California Assembly Bill AB511 Amended / Bill

 BILL NUMBER: AB 511AMENDED BILL TEXT AMENDED IN ASSEMBLY APRIL 20, 2009 AMENDED IN ASSEMBLY APRIL 13, 2009 INTRODUCED BY Assembly Member De La Torre FEBRUARY 24, 2009 An act to add and repeal Chapter 13 (commencing with Section 1799.300)  to  of  Division 2.5 of the Health and Safety Code, relating to Medi-Cal. LEGISLATIVE COUNSEL'S DIGEST AB 511, as amended, De La Torre. Medi-Cal: ambulance transportation services providers: quality assurance fees. Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which health care services, including medical transportation services, are provided to qualified low-income persons. The Medi-Cal program is partially governed and funded under federal Medicaid provisions. Existing law establishes a quality assurance fee program for skilled nursing and intermediate care facilities, as prescribed. This bill would provide, as a condition of participation in the Medi-Cal program, that there be imposed a quality assurance fee on  certain  ambulance transportation services providers, to be administered by the Director of Health Care Services. The proceeds from the fee would be required to be deposited into the Medi-Cal Ambulance Transportation Services Providers Fund, which the bill would create. The bill would provide that moneys in the fund shall, upon appropriation by the Legislature, be available exclusively to enhance federal financial participation for ambulance transportation services under the Medi-Cal program or to provide additional reimbursement to, and to support quality improvement efforts of, ambulance transportation services providers, including increased reimbursement for, and improvement of the quality of, the provision of advanced life support services, as defined. The bill would provide that these provisions are to be implemented only if, and as long as, the state receives federal approval for the fee and legislation is enacted during the 2009-10 Regular Session of the Legislature that makes an appropriation from the fund and from the Federal Trust Fund to fund a Medi-Cal rate increase for ambulance transportation services providers. The bill would provide that it shall remain operative only as long as certain conditions are met and if any one of the conditions is not met, its provisions shall become inoperative and be repealed. Vote: majority. Appropriation: no. Fiscal committee: yes. State-mandated local program: no. THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS: SECTION 1. Chapter 13 (commencing with Section 1799.300) is added to Division 2.5 of the Health and Safety Code, to read: CHAPTER 13. AMBULANCE TRANSPORTATION SERVICES PROVIDER  UNIFORM  QUALITY ASSURANCE FEE 1799.300. (a) As a condition of participation in the Medi-Cal program, for each ambulance transportation services provider  that operates at least one ambulance vehicle certified by the Department of the California Highway Patrol pursuant to Article 1 (commencing with Section 1100) of Title 13 of the California Code of Regulations, there shall be imposed each state fiscal year a uniform quality assurance fee if a certified ambulance vehicle is operated by the provider during that state fiscal year, or any portion thereof. The uniform quality assurance fee shall be based upon the revenue from providing ambulance transportation services under the Medi-Cal program that is derived by all providers subject to the fee. The uniform quality assurance fee shall not include the revenue of any exempt Medi-Cal ambulance transportation services provider that is exempt pursuant to   that derives revenue from the provision of ambulance transportation services, there shall be imposed each state fiscal year a quality assurance fee based on the provision of ambulance transportation services. The quality assurance fee shall be assessed on all Medi-Cal ambulance transportation services providers, except for a Medi-Cal ambulance transportation services provider that is exempt pursuant to  paragraph (2) of subdivision (a) of Section 1799.305. (b) The amount of the quality assurance fee assessed on  each  Medi-Cal ambulance transportation services  providers   provider  shall be based on the  aggregate revenue received by  providers subject to the fee   the provider  from the provision of  Medi-Cal  ambulance transportation services and shall be calculated in accordance with the methodology outlined in subdivision (c), in the request for federal approval required by Section 1799.305, and in regulations, provider bulletins, or similar instructions. (c) The  uniform  quality assurance fee shall be calculated as follows:  (1) For the 2009-10 fiscal year, the State Department of Health Care Services shall project the aggregate revenue for all providers subject to the fee received from providing ambulance transportation services under the Medi-Cal program. The projection shall be based on data that the department collects from Medi-Cal ambulance transportation services providers. Once determined, the aggregate projected revenue derived by all Medi-Cal ambulance transportation services providers subject to the fee received from the provision of Medi-Cal ambulance transportation services shall be multiplied by 5.5 percent, as determined under the approved methodology, and then divided by the number of certified ambulance vehicles operated by the providers that are subject to the quality assurance fee. The amount so determined shall be the quality assurance fee that Medi-Cal ambulance services providers subject to the fee are required to pay.   (2) For the 2010-11 to 2015-16, inclusive, fiscal years, the department shall project the aggregate revenue for all providers subject to the fee received from the provision of ambulance transportation services provided under the Medi-Cal program. The projection shall be based on data that the department collects from Medi-Cal ambulance transportation services providers. Once determined, the projected aggregate revenue derived by all Medi-Cal providers subject to the fee received from the provision of Medi-Cal ambulance transportation services shall be multiplied by 5.5 percent, as determined under the approved methodology, and then divided by the number of certified ambulance vehicles operated by the providers that are subject to the fee. The amount so determined shall be the quality assurance fee that Medi-Cal providers subject to the fee are required to pay, but in no case shall the fees calculated pursuant to this paragraph, taken together with applicable licensing fees, exceed the amounts allowable under federal law.   (1) For the 2009-10 fiscal year, the quality assurance fee for each ambulance transportation services provider shall be calculated by multiplying the revenue that the ambulance transportation services provider derived from providing ambulance transportation services by 5.5 percent, as determined under the approved methodology. The amount so determined shall be the quality assurance fee for that ambulance transportation services provider.   (2) For the 2010-11 to 2015-16, inclusive, fiscal years, the quality assurance fee for each ambulance transportation services provider shall be calculated by multiplying the revenue that the ambulance transportation services provider derived from providing ambulance transportation services by 5.5 percent, as determined under the approved methodology. The amount so determined shall be the quality assurance fee for that ambulance transportation services provider, but in no case shall the fees calculated pursuant to this paragraph and collected pursuant to this article, taken together with applicable licensing fees, exceed the amounts allowable under federal law.  (d) If there is a delay in the implementation of this article for any reason, including a delay in the approval of the quality assurance fee and methodology by the federal Centers for Medicare and Medicaid Services, in the 2009-10 fiscal year or in any other fiscal year, all of the following shall apply: (1) A provider subject to the fee may be assessed the amount the provider would be required to pay to the department if the methodology were already approved, but shall not be required to pay the fee until both the following occur: (A) The methodology is approved. (B) Medi-Cal rates are increased in accordance with paragraph (2) of subdivision (a) of Section 1799.306 and the increased rates are paid to Medi-Cal ambulance transportation services providers. (2) The department may retroactively increase and make payment of rates to Medi-Cal ambulance transportation services providers. (3) Providers that have been assessed a fee by the department shall pay the fee assessed within 60 days of the date rates are increased in accordance with paragraph (2) of subdivision (a) of Section 1799.306 and paid to those providers. (4) The department shall accept a provider's payment even if the payment is submitted in a subsequent rate year than the rate year in which the fee was assessed. 1799.301. (a) The quality assurance fee, as calculated pursuant to Section 1799.300, shall be paid by the providers to the department on  an annual   a quarterly  basis on or before the last  fiscal  day of the fiscal  year   quarter  following the fiscal  year during   quarter for  which the fee was  assessed   imposed  , except as provided in subdivision (d) of Section 1799.300.  (b) A provider that is operating a certified ambulance vehicle, as defined by the Department of the California Highway Patrol, for the first time, and is participating in the Medi-Cal program, shall comply with subdivision (a), but it shall only be required to pay a pro rata quality assurance fee consistent with the time that it operated the certified ambulance vehicle.   (c)   (b)  When a provider fails to pay all or part of the quality assurance fee within 60 days of the date that payment is due, the department may deduct the unpaid fee and interest owed from any Medi-Cal reimbursement payments owed to the provider until the full amount of the fee and interest are recovered. Any deduction made pursuant to this subdivision shall be made only after the department gives the provider written notification. Any deduction made pursuant to this subdivision may be deducted over a period of time that takes into account the financial condition of the provider.  (d)   (c)  If all or any part of the quality assurance fee remains unpaid, the department may assess a penalty on the provider equal to 50 percent of the unpaid fee amount. 