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, including emergency medical transportation 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 specified entities, including a fire protection 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 that would seek to increase the reimbursement to those eligible providers, and 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 requires the department to implement, 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 authorizes the department to continue conducting any administrative duties related to the above-specified supplemental Medi-Cal reimbursement. Existing law requires 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 requires 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.
Existing law, the Medi-Cal Emergency Medical Transportation Reimbursement Act, 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 exempts 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 program is implemented. Existing law requires each applicable Medi-Cal managed care health plan to satisfy a specified obligation for emergency medical transports and to provide payment to noncontract emergency medical transport providers, and provides that this provision does not apply to an eligible provider who provides noncontract emergency medical transports to an enrollee of a Medi-Cal managed care plan during any Medi-Cal managed care rating period that the program is implemented.
The bill would provide that during the entirety of any Medi-Cal managed care rating period for which the program is implemented an eligible provider shall not be an emergency medical transport provider, as defined, who is subject to a quality assurance fee or eligible for the add-on increase, and would provide that the program’s provisions do not affect the application of the specified add-on to any payment to a nonpublic emergency medical transport provider. The bill would redefine “emergency medical transport provider” to mean any provider of emergency medical transports, except during the entirety of any Medi-Cal managed care rating period for which the program is implemented, in whole or in part, that excludes any public provider of emergency medical transports, including any provider who meets prescribed requirements. With respect to the quality assurance fee, commencing in the 2022–23 state fiscal year, and for each state fiscal year thereafter, the bill would require the Director of Health Care Services to comply with specified requirements, including calculating the annual quality assurance fee applicable to a specified program period at least 150 days before the start of the state fiscal year, and would make conforming changes. The bill would delete the above-specified limitation on the provision relating to Medi-Cal managed care health plans and their obligation to provide emergency medical transports and payment to noncontract providers.