Bill Text: CA SB1300 | 2015-2016 | Regular Session | Enrolled
Bill Title: Medi-Cal: emergency medical transport providers: quality assurance fee.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Vetoed) 2016-11-30 - Last day to consider Governor's veto pursuant to Joint Rule 58.5. [SB1300 Detail]
Download: California-2015-SB1300-Enrolled.html
BILL NUMBER: SB 1300 ENROLLED
BILL TEXT
PASSED THE SENATE AUGUST 25, 2016
PASSED THE ASSEMBLY AUGUST 23, 2016
AMENDED IN ASSEMBLY AUGUST 19, 2016
AMENDED IN ASSEMBLY AUGUST 15, 2016
AMENDED IN ASSEMBLY JUNE 30, 2016
AMENDED IN SENATE MAY 31, 2016
AMENDED IN SENATE APRIL 26, 2016
AMENDED IN SENATE APRIL 5, 2016
INTRODUCED BY Senator Hernandez
FEBRUARY 19, 2016
An act to add Article 3.91 (commencing with Section 14129) to
Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions
Code, relating to Medi-Cal, making an appropriation therefor, and
declaring the urgency thereof, to take effect immediately.
LEGISLATIVE COUNSEL'S DIGEST
SB 1300, Hernandez. Medi-Cal: emergency medical transport
providers: quality assurance fee.
Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services, 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 establishes a quality
assurance fee program for skilled nursing and intermediate care
facilities, as prescribed.
This bill, commencing July 1, 2017, and subject to federal
approval, would impose a quality assurance fee for each emergency
medical transport provided by an emergency medical transport
provider, as defined, subject to the quality assurance fee in
accordance with a prescribed methodology. The bill would authorize
the director to exempt categories of emergency medical transport
providers from the quality assurance fee if necessary to obtain
federal approval. The bill would require the Director of Health Care
Services to deposit the collected quality assurance fee into the
Medi-Cal Emergency Medical Transport Fund, which the bill would
create in the State Treasury, to be continuously appropriated,
thereby making an appropriation, to the department to be used
exclusively 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. The bill, on or
before November 15, 2016, would require each emergency medical
transport provider to report to the department specified data,
including data on gross receipts, as defined, from the provision of
emergency medical transports, as specified, in a manner and form
prescribed by the department and, commencing on January 1, 2017, and
each fiscal quarter thereafter, would require each emergency medical
transport provider to report this data to the department. The bill
would authorize the department to establish an Internet Web site for
the submission of these data reports. The bill would authorize the
department to require a certification by each emergency medical
transport provider, under penalty of perjury, of the truth of these
data reports. By expanding the scope of the crime of perjury, the
bill would impose a state-mandated local program. The bill would
authorize the department, upon written notice to the emergency
medical transport provider, to impose a $100 per day penalty against
the provider for each day that the provider fails to make a report
within 5 business days of the date upon which the data report was
due.
The bill, commencing July 1, 2017, and subject to federal
approval, would increase the Medi-Cal reimbursement to emergency
medical transport providers for 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,
as specified.
The bill would authorize the department to adopt regulations as
necessary to implement these provisions, as specified.
The bill would provide that the provisions of the bill shall cease
to be implemented if any of certain conditions, including withdrawal
of federal approval, are satisfied.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
This bill would declare that it is to take effect immediately as
an urgency statute.
Appropriation: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all of the
following:
(a) The Legislature recognizes the essential role that emergency
medical transport providers play in serving the state's Medi-Cal
beneficiaries. To that end, it has been and remains the intent of the
Legislature to improve funding for emergency medical transport
providers and obtain all available federal funds to make supplemental
Medi-Cal payments to emergency medical transport providers.
(b) It is the intent of the Legislature to impose a quality
assurance fee to be paid by emergency medical transport providers,
which will be used to increase federal financial participation in
order to increase Medi-Cal payments to emergency medical transport
providers.
