Bill Text: CA AB1705 | 2019-2020 | Regular Session | Amended

California Assembly Bill 1705 (Prior Session Legislation)

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

Amended IN Assembly May 16, 2019

Amended IN Assembly April 11, 2019

Amended IN Assembly March 28, 2019

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 Section 14129 of, to amend and repeal Section 14105.94 of, and to add Section 14105.945 to, 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 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 eligible 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 the above-described eligible providers. 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 delete the provisions relating to the modified supplemental reimbursement program, and would repeal these provisions on July 1, 2021. The bill, subject to any necessary federal approvals, would require the department to implement, by commencing July 1, 2021, ~~a modified program~~ the Public Provider Intergovernmental Transfer Program (program) for ~~supplemental~~ reimbursement of Medi-Cal ground emergency medical transportation ~~services (“modified program”), which would include an intergovernmental transfer program,~~ services, and to terminate the existing supplemental Medi-Cal reimbursement upon the implementation of the ~~modified~~ program. The bill would require the eligible providers to participate in the ~~modified~~ program, and ~~to receive reimbursement in accordance with~~ would require the rate of reimbursement to be developed pursuant to a specified calculation that includes several components, such as ~~the amount paid to the provider using the established Medi-Cal~~ the schedule of maximum ~~allowance rates.~~ allowances rate under the Medi-Cal program. The bill would require a governmental entity to be responsible for performing various tasks related to the modified program, including facilitating communication between 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. Medi-Cal managed care health plans and noncontract emergency medical transport providers to comply with specified federal standards relating to the provision of payment for emergency medical transportation services. The bill would impose duties on an eligible provider who seeks reimbursement under this program, such as certifying that the claimed expenditures for the ground emergency medical transportation services are eligible for federal financial participation. The bill would require eligible providers participating in the ~~modified~~ program to reimburse the department for specified costs, including those associated with administering the ~~modified~~ program. The bill would require the department to cease operation of the ~~modified~~ program if the department determines that the implementation of the ~~modified~~ program is no longer financially and programmatically supportive of the Medi-Cal program.

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, including to enhance federal financial participation for ambulance services under the Medi-Cal program. Existing law requires each emergency medical transport provider to report to the department specified data and material, including the number of actual emergency medical transports by payer type. The act increases Medi-Cal reimbursement to emergency medical transport providers for emergency medical transports.

This bill would, upon the date that the department obtains federal approval to implement the ~~modified~~ program or the implementation date of the ~~modified~~ program, whichever occurs last, 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.

Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO

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), may, 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.

(b) A provider shall be eligible for supplemental reimbursement if the provider has all of the following characteristics continuously during a state fiscal year:

(1) Provides ground emergency medical transportation services to Medi-Cal beneficiaries.

(2) Is a provider that is enrolled as a Medi-Cal provider for the period being claimed.

(3) 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.

(1) The supplemental reimbursement to an eligible provider, as described in subdivision (b), shall be equal to the amount of federal financial participation received as a result of the claims submitted pursuant to paragraph (2) of subdivision (f).

(2) The amount certified pursuant to paragraph (1) of subdivision (e), when combined with the amount received from all other sources of reimbursement from the Medi-Cal program, shall not exceed 100 percent of actual costs, as determined pursuant to the Medi-Cal State Plan, for ground emergency medical transportation services.

(3) The supplemental 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 supplemental reimbursement described in this section without any expenditure from the General Fund. 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 supplemental reimbursement 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) of subdivision (b) and certified to the state as provided in subdivision (e).

(e) Participation in the program by an eligible provider described in this section is voluntary. If an applicable governmental entity elects to seek supplemental reimbursement pursuant to this section on behalf of an eligible provider owned or operated by the entity, as described in paragraph (3) of subdivision (b), 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.

(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 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 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) This section shall remain in effect only until July 1, 2021, and as of that date is repealed.

SEC. 2.

Section 14105.945 is added to the Welfare and Institutions Code, to read:

14105.945.

(a) ~~The following definitions apply for purposes of this section:~~

~~(1)“Eligible~~ For purposes of this section, “eligible provider” means a provider who is eligible for ~~supplemental~~ reimbursement of Medi-Cal ground emergency medical transportation services pursuant to this section and who continually meets all of the following requirements during the state fiscal year:

~~(A)~~

(1) Provides ground emergency medical transportation services to Medi-Cal beneficiaries.

~~(B)~~

(2) Is enrolled as a Medi-Cal provider for the period being claimed.

~~(C)~~

(3) 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)“Modified program” means a modified program for supplemental reimbursement of Medi-Cal ground emergency medical transportation services, as established pursuant to this section, and shall include an intergovernmental transfer program.

(b) By Commencing July 1, 2021, the department shall implement the ~~modified program~~ Public Provider Intergovernmental Transfer Program (program) pursuant to this section, and shall ensure that the ~~modified~~ program has no additional impact on state General Fund expenditures. Upon the implementation of the ~~modified~~ program, the department shall terminate supplemental Medi-Cal reimbursements of Medi-Cal ground emergency medical transportation services as prescribed in Section 14105.94.

(c) (1) To the extent authorized under federal and state law, an eligible provider shall participate in the ~~modified~~ program, and ~~shall receive, in addition to the~~ receive a rate of ~~payment that the provider would otherwise receive~~ reimbursement for Medi-Cal ground emergency medical transportation ~~services, supplemental Medi-Cal reimbursement under the modified program.~~ services that is based on 100 percent of all eligible providers’ costs of providing those services to Medi-Cal beneficiaries, as determined pursuant to subdivision (d).

(2) An eligible provider, as a condition of ~~receiving supplemental reimbursement~~ participating in the program 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.

