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AB-1104 Air ambulance services.(2021-2022)

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Date Published: 07/01/2021 09:00 PM
AB1104:v95#DOCUMENT

Amended  IN  Senate  July 01, 2021
Amended  IN  Assembly  May 24, 2021
Amended  IN  Assembly  April 12, 2021
Amended  IN  Assembly  March 18, 2021

CALIFORNIA LEGISLATURE— 2021–2022 REGULAR SESSION

Assembly Bill
No. 1104


Introduced by Assembly Member Grayson

February 18, 2021


An act to amend Section 76000.10 of the Government Code, and to add Section 14124.15 to the Welfare and Institutions Code, relating to air ambulance services, and declaring the urgency thereof, to take effect immediately.


LEGISLATIVE COUNSEL'S DIGEST


AB 1104, as amended, Grayson. Air ambulance services.
(1) Existing law imposes a penalty of $4 until July 1, 2021, upon every conviction for a violation of the Vehicle Code or a local ordinance adopted pursuant to the Vehicle Code, other than a parking offense. The act requires the county or court that imposed the fine to transfer the revenues collected to the Treasurer for deposit into the Emergency Medical Air Transportation and Children’s Coverage Fund. Existing law requires the assessed penalty to continue to be collected, administered, and distributed until exhausted or until December 31, 2022, whichever occurs first. These provisions remain in effect until January 1, 2024, and are repealed effective January 1, 2025.
This bill would extend the assessment of penalties pursuant to the above-described provisions until December 31, 2022, and would extend the collection and transfer of penalties until December 31, 2023. By extending the length of time a county is required to collect and transfer the fines imposed, the bill would impose a state-mandated local program.
(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 authorizes an eligible provider to receive increased reimbursement, by application of an add-on increase to the associated Medi-Cal fee-for-service payment schedule, for emergency medical transports provided to applicable Medi-Cal beneficiaries, and excludes air ambulances from that increased reimbursement.

Commencing January 1, 2023, this bill would require the department to set and maintain Medi-Cal reimbursement rates for air ambulance services provided by fixed or rotary wing aircraft at 80% of the Medicare program reimbursement rate of the applicable common procedure terminology code, and would authorize the department to establish those rates by various means, including provider bulletins. The bill would limit the amounts a noncontracting emergency medical transport provider may collect if the beneficiary received medical assistance other than through enrollment in a Medi-Cal managed care health plan to the Medi-Cal fee-for-service reimbursement rate, as described above.

Effective January 1, 2023, subject to appropriation by the Legislature, this bill would require the department to design and implement a supplemental payment program for emergency medical air transportation services to increase the Medi-Cal reimbursement in an amount not to exceed normal and customary charges charged by qualified emergency medical air transportation providers. The bill would require the department to seek any necessary federal approvals to implement these provisions and would make these provisions inoperative if the federal Centers for Medicare or Medicaid Services denies approval for the implementation of these provisions, if the Legislature fails to appropriate funds, as specified, or if a lawsuit related to this implementation is filed against the state and a preliminary injunction or other order is issued that results in a financial disadvantage to the state, including, but not limited to, a loss of federal financial participation. The bill would authorize the department to implement, interpret, or make specific these provisions, in whole or in part, and any applicable federal waivers and state plan amendments by means of plan letters, plan or provider bulletins, or similar instructions without taking any further regulatory action.
(3) 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.
(4) This bill would declare that it is to take effect immediately as an urgency statute.
Vote: 2/3   Appropriation: NO   Fiscal Committee: YES   Local Program: YES  

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


SECTION 1.

 The Legislature finds and declares all of the following:
(a) Penalty assessments have been used to fund an increasing number of programs that should properly be funded by broad-based financing mechanisms.
(b) The ever-increasing reliance on penalty assessments to fund core state programs is a regressive financing mechanism, and is particularly harmful to individuals who can least afford these assessments. High fines and assessments can perpetuate a cycle of poverty and inequality, given that individuals with lower incomes are more likely to miss payments and suffer the consequences.
(c) It is in the state’s interest to ensure funding for emergency medical air transportation is sufficient to maintain access to these critical services for Medi-Cal beneficiaries and all individuals in California.
(d) Therefore, it is the intent of the Legislature to reimburse for these services using appropriately broad-based funding sources, such as the General Fund, and cease reliance on penalty assessment revenue to fund these services.
(e) Accordingly, it is the intent of the Legislature to cease the collection of penalty assessments on January 1, 2023, pursuant to the Emergency Medical Air Transportation Act.

SEC. 2.

 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, the following definitions apply:
(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. The 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, and to calculate the other additional penalties levied pursuant to this chapter.
(d) The court that imposed the fine shall transfer, in accordance with the procedures set out in Section 68101, 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 December 31, 2022. Penalties assessed before December 31, 2022, shall continue to be collected, administered, and distributed pursuant to this section until exhausted or until December 31, 2023, whichever occurs first. On December 31, 2023, 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 become inoperative on July 1, 2024, and, as of January 1, 2025, is repealed.

SEC. 3.Section 14124.15 is added to the Welfare and Institutions Code, immediately following Section 14124.14, to read:
14124.15.

(a)Effective January 1, 2023, the department shall set and maintain Medi-Cal reimbursement rates for air ambulance services provided by fixed or rotary wing aircraft at 80 percent of the Medicare program reimbursement rate of the applicable common procedure terminology code.

(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 noncontracting emergency medical transport providers described in subdivision (a), consistent with Section 1396u-2(b)(2)(D) of Title 42 of the United States Code. Commencing in the calendar year beginning January 1, 2023, and for each calendar year thereafter for which this section is operative, the amounts a noncontracting emergency medical transport provider may 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 Medi-Cal fee-for-service reimbursement rate, as specified in subdivision (a).

(c)Notwithstanding the rulemaking provisions of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the director may establish and update the Medi-Cal reimbursement rates for air ambulance services described in this section by means of a provider bulletin or manual, or similar instructions.

SEC. 3.

 Section 14124.15 is added to the Welfare and Institutions Code, immediately following Section 14124.14, to read:

14124.15.
 (a) Effective January 1, 2023, subject to appropriation by the Legislature, the department shall design and implement a supplemental payment program for emergency medical air transportation services to increase the Medi-Cal reimbursement in an amount not to exceed normal and customary charges charged by qualified emergency medical air transportation providers.
(b) Notwithstanding the rulemaking provisions of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section, in whole or in part, and any applicable federal waivers and state plan amendments by means of plan letters, plan or provider bulletins, or similar instructions without taking any further regulatory action.
(c) In implementing this section, the department shall seek any federal approvals it deems necessary. This section shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available and is not otherwise jeopardized.
(d) This section shall become inoperative if any of the following occurs:
(1) The federal Centers for Medicare and Medicaid Services denies approval for the implementation of this section.
(2) The Legislature fails to appropriate moneys for the program in the annual Budget Act, or fails to appropriate such moneys in a separate bill enacted within 30 days following enactment of the annual Budget Act.
(3) A lawsuit related to this section is filed against the state and a preliminary injunction or other order has been issued that results in a financial disadvantage to the state, including, but not limited to, a loss of federal financial participation.

SEC. 4.

 No reimbursement is required by this act pursuant to Section 6 of Article XIII B of the California Constitution because a local agency or school district has the authority to levy service charges, fees, or assessments sufficient to pay for the program or level of service mandated by this act, within the meaning of Section 17556 of the Government Code.

SEC. 5.

 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:
To protect the health and safety of Medi-Cal beneficiaries after the current penalty expires on July 1, 2021, this act is needed to continue the assessment and associated program, and it is necessary that this act take effect immediately.