(c) It is the intent of the Legislature to increase the Medi-Cal
emergency medical transport reimbursement in Medi-Cal fee-for-service
and Medi-Cal managed care by increasing the fee-for-service payment
schedule for emergency medical transports to support quality
improvement efforts by emergency medical transport providers,
including, but not limited to, the provision of advanced life support
services, as defined in Section 1797.52 of the Health and Safety
Code.
(d) It is the further intent of the Legislature that the increased
fee-for-service and Medi-Cal managed care payment schedule amounts
pursuant to this article shall not result in any expenditure from the
General Fund.
SEC. 2. Article 3.91 (commencing with Section 14129) is added to
Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions
Code, to read:
Article 3.91. Medi-Cal Emergency Medical Transportation
Reimbursement Act
14129. For purposes of this article, the following definitions
shall apply:
(a) "Annual quality assurance fee rate" means the quality
assurance fee assessed on each emergency medical transport applicable
to each state fiscal year.
(b) "Aggregate fee schedule increase amount" means the product of
the quotient described in paragraph (2) of subdivision (a) of 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 Transportation
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 Transportation Fund for the applicable 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
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 transports" shall not include transportation of
beneficiaries by passenger car, taxicabs, litter vans, wheelchair
vans, or other forms of public or private conveyances, nor shall it
include 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" shall include 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" shall not include
supplemental amounts received pursuant to Section 14105.94.
(i) "Emergency medical transport provider" means any provider of
emergency medical transports.
(j) "Emergency medical transport provider subject to the fee"
means all emergency medical transport providers 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.
14129.1. (a) On or before November 15, 2016, each emergency
medical transport provider shall report to the department data on the
number of actual emergency medical transports by payor type,
including, without limitation, Medi-Cal fee-for-service emergency
medical transports and Medi-Cal managed care emergency medical
transports, and gross receipts from the provision of emergency
medical transports provided in each quarter from July 1, 2015, to
October 31, 2016, inclusive, in a manner and format prescribed by the
department.
(b) Commencing with the fiscal quarter beginning on January 1,
2017, and each fiscal quarter thereafter, on or before the 45th day
of the quarter, each emergency medical transport provider shall
report to the department data on the number of actual emergency
medical transports by payor type, including, without limitation,
Medi-Cal fee-for-service emergency medical transports and Medi-Cal
managed care emergency medical transports, and gross receipts from
the provision of emergency medical transports provided in the quarter
preceding the quarter in which the report is due, in a manner and
format prescribed by the department.
(c) The department may establish an Internet Web site for the
submission of reports required by this section.
(d) The department may require a certification by each emergency
medical transport under penalty of perjury of the truth of the
reports required under this section. Upon written notice to an
emergency medical transport provider, the department may impose a
penalty of one hundred dollars ($100) per day against an emergency
medical transport provider for every day that an emergency medical
transport provider fails to make a report required by this section
within five days of the date upon which the report was due.
14129.2. (a) Commencing with the state fiscal quarter beginning
on July 1, 2017, and continuing each state fiscal quarter thereafter,
there shall be imposed a quality assurance fee for each emergency
medical transport provided by each emergency medical transport
provider subject to the fee in accordance with this section.
(b) (1) On or before June 15, 2017, and each June 15 thereafter,
the director shall calculate the annual quality assurance fee rate
applicable to the following state fiscal year based on the most
recently collected data collected from emergency medical transport
providers pursuant to Section 14129.1, and publish the annual quality
assurance fee rate on its Internet Web site. In no case shall the
fees calculated pursuant to this subdivision and collected pursuant
to this article exceed the amounts allowable under federal law.
(A) For state fiscal year 2017-18, the annual quality assurance
fee rate shall be calculated by multiplying the projected total
annual gross receipts for all emergency medical transport providers
subject to the fee by 5.1 percent, which resulting product shall be
divided by the projected total annual emergency medical transports by
all emergency medical transport providers subject to the fee for the
state fiscal year.
