Today's Law As Amended

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AB-2593 Air ambulance services.(2017-2018)



SECTION 1.

 Section 76000.10 of the Government Code is amended to read:

76000.10.
 (a) This section shall be known, and may be cited, as the Emergency Medical Air Transportation Act.
(b) For purposes of this section:
(1) “Department” means the State Department of Health Care Services.
(2) “Director” means the Director of Health Care Services.
(3) “Provider” means a provider of emergency medical air transportation services.
(4) “Rotary wing” means a type of aircraft, commonly referred to as a helicopter, that generates lift through the use of wings, known as rotor blades, that revolve around a mast.
(5) “Fixed wing” means a type of aircraft, commonly referred to as an airplane, that generates lift through the use of the forward motion of the aircraft and wings that do not revolve around a mast but are fixed in relation to the fuselage of the aircraft.
(6) “Air mileage rate” means the per-mileage reimbursement rate paid for services rendered by rotary-wing and fixed-wing providers.
(c) (1) For purposes of implementing this section, a penalty of four dollars ($4) shall be imposed upon every conviction for a violation of the Vehicle Code or a local ordinance adopted pursuant to the Vehicle Code, except parking offenses subject to Article 3 (commencing with Section 40200) of Chapter 1 of Division 17 of the Vehicle Code.
(2) The penalty described in this subdivision shall be  is  in addition to the state penalty assessed pursuant to Section 1464 of the Penal Code. However, this penalty shall not be included in the base fine used to calculate the state penalty assessment pursuant to subdivision (a) of Section 1464 of the Penal Code, the state surcharge levied pursuant to Section 1465.7 of the Penal Code, and the state court construction penalty pursuant to Section 70372 of this code, and to calculate the other additional penalties levied pursuant to this chapter.
(d) The county or the court that imposed the fine shall, in accordance with the procedures set out in Section 68101, transfer moneys collected pursuant to this section to the Treasurer for deposit into the Emergency Medical Air Transportation and Children’s Coverage Fund, which is hereby established in the State Treasury. Notwithstanding Section 16305.7, the Emergency Medical Air Transportation and Children’s Coverage Fund shall include interest and dividends earned on money in the fund. Any law that references the Emergency Medical Air Transportation Act Fund, as previously established by this subdivision, shall be construed to reference the Emergency Medical Air Transportation and Children’s Coverage Fund, effective January 1, 2018.
(e) (1) The Emergency Medical Air Transportation and Children’s Coverage Fund shall be administered by the State Department of Health Care Services. Moneys in the Emergency Medical Air Transportation and Children’s Coverage Fund shall be made available, upon appropriation by the Legislature, to the department for any of the following purposes:
(A) For children’s health care coverage.
(B) For emergency medical air transportation provider payments, as follows:
(i) For payment of the administrative costs of the department in administering emergency medical air transportation provider payments.
(ii) Twenty percent of the appropriated money remaining after payment of administrative costs pursuant to clause (i) shall be used to offset the state portion of the Medi-Cal reimbursement rate for emergency medical air transportation services.
