Today's Law As Amended

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AB-2118 Medi-Cal: emergency medical transportation services.(2017-2018)



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 provider’s supplemental  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.
(1) (2)  The supplemental reimbursement 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) (3)  In no instance shall the amount certified  The amount claimed and paid  pursuant to paragraph (1) of subdivision (e),  (1),  when combined with the amount received pursuant to paragraph (2) or  from all other sources of reimbursement from the Medi-Cal program, exceed  shall equal  100 percent of actual projected  costs, as determined pursuant to the Medi-Cal State Plan, for ground emergency medical transportation services. services by each qualified provider. The provider’s 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 provider’s 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 Legislature’s 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  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 transferred  to the state as provided in subdivision (e). 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 department’s 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 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 increase  amount” means the product of the quotient described in paragraph (2) of subdivision (a) of  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 transports” shall 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” 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) (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  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.
 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.