(B) For state fiscal years 2018-19 and thereafter, the annual
quality assurance fee rate shall be calculated by a ratio, the
numerator of which shall be the sum of the product of the projected
aggregate fee schedule amount and the effective state medical
assistance percentage, and the amount described in subparagraph (A)
of paragraph (2) of subdivision (f), and the denominator of which
shall be 90 percent of the projected total annual emergency medical
transports by all emergency medical transport providers subject to
the fee for the state fiscal year.
(2) On or before June 15, 2017, and each June 15 thereafter, the
director shall publish the annual quality assurance fee rate on its
Internet Web site.
(3) In no case shall the fees calculated pursuant to this
subdivision and collected pursuant to this article exceed the amounts
allowable under federal law. If, on or before June 15 of each year,
the director makes a determination that the fees collected pursuant
to this subdivision exceed the amounts allowable under federal law,
the director may reduce the increased fee-for-service payment
schedule described in Section 14129.3 only to the extent necessary to
reduce the fees calculated pursuant to this subdivision to comply
with the amount allowable under federal law.
(4) If, during a state fiscal year, the actual or projected
available fee amount exceeds or is less than the actual or projected
aggregate fee schedule amount by more than 1 percent, the director
shall adjust the annual quality assurance fee rate so that the
available fee amount for the state fiscal year will approximately
equal the aggregate fee schedule amount for the state fiscal year.
The available fee amount for a state fiscal year will be considered
to equal the aggregate fee schedule amount for the state fiscal year
if the difference between the available fee amount for the state
fiscal year and the aggregate fee schedule amount for the state
fiscal year constitutes less than 1 percent of the aggregate fee
schedule amount for the state fiscal year.
(c) (1) Each emergency medical transport provider subject to the
fee shall remit to the department an amount equal to the annual
quality assurance fee rate for the 2017-18 state fiscal year
multiplied by the number of transports reported or that should have
been reported by the emergency medical transport provider pursuant to
subdivision (b) of Section 14129.1 in the quarter commencing April
1, 2017, based on a schedule established by the director. The
schedule established by the director for the fee payment described in
this paragraph shall require remittance of the fee payment according
to the following guidelines:
(A) The director shall require an emergency medical transport
provider that rendered 35,000 or more Medi-Cal fee-for-service
emergency medical transports during the 2016 calendar year to remit
the fee payment described in this paragraph on or after June 20,
2017.
(B) The director shall require an emergency medical transport
provider that rendered fewer than 35,000 Medi-Cal fee-for-service
emergency medical transports during the 2016 calendar year to remit
50 percent or less of the fee payment described in this paragraph on
or after July 1, 2017.
(C) The director shall require an emergency medical transport
provider that rendered fewer than 35,000 Medi-Cal fee-for-service
emergency medical transports during the 2016 calendar year to remit
any remaining fee payment amount described in this paragraph on or
after August 15, 2017.
(2) Commencing with the state fiscal quarter beginning on October
1, 2017, and each state fiscal quarter thereafter, on or before the
first day of each state fiscal quarter, each emergency medical
transport provider subject to the fee shall remit to the department
an amount equal to the annual quality assurance fee rate for the
applicable state fiscal year multiplied by the number of transports
reported or that should have been reported by the emergency medical
transport provider pursuant to subdivision (b) of Section 14129.1 in
the immediately preceding quarter.
(d) (1) Interest shall be assessed on quality assurance fees not
paid on the date due at the greater of 10 percent per annum or the
rate at which the department assesses interest on Medi-Cal program
overpayments to hospitals that are not repaid when due. Interest
shall begin to accrue the day after the date the payment was due and
shall be deposited in the Medi-Cal Emergency Medical Transport Fund
established in subdivision (f).
(2) In the event that any fee payment is more than 60 days
overdue, 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, interest, and any penalties assessed
under this article 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.
(3) In the event that any fee payment is more than 60 days
overdue, a penalty equal to the interest charge described in
paragraph (1) shall be assessed and due for each month for which the
payment is not received after 60 days.
