Medi-Cal: emergency medical transportation services.

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 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 eligible 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 the above-described eligible providers. 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. The bill would instead require the department to implement, subject to any necessary federal approvals, and no sooner than July 1, 2021, the Public Provider Intergovernmental Transfer Program (program) , for the duration of any Medi-Cal managed care rating period, and would authorize the department to continue conducting any administrative duties related to the above-specified supplemental Medi-Cal reimbursement. The bill would require an eligible provider, defined, in part, as a provider of emergency medical transport, to receive an add-on increase to the associated Medi-Cal fee-for-service payment schedule, and would require the department to develop the add-on increase pursuant to specified standards, including an eligible provider's average cost directly associated with providing a Medi-Cal emergency medical transport under the Medi-Cal program. The bill would require Medi-Cal managed care health plans and emergency medical transport providers to comply with specified federal standards relating to the payment standards for emergency medical transport. The bill would limit the amount that a noncontract eligible provider may collect for emergency medical transport. The bill would require the department to assess a 10% fee on each transfer of public funds to the state to pay for health care coverage and to reimburse the department for its administrative costs relating to the program. The bill would limit the operation of the program on the condition that the program would be financially and programmatically supportive of the Medi-Cal program. The bill would authorize the department to implement these provisions by various means, including all-county letters or provider bulletins, without taking regulatory action. 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, including to enhance federal financial participation for ambulance services under the Medi-Cal program. Existing law requires each emergency medical transport provider to report to the department specified data and material, including the number of actual emergency medical transports by payer type. The act increases Medi-Cal reimbursement to emergency medical transport providers for emergency medical transports. The bill would exempt an eligible provider from the quality assurance fee and add-on increase for the duration of any Medi-Cal managed care rating during which the Public Provider Intergovernmental Transfer Program is implemented.