providers described in subdivision (l).
(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.
(l)Exempt provider means any emergency transport provider owned or operated by the state, a city, county, city and county, fire protection district organized pursuant to Part 2.7 (commencing with Section 13800) of Division 12 of the Health and Safety Code, special district organized pursuant to Chapter 1 (commencing with Section 58000) of Division 1 of Title 6 of the Government Code, community services district organized pursuant to Part 1 (commencing with Section 61000) of Division 3 of Title 6 of the Government Code, health care district organized pursuant to Chapter 1 (commencing with Section 32000) of Division 23 of the Health and Safety Code, or a federally recognized Indian tribe.
SEC. 3.Section 14129.1 of the Welfare and Institutions Code is amended to read:14129.1.(a)(1)The department shall establish the manner and format for emergency medical transport providers that are not exempt to report the data required pursuant to this section.
(2)The department may establish an Internet Web site for the submission of reports required by this section.
(3)The department may require a certification by each emergency medical transport provider 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. Any funds resulting from a penalty imposed pursuant to this paragraph shall be deposited in the Medi-Cal Emergency Medical Transport Fund created pursuant to subdivision (f) of Section 14129.2.
(b)Each emergency medical transport provider shall report to the department data on the number of actual emergency medical transports by payer type, including, without limitation, Medi-Cal fee-for-service emergency medical transports and Medi-Cal managed care emergency medical transports per quarter, as follows:
(1)For each quarter beginning on July 1, 2015, through the quarter beginning on July 1, 2017, inclusive, the data shall be submitted on or before October 15, 2017.
(2)For the quarter beginning on October 1, 2017, and continuing each quarter thereafter, the data shall be submitted on or before the 45th day after the last day of the applicable quarter.
(c)Each emergency medical transport provider shall report to the department data on the gross receipts received from the provision of emergency medical transports per state fiscal year, as follows:
(1)For the state fiscal years beginning on July 1, 2015, and July 1, 2016, the data shall be submitted on or before October 15, 2017.
(2)For each state fiscal year beginning on July 1, 2017, and continuing each state fiscal year thereafter, the data shall be submitted on or before the 45th day after the last day of the applicable state fiscal year.
SEC. 4.Section 14129.2 of the Welfare and Institutions Code is amended to read:14129.2.(a)(1)Commencing with the state fiscal quarter beginning on July 1, 2018, and continuing each state fiscal quarter thereafter for which this article is implemented, there shall be imposed a quality assurance fee for each emergency medical transport provided by each emergency medical transport provider subject to the fee and that is not exempt, in accordance with this section.
(2)The director shall ensure that the quality assurance fee per emergency medical transport imposed pursuant to this article is collected.
(b)(1)On or before June 15, 2018, and continuing each June 15 thereafter for which this article is implemented, the director shall calculate the annual quality assurance fee rate applicable to the following state fiscal year based on the most recently collected data from emergency medical transport providers pursuant to Section 14129.1. The director may correct any identified material or significant errors in the data collected from emergency medical transport providers pursuant to Section 14129.1 for the purposes of calculating the annual quality assurance fee rate. The directors determination whether to exercise his or her discretion to correct any data pursuant to this paragraph shall not be subject to judicial review, except that an emergency medical transport provider may bring a writ of mandate under Section 1085 of the Code of Civil Procedure to rectify an abuse of discretion by the director in correcting that emergency medical transport providers data when that correction results in a greater fee amount for that provider pursuant to this section.
(A)For the state fiscal year beginning on July 1, 2018, 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 beginning July 1, 2019, and continuing each state fiscal year thereafter, the annual quality assurance fee rate shall be calculated by a ratio, the numerator of which shall be the sum of: (i) the product of the projected aggregate fee schedule amount and the effective state medical assistance percentage and (ii) the amount described in subparagraph (A) of paragraph (2) of subdivision (f) for the state fiscal year, 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, 2018, and continuing each June 15 thereafter for which this article is implemented, 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 add-on increase to the fee-for-service payment schedule described in Section 14129.3 only to the extent necessary to reflect the amount of fees allowable under federal law in an applicable state fiscal year.
(4)If, during a state fiscal year for which this article is operative, 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 shall 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 201819 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 beginning on April 1, 2018, 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 201617 state fiscal year to remit the fee payment described in this paragraph on or after July 1, 2018.
(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 201617 state fiscal year to remit 50 percent or less of the fee payment described in this paragraph on or after August 1, 2018.
(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 201617 state fiscal year to remit any remaining fee payment amount described in this paragraph on or after August 15, 2018.
(2)Commencing with the state fiscal quarter beginning on October 1, 2018, and continuing 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 pursuant to subdivision (h) of Section 14171. 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 emergency medical transport 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 emergency medical transport 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 emergency medical transport 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. Any funds resulting from a penalty imposed pursuant to this paragraph shall be deposited into the Medi-Cal Emergency Medical Transport Fund created pursuant to subdivision (f).
(4)The director may waive a portion or all of either the interest or penalties, or both, assessed under this article in the event the director determines, in his or her sole discretion, that the emergency medical transport provider has demonstrated that imposition of the full amount of the quality assurance fee pursuant to the timelines applicable under this article has a high likelihood of creating an undue financial hardship for the provider. Waiver of some or all of the interest or penalties pursuant to this paragraph shall be conditioned on the emergency medical transport providers agreement to make fee payments on an alternative schedule developed by the department.
(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 fees collected pursuant to this section in the Medi-Cal Emergency Medical Transport Fund, which is hereby created in the State Treasury and, notwithstanding Section 13340 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, and 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 201819 state fiscal year, one million three thousand dollars ($1,003,000), exclusive of any federal matching funds.
(ii)For the 201920 state fiscal year and each state 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 applicable state fiscal year in the amount of 10 percent of the annual quality assurance fee collection amount, exclusive of any federal matching funds.
(C)To make increased payments to emergency medical transport providers pursuant to this article.
(g)In the event of a merger, acquisition, or similar transaction involving an emergency medical transport provider that has outstanding quality assurance fee payment obligations pursuant to this article, including any interest and penalty amounts owed, the resultant or successor emergency medical transport provider shall be responsible for paying to the department the full amount of outstanding quality assurance fee payments, including any applicable interest and penalties, attributable to the emergency medical transport provider for which it was assessed, upon the effective date of such transaction. An entity considering a merger, acquisition, or similar transaction involving an emergency medical transport provider may submit a request pursuant to Chapter 3.5 (commencing with Section 6250) of Title 1 of the Government Code to ascertain the outstanding quality assurance fee payment obligations of the emergency medical transport provider pursuant to this article as of the date of the departments response to that request.
(h)The department shall seek approval from the federal Centers for Medicare and Medicaid Services to exempt those providers identified in subdivision (l) of Section 14129 as exempt from the fees specified, including the submission, as may be necessary, of a request for waiver of the broad-based requirement, waiver of the uniform fee requirement, or both, pursuant to paragraphs (1) and (2) of Section 433.68(e) of Title 42 of the Code of Federal Regulations.
SEC. 5.Section 14129.3 of the Welfare and Institutions Code is amended to read:14129.3.(a)Commencing July 1, 2018, and for each state fiscal year thereafter for which this article is operative, reimbursement to emergency medical transport providers that are not exempt for emergency medical transports shall be increased by application of an add-on to the associated Medi-Cal fee-for-service payment schedule. The add-on increase to the fee-for-service payment schedule under this section shall be calculated on or before June 15, 2018, and shall remain the same for later state fiscal years for which this article is operative, to the extent the department determines federal financial participation is available and is not otherwise jeopardized. The add-on 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 fee-for-service add-on shall be equal to the quotient of the available fee amount projected by the department on or before June 15, 2018, for the 201819, state fiscal year, 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, 2018, for the 201819 state fiscal year. The resulting fee-for-service payment schedule amounts after the application of this section shall be equal to the sum of the Medi-Cal fee-for-service payment schedule amount for the 201516 state fiscal year and the add-on increase.
(b)Each applicable 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 and shall provide payment to noncontract emergency medical transport providers consistent with Section 1396u-2(b)(2)(D) of Title 42 of the United States Code. Effective July 1, 2018, and for each state fiscal year thereafter for which this article is operative, the amounts a noncontract emergency medical transport provider could collect if the beneficiary received medical assistance other than through enrollment in a Medi-Cal managed care health plan pursuant to Section 1396u-2(b)(2)(D) of Title 42 of the United States Code shall be the resulting fee-for-service payment schedule amounts after the application of this section.
(c)The increased payments required by 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 earned on those funds.
(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 medical transport providers and not to supplant this funding.
(e)Notwithstanding any provision of this article, the department may seek federal approval to implement any add-on increase to the fee-for-service payment schedule pursuant to this section for any state fiscal year or years, as applicable, on a time-limited basis for a fixed program period, as determined by the department.
(f)Notwithstanding any provision of this article, the add-on increase to the fee-for-service payment schedule pursuant to this section shall only be required and payable for state fiscal years for which a quality assurance fee payment obligation exists for emergency medical transport providers.
SEC. 6.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 California Constitution and shall go into immediate effect. The facts constituting the necessity are:
In order to avoid the imposition of quality assurance fees under the Medi-Cal Emergency Medical Transportation Reimbursement Act on the providers exempted pursuant to this act, it is necessary that this act take effect immediately.
(a)An eligible provider, as described in subdivision (b), may, in addition to the rate of payment that the provider would otherwise receive for Medi-Cal ground emergency medical transportation services, receive supplemental Medi-Cal reimbursement to the extent provided in this section.
(b)A provider shall be eligible for supplemental reimbursement only if the provider has all of the following characteristics continuously during a state fiscal year:
(1)Provides ground emergency medical transportation services to Medi-Cal beneficiaries.
(2)Is a provider that is enrolled as a Medi-Cal provider for the period being claimed.
(3)Is owned or operated by the state, a city, county, city and county, fire protection district organized pursuant to Part 2.7 (commencing with Section 13800) of Division 12 of the Health and Safety Code, special district organized pursuant to Chapter 1 (commencing with Section 58000) of Division 1 of Title 6 of the Government Code, community services district organized pursuant to Part 1 (commencing with Section 61000) of Division 3 of Title 6 of the Government Code, health care district organized pursuant to Chapter 1 (commencing with Section 32000) of Division 23 of the Health and Safety Code, or a federally recognized Indian tribe.
(c)An eligible providers reimbursement pursuant to this section shall be calculated and paid as follows:
(1)The amount paid to the provider using the established Medi-Cal schedule of maximum allowance rates as may be revised from time to time.
(2)An additional payment to an eligible provider, as described in subdivision (b), that shall be equal to the amount of federal financial participation received as a result of the claims submitted and, if applicable, the amount of intergovernmental transfer funds needed to claim the federal share.
(3)The amount claimed and paid pursuant to paragraph (1), when combined with the amount received pursuant to paragraph (2) or from all other sources of reimbursement from the Medi-Cal program, shall equal 100 percent of projected costs, as determined pursuant to the Medi-Cal State Plan, for ground emergency medical transportation services by each qualified provider. The providers rate as prescribed in paragraph (2) shall be adjusted annually based upon the ground emergency medical transportation services cost report. Providers shall have the ability to annually request a change in their rate as prescribed in paragraph (2) due to either a change in the scope, intensity, or mix of services that the provider provides or due to extraordinary increases in the cost of providing services. The department shall review and evaluate these requests and adjust a providers rate as demonstrated in this review.
(4)The Medi-Cal reimbursement provided by this section shall be distributed exclusively to eligible providers under a payment methodology based on ground emergency medical transportation services provided to Medi-Cal beneficiaries by eligible providers on a per-transport basis or other federally permissible basis. The department shall obtain approval from the federal Centers for Medicare and Medicaid Services for the payment methodology to be utilized, and may not make any payment pursuant to this section prior to obtaining that approval.
(d)(1)It is the Legislatures intent in enacting this section to provide the supplemental reimbursement described in this section without any expenditure from the General Fund. An eligible provider, as a condition of receiving supplemental reimbursement pursuant to this section, shall enter into, and maintain, an agreement with the department for the purposes of implementing this section and reimbursing the department for the costs of administering this section.
(2)The nonfederal share of the reimbursement specified in paragraph (2) of subdivision (c) submitted to the federal Centers for Medicare and Medicaid Services for purposes of claiming federal financial participation shall be paid only with funds from the governmental entities described in paragraph (3) of subdivision (b) and transferred to the state.
(e)Participation in the program by an eligible provider described in this section is voluntary. If an applicable governmental entity elects to seek reimbursement pursuant to paragraph (2) of subdivision (c) on behalf of an eligible provider owned or operated by the entity, as described in paragraph (3) of subdivision (b), the governmental entity shall do all of the following:
(1)Certify, in conformity with the requirements of Section 433.51 of Title 42 of the Code of Federal Regulations, that the claimed expenditures for the ground emergency medical transportation services are eligible for federal financial participation.
(2)Provide evidence supporting the certification as specified by the department.
(3)Submit data as specified by the department to determine the appropriate amounts to claim as expenditures qualifying for federal financial participation.
(4)Keep, maintain, and have readily retrievable, any records specified by the department to fully disclose reimbursement amounts to which the eligible provider is entitled, and any other records required by the federal Centers for Medicare and Medicaid Services.
