Medi-Cal: emergency medical transportation services.

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, the Medi-Cal Emergency Medical Transportation Reimbursement Act, commencing July 1, 2018, and subject to federal approval and the availability of federal financial participation, imposes a quality assurance fee for each emergency medical transport provided by an emergency medical transport provider subject to the fee in accordance with a prescribed methodology. Existing law requires the Director of Health Care Services to deposit the collected quality assurance fee into the continuously appropriated Medi-Cal Emergency Medical Transport Fund, for exclusive use 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. Existing law requires each emergency medical transport provider to report to the department data on the number of actual emergency medical transports by payer type and on gross receipts, as defined. The act increases Medi-Cal reimbursement to emergency medical transport providers for emergency medical transports, as specified. Existing law authorizes a Medi-Cal provider of ground emergency medical transportation services, that is owned or operated by the state, a city, county, city and county, fire protection district, special district, community services district, health care district, or a federally recognized Indian tribe, to receive supplemental Medi-Cal reimbursement in addition to the rate of payment the provider would otherwise receive for those services. Existing law requires the department to develop a modified supplemental reimbursement program, with necessary federal approvals, that would seek to increase the reimbursement to an eligible provider, as specified. Existing law requires the nonfederal share of any supplemental reimbursement provided under the modified program to be derived from voluntary intergovernmental transfers of local funds. Existing law states the Legislature's intent in enacting these provisions to provide the supplemental reimbursement without any expenditure from the General Fund. This bill would exempt the above-described providers owned or operated by the specified governmental entities from the Medi-Cal Emergency Medical Transportation Reimbursement Act and the quality assurance fee requirements. The bill, subject to any necessary federal approvals, would change the calculation of the supplemental Medi-Cal reimbursement by requiring those governmental entities to participate in a managed care intergovernmental transfer program. The bill would require the combined amounts of payment under the new calculation to equal 100% of projected costs for ground emergency medical transportation services by each qualified provider. The bill would require the department to review and evaluate providers' requests for rate changes and make adjustments to those rates, as specified. The bill would require that the department be reimbursed for costs associated with administering the modified program and for any state revenue not obtained due to government providers being exempted from the quality assurance fee. The bill would also make technical, nonsubstantive changes to the above-described provisions. This bill would declare that it is to take effect immediately as an urgency statute.