(iii) Eighty percent of the appropriated money remaining after payment of administrative costs pursuant to clause (i) shall be used to augment emergency medical air transportation reimbursement payments made through the Medi-Cal program, as set forth in paragraphs (2) and (3).
(2) If money in the Emergency Medical Air Transportation and Children’s Coverage  Fund is made available to the department for the purpose described in subparagraph (B) of paragraph (1), both of the following shall occur:
(A) The department shall seek to obtain federal matching funds by using the moneys in the Emergency Medical Air Transportation and Children’s Coverage Fund for the purpose of augmenting Medi-Cal reimbursement paid to emergency medical air transportation providers.
(B) The director shall augment emergency medical air transportation provider payments in accordance with a federally approved reimbursement methodology. The director may seek federal approvals or waivers as may be necessary to implement this section and to obtain federal financial participation to the maximum extent possible for the payments under this section.
(3) (A) Upon appropriation by the Legislature, the department shall use moneys in the Emergency Medical Air Transportation and Children’s Coverage Fund and any federal matching funds to do any of the following:
(i) Fund children’s health care coverage.
(ii) Increase the Medi-Cal reimbursement for emergency medical air transportation services in an amount not to exceed normal and customary charges charged by the providers.
(B) Notwithstanding any other law, and pursuant to this section, if money in the Emergency Medical Air Transportation and Children’s Coverage Fund is made available to the department for the purpose described in subparagraph (B) of paragraph (1), the department shall increase the Medi-Cal reimbursement for emergency medical air transportation services if both of the following conditions are met:
(i) Moneys in the Emergency Medical Air Transportation and Children’s Coverage Fund will cover the cost of increased payments pursuant to clause (iii) of subparagraph (B) of paragraph (1).
(ii) The state does not incur any General Fund expense to pay for the Medi-Cal emergency medical air transportation services increase.
(f) The assessment of penalties pursuant to this section shall terminate on January 1, 2020. Penalties assessed before January 1, 2020, shall continue to be collected, administered, and distributed pursuant to this section until exhausted or until June 30, 2021, whichever occurs first. On June 30, 2021, moneys remaining unexpended and unencumbered in the Emergency Medical Air Transportation and Children’s Coverage Fund shall be transferred to the General Fund, to be available, upon appropriation by the Legislature, for the purposes of augmenting Medi-Cal reimbursement for emergency medical air transportation and related costs, generally, or funding children’s health care coverage.
(g) Notwithstanding the rulemaking provisions of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2, the department may implement, interpret, or make specific this section and any applicable federal waivers and state plan amendments by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions without taking regulatory action.
(h) This section shall remain in effect only until January 1, 2022, and as of that date is repealed, unless a later enacted statute, that is enacted before January 1, 2022, deletes or extends that date. the earlier of either of the following: 
(1) The date on which the rate change to the Medi-Cal fee rate for air ambulance services is implemented pursuant to Section 14124.15 of the Welfare and Institutions Code, and as of that date is repealed.
(2) January 1, 2022, and as of that date is repealed.

