Bill Text: CA AB511 | 2009-2010 | Regular Session | Amended

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

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Bill Title: Medi-Cal: ambulance transportation services providers:

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Engrossed - Dead) 2010-06-24 - In committee: Set, first hearing. Hearing canceled at the request of author. [AB511 Detail]

Download: California-2009-AB511-Amended.html

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BILL NUMBER: AB 511	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  APRIL 20, 2009
	AMENDED IN ASSEMBLY  APRIL 13, 2009

INTRODUCED BY   Assembly Member De La Torre

                        FEBRUARY 24, 2009

   An act to add and repeal Chapter 13 (commencing with Section
1799.300)  to  of  Division 2.5 of the
Health and Safety Code, relating to Medi-Cal.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 511, as amended, De La Torre. Medi-Cal: ambulance
transportation services providers: quality assurance fees.
   Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services, under
which health care services, including medical transportation
services, are provided to qualified low-income persons. The Medi-Cal
program is partially governed and funded under federal Medicaid
provisions.
   Existing law establishes a quality assurance fee program for
skilled nursing and intermediate care facilities, as prescribed.
   This bill would provide, as a condition of participation in the
Medi-Cal program, that there be imposed a quality assurance fee on
 certain  ambulance transportation services
providers, to be administered by the Director of Health Care
Services. The proceeds from the fee would be required to be deposited
into the Medi-Cal Ambulance Transportation Services Providers Fund,
which the bill would create. The bill would provide that moneys in
the fund shall, upon appropriation by the Legislature, be available
exclusively to enhance federal financial participation for ambulance
transportation services under the Medi-Cal program or to provide
additional reimbursement to, and to support quality improvement
efforts of, ambulance transportation services providers, including
increased reimbursement for, and improvement of the quality of, the
provision of advanced life support services, as defined. The bill
would provide that these provisions are to be implemented only if,
and as long as, the state receives federal approval for the fee and
legislation is enacted during the 2009-10 Regular Session of the
Legislature that makes an appropriation from the fund and from the
Federal Trust Fund to fund a Medi-Cal rate increase for ambulance
transportation services providers. The bill would provide that it
shall remain operative only as long as certain conditions are met and
if any one of the conditions is not met, its provisions shall become
inoperative and be repealed.
   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.  Chapter 13 (commencing with Section 1799.300) is added
to Division 2.5 of the Health and Safety Code, to read:
      CHAPTER 13.  AMBULANCE TRANSPORTATION SERVICES PROVIDER
 UNIFORM  QUALITY ASSURANCE FEE


   1799.300.  (a) As a condition of participation in the Medi-Cal
program, for each ambulance transportation services provider 
that operates at least one ambulance vehicle certified by the
Department of the California Highway Patrol pursuant to Article 1
(commencing with Section 1100) of Title 13 of the California Code of
Regulations, there shall be imposed each state fiscal year a uniform
quality assurance fee if a certified ambulance vehicle is operated by
the provider during that state fiscal year, or any portion thereof.
The uniform quality assurance fee shall be based upon the revenue
from providing ambulance transportation services under the Medi-Cal
program that is derived by all providers subject to the fee. The
uniform quality assurance fee shall not include the revenue of any
exempt Medi-Cal ambulance transportation services provider that is
exempt pursuant to   that derives revenue from the
provision of ambulance transportation services, there shall be
imposed each state fiscal year a quality assurance fee based on the
provision of ambulance transportation services. The quality assurance
fee shall be assessed on all Medi-Cal ambulance transportation
services providers, except for a Medi-Cal ambulance transportation
services provider that is exempt pursuant to  paragraph (2) of
subdivision (a) of Section 1799.305.
   (b) The amount of the quality assurance fee assessed on  each
 Medi-Cal ambulance transportation services  providers
  provider  shall be based on the 
aggregate revenue received by  providers subject to
the fee   the provider  from the provision of
 Medi-Cal  ambulance transportation services and
shall be calculated in accordance with the methodology outlined in
subdivision (c), in the request for federal approval required by
Section 1799.305, and in regulations, provider bulletins, or similar
instructions.
   (c) The  uniform  quality assurance fee shall be
calculated as follows: 
   (1) For the 2009-10 fiscal year, the State Department of Health
Care Services shall project the aggregate revenue for all providers
subject to the fee received from providing ambulance transportation
services under the Medi-Cal program. The projection shall be based on
data that the department collects from Medi-Cal ambulance
transportation services providers. Once determined, the aggregate
projected revenue derived by all Medi-Cal ambulance transportation
services providers subject to the fee received from the provision of
Medi-Cal ambulance transportation services shall be multiplied by 5.5
percent, as determined under the approved methodology, and then
divided by the number of certified ambulance vehicles operated by the
providers that are subject to the quality assurance fee. The amount
so determined shall be the quality assurance fee that Medi-Cal
ambulance services providers subject to the fee are required to pay.
 
