Air ambulance services.

(1) Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of the act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires that health care service plans and health insurance policies, as specified, provide coverage for certain services and treatments, including emergency medical transportation services. This bill would require a health care service plan contract or a health insurance policy issued, amended, or renewed on or after January 1, 2019, to provide that if an enrollee, insured, or subscriber, as applicable, receives covered services from a noncontracting air ambulance provider, the enrollee, insured, or subscriber shall pay no more than the same cost sharing that the enrollee, insured, or subscriber would pay for the same covered services received from a contracting air ambulance provider, referred to as the in-network cost-sharing amount. The bill would specify that an enrollee, subscriber, or insured would not owe the noncontracting provider more than the in-network cost-sharing amount for services subject to the bill, as specified. The bill would allow a noncontracting provider to advance to collections only the in-network cost-sharing amount, as determined by the health care service plan or insurer, that the enrollee, insured, or subscriber has failed to pay. The bill would authorize a health care service plan, health insurer, or provider to seek relief in any court for the purpose of resolving a payment dispute, and would not prohibit a provider from using a health care service plan's or health insurer's existing dispute resolution processes. Because a willful violation of the bill's requirements relative to health care service plans would be a crime, the bill would impose a state-mandated local program. (2) Existing law establishes 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 provides for the federal Medicare Program, which is a public health insurance program for persons 65 years of age and older and specified persons with disabilities who are under 65 years of age. This bill would require the department to set and maintain the Medi-Cal fee rate for air ambulance services provided by either fixed or rotary wing aircraft that is equal to a percentage of the rural Medicare rates for those services, as described and effective July 1, 2019, and to the extent federal financial participation is available and any necessary federal approvals have been obtained. The bill would specify that, commencing July 1, 2019, the amounts a noncontract emergency medical transport provider could collect if the beneficiary received medical assistance other than through enrollment in a Medi-Cal managed care health plan pursuant to a specified federal law would be the resulting fee-for-service payment schedule amounts after the application of the rate established pursuant to the bill. (3) Existing law, the Emergency Medical Air Transportation Act, effective until January 1, 2022, imposes a penalty of $4 until January 1, 2020, upon every conviction for a violation of the Vehicle Code or a local ordinance adopted pursuant to the Vehicle Code, other than a parking offense. The act requires the county or the court that imposed the fine to transfer the moneys collected pursuant to that act to the Treasurer for deposit into the Emergency Medical Air Transportation and Children's Coverage Fund. Under the act, moneys in the fund are made available, upon appropriation by the Legislature, to the State Department of Health Care Services for children's health care coverage and administrative costs relating to emergency medical air transportation provider payments, with the appropriated moneys remaining after payment of the administrative costs to be used as follows: (A) 20% of the amount for offsetting the state portion of the Medi-Cal reimbursement rate for emergency medical air transportation services, and (B) 80% of the amount for augmenting emergency medical air transportation reimbursement payments made through the Medi-Cal program. This bill, if the rate change to the Medi-Cal fee rate for air ambulance services is implemented pursuant to paragraph (2) , would delete the authorization to use the moneys appropriated from the fund for augmenting Medi-Cal emergency medical air transportation reimbursement payments, while maintaining the authorization to use the moneys for offsetting the state portion of the Medi-Cal reimbursement rate for those services. The bill would preserve the authorization to use the moneys for augmentation of payments for purposes of emergency medical air transportation that was provided before July 1, 2019, as specified. The bill would make conforming changes by deleting or amending related provisions. The bill would repeal these provisions on January 1, 2022. (4) 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.