(5)If applicable, participate in the managed care intergovernmental transfer program established under subdivision (k).
(f)(1)The department shall promptly seek any necessary federal approvals for the implementation of this section. The department may limit the program to those costs that are allowable expenditures under Title XIX of the federal Social Security Act (42 U.S.C. 1396 et seq.). If federal approval is not obtained for implementation of this section, this section shall not be implemented.
(2)The department shall submit claims for federal financial participation for the expenditures for the services described in subdivision (e) that are allowable expenditures under federal law.
(3)The department shall, on an annual basis, submit any necessary materials to the federal government to provide assurances that claims for federal financial participation will include only those expenditures that are allowable under federal law.
(g)(1)If either a final judicial determination is made by any court of appellate jurisdiction or a final determination is made by the administrator of the federal Centers for Medicare and Medicaid Services that the supplemental reimbursement provided for in this section must be made to any provider not described in this section, the director shall execute a declaration stating that the determination has been made and on that date this section shall become inoperative.
(2)The declaration executed pursuant to this subdivision shall be retained by the director, provided to the fiscal and appropriate policy committees of the Legislature, the Secretary of State, the Secretary of the Senate, the Chief Clerk of the Assembly, and the Legislative Counsel, and posted on the departments Internet Web site.
(h)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement and administer this section by means of provider bulletins, or similar instructions, without taking regulatory action.
(i)(1)Upon the effective date of the act that added this subdivision, the department shall develop, in consultation with the providers described in subdivision (b), and seek any necessary federal approvals for, a modified program for the supplemental reimbursement authorized by this section that will seek to provide increased reimbursement to an eligible provider that participates in the program. The nonfederal share of any supplemental reimbursement provided under the modified program shall be derived from voluntary intergovernmental transfers of local funds. The department shall otherwise develop the modified program consistent with the requirements of this section, except for paragraph (3) of subdivision (c), and only to the extent that federal financial participation is available.
(2)The department shall be reimbursed for costs associated with administering the modified program described in paragraph (1) in accordance with subdivision (d) and for any state revenue not obtained due to government providers being exempted from the quality assurance fee pursuant to subdivision (l) of Section 14129 and Section 14129.2. The department shall not otherwise assess a percentage fee in connection with any intergovernmental transfer of funds made pursuant to this subdivision.
(3)The department shall not implement the modified program described in paragraph (1) until it obtains all necessary federal approvals. Until those federal approvals are obtained, supplemental reimbursement shall continue to be available pursuant to the provisions of this section that were operative prior to the effective date of the act that added this subdivision.
(j)The department shall not implement the modified program described in paragraph (1) of subdivision (i) unless it determines that the modified program will likely result in an overall increase to the supplemental reimbursement available pursuant to the provisions of this section that were operative prior to the effective date of the act that added this subdivision.
(k)Subdivision (c) creates a new reimbursement rate for government-operated emergency transportation by government providers that is equal to the projected cost for that provider. Consistent with Section 6085 of the federal Deficit Reduction Act of 2005 (P.L. 109-171), also known as the Rogers Amendment, the department shall require Medi-Cal managed care plans to pay noncontracting government emergency transportation providers an amount equal to the rate established in subdivision (c). The nonfederal share of the payment for paragraph (2) of subdivision (c) shall be paid by intergovernmental transfer from the participating government entity.
SEC. 2.Section 14129 of the Welfare and Institutions Code is amended to read:14129.For purposes of this article, the following definitions apply:
(a)Annual quality assurance fee rate means the quality assurance fee assessed on each emergency medical transport that is not exempt during each applicable state fiscal year.
(b)Aggregate fee schedule increase amount means the product of the quotient described in subdivision (a) of Section 14129.3 and the Medi-Cal emergency medical transports that are not exempt, 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 Medical Transport 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 Medical Transport Fund, created pursuant to Section 14129.2, for the applicable state 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 does 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 includes 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 does not include supplemental amounts received pursuant to Section 14105.94.
(i)Emergency medical transport provider means any provider of emergency medical transports, except for exempt providers described in subdivision (l).
(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.
(l)Exempt provider means any emergency transport provider owned or operated by the state, a city, county, city and county, fire protection district organized pursuant to Part 2.7 (commencing with Section 13800) of Division 12 of the Health and Safety Code, special district organized pursuant to Chapter 1 (commencing with Section 58000) of Division 1 of Title 6 of the Government Code, community services district organized pursuant to Part 1 (commencing with Section 61000) of Division 3 of Title 6 of the Government Code, health care district organized pursuant to Chapter 1 (commencing with Section 32000) of Division 23 of the Health and Safety Code, or a federally recognized Indian tribe.
SEC. 3.Section 14129.1 of the Welfare and Institutions Code is amended to read:14129.1.(a)(1)The department shall establish the manner and format for emergency medical transport providers that are not exempt to report the data required pursuant to this section.
(2)The department may establish an Internet Web site for the submission of reports required by this section.
(3)The department may require a certification by each emergency medical transport provider 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. Any funds resulting from a penalty imposed pursuant to this paragraph shall be deposited in the Medi-Cal Emergency Medical Transport Fund created pursuant to subdivision (f) of Section 14129.2.
(b)Each emergency medical transport provider shall report to the department data on the number of actual emergency medical transports by payer type, including, without limitation, Medi-Cal fee-for-service emergency medical transports and Medi-Cal managed care emergency medical transports per quarter, as follows:
(1)For each quarter beginning on July 1, 2015, through the quarter beginning on July 1, 2017, inclusive, the data shall be submitted on or before October 15, 2017.
(2)For the quarter beginning on October 1, 2017, and continuing each quarter thereafter, the data shall be submitted on or before the 45th day after the last day of the applicable quarter.
(c)Each emergency medical transport provider shall report to the department data on the gross receipts received from the provision of emergency medical transports per state fiscal year, as follows:
(1)For the state fiscal years beginning on July 1, 2015, and July 1, 2016, the data shall be submitted on or before October 15, 2017.
(2)For each state fiscal year beginning on July 1, 2017, and continuing each state fiscal year thereafter, the data shall be submitted on or before the 45th day after the last day of the applicable state fiscal year.
SEC. 4.Section 14129.2 of the Welfare and Institutions Code is amended to read:14129.2.(a)(1)Commencing with the state fiscal quarter beginning on July 1, 2018, and continuing each state fiscal quarter thereafter for which this article is implemented, there shall be imposed a quality assurance fee for each emergency medical transport provided by each emergency medical transport provider subject to the fee and that is not exempt, in accordance with this section.
(2)The director shall ensure that the quality assurance fee per emergency medical transport imposed pursuant to this article is collected.
(b)(1)On or before June 15, 2018, and continuing each June 15 thereafter for which this article is implemented, the director shall calculate the annual quality assurance fee rate applicable to the following state fiscal year based on the most recently collected data from emergency medical transport providers pursuant to Section 14129.1. The director may correct any identified material or significant errors in the data collected from emergency medical transport providers pursuant to Section 14129.1 for the purposes of calculating the annual quality assurance fee rate. The directors determination whether to exercise his or her discretion to correct any data pursuant to this paragraph shall not be subject to judicial review, except that an emergency medical transport provider may bring a writ of mandate under Section 1085 of the Code of Civil Procedure to rectify an abuse of discretion by the director in correcting that emergency medical transport providers data when that correction results in a greater fee amount for that provider pursuant to this section.
(A)For the state fiscal year beginning on July 1, 2018, 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 beginning July 1, 2019, and continuing each state fiscal year thereafter, the annual quality assurance fee rate shall be calculated by a ratio, the numerator of which shall be the sum of: (i) the product of the projected aggregate fee schedule amount and the effective state medical assistance percentage and (ii) the amount described in subparagraph (A) of paragraph (2) of subdivision (f) for the state fiscal year, 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, 2018, and continuing each June 15 thereafter for which this article is implemented, 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 add-on increase to the fee-for-service payment schedule described in Section 14129.3 only to the extent necessary to reflect the amount of fees allowable under federal law in an applicable state fiscal year.
(4)If, during a state fiscal year for which this article is operative, 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 shall 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 201819 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 beginning on April 1, 2018, 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 201617 state fiscal year to remit the fee payment described in this paragraph on or after July 1, 2018.
(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 201617 state fiscal year to remit 50 percent or less of the fee payment described in this paragraph on or after August 1, 2018.
(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 201617 state fiscal year to remit any remaining fee payment amount described in this paragraph on or after August 15, 2018.
(2)Commencing with the state fiscal quarter beginning on October 1, 2018, and continuing 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 pursuant to subdivision (h) of Section 14171. 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 emergency medical transport 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 emergency medical transport 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 emergency medical transport 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. Any funds resulting from a penalty imposed pursuant to this paragraph shall be deposited into the Medi-Cal Emergency Medical Transport Fund created pursuant to subdivision (f).
(4)The director may waive a portion or all of either the interest or penalties, or both, assessed under this article in the event the director determines, in his or her sole discretion, that the emergency medical transport provider has demonstrated that imposition of the full amount of the quality assurance fee pursuant to the timelines applicable under this article has a high likelihood of creating an undue financial hardship for the provider. Waiver of some or all of the interest or penalties pursuant to this paragraph shall be conditioned on the emergency medical transport providers agreement to make fee payments on an alternative schedule developed by the department.
(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 fees collected pursuant to this section in the Medi-Cal Emergency Medical Transport Fund, which is hereby created in the State Treasury and, notwithstanding Section 13340 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, and 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 201819 state fiscal year, one million three thousand dollars ($1,003,000), exclusive of any federal matching funds.
(ii)For the 201920 state fiscal year and each state 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 applicable state fiscal year in the amount of 10 percent of the annual quality assurance fee collection amount, exclusive of any federal matching funds.
(C)To make increased payments to emergency medical transport providers pursuant to this article.
(g)In the event of a merger, acquisition, or similar transaction involving an emergency medical transport provider that has outstanding quality assurance fee payment obligations pursuant to this article, including any interest and penalty amounts owed, the resultant or successor emergency medical transport provider shall be responsible for paying to the department the full amount of outstanding quality assurance fee payments, including any applicable interest and penalties, attributable to the emergency medical transport provider for which it was assessed, upon the effective date of such transaction. An entity considering a merger, acquisition, or similar transaction involving an emergency medical transport provider may submit a request pursuant to Chapter 3.5 (commencing with Section 6250) of Title 1 of the Government Code to ascertain the outstanding quality assurance fee payment obligations of the emergency medical transport provider pursuant to this article as of the date of the departments response to that request.
(h)The department shall seek approval from the federal Centers for Medicare and Medicaid Services to exempt those providers identified in subdivision (l) of Section 14129 as exempt from the fees specified, including the submission, as may be necessary, of a request for waiver of the broad-based requirement, waiver of the uniform fee requirement, or both, pursuant to paragraphs (1) and (2) of Section 433.68(e) of Title 42 of the Code of Federal Regulations.
SEC. 5.Section 14129.3 of the Welfare and Institutions Code is amended to read:14129.3.(a)Commencing July 1, 2018, and for each state fiscal year thereafter for which this article is operative, reimbursement to emergency medical transport providers that are not exempt for emergency medical transports shall be increased by application of an add-on to the associated Medi-Cal fee-for-service payment schedule. The add-on increase to the fee-for-service payment schedule under this section shall be calculated on or before June 15, 2018, and shall remain the same for later state fiscal years for which this article is operative, to the extent the department determines federal financial participation is available and is not otherwise jeopardized. The add-on 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 fee-for-service add-on shall be equal to the quotient of the available fee amount projected by the department on or before June 15, 2018, for the 201819, state fiscal year, 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, 2018, for the 201819 state fiscal year. The resulting fee-for-service payment schedule amounts after the application of this section shall be equal to the sum of the Medi-Cal fee-for-service payment schedule amount for the 201516 state fiscal year and the add-on increase.
(b)Each applicable 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 and shall provide payment to noncontract emergency medical transport providers consistent with Section 1396u-2(b)(2)(D) of Title 42 of the United States Code. Effective July 1, 2018, and for each state fiscal year thereafter for which this article is operative, the amounts a noncontract emergency medical transport provider could collect if the beneficiary received medical assistance other than through enrollment in a Medi-Cal managed care health plan pursuant to Section 1396u-2(b)(2)(D) of Title 42 of the United States Code shall be the resulting fee-for-service payment schedule amounts after the application of this section.
(c)The increased payments required by 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 earned on those funds.
(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 medical transport providers and not to supplant this funding.
(e)Notwithstanding any provision of this article, the department may seek federal approval to implement any add-on increase to the fee-for-service payment schedule pursuant to this section for any state fiscal year or years, as applicable, on a time-limited basis for a fixed program period, as determined by the department.
(f)Notwithstanding any provision of this article, the add-on increase to the fee-for-service payment schedule pursuant to this section shall only be required and payable for state fiscal years for which a quality assurance fee payment obligation exists for emergency medical transport providers.