SEC. 2.

 Section 76000.10 is added to the Government Code, to read:

76000.10.
 (a) This section shall be known, and may be cited, as the Emergency Medical Air Transportation Act.
(b) For purposes of this section:
(1) “Department” means the State Department of Health Care Services.
(2) “Director” means the Director of Health Care Services.
(3) “Provider” means a provider of emergency medical air transportation services.
(4) “Rotary wing” means a type of aircraft, commonly referred to as a helicopter, that generates lift through the use of wings, known as rotor blades, that revolve around a mast.
(5) “Fixed wing” means a type of aircraft, commonly referred to as an airplane, that generates lift through the use of the forward motion of the aircraft and wings that do not revolve around a mast but are fixed in relation to the fuselage of the aircraft.
(6) “Air mileage rate” means the per-mileage reimbursement rate paid for services rendered by rotary-wing and fixed-wing providers.
(c) (1) For purposes of implementing this section, a penalty of four dollars ($4) shall be imposed upon every conviction for a violation of the Vehicle Code or a local ordinance adopted pursuant to the Vehicle Code, except parking offenses subject to Article 3 (commencing with Section 40200) of Chapter 1 of Division 17 of the Vehicle Code.
(2) The penalty described in this subdivision is in addition to the state penalty assessed pursuant to Section 1464 of the Penal Code. However, this penalty shall not be included in the base fine used to calculate the state penalty assessment pursuant to subdivision (a) of Section 1464 of the Penal Code, the state surcharge levied pursuant to Section 1465.7 of the Penal Code, and the state court construction penalty pursuant to Section 70372 of this code, and to calculate the other additional penalties levied pursuant to this chapter.
(d) The county or the court that imposed the fine shall, in accordance with the procedures set out in Section 68101, transfer moneys collected pursuant to this section to the Treasurer for deposit into the Emergency Medical Air Transportation and Children’s Coverage Fund, which is hereby established in the State Treasury. Notwithstanding Section 16305.7, the Emergency Medical Air Transportation and Children’s Coverage Fund shall include interest and dividends earned on money in the fund. Any law that references the Emergency Medical Air Transportation Act Fund, as previously established by this subdivision, shall be construed to reference the Emergency Medical Air Transportation and Children’s Coverage Fund, effective January 1, 2018.
(e) The Emergency Medical Air Transportation and Children’s Coverage Fund shall be administered by the State Department of Health Care Services. Moneys in the Emergency Medical Air Transportation and Children’s Coverage Fund shall be made available, upon appropriation by the Legislature, to the department for any of the following purposes:
(1) For children’s health care coverage.
(2) For emergency medical air transportation provider payments, as follows:
(A) For payment of the administrative costs of the department in administering emergency medical air transportation provider payments.
(B) The appropriated money remaining after payment of administrative costs pursuant to subparagraph (A) shall be used to offset the state portion of the Medi-Cal reimbursement rate for emergency medical air transportation services.
(f) The assessment of penalties pursuant to this section shall terminate on January 1, 2020. Penalties assessed before January 1, 2020, shall continue to be collected, administered, and distributed pursuant to this section until exhausted or until June 30, 2021, whichever occurs first. On June 30, 2021, moneys remaining unexpended and unencumbered in the Emergency Medical Air Transportation and Children’s Coverage Fund shall be transferred to the General Fund, to be available, upon appropriation by the Legislature, for the purposes of offsetting the state portion of the Medi-Cal reimbursement rate for emergency medical air transportation and related costs, generally, or funding children’s health care coverage.
(g) Notwithstanding the rulemaking provisions of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2, the department may implement, interpret, or make specific this section and any applicable federal waivers and state plan amendments by means of all-county letters, plan letters, plan or provider bulletins, or similar instructions without taking regulatory action.
(h) (1) This section shall become operative only if, and on the date upon which, the rate change to the Medi-Cal fee rate for air ambulance services is implemented pursuant to Section 14124.15 of the Welfare and Institutions Code.
(2) (A) Except as described in subdivision (f), moneys in the Emergency Medical Air Transportation and Children’s Coverage Fund shall remain available, upon appropriation by the Legislature, to be used to augment emergency medical air transportation reimbursement payments made through the Medi-Cal program for purposes of emergency medical air transportation that was provided before July 1, 2019, and that is therefore not eligible for the Medi-Cal rate change made pursuant to Section 14124.15 of the Welfare and Institutions Code. The emergency medical air transportation reimbursement payments may be augmented pursuant to this subparagraph using moneys deposited in the fund within 90 calendar days following July 1, 2019.
(B) Moneys in the Emergency Medical Air Transportation and Children’s Coverage Fund shall not be available to be used to augment emergency medical air transportation reimbursement payments made through the Medi-Cal program for purposes of emergency medical air transportation that is provided on or after July 1, 2019, and that is therefore eligible for the Medi-Cal rate change made pursuant to Section 14124.15 of the Welfare and Institutions Code.
(i) This section shall remain in effect only until January 1, 2022, and as of that date is repealed.

SEC. 3.