(d) ~~An eligible provider’s reimbursement under the modified~~ The rate of reimbursement to be provided under the program shall ~~be calculated and paid as follows:~~ be developed pursuant to both of the following:

~~(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 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)(A)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 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 specified 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.
(1) The department shall calculate a statewide rate that is based on the most recent cost reports, as approved by the federal Centers for Medicare and Medicaid Services, and developed in accordance with the provisions of former Section 14105.94.
(2) The statewide rate shall be the sum of the established schedule of maximum allowances rate under the Medi-Cal program and an amount that represents the difference between both of the following:
(A) The schedule of maximum allowances rate under the Medi-Cal program.
(B) The average cost of providing Medi-Cal ground emergency medical transportation services under the Medi-Cal program, as determined by the providers’ cost reports pursuant to paragraph (1).
(e) Consistent with paragraph (4) of subdivision (j), an eligible provider shall complete a cost report, as approved by the federal Centers for Medicare and Medicaid Services, every three years. The statewide rate shall be adjusted annually. The adjustment shall be based on all eligible providers’ most recently submitted cost reports or by other similar means, as determined by the department.
~~(B)~~

(f) The nonfederal share of the ~~reimbursement~~ difference between the Medi-Cal base rate and the average cost that is 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 ~~subparagraph (C) of paragraph (1)~~ paragraph (3) of subdivision (a) and transferred to the state.

(g) (1) A 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 ground emergency medical transportation services, 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.
(2) Effective July 1, 2021, and for each state fiscal year thereafter, and pursuant to Section 1396u-2(b)(2)(D) of Title 42 of the United States Code, a noncontract emergency medical transport provider shall accept as payment in full no more than the amount that the provider would collect if the beneficiary received medical assistance other than through their enrollment in a Medi-Cal managed health care plan, and this amount shall be equal to the resulting reimbursement amount that is calculated pursuant to this section.
~~(e)~~

(h) The Medi-Cal reimbursement provided by this section shall be exclusively distributed 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.

(i) The department, in consultation with eligible providers, as defined in subdivision (a), shall develop and maintain a protocol to determine the available funding for the nonfederal share associated with payments for each state fiscal year pursuant to this section.
~~(f)An applicable governmental entity~~

(j) An eligible provider shall be responsible for seeking the ~~supplemental~~ reimbursement of Medi-Cal ground emergency medical transportation services ~~on behalf of an eligible provider owned or operated by the entity, as described in subparagraph (C) of paragraph (1) of subdivision (a), and the governmental entity~~ under this section, and shall do all of the following:

(2) Provide evidence supporting the certification as specified by the department.

(3) Submit ~~data~~ data, as specified by the ~~department~~ department, to determine the appropriate amounts to claim as expenditures qualifying for federal financial participation.

(4) Complete a cost report, as approved by the federal Centers for Medicare and Medicaid Services, every three years, and submit it to the department.
~~(4)~~

(5) 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)Facilitate communication between the eligible providers and the department.~~
~~(g)~~

(k) (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 ~~annually submit~~ submit annually 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.

~~(h)~~

(l) (1) If 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 is required to 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.

~~(i)~~

(m) 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.

~~(j)~~

(n) (1) The department shall develop, in consultation with the eligible providers, and seek any necessary federal approvals for, the ~~modified~~ program. The nonfederal share of any ~~supplemental~~ additional reimbursement provided under the ~~modified~~ program shall be derived from voluntary intergovernmental transfers of local funds. The ~~modified~~ program shall be implemented to the extent that federal financial participation is available and necessary federal approvals are obtained.

(2) Eligible providers shall be responsible for reimbursing the department for costs associated with administering the ~~modified~~ program, and for any state revenue not obtained due to the government provider exemption from the quality assurance fee pursuant to Section ~~14129, and for the nonfederal share of payments under the modified program.~~ 14129. The department shall not otherwise assess a percentage fee in connection with any intergovernmental transfer of funds made pursuant to this subdivision.

~~(k)~~

(o) The department shall not implement the ~~modified~~ program 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.

~~(l)~~

(p) This section shall cease to be operative on the first day of the state fiscal year beginning on or after the date the department determines, after consultation with the eligible providers, that implementation of this section is no longer financially and programmatically supportive of the Medi-Cal program. ~~This determination shall be based solely on~~ The department shall make this determination if the projected amount of nonfederal share funds available is would be insufficient to support implementation of this section in the subject state fiscal year.

(m)This section 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.” Medi-Cal managed care plans shall be responsible for paying noncontracting government emergency transportation providers an amount equal to the rate established in subdivision (d). The nonfederal share of the payment for paragraph (2) of subdivision (d) shall be paid by intergovernmental transfer from the participating government entity.
~~(n)~~

(q) Upon the date that the department obtains federal approval to implement the ~~modified~~ program or the implementation date of the ~~modified~~ program, whichever occurs last, an eligible provider, as defined in ~~paragraph (1) of~~ subdivision (a), shall be exempt from the Emergency Medical Transportation Reimbursement Act, as established in Article 3.91 (commencing with Section 14129), and the quality assurance fee requirements.

SEC. 3.

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.

(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” excludes transportation of beneficiaries by passenger car, taxicabs, litter vans, wheelchair vans, other forms of public or private conveyances, 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” excludes supplemental amounts received pursuant to Section 14105.94.

(i) (1) “Emergency medical transport provider” means any nonpublic provider of emergency medical transports.

(2) Upon the implementation of the ~~modified program for supplemental reimbursement of Medi-Cal ground emergency medical transportation services, as specified in subdivision (m) of Section 14105.945, “emergency~~ Public Provider Intergovernmental Transfer Program, and consistent with subdivision (q) of Section 14105.945, “emergency medical transport provider” shall exclude 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.