SEC. 6.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 California Constitution and shall go into immediate effect. The facts constituting the necessity are:In order to avoid the imposition of quality assurance fees under the Medi-Cal Emergency Medical Transportation Reimbursement Act on the providers exempted pursuant to this act, it is necessary that this act take effect immediately.(a)An eligible provider, as described in subdivision (b), may, in addition to the rate of payment that the provider would otherwise receive for Medi-Cal ground emergency medical transportation services, receive supplemental Medi-Cal reimbursement to the extent provided in this section.
(b)A provider shall be eligible for supplemental reimbursement only if the provider has all of the following characteristics continuously during a state fiscal year:
(1)Provides ground emergency medical transportation services to Medi-Cal beneficiaries.
(2)Is a provider that is enrolled as a Medi-Cal provider for the period being claimed.
(3)Is owned or operated by the state, a city, county, city and county, fire protection district organized pursuant to Part 2.7 (commencing with Section 13800) of Division 12 of the Health and Safety Code, special district organized pursuant to Chapter 1 (commencing with Section 58000) of Division 1 of Title 6 of the Government Code, community services district organized pursuant to Part 1 (commencing with Section 61000) of Division 3 of Title 6 of the Government Code, health care district organized pursuant to Chapter 1 (commencing with Section 32000) of Division 23 of the Health and Safety Code, or a federally recognized Indian tribe.
(c)An eligible providers supplemental reimbursement pursuant to this section shall be calculated and paid as follows:
(1)The supplemental reimbursement to(1)The amount paid to the provider using the established Medi-Cal schedule of maximum allowance rates as may be revised from time to time.
(2)An additional payment to an eligible provider, as described in subdivision (b), that shall be equal to the amount of federal financial participation received as a result of the claims submitted pursuant to paragraph (2) of subdivision (f). and, if applicable, the amount of intergovernmental transfer funds needed to claim the federal share.
(2)In no instance shall the amount certified pursuant to paragraph (1) of subdivision (e), when combined with the amount received from all other sources of reimbursement from the Medi-Cal program, exceed 100 percent of actual costs, as determined pursuant to the Medi-Cal State Plan, for ground emergency medical transportation services.(3)The amount claimed and paid pursuant to paragraph (1), when combined with the amount received pursuant to paragraph (2) or from all other sources of reimbursement from the Medi-Cal program, shall equal 100 percent of projected costs, as determined pursuant to the Medi-Cal State Plan, for ground emergency medical transportation services by each qualified provider. The providers rate as prescribed in paragraph (2) shall be adjusted annually based upon the ground emergency medical transportation services cost report. Providers shall have the ability to annually request a change in their rate as prescribed in paragraph (2) due to either a change in the scope, intensity, or mix of services that the provider provides or due to extraordinary increases in the cost of providing services. The department shall review and evaluate these requests and adjust a providers rate as demonstrated in this review.
(3)(4)The supplemental Medi-Cal reimbursement provided by this section shall be distributed exclusively to eligible providers under a payment methodology based on ground emergency medical transportation services provided to Medi-Cal beneficiaries by eligible providers on a per-transport basis or other federally permissible basis. The department shall obtain approval from the federal Centers for Medicare and Medicaid Services for the payment methodology to be utilized, and may not make any payment pursuant to this section prior to obtaining that approval.
(d)(1)It is the Legislatures intent in enacting this section to provide the supplemental reimbursement described in this section without any expenditure from the General Fund. An eligible provider, as a condition of receiving supplemental reimbursement pursuant to this section, shall enter into, and maintain, an agreement with the department for the purposes of implementing this section and reimbursing the department for the costs of administering this section.
(2)The nonfederal share of the supplemental reimbursement specified in paragraph (2) of subdivision (c) submitted to the federal Centers for Medicare and Medicaid Services for purposes of claiming federal financial participation shall be paid only with funds from the governmental entities described in paragraph (3) of subdivision (b) and certified to the state as provided in subdivision (e). transferred to the state.
(e)Participation in the program by an eligible provider described in this section is voluntary. If an applicable governmental entity elects to seek supplemental reimbursement pursuant to this section paragraph (2) of subdivision (c) on behalf of an eligible provider owned or operated by the entity, as described in paragraph (3) of subdivision (b), the governmental entity shall do all of the following:
(1)Certify, in conformity with the requirements of Section 433.51 of Title 42 of the Code of Federal Regulations, that the claimed expenditures for the ground emergency medical transportation services are eligible for federal financial participation.
(2)Provide evidence supporting the certification as specified by the department.
(3)Submit data as specified by the department to determine the appropriate amounts to claim as expenditures qualifying for federal financial participation.
(4)Keep, maintain, and have readily retrievable, any records specified by the department to fully disclose reimbursement amounts to which the eligible provider is entitled, and any other records required by the federal Centers for Medicare and Medicaid Services.
(5)If applicable, participate in the managed care intergovernmental transfer program established under subdivision (k).
(f)(1)The department shall promptly seek any necessary federal approvals for the implementation of this section. The department may limit the program to those costs that are allowable expenditures under Title XIX of the federal Social Security Act (42 U.S.C. 1396 et seq.). If federal approval is not obtained for implementation of this section, this section shall not be implemented.
(2)The department shall submit claims for federal financial participation for the expenditures for the services described in subdivision (e) that are allowable expenditures under federal law.
(3)The department shall, on an annual basis, submit any necessary materials to the federal government to provide assurances that claims for federal financial participation will include only those expenditures that are allowable under federal law.
(g)(1)If either a final judicial determination is made by any court of appellate jurisdiction or a final determination is made by the administrator of the federal Centers for Medicare and Medicaid Services that the supplemental reimbursement provided for in this section must be made to any provider not described in this section, the director shall execute a declaration stating that the determination has been made and on that date this section shall become inoperative.
(2)The declaration executed pursuant to this subdivision shall be retained by the director, provided to the fiscal and appropriate policy committees of the Legislature, the Secretary of State, the Secretary of the Senate, the Chief Clerk of the Assembly, and the Legislative Counsel, and posted on the departments Internet Web site.
(h)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement and administer this section by means of provider bulletins, or similar instructions, without taking regulatory action.
(i)(1)Upon the effective date of the act that added this subdivision, the department shall develop, in consultation with the providers described in subdivision (b), and seek any necessary federal approvals for, a modified program for the supplemental reimbursement authorized by this section that will seek to provide increased reimbursement to an eligible provider that participates in the program. The nonfederal share of any supplemental reimbursement provided under the modified program shall be derived from voluntary intergovernmental transfers of local funds. The department shall otherwise develop the modified program consistent with the requirements of this section, except for paragraph (2) (3) of subdivision (c), and only to the extent that federal financial participation is available.
(2)The department shall be reimbursed for costs associated with administering the modified program described in paragraph (1) in accordance with subdivision (d). (d) and for any state revenue not obtained due to government providers being exempted from the quality assurance fee pursuant to subdivision (l) of Section 14129 and Section 14129.2. The department shall not otherwise assess a percentage fee in connection with any intergovernmental transfer of funds made pursuant to this subdivision.
(3)The department shall not implement the modified program described in paragraph (1) until it obtains all necessary federal approvals. Until those federal approvals are obtained, supplemental reimbursement shall continue to be available pursuant to the provisions of this section that were operative prior to the effective date of the act that added this subdivision.
(j)The department shall not implement the modified program described in paragraph (1) of subdivision (i) unless it determines that the modified program will likely result in an overall increase to the supplemental reimbursement available pursuant to the provisions of this section that were operative prior to the effective date of the act that added this subdivision.
(k)Subdivision (c) creates a new reimbursement rate for government-operated emergency transportation by government providers that is equal to the projected cost for that provider. Consistent with Section 6085 of the federal Deficit Reduction Act of 2005 (P.L. 109-171), also known as the Rogers Amendment, the department shall require Medi-Cal managed care plans to pay noncontracting government emergency transportation providers an amount equal to the rate established in subdivision (c). The nonfederal share of the payment for paragraph (2) of subdivision (c) shall be paid by intergovernmental transfer from the participating government entity.
SECTION 1.SEC. 2.Section 14129 of the Welfare and Institutions Code is amended to read:14129.For purposes of this article, the following definitions apply:
(a)Annual quality assurance fee rate means the quality assurance fee assessed on each emergency medical transport that is not exempt during each applicable state fiscal year.
(b)Aggregate fee schedule increase amount means the product of the quotient described in subdivision (a) of Section 14129.3 and the Medi-Cal emergency medical transports, transports that are not exempt, 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 Medical Transport 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 Medical Transport Fund, created pursuant to Section 14129.2, for the applicable state 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 does 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 includes 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 does not include supplemental amounts received pursuant to Section 14105.94.
(i)Emergency medical transport provider means any provider of emergency medical transports, except for local agencies, as defined in subdivision (a) of Section 6252 of the Government Code. exempt providers described in subdivision (l).
(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.
(l)Exempt provider means any emergency transport provider owned or operated by the state, a city, county, city and county, fire protection district organized pursuant to Part 2.7 (commencing with Section 13800) of Division 12 of the Health and Safety Code, special district organized pursuant to Chapter 1 (commencing with Section 58000) of Division 1 of Title 6 of the Government Code, community services district organized pursuant to Part 1 (commencing with Section 61000) of Division 3 of Title 6 of the Government Code, health care district organized pursuant to Chapter 1 (commencing with Section 32000) of Division 23 of the Health and Safety Code, or a federally recognized Indian tribe.
SEC. 3.Section 14129.1 of the Welfare and Institutions Code is amended to read:14129.1.(a)(1)The department shall establish the manner and format for emergency medical transport providers that are not exempt to report the data required pursuant to this section.
(2)The department may establish an Internet Web site for the submission of reports required by this section.
(3)The department may require a certification by each emergency medical transport provider 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. Any funds resulting from a penalty imposed pursuant to this paragraph shall be deposited in the Medi-Cal Emergency Medical Transport Fund created pursuant to subdivision (f) of Section 14129.2.
(b)Each emergency medical transport provider shall report to the department data on the number of actual emergency medical transports by payer type, including, without limitation, Medi-Cal fee-for-service emergency medical transports and Medi-Cal managed care emergency medical transports per quarter, as follows:
(1)For each quarter beginning on July 1, 2015, through the quarter beginning on July 1, 2017, inclusive, the data shall be submitted on or before October 15, 2017.
(2)For the quarter beginning on October 1, 2017, and continuing each quarter thereafter, the data shall be submitted on or before the 45th day after the last day of the applicable quarter.
(c)Each emergency medical transport provider shall report to the department data on the gross receipts received from the provision of emergency medical transports per state fiscal year, as follows:
(1)For the state fiscal years beginning on July 1, 2015, and July 1, 2016, the data shall be submitted on or before October 15, 2017.
(2)For each state fiscal year beginning on July 1, 2017, and continuing each state fiscal year thereafter, the data shall be submitted on or before the 45th day after the last day of the applicable state fiscal year.
SEC. 4.Section 14129.2 of the Welfare and Institutions Code is amended to read:14129.2.(a)(1)Commencing with the state fiscal quarter beginning on July 1, 2018, and continuing each state fiscal quarter thereafter for which this article is implemented, there shall be imposed a quality assurance fee for each emergency medical transport provided by each emergency medical transport provider subject to the fee and that is not exempt, in accordance with this section.
(2)The director shall ensure that the quality assurance fee per emergency medical transport imposed pursuant to this article is collected.
(b)(1)On or before June 15, 2018, and continuing each June 15 thereafter for which this article is implemented, the director shall calculate the annual quality assurance fee rate applicable to the following state fiscal year based on the most recently collected data from emergency medical transport providers pursuant to Section 14129.1. The director may correct any identified material or significant errors in the data collected from emergency medical transport providers pursuant to Section 14129.1 for the purposes of calculating the annual quality assurance fee rate. The directors determination whether to exercise his or her discretion to correct any data pursuant to this paragraph shall not be subject to judicial review, except that an emergency medical transport provider may bring a writ of mandate under Section 1085 of the Code of Civil Procedure to rectify an abuse of discretion by the director in correcting that emergency medical transport providers data when that correction results in a greater fee amount for that provider pursuant to this section.
(A)For the state fiscal year beginning on July 1, 2018, 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 beginning July 1, 2019, and continuing each state fiscal year thereafter, the annual quality assurance fee rate shall be calculated by a ratio, the numerator of which shall be the sum of: (i) the product of the projected aggregate fee schedule amount and the effective state medical assistance percentage and (ii) the amount described in subparagraph (A) of paragraph (2) of subdivision (f) for the state fiscal year, 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, 2018, and continuing each June 15 thereafter for which this article is implemented, 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 add-on increase to the fee-for-service payment schedule described in Section 14129.3 only to the extent necessary to reflect the amount of fees allowable under federal law in an applicable state fiscal year.
(4)If, during a state fiscal year for which this article is operative, 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 shall 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 201819 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 beginning on April 1, 2018, 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 201617 state fiscal year to remit the fee payment described in this paragraph on or after July 1, 2018.
(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 201617 state fiscal year to remit 50 percent or less of the fee payment described in this paragraph on or after August 1, 2018.
(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 201617 state fiscal year to remit any remaining fee payment amount described in this paragraph on or after August 15, 2018.
