14105.198.

 (a) For dates of service on or after July 1, 2024, the department shall establish a workforce adjustment, as further described in subdivision (b), for each ground ambulance transport performed by a provider of medical transportation services, excluding any eligible provider as defined in Section 14105.945, that meets the workforce standard as described in subdivision (c), as determined by the department.

(b) (1) For emergency ground ambulance transports, the workforce adjustment authorized by this section shall be equal to 80 percent of the lowest maximum allowance established by the federal Medicare Program for the applicable base rate and mileage rate for the transportation service in the ZIP Code of the point of pickup, or, if the point of pickup is without an apparent ZIP Code, the ZIP Code nearest to the point of pickup, reduced by the fee-for-service payment schedule amount for the 2015–16 state fiscal year.

(2) For nonemergency ground ambulance transports, the workforce adjustment authorized by this section shall be equal to 80 percent of the lowest maximum allowance established by the federal Medicare Program for the applicable base rate and mileage rate for the transportation service in the ZIP Code of the point of pickup, or, if the point of pickup is without an apparent ZIP Code, the ZIP Code nearest to the point of pickup, reduced by the fee-for-service payment schedule amount for the 2022–23 state fiscal year.

(c) (1) (A) The workforce standard shall apply to all of the following classes of employees:

(i) Dispatchers certified as an emergency medical dispatcher or an emergency telecommunicator by the International Academies of Emergency Dispatch, any successor organization, or any other state or national certifying organization, as may be determined by the department.

(ii) Certified emergency medical technicians, as defined in Section 1797.80 of the Health and Safety Code.

(iii) Certified advanced emergency medical technicians, as defined in Section 1797.82 of the Health and Safety Code.

(iv) Licensed paramedics, as defined in Section 1797.84 of the Health and Safety Code.

(v) Registered nurses licensed pursuant to Chapter 6 (commencing with Section 2700) of Division 2 of the Business and Professions Code.

(B) A class of employees shall include all employees who meet all of the following:

(i) Are certified or licensed as described in subparagraph (A).

(ii) Are performing duties in the scope of that certification or licensure.

(iii) Are not managers or supervisors.

(2) (A) For the 2024–25 fiscal year, a provider not described in paragraph (3) shall meet the workforce standard if the provider pays a base hourly wage to each employee within a class of employees that is at least 110 percent of the average base hourly wage paid to that employee during the 2023–24 fiscal year.

(B) For the 2025–26 fiscal year, and each subsequent fiscal year, a provider not described in paragraph (3) shall meet the workforce standard if the provider meets both of the following:

(i) Pays each employee described in subparagraph (A) at least the base hourly wage that the provider paid the employee in the 2024–25 fiscal year, increased by the percentage increase of the average maximum allowance established by the federal Medicare Program for ground ambulance transports for the calendar year in which the applicable state fiscal year begins over the average maximum allowance established by the federal Medicare Program for ground ambulance transports for the 2024 calendar year.

(ii) Pays each new employee falling within a class of employees at least the lowest average base hourly wage paid by the provider to an employee in the respective class in the respective county.

(3) (A) For the 2024–25 fiscal year, and each subsequent fiscal year, a new provider of ground ambulance services shall meet the workforce standard in the first year of operating in a county if the provider meets both of the following:

(i) Pays each employee within a class of employees a base hourly wage that is at least the lowest base hourly wage paid by any provider of ground ambulance services to an employee in the respective class in the respective county.

(ii) Pays an average base hourly wage to all employees in each class of employees that is at least the average base hourly wage paid by all providers of ground ambulance services to all employees in the respective class in the respective county.

(B) A new provider of ground ambulance services meeting the workforce standard pursuant to subparagraph (A) shall meet the workforce standard in the second and later years of operating in a county if the provider meets both of the following:

(i) Pays each employee described in subparagraph (A) at least the base hourly wage that the provider paid the employee in its first year of operation, increased by the percentage increase of the average maximum allowance established by the federal Medicare Program for ground ambulance transports for the calendar year in which the applicable state fiscal year begins over the average maximum allowance established by the federal Medicare Program for ground ambulance transports for the calendar year in which the applicable state fiscal year began for the provider’s first year of operation in the county.

(ii) Pays each new employee falling within a class of employees at least the lowest average base hourly wage paid by the provider to an employee in the respective class in the respective county.