 Section 1371.6 is added to the Health and Safety Code, to read:

1371.6.
 (a) (1) Notwithstanding Section 1367.11, a health care service plan contract issued, amended, or renewed on or after January 1, 2019, shall provide that if an enrollee receives covered services from a noncontracting air ambulance provider, the enrollee shall pay no more than the same cost sharing that the enrollee would pay for the same covered services received from a contracting air ambulance provider. This amount shall be referred to as the “in-network cost-sharing amount.”
(2) An enrollee shall not owe the noncontracting provider more than the in-network cost-sharing amount for services subject to this section. At the time of payment by the plan to the noncontracting provider, the plan shall inform the enrollee and the noncontracting provider of the in-network cost-sharing amount owed by the enrollee.
(b) The following shall apply for purposes of this section:
(1) Any cost sharing paid by the enrollee for the services subject to this section shall count toward the limit on annual out-of-pocket expenses established under Section 1367.006.
(2) Cost sharing arising from services subject to this section shall be counted toward any deductible in the same manner as cost sharing would be attributed to a contracting provider.
(3) The cost sharing paid by the enrollee pursuant to this section shall satisfy the enrollee’s obligation to pay cost sharing for the health service.
(c) A noncontracting provider may advance to collections only the in-network cost-sharing amount, as determined by the plan pursuant to subdivision (a), that the enrollee has failed to pay.
(d) A health care service plan or a provider may seek relief in any court for the purpose of resolving a payment dispute. A provider is not prohibited from using a health care service plan’s existing dispute resolution processes.
(e) Air ambulance services providers remain subject to the balance billing protections for Medi-Cal beneficiaries under Section 14019.4 of the Welfare and Institutions Code.

SEC. 4.

 Section 10126.65 is added to the Insurance Code, to read:

10126.65.
 (a) (1) Notwithstanding Section 10352, a health insurance policy issued, amended, or renewed on or after January 1, 2019, shall provide that if an insured or subscriber receives covered services from a noncontracting air ambulance provider, the insured or subscriber shall pay no more than the same cost sharing that the insured or subscriber would pay for the same covered services received from a contracting air ambulance provider. This amount shall be referred to as the “in-network cost-sharing amount.”
(2) A subscriber or insured shall not owe the noncontracting provider more than the in-network cost-sharing amount for services subject to this section. At the time of payment by the insurer to the noncontracting provider, the insurer shall inform the insured or subscriber and the noncontracting provider of the in-network cost-sharing amount owed by the insured or subscriber.
(b) The following shall apply for purposes of this section:
(1) Any cost sharing paid by the insured or subscriber for the services subject to this section shall count toward the limit on annual out-of-pocket expenses established under Section 10112.28.
(2) Cost sharing arising from services subject to this section shall be counted toward any deductible in the same manner as cost sharing would be attributed to a contracting provider.
(3) The cost sharing paid by the insured or subscriber pursuant to this section shall satisfy the insured’s or subscriber’s obligation to pay cost sharing for the health service.
(c) A noncontracting provider may advance to collections only the in-network cost-sharing amount, as determined by the insurer pursuant to subdivision (a), that the insured or subscriber has failed to pay.
(d) A health insurer or a provider may seek relief in any court for the purpose of resolving a payment dispute. A provider is not prohibited from using a health insurer’s existing dispute resolution processes.

SEC. 5.

 Section 14124.15 is added to the Welfare and Institutions Code, to read:

14124.15.
 (a) The department shall set and maintain the Medi-Cal fee rate for air ambulance services provided by either fixed or rotary wing aircraft that is equal to a percentage, as specified in subdivision (b), of the rural Medicare rates for those services.
(b) The final rate shall either meet or exceed the sum of the air ambulance service rate as provided in the Medi-Cal program on December 31, 2017, and the supplemental payment offered in the year 2017 pursuant to Section 76000.10 of the Government Code.
(c) 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, 2019, and for each state fiscal year thereafter for which this chapter 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.
(d) This section shall be effective July 1, 2019, and the section shall be implemented only to the extent federal financial participation is available and only if any necessary federal approvals have been obtained.
SEC. 6.
 No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because the only costs that may be incurred by a local agency or school district will be incurred because this act creates a new crime or infraction, eliminates a crime or infraction, or changes the penalty for a crime or infraction, within the meaning of Section 17556 of the Government Code, or changes the definition of a crime within the meaning of Section 6 of Article XIII B of the California Constitution.