(2)Commencing with the state fiscal quarter beginning on October 1, 2018, and continuing 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 pursuant to subdivision (h) of Section 14171. 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 emergency medical transport 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 emergency medical transport 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 emergency medical transport 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. Any funds resulting from a penalty imposed pursuant to this paragraph shall be deposited into the Medi-Cal Emergency Medical Transport Fund created pursuant to subdivision (f).
(4)The director may waive a portion or all of either the interest or penalties, or both, assessed under this article in the event the director determines, in his or her sole discretion, that the emergency medical transport provider has demonstrated that imposition of the full amount of the quality assurance fee pursuant to the timelines applicable under this article has a high likelihood of creating an undue financial hardship for the provider. Waiver of some or all of the interest or penalties pursuant to this paragraph shall be conditioned on the emergency medical transport providers agreement to make fee payments on an alternative schedule developed by the department.
(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 fees collected pursuant to this section in the Medi-Cal Emergency Medical Transport Fund, which is hereby created in the State Treasury and, notwithstanding Section 13340 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, and 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 201819 state fiscal year, one million three thousand dollars ($1,003,000), exclusive of any federal matching funds.
(ii)For the 201920 state fiscal year and each state 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 applicable state fiscal year in the amount of 10 percent of the annual quality assurance fee collection amount, exclusive of any federal matching funds.
(C)To make increased payments to emergency medical transport providers pursuant to this article.
(g)In the event of a merger, acquisition, or similar transaction involving an emergency medical transport provider that has outstanding quality assurance fee payment obligations pursuant to this article, including any interest and penalty amounts owed, the resultant or successor emergency medical transport provider shall be responsible for paying to the department the full amount of outstanding quality assurance fee payments, including any applicable interest and penalties, attributable to the emergency medical transport provider for which it was assessed, upon the effective date of such transaction. An entity considering a merger, acquisition, or similar transaction involving an emergency medical transport provider may submit a request pursuant to Chapter 3.5 (commencing with Section 6250) of Title 1 of the Government Code to ascertain the outstanding quality assurance fee payment obligations of the emergency medical transport provider pursuant to this article as of the date of the departments response to that request.
(h)The department shall seek approval from the federal Centers for Medicare and Medicaid Services to exempt those providers identified in subdivision (l) of Section 14129 as exempt from the fees specified, including the submission, as may be necessary, of a request for waiver of the broad-based requirement, waiver of the uniform fee requirement, or both, pursuant to paragraphs (1) and (2) of Section 433.68(e) of Title 42 of the Code of Federal Regulations.
SEC. 5.Section 14129.3 of the Welfare and Institutions Code is amended to read:14129.3.(a)Commencing July 1, 2018, and for each state fiscal year thereafter for which this article is operative, reimbursement to emergency medical transport providers that are not exempt for emergency medical transports shall be increased by application of an add-on to the associated Medi-Cal fee-for-service payment schedule. The add-on increase to the fee-for-service payment schedule under this section shall be calculated on or before June 15, 2018, and shall remain the same for later state fiscal years for which this article is operative, to the extent the department determines federal financial participation is available and is not otherwise jeopardized. The add-on 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 fee-for-service add-on shall be equal to the quotient of the available fee amount projected by the department on or before June 15, 2018, for the 201819, state fiscal year, 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, 2018, for the 201819 state fiscal year. The resulting fee-for-service payment schedule amounts after the application of this section shall be equal to the sum of the Medi-Cal fee-for-service payment schedule amount for the 201516 state fiscal year and the add-on increase.
(b)Each applicable 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 and shall provide payment to noncontract emergency medical transport providers consistent with Section 1396u-2(b)(2)(D) of Title 42 of the United States Code. Effective July 1, 2018, and for each state fiscal year thereafter for which this article is operative, the amounts a noncontract emergency medical transport provider could collect if the beneficiary received medical assistance other than through enrollment in a Medi-Cal managed care health plan pursuant to Section 1396u-2(b)(2)(D) of Title 42 of the United States Code shall be the resulting fee-for-service payment schedule amounts after the application of this section.
(c)The increased payments required by 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 earned on those funds.
(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 medical transport providers and not to supplant this funding.
(e)Notwithstanding any provision of this article, the department may seek federal approval to implement any add-on increase to the fee-for-service payment schedule pursuant to this section for any state fiscal year or years, as applicable, on a time-limited basis for a fixed program period, as determined by the department.
(f)Notwithstanding any provision of this article, the add-on increase to the fee-for-service payment schedule pursuant to this section shall only be required and payable for state fiscal years for which a quality assurance fee payment obligation exists for emergency medical transport providers.
SEC. 6.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 California Constitution and shall go into immediate effect. The facts constituting the necessity are:
In order to avoid the imposition of quality assurance fees under the Medi-Cal Emergency Medical Transportation Reimbursement Act on the providers exempted pursuant to this act, it is necessary that this act take effect immediately.
For purposes of this article, the following definitions apply:
(a)Annual quality assurance fee rate means the quality assurance fee assessed on each emergency medical transport during each applicable 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 Medical Transport 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 Medical Transport Fund, created pursuant to Section 14129.2, for the applicable state 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 does 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 includes 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 does not include supplemental amounts received pursuant to Section 14105.94.
(i)Emergency medical transport provider means any provider of emergency medical transports. transports, except for local agencies, as defined in subdivision (a) of Section 6252 of the Government Code.
(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.
SECTION 1.Section 14105.94 of the Welfare and Institutions Code is amended to read:14105.94.(a)An eligible provider, as described in subdivision (b), may, in addition to the rate of payment that the provider would otherwise receive for Medi-Cal ground emergency medical transportation services, receive supplemental Medi-Cal reimbursement to the extent provided in this section.(b)A provider shall be eligible for supplemental reimbursement only if the provider has all of the following characteristics continuously during a state fiscal year:(1)Provides ground emergency medical transportation services to Medi-Cal beneficiaries.(2)Is a provider that is enrolled as a Medi-Cal provider for the period being claimed.(3)Is owned or operated by the state, a city, county, city and county, fire protection district organized pursuant to Part 2.7 (commencing with Section 13800) of Division 12 of the Health and Safety Code, special district organized pursuant to Chapter 1 (commencing with Section 58000) of Division 1 of Title 6 of the Government Code, community services district organized pursuant to Part 1 (commencing with Section 61000) of Division 3 of Title 6 of the Government Code, health care district organized pursuant to Chapter 1 (commencing with Section 32000) of Division 23 of the Health and Safety Code, or a federally recognized Indian tribe.(c)An eligible providers supplemental reimbursement pursuant to this section shall be calculated and paid as follows:(1)The supplemental reimbursement to an eligible provider, as described in subdivision (b), shall be equal to the amount of federal financial participation received as a result of the claims submitted pursuant to paragraph (2) of subdivision (f).(2)In no instance shall the amount certified pursuant to paragraph (1) of subdivision (e), when combined with the amount received from all other sources of reimbursement from the Medi-Cal program, exceed 100 percent of actual costs, as determined pursuant to the Medi-Cal State Plan, for ground emergency medical transportation services.(3)The supplemental Medi-Cal reimbursement provided by this section shall be distributed exclusively to eligible providers under a payment methodology based on ground emergency medical transportation services provided to Medi-Cal beneficiaries by eligible providers on a per-transport basis or other federally permissible basis. The department shall obtain approval from the federal Centers for Medicare and Medicaid Services for the payment methodology to be utilized, and may not make any payment pursuant to this section prior to obtaining that approval.(d)(1)It is the intent of the Legislature in enacting this section to provide the supplemental reimbursement described in this section without any expenditure from the General Fund. An eligible provider, as a condition of receiving supplemental reimbursement pursuant to this section, shall enter into, and maintain, an agreement with the department for the purposes of implementing this section and reimbursing the department for the costs of administering this section.(2)The nonfederal share of the supplemental reimbursement submitted to the federal Centers for Medicare and Medicaid Services for purposes of claiming federal financial participation shall be paid only with funds from the governmental entities described in paragraph (3) of subdivision (b) and certified to the state as provided in subdivision (e).(e)Participation in the program by an eligible provider described in this section is voluntary. If an applicable governmental entity elects to seek supplemental reimbursement pursuant to this section on behalf of an eligible provider owned or operated by the entity, as described in paragraph (3) of subdivision (b), the governmental entity shall do all of the following:(1)Certify, in conformity with the requirements of Section 433.51 of Title 42 of the Code of Federal Regulations, that the claimed expenditures for the ground emergency medical transportation services are eligible for federal financial participation.(2)Provide evidence supporting the certification as specified by the department.(3)Submit data as specified by the department to determine the appropriate amounts to claim as expenditures qualifying for federal financial participation.(4)Keep, maintain, and have readily retrievable, any records specified by the department to fully disclose reimbursement amounts to which the eligible provider is entitled, and any other records required by the federal Centers for Medicare and Medicaid Services.(f)(1)The department shall promptly seek any necessary federal approvals for the implementation of this section. The department may limit the program to those costs that are allowable expenditures under Title XIX of the federal Social Security Act (42 U.S.C. 1396 et seq.). If federal approval is not obtained for implementation of this section, this section shall not be implemented.(2)The department shall submit claims for federal financial participation for the expenditures for the services described in subdivision (e) that are allowable expenditures under federal law.(3)The department shall, on an annual basis, submit any necessary materials to the federal government to provide assurances that claims for federal financial participation will include only those expenditures that are allowable under federal law.(g)(1)If either a final judicial determination is made by any court of appellate jurisdiction or a final determination is made by the administrator of the federal Centers for Medicare and Medicaid Services that the supplemental reimbursement provided for in this section must be made to any provider not described in this section, the director shall execute a declaration stating that the determination has been made and on that date this section shall become inoperative.(2)The declaration executed pursuant to this subdivision shall be retained by the director, provided to the fiscal and appropriate policy committees of the Legislature, the Secretary of State, the Secretary of the Senate, the Chief Clerk of the Assembly, and the Legislative Counsel, and posted on the departments Internet Web site.(h)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement and administer this section by means of provider bulletins, or similar instructions, without taking regulatory action.(i)(1)Upon the effective date of the act that added this subdivision, the department shall develop, in consultation with the providers described in subdivision (b), and seek any necessary federal approvals for, a modified program for the supplemental reimbursement authorized by this section that will seek to provide increased reimbursement to an eligible provider that participates in the program. The nonfederal share of any supplemental reimbursement provided under the modified program shall be derived from voluntary intergovernmental transfers of local funds. The department shall otherwise develop the modified program consistent with the requirements of this section, except for paragraph (2) of subdivision (c), and only to the extent that federal financial participation is available.(2)The department shall be reimbursed for costs associated with administering the modified program described in paragraph (1) in accordance with subdivision (d). The department shall not otherwise assess a percentage fee in connection with any intergovernmental transfer of funds made pursuant to this subdivision.(3)The department shall not implement the modified program described in paragraph (1) until it obtains all necessary federal approvals. Until those federal approvals are obtained, supplemental reimbursement shall continue to be available pursuant to the provisions of this section that were operative prior to the effective date of the act that added this subdivision.(j)The department shall not implement the modified program described in paragraph (1) of subdivision (i) unless it determines that the modified program will likely result in an overall increase to the supplemental reimbursement available pursuant to the provisions of this section that were operative prior to the effective date of the act that added this subdivision.(a)An eligible provider, as described in subdivision (b), may, in addition to the rate of payment that the provider would otherwise receive for Medi-Cal ground emergency medical transportation services, receive supplemental Medi-Cal reimbursement to the extent provided in this section.
(b)A provider shall be eligible for supplemental reimbursement only if the provider has all of the following characteristics continuously during a state fiscal year:
(1)Provides ground emergency medical transportation services to Medi-Cal beneficiaries.
(2)Is a provider that is enrolled as a Medi-Cal provider for the period being claimed.
(3)Is owned or operated by the state, a city, county, city and county, fire protection district organized pursuant to Part 2.7 (commencing with Section 13800) of Division 12 of the Health and Safety Code, special district organized pursuant to Chapter 1 (commencing with Section 58000) of Division 1 of Title 6 of the Government Code, community services district organized pursuant to Part 1 (commencing with Section 61000) of Division 3 of Title 6 of the Government Code, health care district organized pursuant to Chapter 1 (commencing with Section 32000) of Division 23 of the Health and Safety Code, or a federally recognized Indian tribe.
(c)An eligible providers supplemental reimbursement pursuant to this section shall be calculated and paid as follows:
(1)The supplemental reimbursement to an eligible provider, as described in subdivision (b), shall be equal to the amount of federal financial participation received as a result of the claims submitted pursuant to paragraph (2) of subdivision (f).
(2)In no instance shall the amount certified pursuant to paragraph (1) of subdivision (e), when combined with the amount received from all other sources of reimbursement from the Medi-Cal program, exceed 100 percent of actual costs, as determined pursuant to the Medi-Cal State Plan, for ground emergency medical transportation services.
(3)The supplemental Medi-Cal reimbursement provided by this section shall be distributed exclusively to eligible providers under a payment methodology based on ground emergency medical transportation services provided to Medi-Cal beneficiaries by eligible providers on a per-transport basis or other federally permissible basis. The department shall obtain approval from the federal Centers for Medicare and Medicaid Services for the payment methodology to be utilized, and may not make any payment pursuant to this section prior to obtaining that approval.
