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  MAY 4, 2009
	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) 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
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 QUALITY
ASSURANCE FEE


   1799.300.  (a) As a condition of participation in the Medi-Cal
program, for each ambulance transportation services provider 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 provider shall be based on
the revenue received by the provider from the provision of 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 quality assurance fee shall be calculated as follows:

   (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 a quarterly basis on or before the last fiscal day of the fiscal
quarter following the fiscal quarter for which the fee was imposed,
except as provided in subdivision (d) of Section 1799.300. 
   (b) In order for the department to verify the accuracy of the
quality assurance fee paid, each provider paying a quality assurance
fee shall submit with the fee paid, in a form prescribed by the
department, data on the gross receipts from the provision of
ambulance transportation services provided during the fiscal quarter
for which the fee is being paid.  
   (b) 
    (c)  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. 
   (c) 
    (d)  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 quality assurance fee for any provider in a
particular state fiscal year does not exceed 5.5 percent of the
revenue derived by a provider subject to the fee from the provision
of ambulance transportation services.
   1799.306.  (a) This article shall be implemented only if, and as
long as, 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.
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