1799.302. (a) The Director of Health Care Services, or his or her designee, shall administer this article. (b) The director may adopt regulations as are necessary to implement this article. These regulations may be adopted as emergency regulations in accordance with the rulemaking provisions of the Administrative Procedure Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code). For purposes of this article, the adoption of regulations shall be deemed an emergency and necessary for the immediate preservation of the public peace, health and safety, or general welfare. The regulations shall include, but need not be limited to, any regulations necessary for any of the following purposes: (1) The administration of this article, including the proper imposition and collection of the quality assurance fee. The costs associated with the administration of this article are not to exceed the amounts reasonably necessary to administer this article. (2) The development of any forms necessary to obtain required information from providers subject to the quality assurance fee. (3) To provide details, definitions, formulas, and other requirements. (c) As an alternative to subdivision (b), and notwithstanding the rulemaking provisions of Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the director may implement this article, in whole or in part, by means of a provider bulletin, or other similar instructions, without taking regulatory action, provided that no such bulletin or other similar instructions shall remain in effect after July 31, 2012. It is the intent of the Legislature that the regulations adopted pursuant to subdivision (b) be adopted on or before July 31, 2012. 1799.303. The department shall deposit the quality assurance fee collected pursuant to this article in the Medi-Cal Ambulance Transportation Services Providers Fund, which is hereby created in the State Treasury. Notwithstanding Section 16305.7 of the Government Code, the fund shall also include interest and dividends earned on moneys in the fund. 1799.304. Moneys in the Medi-Cal Ambulance Transportation Services Providers Fund shall, upon appropriation by the Legislature, be available to exclusively enhance federal financial participation for ambulance transportation services under the Medi-Cal program or to provide additional reimbursement to, and to support quality improvement efforts of, ambulance transportation services providers, including increased reimbursement for, and improvement of the quality of, the provision of advanced life support services as defined in Section 1797.52. 1799.305. (a) (1) The department shall request approval from the federal Centers for Medicare and Medicaid Services for the implementation of this article. (2) The director may alter the methodology specified in this article, to the extent necessary to meet the requirements of federal law or regulations or to obtain federal approval. The director may also add categories of exempt ambulance transportation services providers or apply a nonuniform fee to ambulance transportation services providers that are subject to the fee in order to meet requirements of federal law or regulations. The director may exempt categories of ambulance transportation services providers from the fee, if necessary to obtain federal approval. (b) The department shall make retrospective adjustments, as necessary, to the amounts calculated pursuant to Section 1799.300 in order to ensure that the  aggregate  quality assurance fee for any  provider in a  particular state fiscal year does not exceed 5.5 percent of the  aggregate  revenue derived by  providers   a provider  subject to the fee from the provision of ambulance transportation services  under the Medi-Cal program  . 1799.306. (a) This article shall be implemented only if,  and  as long as,  and  both of the following conditions are met: (1) The state receives federal approval of the quality assurance fee from the federal Centers for Medicare and Medicaid Services. (2) Legislation is enacted during the 2009-10 Regular Session of the Legislature that makes an appropriation from the Medi-Cal Ambulance Transportation Services Providers Fund and from the Federal Trust Fund to fund a Medi-Cal rate increase for ambulance transportation services providers. (b) This article shall remain operative only as long as all of the following conditions are met: (1) The federal Centers for Medicare and Medicaid Services continues to allow the use of the provider assessment provided in this article. (2) The Medi-Cal rate increase referenced in paragraph (2) of subdivision (a) remains in effect. (3) The full amount of the quality assurance fee assessed and collected pursuant to this article remains available for the purposes specified in Section 1799.304 and for related purposes. (c) If all of the conditions in subdivision (a) are met, this article is implemented, and subsequently, any one of the conditions in subdivision (b) is not met, on and after the date that the director executes a declaration that makes the determination that any condition is not met, this article shall become inoperative notwithstanding that the condition or conditions subsequently may be met. (d) Notwithstanding subdivisions (a), (b), and (c), in the event of a final judicial determination made by any state or federal court that is not appealed, or by a court of appellate jurisdiction that is not further appealed, in any action by any party, or a final determination by the administrator of the federal Centers for Medicare and Medicaid Services, that federal financial participation is not available with respect to any payment made under the methodology implemented pursuant to this article because the methodology is invalid, unlawful, or contrary to any provision of federal law or regulations, or of state law, this article shall become inoperative. (e) This article shall be repealed on the date that it becomes inoperative. ____ CORRECTIONS Text--Pages 2 and 3. ____