   (2) For the 2010-11 to 2015-16, inclusive, fiscal years, the
department shall project the aggregate revenue for all providers
subject to the fee received from the provision of ambulance
transportation services provided under the Medi-Cal program. The
projection shall be based on data that the department collects from
Medi-Cal ambulance transportation services providers. Once
determined, the projected aggregate revenue derived by all Medi-Cal
providers subject to the fee received from the provision of Medi-Cal
ambulance transportation services shall be multiplied by 5.5 percent,
as determined under the approved methodology, and then divided by
the number of certified ambulance vehicles operated by the providers
that are subject to the fee. The amount so determined shall be the
quality assurance fee that Medi-Cal providers subject to the fee are
required to pay, but in no case shall the fees calculated pursuant to
this paragraph, taken together with applicable licensing fees,
exceed the amounts allowable under federal law. 

    (1) For the 2009-10 fiscal year, the quality assurance fee
for each ambulance transportation services provider shall be
calculated by multiplying the revenue that the ambulance
transportation services provider derived from providing ambulance
transportation services by 5.5 percent, as determined under the
approved methodology. The amount so determined shall be the quality
assurance fee for that ambulance transportation services provider.

    (2) For the 2010-11 to 2015-16, inclusive, fiscal years, the
quality assurance fee for each ambulance transportation services
provider shall be calculated by multiplying the revenue that the
ambulance transportation services provider derived from providing
ambulance transportation services by 5.5 percent, as determined under
the approved methodology. The amount so determined shall be the
quality assurance fee for that ambulance transportation services
provider, but in no case shall the fees calculated pursuant to this
paragraph and collected pursuant to this article, taken together with
applicable licensing fees, exceed the amounts allowable under
federal law. 
   (d) If there is a delay in the implementation of this article for
any reason, including a delay in the approval of the quality
assurance fee and methodology by the federal Centers for Medicare and
Medicaid Services, in the 2009-10 fiscal year or in any other fiscal
year, all of the following shall apply:
   (1) A provider subject to the fee may be assessed the amount the
provider would be required to pay to the department if the
methodology were already approved, but shall not be required to pay
the fee until both the following occur:
   (A) The methodology is approved.
   (B) Medi-Cal rates are increased in accordance with paragraph (2)
of subdivision (a) of Section 1799.306 and the increased rates are
paid to Medi-Cal ambulance transportation services providers.
   (2) The department may retroactively increase and make payment of
rates to Medi-Cal ambulance transportation services providers.
   (3) Providers that have been assessed a fee by the department
shall pay the fee assessed within 60 days of the date rates are
increased in accordance with paragraph (2) of subdivision (a) of
Section 1799.306 and paid to those providers.
   (4) The department shall accept a provider's payment even if the
payment is submitted in a subsequent rate year than the rate year in
which the fee was assessed.
   1799.301.  (a) The quality assurance fee, as calculated pursuant
to Section 1799.300, shall be paid by the providers to the department
on  an annual   a quarterly  basis on or
before the last  fiscal  day of the fiscal  year
  quarter  following the fiscal  year
during   quarter for  which the fee was 
assessed   imposed  , except as provided in
subdivision (d) of Section 1799.300. 
   (b) A provider that is operating a certified ambulance vehicle, as
defined by the Department of the California Highway Patrol, for the
first time, and is participating in the Medi-Cal program, shall
comply with subdivision (a), but it shall only be required to pay a
pro rata quality assurance fee consistent with the time that it
operated the certified ambulance vehicle.  
   (c) 
    (b)  When a provider fails to pay all or part of the
quality assurance fee within 60 days of the date that payment is due,
the department may deduct the unpaid fee and interest owed from any
Medi-Cal reimbursement payments owed to the provider until the full
amount of the fee and interest are recovered. Any deduction made
pursuant to this subdivision shall be made only after the department
gives the provider written notification. Any deduction made pursuant
to this subdivision may be deducted over a period of time that takes
into account the financial condition of the provider. 
   (d) 
    (c)  If all or any part of the quality assurance fee
remains unpaid, the department may assess a penalty on the provider
equal to 50 percent of the unpaid fee amount.
   1799.302.  (a) The Director of Health Care Services, or his or her
designee, shall administer this article.
   (b) The director may adopt regulations as are necessary to
implement this article. These regulations may be adopted as emergency
regulations in accordance with the rulemaking provisions of the
Administrative Procedure Act (Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code).
For purposes of this article, the adoption of regulations shall be
deemed an emergency and necessary for the immediate preservation of
