Emergency medical services. This bill would set the Medi-Cal fee-for-service reimbursement rate for emergency medical transports at $350 per transport. Under the bill, the resulting fee-for-service payment schedule amounts would instead be equal to the sum of the Medi-Cal fee-for-service payment schedule amount, based on the $350 rate, and the add-on increase.
Under existing law, the increased payments under the add-on provisions are funded solely from a quality assurance fee (QAF), which emergency medical transport providers are required to pay based on a specified formula, and from federal reimbursement and any other related federal funds.
This bill would specify that the $350 reimbursement rate would not affect the calculation of the QAF rate, and that the calculation of the QAF rate would be based on the methodology and reimbursement rate in effect as of January 1, 2023.
Existing law authorizes the Director of Health Care Services to modify or make adjustments to any methodology or fee amount under these provisions to the extent necessary to meet federal requirements or to obtain federal approval.
If a modification or adjustment is needed to meet federal requirements or to obtain federal approval, this bill would require the director to recalculate and reduce the add-on amount as necessary, and would prohibit the director from reducing the $350 reimbursement rate.