(d)(1)It is the Legislatures intent of the Legislature in enacting this section to provide the supplemental reimbursement described in this section without any expenditure from the General Fund. An eligible provider, as a condition of receiving supplemental reimbursement pursuant to this section, shall enter into, and maintain, an agreement with the department for the purposes of implementing this section and reimbursing the department for the costs of administering this section.
(2)The nonfederal share of the supplemental reimbursement submitted to the federal Centers for Medicare and Medicaid Services for purposes of claiming federal financial participation shall be paid only with funds from the governmental entities described in paragraph (3) of subdivision (b) and certified to the state as provided in subdivision (e).
(e)Participation in the program by an eligible provider described in this section is voluntary. If an applicable governmental entity elects to seek supplemental reimbursement pursuant to this section on behalf of an eligible provider owned or operated by the entity, as described in paragraph (3) of subdivision (b), the governmental entity shall do all of the following:
(1)Certify, in conformity with the requirements of Section 433.51 of Title 42 of the Code of Federal Regulations, that the claimed expenditures for the ground emergency medical transportation services are eligible for federal financial participation.
(2)Provide evidence supporting the certification as specified by the department.
(3)Submit data as specified by the department to determine the appropriate amounts to claim as expenditures qualifying for federal financial participation.
(4)Keep, maintain, and have readily retrievable, any records specified by the department to fully disclose reimbursement amounts to which the eligible provider is entitled, and any other records required by the federal Centers for Medicare and Medicaid Services.
(f)(1)The department shall promptly seek any necessary federal approvals for the implementation of this section. The department may limit the program to those costs that are allowable expenditures under Title XIX of the federal Social Security Act (42 U.S.C. 1396 et seq.). If federal approval is not obtained for implementation of this section, this section shall not be implemented.
(2)The department shall submit claims for federal financial participation for the expenditures for the services described in subdivision (e) that are allowable expenditures under federal law.
(3)The department shall, on an annual basis, submit any necessary materials to the federal government to provide assurances that claims for federal financial participation will include only those expenditures that are allowable under federal law.
(g)(1)If either a final judicial determination is made by any court of appellate jurisdiction or a final determination is made by the administrator of the federal Centers for Medicare and Medicaid Services that the supplemental reimbursement provided for in this section must be made to any provider not described in this section, the director shall execute a declaration stating that the determination has been made and on that date this section shall become inoperative.
(2)The declaration executed pursuant to this subdivision shall be retained by the director, provided to the fiscal and appropriate policy committees of the Legislature, the Secretary of State, the Secretary of the Senate, the Chief Clerk of the Assembly, and the Legislative Counsel, and posted on the departments Internet Web site.
(h)Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement and administer this section by means of provider bulletins, or similar instructions, without taking regulatory action.
(i)(1)Upon the effective date of the act that added this subdivision, the department shall develop, in consultation with the providers described in subdivision (b), and seek any necessary federal approvals for, a modified program for the supplemental reimbursement authorized by this section that will seek to provide increased reimbursement to an eligible provider that participates in the program. The nonfederal share of any supplemental reimbursement provided under the modified program shall be derived from voluntary intergovernmental transfers of local funds. The department shall otherwise develop the modified program consistent with the requirements of this section, except for paragraph (2) of subdivision (c), and only to the extent that federal financial participation is available.
(2)The department shall be reimbursed for costs associated with administering the modified program described in paragraph (1) in accordance with subdivision (d). The department shall not otherwise assess a percentage fee in connection with any intergovernmental transfer of funds made pursuant to this subdivision.
(3)The department shall not implement the modified program described in paragraph (1) until it obtains all necessary federal approvals. Until those federal approvals are obtained, supplemental reimbursement shall continue to be available pursuant to the provisions of this section that were operative prior to the effective date of the act that added this subdivision.
(j)The department shall not implement the modified program described in paragraph (1) of subdivision (i) unless it determines that the modified program will likely result in an overall increase to the supplemental reimbursement available pursuant to the provisions of this section that were operative prior to the effective date of the act that added this subdivision.
|
Date
|
Status
|
|---|---|
| Aug 16, 2018 | In committee: Held under submission. |
| Aug 6, 2018 | In committee: Referred to APPR. suspense file. |
| Jun 18, 2018 | Read second time and amended. Re-referred to Com. on APPR. |
| Jun 14, 2018 | From committee: Amend, and do pass as amended and re-refer to Com. on APPR. (Ayes 7. Noes 0.) (June 13). |
| Jun 7, 2018 | From committee chair, with author's amendments: Amend, and re-refer to committee. Read second time, amended, and re-referred to Com. on HEALTH. |
| Jun 7, 2018 | Referred to Com. on HEALTH. |
| May 30, 2018 | In Senate. Read first time. To Com. on RLS. for assignment. |
| May 29, 2018 | Read third time. Urgency clause adopted. Passed. Ordered to the Senate. |
| May 25, 2018 | From committee: Do pass. (Ayes 16. Noes 0.) (May 25). |
| May 16, 2018 | In committee: Set, first hearing. Referred to APPR. suspense file. |
| Apr 30, 2018 | Re-referred to Com. on APPR. |
| Apr 26, 2018 | Read second time and amended. |
| Apr 25, 2018 | From committee: Amend, and do pass as amended and re-refer to Com. on APPR. with recommendation: To Consent Calendar. (Ayes 15. Noes 0.) (April 24). |
| Apr 23, 2018 | Re-referred to Com. on HEALTH. |
| Apr 19, 2018 | From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended. |
| Apr 18, 2018 | Re-referred to Com. on HEALTH. |
| Apr 17, 2018 | From committee chair, with author's amendments: Amend, and re-refer to Com. on HEALTH. Read second time and amended. |
| Mar 19, 2018 | Re-referred to Com. on HEALTH. |
| Mar 15, 2018 | Referred to Com. on HEALTH. |
| Feb 9, 2018 | From printer. May be heard in committee March 11. |
| Feb 8, 2018 | Read first time. To print. |
|
Date
|
Description
|
Location
|
Votes
|
|
|---|---|---|---|---|
| Aug 6, 2018 | Placed on suspense file | Senate Standing Committee on Appropriations |
Passed |
|
| Jun 13, 2018 | Do pass as amended, but first amend, and re-refer to the Committee on [Appropriations] | Senate Standing Committee on Health |
Passed |
|
| May 29, 2018 | AB 2118 COOLEY Third Reading Urgency | Assembly Floor |
Passed |
|
| May 25, 2018 | Do pass. | Assembly Standing Committee on Appropriations |
Passed |
|
| Apr 24, 2018 | Do pass as amended, and be re-referred to the Committee on [Appropriations] with recommendation: To Consent Calendar | Assembly 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
|
|---|---|---|
| California Fire Chief Association | ** Support | Jun 15, 2018 |
| Consumnes River Fire Department | * Support | Jun 13, 2018 |
| Fire Districts Association Of California | ** Support | Jun 15, 2018 |
SENATE COMMITTEE ON APPROPRIATIONS
Senator Anthony Portantino, Chair
2017 - 2018 Regular Session
AB 2118 (Cooley) - Medi-Cal: emergency medical transportation services
Version: June 18, 2018 | Policy Vote: HEALTH 7 - 0 |
Urgency: Yes | Mandate: No |
Hearing Date: August 6, 2018 | Consultant: Samantha Lui |
This bill meets the criteria for referral to the Suspense File.
Bill Summary:
Urgency bill to exempt public ambulance providers from the Quality Assurance Fee (QAF), to be implemented later this year, and the resulting Medi-Cal add on payments resulting from revenue from the QAF. Establishes a new Medi-Cal reimbursement rate for government-operated ground emergency transportation providers that is equal to the projected cost for that provider, using a voluntary intergovernmental transfer (IGT) program that is funded by those providers. Requires Medi-Cal managed care plans to pay non-contracting public emergency transportation providers an amount equal to the Medi-Cal cost-based rate, funded by IGTs and the existing ground ambulance transportation provider certified public expenditure program.
Fiscal Impact:
Staff notes the following:
- Lower revenues to an existing quality assurance fee (QAF) program for ground ambulance providers (Medi-Cal Emergency Medical Transport Fund).
- No GF impact. (Reductions in revenue to the QAF program would have resulted in a loss of GF, but this bill specifies any state revenue loss incurred as a result of exempting government providers from the QAF program will be reimbursed by IGTs from public providers—essentially keeping the state whole.)
- Higher managed care payments to publicly operated ground ambulance providers to match fee-for-service rates will require the state to pay higher managed care rates (IGTs from the public providers/federal funds).
- Ongoing administrative costs to DHCS (likely in the hundreds of thousands to low millions annually) for the Department of Health Care Services to operate the IGT program and to process annual rate adjustment requests (intergovernmental transfer funds from the participating government entity, as well as ensure appropriate audit records.
Background:
- Counties, municipalities, and other units of local government, including providers operated by local governments, contribute to the non-federal share of Medicaid spending in many states, including California. Certified public expenditures (CPE) are a statutorily recognized Medicaid financing approach by which a governmental entity, including a governmental provider (e.g., county hospital, local education agency, a county, fire district), incurs an expenditure eligible for FFP under the state’s approved Medicaid state plan. Based on this certification, the state then claims additional FFP. CPEs can be used to fund the entire non-federal share of the rate or to provide a supplemental payment above the Medi-Cal rate for the costs incurred by the provider that are in excess of that rate.
Publicly owned or operated ground ambulance providers fund their nonfederal share for the ground emergency medical transport (GEMT) program through CPEs under the provisions of AB 678 (Pan, Chapter 397, Statutes of 2011). The GEMT program is a voluntary program to provide supplemental reimbursement to publicly owned or operated ambulance providers in fee-for-service Medi-Cal for the costs they incur that are above what they are reimbursed through base Medi-Cal rates. The GEMT supplemental payment is the difference between their actual costs and the reimbursement from Medi-Cal via the fee schedule rates. The additional federal funds resulting from the GEMT in 2017-18 is estimated at $76.2 million (FFP payments only), and $37.9 million for 2018-19. The GEMT supplemental payment program results in all of the participating eligible providers being reimbursed at 100% of their costs, with the caveat that for the non-federal share of the supplemental payment is funded by public entity.
SB 523 (Hernandez, Chapter 773, Statutes of 2017) imposes a QAF on the revenue resulting from three types of emergency medical reimbursement codes that are provided by a ground emergency medical transport. The QAF is levied on both public and private ambulance providers. The revenue resulting from the QAF is required to be used to provide additional Medi-Cal reimbursement to both public and private emergency medical transport providers in fee-for-service and Medi-Cal managed care, to pay for state administrative costs, and to provide funding for health care coverage for Californians. DHCS is required to provide an add-on payment to the Medi-Cal FFS payment schedule for three reimbursement codes A0427 Advanced Life Support (ALS) Emergency, A0429 Basic Life Support (BLS) Emergency, and A0433 ALS2.
In the May 2018 Medi-Cal Estimate, which assumes an effective date for the add-on payment under SB 523 of July 1, 2018, QAF revenue is projected to be $69.2 million in 2018-19, of which revenue available for the add-on payments for 2018-19 is estimated to be $189.5 million total funds (TF), of which $29. 9 million TF is for FFS Medi-Cal and $159.6 million TF for Medi-Cal managed care. DHCS anticipates the FFS add on payments to be implemented in November 2018. The annual cost is expected to be $29. 9 million TF. The increased Medi-Cal managed care payments are expected to be implemented with the 2018-19 capitation rates, with an annual cost expected to be $159.6 million TF.
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 base rate (the base rate for BLS is $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.
Proposed Law:
Assembly Bill 2118 includes the following provisions, among others:
- Exempts public ambulance providers from the QAF fee, data reporting and the resulting Medi-Cal add on payments resulting from revenue from the QAF. Public ambulance providers include any emergency transport provider owned or operated by the state, a city, county, city and county, fire protection district, special district, community services district, health care district, or a federally recognized Indian tribe.
- Establishes a new Medi-Cal reimbursement rate for government-operated emergency transportation providers that is equal to the projected cost for that provider, using a voluntary IGT to pay up to the costs of the public ambulance provider. Requires the amount paid to public GEMT providers from the GEMT program and the IGT program to equal 100% of projected costs, instead of not exceeding 100% of actual costs for GEMT in existing law.
- Requires DHCS, consistent with a specified provision of federal law known as the “Rogers Amendment,” to require Medi-Cal managed care plans to pay non-contracting government emergency transportation providers an amount equal to the cost-based rate in 3).
- Requires the ground ambulance provider’s rate to be adjusted annually based upon the ground emergency medical transportation services cost report. Requires ground ambulance providers to have the ability to annually request a change in their rate due to either a change in the scope, intensity, or mix of services that the provider provides, or due to extraordinary increases in the cost of providing services. Requires DHCS to review and evaluate these requests and adjust a provider’s rate as demonstrated in this review.
- Requires the nonfederal share of the payment to be paid by IGTs from the participating government entity.