the public peace, health and safety, or general welfare. The
regulations shall include, but need not be limited to, any
regulations necessary for any of the following purposes:
   (1) The administration of this article, including the proper
imposition and collection of the quality assurance fee. The costs
associated with the administration of this article are not to exceed
the amounts reasonably necessary to administer this article.
   (2) The development of any forms necessary to obtain required
information from providers subject to the quality assurance fee.
   (3) To provide details, definitions, formulas, and other
requirements.
   (c) As an alternative to subdivision (b), and 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 implement this article, in whole or in part, by means of
a provider bulletin, or other similar instructions, without taking
regulatory action, provided that no such bulletin or other similar
instructions shall remain in effect after July 31, 2012. It is the
intent of the Legislature that the regulations adopted pursuant to
subdivision (b) be adopted on or before July 31, 2012.
   1799.303.  The department shall deposit the quality assurance fee
collected pursuant to this article in the Medi-Cal Ambulance
Transportation Services Providers Fund, which is hereby created in
the State Treasury. Notwithstanding Section 16305.7 of the Government
Code, the fund shall also include interest and dividends earned on
moneys in the fund.
   1799.304.  Moneys in the Medi-Cal Ambulance Transportation
Services Providers Fund shall, upon appropriation by the Legislature,
be available to exclusively enhance federal financial participation
for ambulance transportation services under the Medi-Cal program or
to provide additional reimbursement to, and to support quality
improvement efforts of, ambulance transportation services providers,
including increased reimbursement for, and improvement of the quality
of, the provision of advanced life support services as defined in
Section 1797.52.
   1799.305.  (a) (1) The department shall request approval from the
federal Centers for Medicare and Medicaid Services for the
implementation of this article.
   (2) The director may alter the methodology specified in this
article, to the extent necessary to meet the requirements of federal
law or regulations or to obtain federal approval. The director may
also add categories of exempt ambulance transportation services
providers or apply a nonuniform fee to ambulance transportation
services providers that are subject to the fee in order to meet
requirements of federal law or regulations. The director may exempt
categories of ambulance transportation services providers from the
fee, if necessary to obtain federal approval.
   (b) The department shall make retrospective adjustments, as
necessary, to the amounts calculated pursuant to Section 1799.300 in
order to ensure that the  aggregate  quality
assurance fee for any  provider in a  particular state
fiscal year does not exceed 5.5 percent of the  aggregate
 revenue derived by  providers   a
provider  subject to the fee from the provision of ambulance
transportation services  under the Medi-Cal program 
.
   1799.306.  (a) This article shall be implemented only if,  and
 as long as,  and  both of the following
conditions are met:
   (1) The state receives federal approval of the quality assurance
fee from the federal Centers for Medicare and Medicaid Services.
   (2) Legislation is enacted during the 2009-10 Regular Session of
the Legislature that makes an appropriation from the Medi-Cal
Ambulance Transportation Services Providers Fund and from the Federal
Trust Fund to fund a Medi-Cal rate increase for ambulance
transportation services providers.
   (b) This article shall remain operative only as long as all of the
following conditions are met:
   (1) The federal Centers for Medicare and Medicaid Services
continues to allow the use of the provider assessment provided in
this article.
   (2) The Medi-Cal rate increase referenced in paragraph (2) of
subdivision (a) remains in effect.
   (3) The full amount of the quality assurance fee assessed and
collected pursuant to this article remains available for the purposes
specified in Section 1799.304 and for related purposes.
   (c) If all of the conditions in subdivision (a) are met, this
article is implemented, and subsequently, any one of the conditions
in subdivision (b) is not met, on and after the date that the
director executes a declaration that makes the determination that any
condition is not met, this article shall become inoperative
notwithstanding that the condition or conditions subsequently may be
met.
   (d) Notwithstanding subdivisions (a), (b), and (c), in the event
of a final judicial determination made by any state or federal court
that is not appealed, or by a court of appellate jurisdiction that is
not further appealed, in any action by any party, or a final
determination by the administrator of the federal Centers for
Medicare and Medicaid Services, that federal financial participation
is not available with respect to any payment made under the
methodology implemented pursuant to this article because the
methodology is invalid, unlawful, or contrary to any provision of
federal law or regulations, or of state law, this article shall
become inoperative.
   (e) This article shall be repealed on the date that it becomes
inoperative.
     ____ CORRECTIONS  Text--Pages 2 and 3.
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