Bill Text: CA SB1374 | 2013-2014 | Regular Session | Amended
Bill Title: Medi-Cal: ground ambulance rates.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2014-05-23 - Held in committee and under submission. [SB1374 Detail]
Download: California-2013-SB1374-Amended.html
BILL NUMBER: SB 1374 AMENDED
BILL TEXT
AMENDED IN SENATE APRIL 21, 2014
INTRODUCED BY Senator Hernandez
FEBRUARY 21, 2014
An act to add Article 5. 8 (commencing with
Section 1418 8) to Chapter 7 of Part 3 of Division 9 of
the Welfare and Institutions Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
SB 1374, as amended, Hernandez. Medi-Cal: ambulance
services. ground ambulance rates.
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. Existing law prohibits a city or county from establishing
equipment and personnel standards for the furnishing of nonemergency
medical transportation services for eligible Medi-Cal beneficiaries
that are in conflict with equipment and personnel standards for
reimbursement established by the department. services,
including medical transportation services. Existing law and
regulations prescribe various requirements governing payment policies
and reimbursement rates for these services.
This bill would state findings and declarations of the Legislature
relative to ambulance services. The bill would express the intent of
the Legislature to enact legislation to ensure the continued
viability of emergency medical systems throughout the state by
establishing payment definitions and policies for the Medi-Cal
program, as related to ambulance services that meet nationally
recognized standards. The bill would also express the intent of the
Legislature to enact legislation to establish Medi-Cal reimbursement
rates for essential emergency and nonemergency ambulance services
that will cover, at a minimum, the actual costs of providing those
services, and to enact legislation to ensure the provision of
essential medically necessary emergency and nonemergency ambulance
response and transportation services to the citizens of California.
This bill would require the department, by July 1, 2015, to adopt
regulations establishing the Medi-Cal reimbursement rate for ground
ambulance services using one of 2 specified methodologies.
Vote: majority. Appropriation: no. Fiscal committee: no
yes . State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all
of the following:
(a) Regarding Medi-Cal payment rates for ground ambulance
services, the State Plan under Title XIX of the federal Social
Security Act for California requires each of the other types of care
or service listed in Section 1396d of Title 42 of the United States
Code that are included in the program under the plan to be reimbursed
at the lesser of usual charges or the limits specified in Article 7
(commencing with Section 51501) of Chapter 3 of Division 3 of Title
22 of the California Code of Regulations.
(b) Current law requires ground ambulance services provided to
state prison inmates to be reimbursed at a rate that does not exceed
120 percent of the Medicare Ambulance Fee Schedule (Section 5023.5 of
the Penal Code).
(c) Current law requires ground ambulance services provided under
the state workers' compensation program to be reimbursed at a rate
that does not exceed 120 percent of the Medicare Ambulance Fee
Schedule (Section 9789.70 of Title 8 of the California Code of
Regulations).
(d) Emergency medical services systems are a critical safety net
service relied upon by the entire California population.
(e) Ninety percent of Medi-Cal ground ambulance transports are
emergencies. Ground ambulance safety net providers cannot legally or
morally refuse to respond to emergency medical requests for service
and cannot refuse medically necessary emergency medical treatment and
transport.
(f) Independent government cost studies indicate that current
Medi-Cal payment rates cover just one-quarter of the average cost of
ground ambulance service. Severe below-cost Medi-Cal payment rates
threaten to collapse the entire 911 emergency medical system safety
net in California.
SEC. 2. Article 5.8 (commencing with Section 14188)
is added to Chapter 7 of Part 3 of Division 9 of the
Welfare and Institutions Code , to read:
Article 5.8. Ground Ambulance Services
14188. (a) No later than July 1, 2015, the department shall adopt
regulations establishing the Medi-Cal reimbursement rate for ground
ambulance services, based upon existing statutes, regulations, and
case law.
(b) In establishing the rates as required in subdivision (a), the
department shall use one of the following methodologies:
(1) Establish payment rates through regulation by doing all of the
following:
(A) Develop a rate study or establish a cost-based evidentiary
base that results in proposed rates.
(B) Present the proposed rates at a public hearing.
(C) Combine public input and the evidentiary base for a final
adopted regulation.
(2) Establish payment rates for ground ambulance services at ____
percent of the current Medicare Ambulance Fee Schedule and designate
the ambulance cost study conducted by the federal Government
Accountability Office (GAO-07-383) as the evidentiary base.
SECTION 1. (a) The Legislature finds and
declares the following:
(1) Ambulance services play a vital role in providing quality
health care and are a critical component of the public safety first
response in times of natural or man-made disasters.
(2) With the passage of the Emergency Medical Services System and
the Prehospital Emergency Medical Care Personnel Act in 1980, the
intent of the Legislature has been to maintain and promote the
development of emergency medical technician paramedic programs where
appropriate throughout the state, and to initiate EMT II limited
advanced life support programs only where geography, population
density, and resources would not make the establishment of a
paramedic program feasible.
(b) It is the intent of the Legislature to enact legislation to
ensure the continued viability of emergency medical systems
throughout the state by establishing payment definitions and policies
for the Medi-Cal program, as related to ambulance services that meet
nationally recognized standards.
(c) It is the intent of the Legislature to enact legislation to
establish Medi-Cal reimbursement rates for essential emergency and
nonemergency ambulance services that will cover, at a minimum, the
actual costs of providing those services.
(d) It is the intent of the Legislature to enact legislation to
ensure the provision of essential medically necessary emergency and
nonemergency ambulance response and transportation services to the
citizens of California.
