Bill Text: CA AB1705 | 2019-2020 | Regular Session | Amended
NOTE: There are more recent revisions of this legislation. Read Latest Draft
Bill Title: Medi-Cal: emergency medical transportation services.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Passed) 2019-10-07 - Chaptered by Secretary of State - Chapter 544, Statutes of 2019. [AB1705 Detail]
Download: California-2019-AB1705-Amended.html
may, shall, 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.
Bill Title: Medi-Cal: emergency medical transportation services.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Passed) 2019-10-07 - Chaptered by Secretary of State - Chapter 544, Statutes of 2019. [AB1705 Detail]
Download: California-2019-AB1705-Amended.html
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Amended
IN
Assembly
March 28, 2019 |
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Amended
IN
Assembly
March 18, 2019 |
CALIFORNIA LEGISLATURE—
2019–2020 REGULAR SESSION
| Assembly Bill | No. 1705 |
| Introduced by Assembly Member Bonta |
February 22, 2019 |
An act to amend Sections 14105.94 and 14129 of the Welfare and Institutions Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 1705, as amended, Bonta.
Medi-Cal: emergency medical transportation services.
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, the Medi-Cal Emergency Medical Transportation Reimbursement Act, commencing July 1, 2018, and subject to federal approval and the availability of federal financial participation, imposes a quality assurance fee for each emergency medical transport provided by an emergency medical transport provider subject to the fee in accordance with a prescribed methodology. Existing law requires the Director of Health Care Services to deposit the collected quality assurance fee into the continuously appropriated Medi-Cal Emergency Medical Transport Fund, for
exclusive use in a specified order of priority to enhance federal financial participation for ambulance services under the Medi-Cal program, and to provide additional reimbursement to, and to support quality improvement efforts of, emergency medical transport providers, to pay for state administrative costs, and to provide funding for health care coverage for Californians. Existing law requires each emergency medical transport provider to report to the department data on specified data and material, including the number of actual emergency medical transports by payer type and on gross receipts, as defined. transports by payer type.
The act increases Medi-Cal reimbursement to emergency medical transport providers for emergency medical transports, as specified.
Existing law authorizes a Medi-Cal provider of ground emergency medical transportation services, that is owned or operated by the state, a city, county, city and county, fire protection district, special district, community services district, health care district, or a federally recognized Indian tribe, to receive supplemental Medi-Cal reimbursement in addition to the rate of payment the provider would otherwise receive for those services. Existing law requires the department to develop a modified supplemental reimbursement program, with necessary federal approvals, that would seek to increase the reimbursement to an eligible provider, as specified. provider.
Existing law requires the nonfederal share of any supplemental reimbursement provided under the modified program to be derived from voluntary intergovernmental transfers of local funds. Existing law states the Legislature’s intent in enacting these provisions to provide the supplemental reimbursement without any expenditure from the General Fund.
This bill would exempt the above-described providers owned or operated by the specified governmental entities from the Medi-Cal Emergency Medical Transportation Reimbursement Act and the quality assurance fee requirements.
The bill, subject to any necessary federal approvals, would change the calculation of the supplemental Medi-Cal reimbursement by requiring those governmental entities to participate in a managed care intergovernmental transfer program.
program, and would require the above-described providers to participate in the modified supplemental reimbursement program. The bill would require a governmental entity to be responsible for performing various tasks related to the modified supplemental reimbursement program, including facilitating communication between specified eligible providers that participate in that program and the department. The bill would require the combined amounts of payment under the new calculation to equal 100% of projected costs for ground emergency medical transportation services by each qualified provider. The bill would require the department to review and evaluate providers’ requests for rate changes and make adjustments to those rates, as specified.
The bill would require that the department be reimbursed for costs
eligible providers participating in the modified supplemental reimbursement program to reimburse the department for specified costs, including those
associated with administering the modified program and for any state revenue not obtained due to government providers being exempted from the quality assurance fee. supplemental reimbursement program. The bill would require the department to terminate that program if eligible providers participating in the modified supplemental reimbursement program fail to contribute to a specified nonfederal share or the modified program results in an additional impact on state General Fund expenditures.
The bill would also make technical, nonsubstantive changes to the above-described provisions.
Digest Key
Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NOBill Text
The people of the State of California do enact as follows:
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),(b) (1) 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)
(A) Provides ground emergency medical transportation services to Medi-Cal beneficiaries.
(2)Is a provider that is
(B) Is
enrolled as a Medi-Cal provider for the period being claimed.
(3)
(C) 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.
(2) A provider who possesses the characteristics described in paragraph (1) shall also participate in the modified program described in paragraph (1) of subdivision (i).
(c) An eligible provider’s 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.
(2) An additional payment to an eligible provider, as
described in
paragraph (1) of subdivision (b), that shall be equal to the amount of federal financial participation received as a result of the claims submitted and, if applicable, the amount of intergovernmental transfer funds needed to claim the federal share.
(3) The amount claimed and paid pursuant to paragraph (1), when combined with the amount received
pursuant to paragraph (2) or from all other sources of reimbursement from the Medi-Cal program, shall equal 100 percent of projected costs, as determined pursuant to the Medi-Cal State Plan, for ground emergency medical transportation services by each qualified provider. The provider’s rate as prescribed in paragraph (2) shall be adjusted annually every 36 months 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.
(4) The 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 The supplemental reimbursement described in this section without any expenditure from the General Fund.
shall have no additional impact on state General Fund expenditures. 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 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)
subparagraph (C) of paragraph (1) of subdivision (b) and transferred to the state.
(e) Participation in the program by an eligible provider described in this section is voluntary. If an applicable mandatory. An applicable governmental entity elects to seek shall be responsible for seeking reimbursement pursuant to
paragraph (2) of subdivision (c) on behalf of an eligible provider owned or operated by the entity, as described in paragraph (3) subparagraph (C) of paragraph (1) of subdivision (b), and 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).
(6) Facilitate communication between the eligible providers and the department.
(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, shall annually
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 website.
(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
paragraph (1) of 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 modified program shall be implemented by July 1, 2021. 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 (3) of subdivision (c), and only to the extent that federal financial participation is available.
(2) The department shall be reimbursed Eligible providers participating in this program shall be responsible for reimbursing the department for costs associated with administering the modified program described in paragraph (1) in accordance with subdivision (d) and (d), 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.
14129.2, and for the nonfederal share of the payment specified in paragraph (2) of subdivision (c). 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) (1) 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.
(2) The department shall terminate the modified program described in paragraph (1) of subdivision (i) if either of the following occurs:
(A) The eligible providers participating in the modified program fail to contribute to the nonfederal share of the payment described in paragraph (2) of subdivision (c).
(B) The modified program results in an additional impact on state General Fund expenditures.
(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 (Public Law 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 amount” means the product of the 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 transport” does not include excludes transportation of beneficiaries by passenger car, taxicabs, litter vans, wheelchair vans, or other forms of public or private conveyances, nor shall it include and 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” 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” does not include excludes 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
excludes 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, 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.