- Requires DHCS’ to be reimbursed for its administrative costs for the IGT program, and for any revenue not obtained due to public ambulance providers being exempt from the QAF through the existing law process, which requires an eligible provider, as a condition of receiving supplemental reimbursement to enter into, and maintain, an agreement with DHCS for the purposes reimbursing DHCS for its administrative costs.
- Makes a clarifying change to the QAF statute related to the amount of the fee-for-service (FFS) add on Medi-Cal payment resulting from the QAF.
Related Legislation:
- SB 1300 (Hernandez, 2016) would have imposed a QAF 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. SB 1300 was vetoed by Governor Brown, who stated he supported establishing a QAF to bring in additional federal funding to support emergency transportation services, but that the structure of the rate increase was unlike any other fee structure supported by health care related QAFs, and he was concerned this structure put the state General Fund (GF) at risk for paying the increased rate if the revenue falls short or if the QAF is reduced or removed in the future. The Governor urged the Legislature and ambulance providers to work with DHCS and the Department of Finance to restructure the QAF in a way that protects the GF allows for an increase in reimbursement for emergency transportation services.
- AB 511 (De La Torre, 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. 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.
Staff Comments:
- This bill would authorize a new supplemental Medi-Cal reimbursement for the publicly owned or operated ground ambulance providers through a Medi-Cal managed care IGT. An IGT is a transfer of funds from another governmental entity (e.g., a county or other state or local agency) to the Medicaid agency before a Medicaid payment is made. When these funds are used as the non-federal share of a Medicaid expenditure, they are eligible for FFP, meaning these funds can be matched by federal Medicaid funds. IGTs are commonly used by counties to contribute the non-federal share for certain governmental providers (e.g., county and University of California hospitals) located in those counties. The ability of states to use IGTs to finance their Medicaid programs is recognized in both federal statute and regulation.
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 BLS base rate of $106.38 is a rate that is $11.82 lower than the rate in 1999.
The bill includes an urgency statute, which reads the necessity of the bill to be: “In order to avoid the imposition of quality assurance fees under the Medi-Cal Emergency Medical Transportation Reimbursement Act on the providers exempted pursuant to this act, it is necessary that this act take effect immediately.”
-- END --
SENATE COMMITTEE ON HEALTH
Senator Dr. Richard Pan, Chair
BILL NO: AB 2118
AUTHOR: | Cooley | ||
VERSION: | June 7, 2018 | ||
HEARING DATE: | June 13, 2018 | ||
CONSULTANT: | Scott Bain | ||
SUBJECT: Medi-Cal: emergency medical transportation services.
SUMMARY:
- Exempts public ambulance providers from the Quality Assurance Fee (QAF) and the resulting Medi-Cal add on payments resulting from revenue from the QAF. Creates a new Medi-Cal reimbursement rate for government-operated ground emergency transportation providers that is equal to the projected cost for that provider, using a voluntary intergovernmental transfer (IGT) program that is funded by those providers. Requires Medi-Cal managed care plans to pay non-contracting public emergency transportation providers an amount equal to the Medi-Cal cost-based rate, funded by IGTs and the existing ground ambulance transportation provider certified public expenditure program. Contains an urgency clause that will make this bill effective upon enactment.
Existing law:
- Establishes the Medi-Cal program, administered by the Department of Health Care Services (DHCS), under which health care services are provided to qualified low-income persons. [WIC §14000, et seq.]
- Establishes a schedule of benefits under the Medi-Cal program, which includes emergency and non-emergency medical transportation. [WIC §14132]
- 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. [CCR, Title 22, §51527]
- Imposes, under the Medi-Cal Emergency Medical Transportation Reimbursement Act, commencing July 1, 2018, and subject to federal approval and the availability of federal financial participation (FFP), a (QAF) on revenue from three specified emergency medical transport codes provided by an emergency medical transport provider subject to the fee. [WIC §14129-14129.7]
- Defines an “emergency medical transport provider” as any provider of emergency medical transports. [WIC §14129]
- Requires the DHCS director to deposit the collected QAF revenue into the continuously appropriated Medi-Cal Emergency Medical Transport Fund, for exclusive use in a specified order of priority to enhance FFP for ambulance services under the Medi-Cal program, to provide additional reimbursement and 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. This program is referred to as the “ambulance QAF.” [WIC §14129.2]
- Authorizes a Medi-Cal ground emergency medical transportation (GEMT) services provider that is owned or operated by the state, a city, county, city and county, fire protection district, special district, community services district, health care district, or a federally recognized Indian tribe, to receive supplemental Medi-Cal reimbursement in addition to the Medi-Cal rate of payment the provider would otherwise receive for those services through certified public expenditures (CPEs). This program is referred to the GEMT program. [WIC §14105.94]
- Requires the supplemental reimbursement to public ground emergency medical transportation provider under the GEMT program to be equal to the amount of FFP received as a result of the claims submitted, and prohibits the amount certified, when combined with the amount received from all other sources of reimbursement from the Medi-Cal program, from exceeding 100% of actual costs. [WIC §14105.94]
This bill:
- Exempts public ambulance providers from the QAF fee, data reporting and the resulting Medi-Cal add on payments resulting from revenue from the QAF. Public ambulance providers include any emergency transport provider owned or operated by the state, a city, county, city and county, fire protection district, special district, community services district, health care district, or a federally recognized Indian tribe.
- Requires DHCS to seek approval from the federal Centers for Medicare and Medicaid Services to exempt public ambulance providers identified in 1) as exempt from the QAF, including the submission, as may be necessary, of a request for waiver of the broad-based requirement and waiver of the uniform fee requirement in federal Medicaid regulations.
- Establishes a new Medi-Cal reimbursement rate for government-operated emergency transportation providers that is equal to the projected cost for that provider, using a voluntary IGT to pay up to the costs of the public ambulance provider. Requires the amount paid to public GEMT providers from the GEMT program and the IGT program to equal 100% of projected costs, instead of not exceeding 100% of actual costs for GEMT in existing law.
- Requires DHCS, consistent with a specified provision of federal law known as the “Rogers Amendment,” to require Medi-Cal managed care plans to pay non-contracting government emergency transportation providers an amount equal to the cost-based rate in 3).
- Requires the ground ambulance provider’s rate to be adjusted annually based upon the ground emergency medical transportation services cost report. Requires ground ambulance providers to have the ability to annually request a change in their rate due to either a change in the scope, intensity, or mix of services that the provider provides, or due to extraordinary increases in the cost of providing services. Requires DHCS to review and evaluate these requests and adjust a provider’s rate as demonstrated in this review.
- Requires the nonfederal share of the payment to be paid by IGTs from the participating government entity.
- Requires DHCS’ to be reimbursed for its administrative costs for the IGT program, and for any revenue not obtained due to public ambulance providers being exempt from the QAF through the existing law process, which requires an eligible provider, as a condition of receiving supplemental reimbursement to enter into, and maintain, an agreement with DHCS for the purposes reimbursing DHCS for its administrative costs.
- Makes a clarifying change to the QAF statute related to the amount of the fee-for-service (FFS) add on Medi-Cal payment resulting from the QAF.
FISCAL EFFECT:
According to the Assembly Appropriations Committee analysis, no modeling of projected overall amounts was available at the time of this analysis. However, fiscal dynamics are described below. This bill is not expected to result in General Fund (GF) costs.
- Lower revenues to an existing QAF program for ground ambulance providers (Medi-Cal Emergency Medical Transport Fund).
- No GF impact. (Reductions in revenue to the QAF program would have resulted in a loss of GF, but this bill specifies any state revenue loss incurred as a result of exempting government providers from the QAF program will be reimbursed by IGTs from public providers- essentially keeping the state whole.)
- Higher managed care payments to publicly operated ground ambulance providers to match fee-for-service rates will require the state to pay higher managed care rates (IGTs from the public providers/federal funds).
- Minor administrative costs to DHCS to operate the IGT program and to process annual rate adjustment requests (intergovernmental transfer funds from the participating government entity.
PRIOR VOTES:
Assembly Floor: | 78 - 0 |
Assembly Appropriations Committee: | 16 - 0 |
Assembly Health Committee: | 15 - 0 |
COMMENTS:
- Author’s statement. According to the author, the QAF, enacted in 2017, presents significant problems for a number of fire departments in California which will pay more in fees than they will receive in increased reimbursement. This is especially problematic given that fire departments participating in the GEMT program are unlikely to receive additional reimbursement in the Medi-Cal fee for service program, as the increase in revenue due to the QAF is offset by a decrease in revenue in the GEMT program. Local fire departments cannot be in a position where tax funds are being used to support activities that do not benefit their taxpayers.
- Medi-Cal funding for ambulance transportation services. Medicaid (Medi-Cal in California) is jointly funded by the federal government and states. The federal government pays states for a specified percentage of program expenditures, called the Federal Medical Assistance Percentage (FMAP). States must ensure that they can fund their share of Medicaid expenditures for the care and services available under their state plan. Funding for the nonfederal or state share of Medicaid comes from a variety of sources, and each state makes its own decisions, within federal requirements, regarding how to finance its share of the Medicaid program. These methods can include general taxes, providers taxes and fees (subject to limits in federal law and regulation), IGTs, and through CPEs, as described below.
- CPEs. Counties, municipalities, and other units of local government, including providers operated by local governments, contribute to the non-federal share of Medicaid spending in many states, including California. CPEs are a statutorily recognized Medicaid financing approach by which a governmental entity, including a governmental provider (e.g., county hospital, local education agency, a county, fire district), incurs an expenditure eligible for FFP under the state’s approved Medicaid state plan. Based on this certification, the state then claims additional FFP. CPEs can be used to fund the entire non-federal share of the rate or to provide a supplemental payment above the Medi-Cal rate for the costs incurred by the provider that are in excess of that rate.
Publicly owned or operated ground ambulance providers fund their nonfederal share for the GEMT program through CPEs under the provisions of AB 678 (Pan, Chapter 397, Statutes of 2011). The GEMT program is a voluntary program to provide supplemental reimbursement to publicly owned or operated ambulance providers in fee-for-service Medi-Cal for the costs they incur that are above what they are reimbursed through base Medi-Cal rates. The GEMT supplemental payment is the difference between their actual costs and the reimbursement from Medi-Cal via the fee schedule rates.
The additional federal funds resulting from the GEMT in 2017-18 is estimated at $76.2 million (FFP payments only), and $37.9 million for 2018-19. The GEMT supplemental payment program results in all of the participating eligible providers being reimbursed at 100% of their costs, with the caveat that for the non-federal share of the supplemental payment is funded by public entity.
- Ambulance QAF. SB 523 (Hernandez, Chapter 773, Statutes of 2017) imposes a QAF on the revenue resulting from three types of emergency medical reimbursement codes that are provided by a ground emergency medical transport. The QAF is levied on both public and private ambulance providers. The revenue resulting from the QAF is required to be used to provide additional Medi-Cal reimbursement to both public and private emergency medical transport providers in fee-for-service and Medi-Cal managed care, to pay for state administrative costs, and to provide funding for health care coverage for Californians. DHCS is required to provide an add-on payment to the Medi-Cal FFS payment schedule for three reimbursement codes A0427 Advanced Life Support (ALS) Emergency, A0429 Basic Life Support (BLS) Emergency, and A0433 ALS2.
In the May 2018 Medi-Cal Estimate, DHCS assume the effective date for the add-on payment under SB 523 is July 1, 2018, QAF revenue is projected to be $69.2 million in 2018-19, of which revenue available for the add-on payments for 2018-19 is estimated to be $189.5 million total funds (TF), of which $29. 9 million TF is for FFS Medi-Cal and $159.6 million TF for Medi-Cal managed care. DHCS anticipates the FFS add on payments to be implemented in November 2018. The annual cost is expected to be $29. 9 million TF. The increased Medi-Cal managed care payments are expected to be implemented with the 2018-19 capitation rates, with an annual cost expected to be $159.6 million TF.
SB 523 has published a document of its intention to file a State Plan Amendment to implement SB 523, but it has not yet been filed with the federal government. - New ambulance IGT program. This bill would authorize a new supplemental Medi-Cal reimbursement for the publicly owned or operated ground ambulance providers through a Medi-Cal managed care IGT. An IGT is a transfer of funds from another governmental entity (e.g., a county or other state or local agency) to the Medicaid agency before a Medicaid payment is made. When these funds are used as the non-federal share of a Medicaid expenditure, they are eligible for FFP, meaning these funds can be matched by federal Medicaid funds. IGTs are commonly used by counties to contribute the non-federal share for certain governmental providers (e.g., county and University of California hospitals) located in those counties. The ability of states to use IGTs to finance their Medicaid programs is recognized in both federal statute and regulation.
- 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 base rate (the base rate for BLS is $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 BLS base rate of $106.38 is a rate that is $11.82 lower than the rate in 1999. - Related legislation. AB 2436 (Mathis) requires DHCS to establish payment rates for Medi-Cal ground ambulance services based on changes in the Consumer Price Index-Urban. AB 2436 was held on the Assembly Appropriations Committee suspense file.
