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

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Date Published: 05/26/2018 04:00 AM
AB2593:v98#DOCUMENT

Amended  IN  Assembly  May 25, 2018

CALIFORNIA LEGISLATURE— 2017–2018 REGULAR SESSION

Assembly Bill No. 2593


Introduced by Assembly Member Grayson
(Principal coauthor: Assembly Member Wood)
(Coauthor: Senator Dodd)

February 15, 2018


An act to add Section 1371.6 to the Health and Safety Code, to add Section 10126.65 to the Insurance Code, and to add Section 14124.14 to the Welfare and Institutions Code, relating to Medi-Cal. air ambulance services.


LEGISLATIVE COUNSEL'S DIGEST


AB 2593, as amended, Grayson. Medi-Cal: air Air ambulance services.
(1) Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires that health care service plans and health insurance policies, as specified, provide coverage for certain services and treatments, including emergency medical transportation services.
This bill would provide that an enrollee, subscriber, or insured shall not be 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. The bill would require a health care service plan contract or health insurer to reimburse providers for air ambulance services either a reasonable and customary value, as defined, or an amount otherwise negotiated, among other things. The bill would authorize a health care service plan, health insurer, or provider to seek relief in any court for the purpose of resolving a payment dispute. Because a willful violation of the bill’s requirements relative to health care service plans would be a crime, the bill would impose a state-mandated local program.

Existing

(2) Existing law establishes 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 provides for the federal Medicare Program, which is a public health insurance program for persons 65 years of age and older and specified persons with disabilities who are under 65 years of age.
This bill would require the department to maintain establish the Medi-Cal fee schedule rate for air ambulance services provided either by fixed or rotary wing aircraft at a level equal to a percentage of the rural Medicare rates for those services, only as described and effective July 1, 2019, and to the extent federal financial participation is available and only if any necessary federal approvals have been obtained.
The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.
This bill would provide that no reimbursement is required by this act for a specified reason.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NOYES  

The people of the State of California do enact as follows:


SECTION 1.

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

1371.6.
 (a) A subscriber or enrollee receiving emergency transportation by an air ambulance services provider covered consistent with paragraph (6) of subdivision (b) of Section 1345 shall not be held liable for the cost of that service, except for applicable cost-sharing amounts, including, but not limited to, a copayment, coinsurance, or a deductible.
(b) (1) A health care service plan shall reimburse providers for services subject to this section in accordance with this chapter, including Section 1371 or 1371.35, as applicable, and the health care service plan shall provide an explanation of benefits or similar claim processing information to the enrollee and provider.
(2) Notwithstanding any other law, reimbursement shall be based on either the reasonable and customary value for the service as described in subparagraph (B) of paragraph (2) of subdivision (a) of Section 1300.71 of Title 28 of the California Code of Regulations or an amount otherwise negotiated between the health care service plan and the provider.
(3) A health care service plan or a provider may seek relief in any court for the purpose of resolving a payment dispute.

SEC. 2.

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

10126.65.
 (a) An insured receiving emergency transportation by an air ambulance services provider covered consistent with paragraph (6) of subdivision (b) of Section 1345 shall not be held liable for the cost of that service, except for applicable cost-sharing amounts, including, but not limited to, a copayment, coinsurance, or a deductible.
(b)  Notwithstanding any other law, a health insurer shall provide an explanation of benefits to the insured or an explanation of benefits or remittance advice to the provider concerning air ambulance services.
(c) (1) A health insurer shall provide reimbursement, in accordance with this chapter, to a provider for a claim submitted for air ambulance services.
(2) Reimbursement to a provider shall be based on either the reasonable and customary value for the service as described in subparagraph (B) of paragraph (2) of subdivision (a) of Section 1300.71 of Title 28 of the California Code of Regulations or an amount otherwise negotiated between the health insurer and the provider.
(3) A health insurer or a provider may seek relief in any court for the purpose of resolving a payment dispute.

SECTION 1.SEC. 3.

 Section 14124.14 is added to the Welfare and Institutions Code, to read:

14124.14.
 (a) The department shall set and maintain the Medi-Cal fee schedule rate for air ambulance services at a level provided either by 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.

(b)

(c) 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. 4.

 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.