BILL NUMBER: SB 359INTRODUCED BILL TEXT INTRODUCED BY Senator Hernandez FEBRUARY 15, 2011 An act to add Article 5.7 (commencing with Section 14186) to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, relating to Medi-Cal. LEGISLATIVE COUNSEL'S DIGEST SB 359, as introduced, Hernandez. Medi-Cal: ground ambulance rates. 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 and regulations prescribe various requirements governing payment policies and reimbursement rates for these services. This bill would require the department, by July 1, 2012, to adopt regulations establishing the Medi-Cal reimbursement rate for ground ambulance services using one of 2 specified methodologies. 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. The Legislature finds and declares all of the following: (a) The State Department of Health Care Services is required to adhere to the current regulations establishing Medi-Cal payment rates for ground ambulance services and the department is currently not in compliance with those regulations. (b) Regarding Medi-Cal payment rates for ground ambulance services, the State Plan under Title XIX of the federal Social Security Act for the State of California requires that reimbursement for each of the other types of care or service listed in Section 1396d of Title 42 of the United States Code that are included in the program under the plan will be at the lesser of usual charges or the limits specified in Article 7 (commencing with Section 51501) of Chapter 3 of Division 3 of Title 22 of the California Code of Regulations. (c) In establishing the evidentiary base, the Ninth Circuit Court of Appeals has ordered the department to consider the costs of providing the service. (d) Current law requires ground ambulance services provided to state prison inmates to be reimbursed at the maximum rate of 120 percent of the Medicare Ambulance Fee Schedule (Sec. 5023.5, Pen. C.). (e) Current law requires ground ambulance services provided under the state workers compensation program to be reimbursed at the maximum rate of 120 percent of the Medicare Ambulance Fee Schedule (8 Cal. Code Regs. 9789.70). (f) Emergency medical services systems are a critical safety net service relied upon by the entire California population. (g) Ninety percent of Medi-Cal ground ambulance transports are emergencies. Ground ambulance safety net providers cannot legally or morally refuse to respond to emergency medical requests for service and cannot refuse medically necessary emergency medical treatment and transport. (h) Independent government cost studies indicate current Medi-Cal payment rates cover just one quarter of the average cost of ground ambulance service. Severe below-cost Medi-Cal payment rates threaten to collapse the entire 911 emergency medical system safety net in California. SEC. 2. Article 5.7 (commencing with Section 14186) is added to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, to read: Article 5.7. Ground Ambulance Services 14186. (a) No later than July 1, 2012, the department shall adopt regulations establishing the Medi-Cal reimbursement rate for ground ambulance services, based upon existing statutes, regulations, and case law. (b) In establishing the rates as required in subdivision (a), the department shall use one of the following methodologies: (1) Establish payment rates through regulation based on the methodology required by the courts including doing all of the following: (A) Develop a rate study or establish a cost-based evidentiary base that results in proposed rates. (B) Present the proposed rates at a public hearing. (C) Combine public input and the evidentiary base for a final adopted regulation. (2) Establish payment rates for ground ambulance services at 120 percent of the current Medicare Ambulance Fee Schedule and designate the ambulance cost study conducted by the federal Government Accountability Office (GAO-07-383) as the evidentiary base.