Air ambulance 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.

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.

This bill would delete the authorization to use the moneys appropriated from the Emergency Medical Air Transportation and Children’s Coverage 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.

*Passed but vetoed by Governor