(d) (1) (A) For dates of service on or after July 1, 2024, for emergency ground ambulance transports, the department shall direct each Medi-Cal managed care plan to implement a value-based purchasing model that provides for reimbursement to a network provider that meets the workforce standard requirement described in subdivision (c) and that furnishes ambulance transport services to a Medi-Cal beneficiary enrolled in that plan at a rate that is at least the workforce adjustment described in subdivision (b) in addition to the fee-for-service payment schedule amount for the 2015–16 state fiscal year plus the add-on established by subdivision (a) of Section 14129.3.

(B) For dates of service on or after July 1, 2024, for nonemergency ground ambulance transports, the department shall direct each Medi-Cal managed care plan to implement a value-based purchasing model that provides for reimbursement to a network provider that meets the workforce standard requirement described in subdivision (c) and that furnishes ambulance transport services to a Medi-Cal beneficiary enrolled in that plan at a rate that is at least the workforce adjustment described in subdivision (b) in addition to the fee-for-service payment schedule amount for the 2022–23 state fiscal year.

(2) Each applicable Medi-Cal managed care plan shall satisfy its obligation under Section 438.114(c) of Title 42 of the Code of Federal Regulations for ground emergency ambulance transports and shall provide payment for noncontract ground emergency ambulance transports consistent with Section 1396u-2(b)(2)(D) of Title 42 of the United States Code. Consistent with subdivision (b) of Section 14129.3, the amounts a noncontract ground emergency ambulance transport provider could collect if the beneficiary received medical assistance other than through enrollment in a Medi-Cal managed care plan pursuant to Section 1396u-2(b)(2)(D) of Title 42 of the United States Code shall be the sum of the workforce adjustment described in subdivision (b), if applicable, the fee-for-service payment schedule amount for the 2015–16 state fiscal year, plus the add-on established by subdivision (a) of Section 14129.3 for ground emergency ambulance transports.

(e) (1) The department shall establish the manner and format for participating providers of medical transports by ambulance to report the data required pursuant to this section.

(2) The department may establish an internet website for the submission of reports required by this section.

(3) Prior to each state fiscal year, a provider of medical transports by ambulance may submit an attestation to the department that it has established wages for the state fiscal year meeting the workforce standard. The department shall add the workforce adjustment established pursuant to this section to payments to a provider that attests pursuant to this paragraph.

(4) Upon the conclusion of each state fiscal year, each provider that has received the workforce adjustment established pursuant to this section shall certify under penalty of perjury that it met the workforce standard during the state fiscal year with such supporting data as may be determined by the department.

(5) Interest shall be assessed on any workforce adjustments paid to a provider during a state fiscal year in which the provider does not meet the workforce standard 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 upon which the workforce adjustment was paid to the provider.

(6) The department may recoup any workforce adjustments paid to a provider for dates of service in a state fiscal year in which the provider does not meet the workforce standard by deducting the workforce adjustments from any Medi-Cal reimbursement payments owed to the emergency medical transport provider until the full amount of the workforce adjustments and interest are recovered. Any deduction made pursuant to this subdivision shall be made only after the department gives the provider written notification, which may be appealed pursuant to Section 14171.

(f) Notwithstanding any other law, implementation of the workforce adjustment pursuant to this section shall not affect the calculation of the add-on established by Section 14129.3, except as it may be adjusted pursuant to subdivision (b) of Section 14129.6. The calculation of the quality assurance fee rate shall be based on the methodology and reimbursement rate in effect as of January 1, 2023, except as it may be adjusted pursuant to subdivision (b) of Section 14129.6.

(g) This section shall be implemented only to the extent that any necessary federal approvals have been obtained and federal financial participation is available. The director shall promptly seek to obtain approval from the federal Centers for Medicare and Medicaid Services for the workforce adjustment, and may not make any workforce adjustment pursuant to this section prior to obtaining that approval. Only to the minimum extent necessary to obtain federal approval and after exercising the authority established in subdivision (b) of Section 14129.6 to the full extent permitted, the director may adjust the workforce adjustment described in subdivision (b).

14129.3.

 (a) Except as provided in subdivision (i) of Section 14105.945, 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 2018–19 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 2018–19 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 2015–16 state fiscal year, the add-on increase, and any applicable workforce adjustment pursuant to Section 14105.198.

(b) (1) 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.

(2) This subdivision shall not apply to an eligible provider, as defined in paragraph (1) of subdivision (a) of Section 14105.945, who provides noncontract emergency medical transports to an enrollee of a Medi-Cal managed care plan during any Medi-Cal managed care rating period that Section 14105.945 is implemented.

(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 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 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 that a quality assurance fee payment obligation exists for emergency medical transport providers.