Bill Text: CA AB2577 | 2013-2014 | Regular Session | Amended

California Assembly Bill 2577 (Prior Session Legislation)

NOTE: There are more recent revisions of this legislation. Read Latest Draft

Bill Title: Medi-Cal: ground emergency medical transportation services.

Spectrum: Partisan Bill (Democrat 2-0)

Status: (Vetoed) 2014-09-29 - Vetoed by Governor. [AB2577 Detail]

Download: California-2013-AB2577-Amended.html

BILL NUMBER: AB 2577	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  APRIL 7, 2014
	AMENDED IN ASSEMBLY  MARCH 28, 2014

INTRODUCED BY   Assembly Members Cooley and Pan

                        FEBRUARY 21, 2014

   An act to amend Section 14105.94 of the Welfare and Institutions
Code, relating to Medi-Cal.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 2577, as amended, Cooley. Medi-Cal: ground emergency 
medical  transportation services: supplemental reimbursement.
   Existing law provides for 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 certain
ground emergency medical transportation providers to receive
supplemental Medi-Cal reimbursement in addition to the rate of
payment the provider would otherwise receive for those services.
Existing law provides that participation in the supplemental
reimbursement program by an eligible provider is voluntary, and
requires the nonfederal share of the supplemental reimbursement to be
paid only with funds from specified governmental entities.
   This bill would include, as eligible providers, those that provide
ground emergency medical transportation to Medi-Cal fee-for-service
or managed care beneficiaries. The bill would also authorize the
governmental entities to include, as the nonfederal share of
expenditures for ground emergency medical transportation services,
and in collaboration with the department, voluntary intergovernmental
transfers  (IGTs)  that conform with federal law.  The
bill would provide specific timeframes for the implementation of
these provisions. 
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated 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
only 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 fee-for-service or managed care 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.
   (c) An eligible provider's supplemental reimbursement pursuant to
this section shall be calculated and paid as follows:
   (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) In no instance shall 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, 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. The governmental
entity may elect to include, in collaboration with the department,
and as the nonfederal share of expenditures for ground emergency
medical transportation services, voluntary intergovernmental 
transfers,   transfers (IGTs),  as long as the
 intergovernmental transfers   IGTs  are in
conformity with federal law.  If a governmental entity elects to
include IGTs as the nonfederal share of expenditures, the IGT funds
shall be submitted no later than November 1 of each year. 
   (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.
 If the state receives IGT funds as described in subdivision (e),
the department shall certify the IGT funds as the nonfederal share
of expenditures   within 60 days of receiving the IGT funds.
The Controller shall transfer the federal financial participation
received as a result of claims for expenditures using IGT funds to
  the department within 10 days of receiving the federal
financial participation. 
   (3) The department shall, on an annual basis, 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) The department shall distribute supplemental reimbursement
for eligible ground emergency medical transportation providers for
services provided to Medi-Cal managed care beneficiaries to managed
care plans within 15 days of receiving the federal financial
participation.  
   (2) Each managed care plan shall, within 30 days of receiving
funds under paragraph (1), distribute 100 percent of the funds
received to the eligible ground emergency medical transportation
providers in accordance with subdivision (c).  
   (g) 
    (   h)  (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 Web
site. 
   (h) 
    (   i)  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.