AB 2593 (Grayson) requires DHCS to set and maintain the Medi-Cal fee rate for air ambulance services that is equal to a percentage of the rural Medicare rates for those services. Requires the final Medi-Cal rate to be either meet or exceed the sum of the Medi-Cal air ambulance service rate on December 31, 2017, and the supplemental payment offered in the year 2017 funded by a penalty assessment. Implements these provisions effective July 1, 2019, and only to the extent FFP is available and only if any necessary federal approvals have been obtained. Prohibits a health plan or health insurance enrollee from being liable for the cost of emergency transportation by an air ambulance service, except for applicable cost-sharing amounts, including, but not limited to, a copayment, coinsurance, or a deductible. Requires health plan and health insurance policies to reimburse air ambulance providers for air ambulance services either a reasonable and customary value, as defined, or an amount otherwise negotiated. Authorizes a health plan, health insurer, or air ambulance provider to seek relief in any court for the purpose of resolving a payment dispute. AB 2593 is pending referral from the Senate Rules Committee.
- Prior legislation. SB 1300 (Hernandez of 2016) would have imposed a QAF 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. SB 1300 was vetoed by Governor Brown, who stated he supported establishing a QAF to bring in additional federal funding to support emergency transportation services, but that the structure of the rate increase was unlike any other fee structure supported by health care related QAFs, and he was concerned this structure put the state General Fund (GF) at risk for paying the increased rate if the revenue falls short or if the QAF is reduced or removed in the future. The Governor urged the Legislature and ambulance providers to work with DHCS and the Department of Finance to restructure the QAF in a way that protects the GF allows for an increase in reimbursement for emergency transportation services.
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. 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.
- Support. This bill is jointly sponsored by the California Fire Chiefs Association (CFCA) and the California Fire Districts Association (CFDA), which state this bill would create a new IGT program for public emergency medical transportation providers that ensures equity in how public and private providers of emergency medical transportation services are able to leverage federal funds, and would correct an unforeseen consequence of SB 523 (Hernandez) from last year. SB 523 established a QAF on both public and private providers of emergency medical transportation services to leverage federal Medicaid funds and thus general net additional revenue to ensure adequate reimbursement for EMT services. At the time SB 523 was considered and ultimately approved, public providers of EMT services believed that the QAF would result in a net revenue gain. However, once DHCS began modeling the actual impact of the QAF, it soon became apparent that many public agencies, primarily fire districts, would suffer actual net losses of revenue. The sponsors indicate representatives of their organizations have had numerous discussions with DHCS and stakeholders to assess the impact of the QAF and consider options on how best to proceed with the goal that public agencies avoid suffering an actual net loss in revenues while ensuring that private ambulance service providers are held harmless from the enactment of any subsequent legislation.
This bill would exempt public EMT service providers from the QAF and establish a new IGT program that will allow public EMT providers to also gain a supplemental reimbursement program in addition to the current GEMT program. Finally, the sponsors conclude that this bill will eliminate any losers on the public side and provide for all participants to receive additional funds (not actual losses) and this bill will make whole the providers on the public side without harm to the private sector. - Recommended amendment. This bill no longer makes a change to existing law in Section 5 (WIC 14129.3) so this section can be deleted from the bill. This bill no longer makes a change to existing law in Section 5 (WIC 14129.3) so this section can be deleted from the bill.
In addition, the proposed change in Section 4 (WIC 14129.2) requiring DHCS to seek CMS approval to exempt public ambulance providers from the QAF appears to already be addressed in existing law, which requires DHCS to obtain any necessary federal approvals for the collection of the QAF and the add-on increase to the fee-for-service payment schedule, and which grants the DHCS director the authority to modify or make adjustments to any methodology, fee amount, or other provision in the ambulance QAF statute to the extent necessary to meet the requirements of federal law or regulations or to obtain federal approval.
SUPPORT AND OPPOSITION:
Support: California Fire Chief Association (co-sponsor)
Fire Districts Association of California (co-sponsor)
Oppose: None received
-- END --
ASSEMBLY THIRD READING
ATR Bill Id:AB 2118
Author:(Cooley)
As Amended Ver:
2/3 vote
Committee | Votes | Ayes | Noes |
Health | 15-0 | Wood, Mayes, Aguiar-Curry, Bigelow, Bonta, Burke, Carrillo, Flora, Limón, McCarty, Nazarian, Rodriguez, Santiago, Thurmond, Waldron | |
Appropriations | 16-0 | Gonzalez Fletcher, Bigelow, Bloom, Bonta, Calderon, Carrillo, Chau, Eggman, Fong, Friedman, Gallagher, Eduardo Garcia, Nazarian, Obernolte, Quirk, Reyes |
|
SUMMARY: Exempts publicly owned or operated ground ambulance providers from the quality assurance fee imposed by the Medi-Cal Emergency Medical Transportation Reimbursement Act (Act) and the resulting add-on payment increases under the Act. Authorizes a supplemental Medi-Cal reimbursement for these governmental entities through a managed care intergovernmental transfer program. Specifically, this bill:
- Requires publicly owned or operated ground ambulance provider's Medi-Cal reimbursement for intergovernmental transfers (IGT) under this bill, and certified public expenditures (CPE) pursuant to the Ground Emergency Medical Transportation Supplemental Reimbursement Program (GEMT Program) under existing law, to be calculated as follows:
- The amount paid to the provider using the established Medi-Cal schedule of maximum allowance rates (as may be revised from time to time); plus,
- An additional amount equal to the amount of federal financial participation received as a result of the claims submitted, and (if applicable), the amount of IGT funds needed to claim the federal share.
- Requires the amount claimed and paid by Medi-Cal, when combined with the amount received under the existing rate under 1) a) above, the amount under 1)b) above, and from all other sources of reimbursement from the Medi-Cal program, to equal 100% of projected costs, as determined pursuant to the Medi-Cal State Plan, instead of the amount being capped at 100% of actual costs based on CPEs under existing law.
- Requires publicly owned or operated GEMT provider's Medi-Cal rate to be adjusted annually based upon the ground emergency medical transportation services cost report.
- Grants providers the ability to annually request a change in their rate in 1) b) above due to either a change in the scope, intensity, or mix of services that the provider provides, or due to extraordinary increases in the cost of providing services.
- Requires the Department of Health Care Services (DHCS) to review and evaluate these requests and adjust a provider's rate as demonstrated in this review.
- Requires DHCS to be reimbursed for any state revenue not obtained due to government providers being exempted from the existing quality assurance fee (QAF).
- Requires the new reimbursement rate for these publicly owned or operated GEMT providers to equal to the projected cost for that provider.
- Provides that consistent with federal law also known as the Rogers Amendment, DHCS to require Medi-Cal managed care plans to pay noncontracting government emergency transportation providers an amount equal to the rate established in 1) above to be paid by IGTs from the participating government entity.
- Exempts from the QAF established under the Act any emergency transport provider owned or operated by the state, a city, county, city and county, fire protection district, special district, community services district, health care district or a federally recognized Indian tribe, as specified.
- Requires DHCS to seek approval from the federal Centers for Medicare and Medicaid Services to exempt the providers specified in 9) above, as specified.
FISCAL EFFECT: According to the Assembly Appropriations Committee analysis, no modeling of projected overall amounts was available at the time of this analysis. However, fiscal dynamics are described below. This bill is not expected to result in General Fund (GF) costs.
- Lower revenues to an existing QAF program for ground ambulance providers (Medi-Cal Emergency Medical Transport Fund).
- No GF impact. (Reductions in revenue to the QAF program would have resulted in a loss of GF, but this bill specifies any state revenue loss incurred as a result of exempting government providers from the QAF program will be reimbursed by IGTs from public providers- essentially keeping the state whole.)
- Higher managed care payments to publicly operated ground ambulance providers to match fee-for-service rates will require the state to pay higher managed care rates (IGTs from the public providers/federal funds).
- Minor administrative costs to DHCS to operate the IGT program and to process annual rate adjustment requests (intergovernmental transfer funds from the participating government entity.
COMMENTS: According to the author, the QAF enacted pursuant to SB 523 (Hernandez), Chapter 773, Statutes of 2017, presents significant problems for a number of fire departments in California which will pay more in fees that they will receive in increased reimbursement. This is especially problematic given that fire departments participating in the GEMT Program are unlikely to receive additional reimbursement in the Medi-Cal fee for service program, as the increase in revenue due to the QAF is offset by a decrease in revenue in the GEMT Program. Local fire departments cannot be in a position where tax funds are being used to support activities that do not benefit their taxpayers.
Analysis Prepared by: Rosielyn Pulmano / HEALTH / (916) 319-2097 FN: 0003168
Date of Hearing: May 16, 2018
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez Fletcher, Chair
ABPCA Bill Id:AB 2118
Author:(Cooley) – As Amended Ver:April 26, 2018
Policy Committee: | Health | Vote: | 15 - 0 |
Urgency: Yes State Mandated Local Program: No Reimbursable: No
SUMMARY:
This urgency bill exempts publicly operated ground ambulance providers from a Medi-Cal quality assurance fee (QAF) program scheduled to be implemented later this year and establishes a different way for these providers to receive supplemental reimbursement for ground ambulance services provided to Medi-Cal managed care enrollees. Specifically, this bill:
- Specifies public emergency transportation services are reimbursed by Medi-Cal at a higher rate than under current practice (for example, at a rate equal to their projected cost), with the non-federal share of the additional cost of the higher rate paid for by intergovernmental transfer (IGT) from the public provider.
- Allows a provider to submit annually a request for a change in rate based on a change in the scope, intensity, or mix of services, or due to an extraordinary increase in costs of providing the service, and requires the Department of Health Care Services (DHCS) to review and adjust rates.
- Requires DHCS to seek federal approval to exempt publicly operated ground ambulance providers from the QAF program.
- Backfills any GF revenue loss that would otherwise occur based on the exemption of publicly operated ground ambulance providers from the QAF program.
FISCAL EFFECT:
No modeling of projected overall amounts was available at the time of this analysis. However, fiscal dynamics are described below. This bill is not expected to result in GF costs.
- Lower revenues to an existing quality assurance fee (QAF) program for ground ambulance providers (Medi-Cal Emergency Medical Transport Fund).
- No GF impact. (Reductions in revenue to the QAF program would have resulted in a loss of GF, but this bill specifies any state revenue loss incurred as a result of exempting government providers from the QAF program will be reimbursed by IGTs from public providers—essentially keeping the state whole.)
- Higher managed care payments to publicly operated ground ambulance providers to match fee-for-service rates will require the state to pay higher managed care rates (IGTs from the public providers/federal funds).
- Minor administrative costs to DHCS to operate the IGT program and to process annual rate adjustment requests (intergovernmental transfer funds from the participating government entity.
COMMENTS:
- Purpose. According to the author, this bill corrects a problem linked to the implementation of SB 523 (Hernández), Chapter 773, Statutes of 2017. That bill created a QAF program to assess providers a fee and create a supplemental reimbursement program for ground ambulance providers. However, because of differences between private and public operators, public operators stand to suffer a net loss associated with the program. This bill carves out public operators and establishes an alternative program for them, using intergovernmental transfers to create the supplemental reimbursement. This bill is co-sponsored by the California Fire Chiefs Association and the Fire Districts Association of California, and has no opposition.
- Background. Medi-Cal payment rates for many services are fairly low, and in some cases are below the cost of the services. This has led to various efforts in recent years to seek supplemental reimbursement for Medi-Cal services. The state can employ various federally allowable mechanisms to leverage funds to create supplemental reimbursement. Local public entities are allowed to use "certified public expenditures"—basically taxpayer dollars spent on Medi-Cal services—to claim federal reimbursement. They can also seek federal reimbursement using intergovernmental transfers (IGTs), whereby funds are transferred prior to Medi-Cal services being rendered. Because Medi-Cal payments are lower than the cost of the service, the difference between payments and costs can be federally reimbursed. Finally, although private providers are not allowed to use these mechanisms, the state has created various fee-based (QAF) supplemental reimbursement programs whereby providers are charged a fee, the funds can be matched with federal dollars, and supplemental reimbursement is paid to the providers using the combination of QAF and federal funds.
AB 678 (Pan), Chapter 397, Statutes of 2011, established a CPE-based program for public ground emergency medical transportation (GEMT) operators to claim supplemental reimbursement in the Medi-Cal fee-for-service (FFS) program. Last year, SB 523 established a QAF program to increase supplemental reimbursement; this bill applied to public and private GEMT providers in FFS. This bill exempts public providers from the QAF program and creates a new IGT-based program for these providers to claim supplemental reimbursement through Medi-Cal managed care.
Analysis Prepared by: Lisa Murawski / APPR. / (916) 319-2081
Date of Hearing: April 24, 2018
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
ABPCA Bill Id:AB 2118
Author:(Cooley) – As Amended Ver:April 19, 2018
SUBJECT: Medi-Cal: ground emergency medical transportation services.
SUMMARY: Exempts publicly owned or operated ground ambulance providers from the quality assurance fee imposed by the Medi-Cal Emergency Medical Transportation Reimbursement Act and the resulting add-on payment increases under the Act. Authorizes a supplemental Medi-Cal reimbursement for these governmental entities through a managed care intergovernmental transfer program. Specifically, this bill:
- Requires publicly owned or operated ground ambulance provider’s Medi-Cal reimbursement for intergovernmental transfers (IGT) under this bill, and certified public expenditures (CPE) pursuant to the Ground Emergency Medical Transportation Supplemental Reimbursement Program (GEMT Program) under existing law, to be calculated as follows:
- The amount paid to the provider using the established Medi-Cal schedule of maximum allowance rates (as may be revised from time to time); plus,
- An additional amount equal to the amount of federal financial participation received as a result of the claims submitted, and (if applicable), the amount of IGT funds needed to claim the federal share.