(e) The department shall accept an emergency medical transport
provider's payment even if the payment is submitted in a rate year
subsequent to the rate year in which the fee was assessed.
(f) (1) The director shall deposit the quality assurance fee
collected pursuant to this section in the Medi-Cal Emergency Medical
Transport Fund, which is hereby created in the State Treasury and,
notwithstanding Section 13440 of the Government Code, is continuously
appropriated without regard to fiscal years to the department for
the purposes specified in this article. Notwithstanding Section
16305.7 of the Government Code, the fund shall also include interest
and dividends earned on moneys in the fund.
(2) The moneys in the Medi-Cal Emergency Medical Transport Fund,
including any interest and dividends earned on money in the fund,
shall be available exclusively 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, as
well as to pay for the state's administrative costs and to provide
funding for health care coverage for Californians, in the following
order of priority:
(A) To pay for the department's staffing and administrative costs
directly attributable to implementing this article, not to exceed the
following amounts:
(i) For the 2016-17 fiscal year, one million three thousand
dollars ($1,003,000), exclusive of any federal matching funds.
(ii) For the 2017-18 fiscal year and each fiscal year thereafter,
three hundred seventy-four thousand dollars ($374,000), exclusive of
any federal matching funds.
(B) To pay for the health care coverage in each fiscal year in the
amount of 10 percent of the projected quality assurance fee revenue
for that fiscal year, as calculated by the department on or before
June 15 preceding that fiscal year, exclusive of any federal matching
funds.
(C) To make increased payments to emergency medical transport
providers pursuant to this article.
14129.3. (a) Effective July 1, 2017, the Medi-Cal fee-for-service
payment schedule governing reimbursement to emergency medical
transport providers for emergency medical transports shall be
increased. The increase to the fee-for-service payment schedule under
this section shall be calculated on or before June 15, 2017, and
shall remain the same for later fiscal years. The increase to the
fee-for-service payment schedule under this section shall apply only
to those billing codes identified in, or any equivalent, predecessor,
or successor billing codes as may be determined by the director
pursuant to, subdivision (g) of Section 14129. The department shall
calculate the projections required by this subdivision based on the
data submitted pursuant to Section 14129.1. The resulting
fee-for-service payment schedule amounts after the application of
this section shall be equal to the sum of both of the following:
(1) The Medi-Cal fee-for-service payment schedule amount for the
state fiscal year 2015-16.
(2) The quotient of the available fee amount projected by the
department on or before June 15, 2017, for the state fiscal year
2017-18, divided by the total 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 these billing codes projected by the department on or
before June 15, 2017, for the state fiscal year 2017-18.
(b) Each 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 emergency medical transports by providing
payment to emergency medical transport providers that is equal to the
amount of payment described in Section 1396u-2(b)(2)(D) of Title 42
of the United States Code.
(c) The fee-for-service and Medi-Cal managed care payment schedule
increase established pursuant to this section shall be funded solely
from the following:
(1) The quality assurance fee set forth in Section 14129.2, along
with any interest or other investment income thereon.
(2) Federal reimbursement and any other related federal funds.
(d) The proceeds of the quality assurance fee set forth in Section
14129.2, the matching amount provided by the federal government, and
any interest earned on those proceeds shall be used to supplement
existing funding for emergency medical transports provided by
emergency transport providers and not supplant this funding.
14129.4. If there is a delay in the implementation of this
article for any reason, including a delay in any required approval of
the quality assurance fee and reimbursement methodology specified by
the federal Centers for Medicare and Medicaid Services, all of the
following shall apply:
(a) An emergency transport provider subject to the fee may be
assessed the amount the provider would be required to pay to the
department if the fee-for-service payment schedule increases
described in Section 14129.3 were already approved, but shall not be
required to pay the fee until the fee-for-service payment schedule
increases described in Section 14129.3 are approved. The director
shall establish a schedule for payment of retroactive fees pursuant
to this subdivision in consultation with emergency medical transport
providers to minimize the disruption to the cashflow of emergency
medical transport providers.