- Requires the amount claimed and paid by Medi-Cal, when combined with the amount received under the existing rate under 1) a) above, the amount under 1) b) above, and from all other sources of reimbursement from the Medi-Cal program, to equal 100% of projected costs, as determined pursuant to the Medi-Cal State Plan, instead of the amount being capped at 100% of actual costs based on CPEs under existing law.
- Requires publicly owned or operated ground emergency medical transportation (GEMT) provider’s Medi-Cal rate to be adjusted annually based upon the ground emergency medical transportation services cost report.
- Grants providers the ability to annually request a change in their rate in 1) b) above due to either a change in the scope, intensity, or mix of services that the provider provides, or due to extraordinary increases in the cost of providing services.
- Requires the Department of Health Care Services (DHCS) to review and evaluate these requests and adjust a provider’s rate as demonstrated in this review.
- Requires DHCS to be reimbursed for any state revenue not obtained due to government providers being exempted from the existing quality assurance fee (QAF).
- Requires the new reimbursement rate for these publicly owned or operated GEMT providers to equal to the projected cost for that provider.
- Provides that consistent with federal law also known as the Rogers Amendment, DHCS to require Medi-Cal managed care plans to pay noncontracting government emergency transportation providers an amount equal to the rate established in 1) above to be paid by IGTs from the participating government entity.
- Exempts from the QAF established under the Medi-Cal Emergency Medical Transportation Reimbursement Act any emergency transport provider owned or operated by the state, a city, county, city and county, fire protection district, special district, community services district, health care district or a federally recognized Indian tribe, as specified.
- Requires DHCS to seek approval from the federal Centers for Medicare and Medicaid Services (CMS) to exempt the providers specified in 9) above, as specified.
EXISTING LAW:
- Establishes the Medi-Cal program, administered by DHCS which provides health benefits to low-income individuals who meet specific eligibility criteria.
- Includes emergency medical transport (EMT) and nonemergency medical transport (NEMT) in the Medi-Cal schedule of benefits.
- Establishes the GEMT Program to provide additional/supplemental payments to publicly owned or operated providers of Medi-Cal GEMT services. Applies the GEMT Program to providers that are owned or operated by the state, a city, county, city and county, fire protection district, special district, as specified, community services district, as specified, health care district, as specified, or a federally recognized Indian tribe (collectively referred to as publicly owned or operated providers).
- Establishes under federal law, Section 6085 of Congress’ Deficit Reduction Act of 2005, also known as the “Rogers Amendment,” which sets payment for emergency services provided by Medicaid health plan out-of-network providers at the Medicaid fee-for-service rates in each state.
- Imposes a QAF on each transport provided by an EMT provider in accordance with a prescribed methodology, and requires the resulting revenue to be placed in a continously appropriated fund to be used to provide an add-on increase to the Medi-Cal fee-for-service (FFS) EMT rate for three emergency transport reimbursement codes, to pay for state administrative costs, and to provide funding for health care coveage for Californians. Requires Medi-Cal managed care plans to provide payment to noncontract EMT providers consistent with the Rogers amendment.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal committee.
COMMENTS:
- PURPOSE OF THIS BILL. According to the author, the QAF enacted pursuant to SB 523 (Hernandez), Chapter 773, Statutes of 2017, presents significant problems for a number of fire departments in California which will pay more in fees that they will receive in increased reimbursement. This is especially problematic given that fire departments participating in the GEMT Program are unlikely to receive additional reimbursement in the Medi-Cal fee for service program, as the increase in revenue due to the QAF is offset by a decrease in revenue in the GEMT Program. Local fire departments cannot be in a position where tax funds are being used to support activities that do not benefit their taxpayers.
- BACKGROUND.
- Medicaid Financing. The Medicaid program (Medi-Cal in California) is jointly funded by the federal government and states. The federal government pays states for a specified percentage of program expenditures, called the Federal Medical Assistance Percentage (FMAP). State must ensure that they can fund their share of Medicaid expenditures for the care and services available under their state plan.
Funding for the nonfederal or state share of Medicaid comes from a variety of sources, and each state makes its own decisions, within federal requirements, regarding how to finance its share of the Medicaid program. Counties, municipalities, and other units of local government, including providers operated by local governments, contribute to the non-federal share of Medicaid spending in many states. These units of local government, which may also be Medicaid providers (e.g., a county hospital or school district), either transfer local government funds in the amount of the non-federal share of Medicaid payments to the state Medicaid agency through an intergovernmental transfer, or certify the total expenditure incurred to provide Medicaid services or Medicaid program administration, known as a CPE.- IGTs. This bill would authorize a supplemental Medi-Cal reimbursement for the publicly owned or operated ground ambulance providers through a managed care IGT. An IGT is a transfer of funds from another governmental entity (e.g., a county or other state agency) to the Medicaid agency before a Medicaid payment is made. When these funds are used as the non-federal share of a Medicaid expenditure, they are eligible for federal financial participation (FFP). That is, they can be matched by federal dollars. IGTs are commonly used by counties to contribute the non-federal share for certain governmental providers (e.g., community mental health centers, hospitals) located in those counties. IGTs may also be contributed directly by governmental providers themselves, such as hospitals operated by state or local government. The ability of states to use IGTs to finance their Medicaid programs is recognized in both federal statute and regulation.
- CPEs. Currently, publicly owned or operated ground ambulance providers fund their nonfederal share for the GEMT program through CPE. CPE is a statutorily recognized Medicaid financing approach by which a governmental entity, including a governmental provider (e.g., county hospital, local education agency), incurs an expenditure eligible for FFP under the state’s approved Medicaid state plan. The governmental entity certifies that the funds expended are public funds used to support the full cost of providing the Medicaid-covered service or the Medicaid program administrative activity. Based on this certification, the state then claims FFP.
- IGTs. This bill would authorize a supplemental Medi-Cal reimbursement for the publicly owned or operated ground ambulance providers through a managed care IGT. An IGT is a transfer of funds from another governmental entity (e.g., a county or other state agency) to the Medicaid agency before a Medicaid payment is made. When these funds are used as the non-federal share of a Medicaid expenditure, they are eligible for federal financial participation (FFP). That is, they can be matched by federal dollars. IGTs are commonly used by counties to contribute the non-federal share for certain governmental providers (e.g., community mental health centers, hospitals) located in those counties. IGTs may also be contributed directly by governmental providers themselves, such as hospitals operated by state or local government. The ability of states to use IGTs to finance their Medicaid programs is recognized in both federal statute and regulation.
- 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 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 fee-for-service (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. Below is a list of the ground base rate:
- Medicaid Financing. The Medicaid program (Medi-Cal in California) is jointly funded by the federal government and states. The federal government pays states for a specified percentage of program expenditures, called the Federal Medical Assistance Percentage (FMAP). State must ensure that they can fund their share of Medicaid expenditures for the care and services available under their state plan.
Medi-Cal Ground Emergency Medical Transportation Base Rates | ||
CPT Code | Description | Medi-Cal FFS Rate |
A0426 | Advance Life Support - 1 | $107.16 |
A0427 | Advance Life Support - Emergency | $118.20 |
A0428 | Basic Life Support | $107.16 |
A0429 | Basic Life Support - Emergency | $118.20 |
A0433 | Advance Life Support - 2 | $118.20 |
- Programs that can increase reimbursement for GEMT. There are currently two programs that can increase reimbursements for GEMT. The first is the GEMT Program for Medi-Cal FFS, enacted by AB 678 (Pan), Chapter 397, Statutes of 2011, and provides supplemental reimbursement to publicly owned or operated GEMT service providers. CMS authorized the GEMT Program via a State Plan Amendment which was approved on September 4, 2013, and retroactive to January 30, 2010. Participation in the GEMT Program is voluntary.
Under the GEMT Program, a provider that delivers GEMT services to Medi-Cal beneficiaries will be eligible for supplemental payment for services if the following requirements are met:- The provider must be enrolled as a Medi-Cal provider for the period being claimed; and,
- The provider must be owned or operated by the state, a city, county, city and county, federally recognized Indian tribe, health care district, special district, community services district, or fire protection district.
- Programs that can increase reimbursement for GEMT. There are currently two programs that can increase reimbursements for GEMT. The first is the GEMT Program for Medi-Cal FFS, enacted by AB 678 (Pan), Chapter 397, Statutes of 2011, and provides supplemental reimbursement to publicly owned or operated GEMT service providers. CMS authorized the GEMT Program via a State Plan Amendment which was approved on September 4, 2013, and retroactive to January 30, 2010. Participation in the GEMT Program is voluntary.
Specified governmental entities will pay the non-federal share of the supplemental reimbursement through CPEs. Supplemental payments combined with other reimbursements cannot exceed 100% of actual costs (the eligible supplemental payment is for the difference between their actual costs and the reimbursement from Medi-Cal via the fee schedule rates). The total program expenditure amount for state fiscal year (SFY) 2015-16 (latest complete data set) is estimated at $28 million (federal financial participation payments only) for 85 participating providers. The GEMT supplemental payment program results in all of the participating eligible providers being reimbursed at 100% of their costs, with the caveat that for the non-federal share of the supplemental payment is funded by public entity.
The second is the GEMT Provider QAF program, established by SB 523. SB 523 imposed a QAF on each transport provided by an EMT provider in accordance with a prescribed methodology. SB 523 requires the resulting revenue to be placed in a continuously appropriated fund to be used to provide an add-on increase to the Medi-Cal FFS EMT rate for three emergency transport reimbursement codes, to pay for state administrative costs, and to provide funding for health care coverage for Californians. SB 523 authorizes DHCS to collect from GEMT providers the following data: i) on a quarterly basis, the number of EMTs, by payer type; and, ii) on an annual basis, gross receipts received from the provision of EMTs per SFY. All providers of GEMT services are required to submit data to DHCS. The QAF collected will be used to provide increased reimbursement in the form of an add-on to the FFS schedule rate for the affected EMT billing codes.
Upon federal approval, DHCS will implement the GEMT QAF and provide the add-on to the FFS schedule rate for the affected EMT billing codes, effective July 1, 2018. DHCS will post notice of the QAF amounts and add-on amounts, by June 15, 2018, for SFY 2018-19, and each June 15 thereafter for each subsequent SFY. It should be noted that DHCS has not filed its state plan amendment for SB 523.
GEMT providers will be required to remit the QAF for each EMT provided during the quarter beginning April 1, 2018, based on the following schedule:
- For GEMT providers that rendered 35,000 or more Medi-Cal FFS EMTs during SFY 2016-17, 100% of the QAF is tentatively due on July 1, 2018, pending federal approval; and,
- For GEMT providers that rendered fewer than 35,000 Medi-Cal FFS EMTs during the SFY 2016-17, 50% of the QAF is tentatively due on August 1, 2018, and the remaining 50% is tentatively due on August 15, 2018, pending federal approval.
- For GEMT providers that rendered 35,000 or more Medi-Cal FFS EMTs during SFY 2016-17, 100% of the QAF is tentatively due on July 1, 2018, pending federal approval; and,
- SUPPORT. The California Fire Chiefs Association and the California Fire Districts Association, both sponsors of this bill, state that this bill is intended to correct an unforeseen consequence of SB 523, which is scheduled to take effect on July 1, 2018. SB 523 established a QAF on both public and private providers of emergency medical transportation services to leverage federal Medicaid funds and thus general net additional revenue to ensure adequate reimbursement for EMT services. At the time SB 523 was considered, public providers of EMT services believed that the QAF would result in a net revenue gain. However, once DHCS began modeling the actual impact of the QAF, it soon became apparent that many public agencies, primarily fire districts, would suffer actual net losses of revenue. This bill establishes an IGT program that will allow public EMT to also gain a supplemental reimbursement program in addition to the current GETM program for managed care. This bill will eliminate any losers on the public side and provide for all participants to receive additional funds.
- RELATED LEGISLATION.
- AB 2436 (Mathis) requires 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 designates the ambulance cost study conducted by the federal Government Accountability Office as the evidentiary base. AB 2436 is pending in Assembly Appropriations Committee.
- AB 2593 (Grayson) requires DHCS to set and maintain the Medi-Cal fee schedule for air ambulance services at a level equal to the rural Medicare rates for those services. Implements this bill only to the extent FFP is available and only if necessary federal approvals have been obtained. AB 2593 is pending in Assembly Appropriations Committee.
REGISTERED SUPPORT / OPPOSITION:
Support
California Fire Chief Association (cosponsor)
Fire Districts Association of California (cosponsor)
Opposition
None on file.
Analysis Prepared by: Rosielyn Pulmano / HEALTH / (916) 319-2097
Discussed in Hearing
1H
Senate Standing Committee on Appropriations
5MIN
Senate Standing Committee on Health
1MIN
Assembly Floor
Bill Author
Bill Co-Author(s):