(b) The department may retroactively increase and make payment of
supplemental rates to emergency medical transport providers pursuant
to Section 14129.3.
14129.5. (a) The director 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 first 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 of the quality assurance fee and process for its
collection, reporting, and refunds. 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) The provision of details, definitions, formulas, and other
requirements.
(c) As an alternative to subdivision (b), and notwithstanding 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), 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 June 30, 2018. It is the intent of the Legislature that
the regulations adopted pursuant to subdivision (b) be adopted on or
before June 30, 2018.
(d) The director shall ensure that the quality assurance fee per
transport imposed pursuant to this article is collected.
14129.6. (a) The department shall request approval from the
federal Centers for Medicare and Medicaid Services for the use of
fees collected pursuant to this article for the purpose of receiving
federal matching funds.
(b) 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. If the director,
after consulting with affected emergency medical transport providers,
determines that an alteration is needed, the director shall execute
a declaration stating that this determination has been made. The
director shall retain the declaration and provide a copy, within five
working days of the execution of the declaration, to the fiscal and
appropriate policy committees of the Legislature.
(c) The director may add categories of exempt emergency medical
transport providers or apply a nonuniform fee per transport to
emergency medical transport providers that are subject to the fee in
order to meet requirements of federal law or regulations. The
director may exempt categories of emergency medical transport
providers from the fee if necessary to obtain federal approval.
14129.7. (a) This article shall be implemented only if, and as
long as, all of the following conditions are met:
(1) The federal Centers for Medicare and Medicaid Services does
not determine that the quality assurance fee revenues may not be used
for the purposes set forth in this article.
(2) The state receives federal approval for the increased
fee-for-service payment schedule increases described in subdivision
(a) of Section 14129.3.
(3) The state continues its maintenance of effort for the level of
state funding of emergency medical transports reimbursement for the
2017-18 rate year, and for every subsequent rate year, in an amount
not less than the amount that the state would have paid for the same
number of emergency medical transports under the rate methodology
that was in effect on July 31, 2016.
(b) This article shall cease to be implemented if one of the
following conditions is satisfied:
(1) The federal Centers for Medicare and Medicaid Services no
longer allows the use of the provider assessment provided in this
article.
(2) The Medi-Cal fee-for-service payment schedule increase
described in subdivision (a) of Section 14129.3 no longer remains in
effect.
(3) The quality assurance fee assessed and collected pursuant to
this article is no longer available for the purposes specified in
this article.
(4) A final judicial determination by the California Supreme Court
or any California Court of Appeal that the revenues collected
pursuant to this article that are deposited in the Medi-Cal Emergency
Medical Transport Fund are either of the following:
(A) "General Fund proceeds of taxes appropriated pursuant to
Article XIII B of the California Constitution," as used in
subdivision (b) of Section 8 of Article XVI of the California
Constitution.
(B) "Allocated local proceeds of taxes," as used in subdivision
(b) of Section 8 of Article XVI of the California Constitution.
(5) The state does not continue its maintenance of effort for the
level of state funding of emergency medical transports reimbursement
for the 2017-18 rate year, or for any subsequent rate year, in an
amount not less than the amount that the state would have paid for
the same number of emergency medical transports under the rate
methodology in effect on July 31, 2016.
(c) If all of the conditions in subdivision (a) are met, this
article is implemented. If, subsequently, any one of the conditions
in subdivision (b) is 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.
SEC. 3. No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.
SEC. 4. This act is an urgency statute necessary for the immediate
preservation of the public peace, health, or safety within the
meaning of Article IV of the Constitution and shall go into immediate
effect. The facts constituting the necessity are:
In order to make the necessary changes to increase Medi-Cal
payments to emergency ambulance providers and to improve access, at
the earliest possible time, to allow this act to be operative
as soon as approval from the
federal Centers for Medicare and Medicaid Services is obtained by the
State Department of Health Care Services, it is necessary that this
act take effect immediately.
