Amended IN Assembly April 10, 2025 Amended IN Assembly March 24, 2025 CALIFORNIA LEGISLATURE 20252026 REGULAR SESSION Assembly Bill No. 1328Introduced by Assembly Member Michelle RodriguezFebruary 21, 2025 An act to amend Sections 14129, 14129.2, 14129.3, and 14129.6 of, to amend the heading of Article 3.91 (commencing with Section 14129) of Chapter 7 of Part 3 of Division 9 of, and to add Sections 14129.05 and 14129.06 to, add Section 14124.151 to the Welfare and Institutions Code, relating to Medi-Cal.LEGISLATIVE COUNSEL'S DIGESTAB 1328, as amended, Michelle Rodriguez. Medi-Cal reimbursements: ambulance transports. nonemergency ambulance transportation.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 or nonemergency medical or nonmedical transportation services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.This bill would require the Medi-Cal fee-for-service reimbursement rates for nonemergency ambulance transports and for interfacility ambulance transports, as defined, to be 100% of the amounts set forth in the federal Medicare ambulance fee schedule for the appropriate level of service billed, as specified.Existing law requires, with exceptions, that Medi-Cal reimbursement to providers of emergency medical transports be increased by application of an add-on to the associated Medi-Cal fee-for-service payment schedule. Under existing law, those increased payments 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.Under this bill, the reimbursement rate for interfacility ambulance transports, in an emergency context, would not affect the calculation of the quality assurance fee rate. Under the bill, the calculation of the quality assurance fee rate would be based on the methodology and reimbursement rate in effect as of January 1, 2025. The bill would make conforming changes to related provisions.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, this bill would require the director to recalculate and reduce the add-on amount as necessary, and would prohibit the director from reducing the Medi-Cal fee-for-service reimbursement rates for nonemergency ambulance transports or interfacility ambulance transports.Existing federal Medicare regulations set forth requirements for certification of the medical necessity of ambulance services, as signed by a physician or a nonphysician depending on the circumstance.Under this bill, whenever the medical necessity of an ambulance transport needs to be certified for purposes of Medi-Cal coverage, a nonphysician would be authorized to complete that certification in place of a physician, and the nonphysician would be authorized to do so with a signature in electronic format or any other format, to the extent authorized by the above-described federal regulations or their successor. The bill would require the department to revise and update the Medi-Cal provider manual or any guidance, as applicable, to implement this provision.Existing state Medi-Cal regulations require that records of medical transportation providers include, among other information, odometer readings at each pickup and delivery location.This bill would require the department to revise and update the above-described regulatory provision in order to allow medical transportation providers to document mileage in their records through other mechanisms, including vehicle Global Positioning System (GPS) tracking, digital mapping software, or another reasonable mechanism identified by the department, as specified, in addition to the option of odometer readings.Under this bill, commencing on January 1, 2026, and subject to an appropriation, Medi-Cal fee-for-service reimbursement for nonemergency ambulance transportation services, as defined, would be in an amount equal to the amount set forth in the federal Medicare ambulance fee schedule for the corresponding level of service, adjusted by the Geographic Practice Cost Index, as specified.The bill would require the department to maximize federal financial participation in implementing the above-described provision to the extent allowable. To the extent that federal financial participation is unavailable, the bill would require the department to implement the provision using state funds, as specified.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO Bill TextThe people of the State of California do enact as follows:SECTION 1. Section 14124.151 is added to the Welfare and Institutions Code, immediately following Section 14124.15, to read:14124.151. (a) (1) Commencing on January 1, 2026, subject to an appropriation made by the Legislature to fund, in whole or in part, the reimbursement levels described in this subdivision, Medi-Cal fee-for-service reimbursement for nonemergency ambulance transportation services shall be in an amount equal to the amount set forth in the federal Medicare ambulance fee schedule established pursuant to Section 1395m of Title 42 of the United States Code, for the corresponding level of service.(2) The reimbursement described in paragraph (1) shall be adjusted by the Geographic Practice Cost Index under the federal Centers for Medicare and Medicaid Services, specific to the area of California in which the services are provided.(b) (1) The department shall maximize federal financial participation in implementing this section to the extent allowable. For purposes of implementing this section, the department shall claim federal financial participation to the extent that the department determines it is available.(2) To the extent that federal financial participation is unavailable, the department shall implement this section using state funds, if appropriated as described in subdivision (a).(3) It is the intent of the Legislature that the appropriation described in subdivision (a) be sufficient to fund the reimbursement levels in whole.(c) 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 department may implement, interpret, or make specific this section, in whole or in part, by means of plan letters, plan or provider bulletins, or similar instructions without taking any further regulatory action.(d) For purposes of this section, nonemergency ambulance transportation services means nonemergency medical transportation services, as described in Section 51323 of Title 22 of the California Code of Regulations, that are conducted by ground ambulance. The term nonemergency ambulance transportation services does not include emergency medical transport services, as defined in subdivision (g) of Section 14129.SECTION 1.The heading of Article 3.91 (commencing with Section 14129) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code is amended to read:3.91.Medi-Cal Emergency and Nonemergency Medical Transportation Reimbursement ActSEC. 2.Section 14129 of the Welfare and Institutions Code is amended to read:14129.For purposes of this article, the following definitions apply:(a)Annual quality assurance fee rate means the quality assurance fee assessed on each emergency medical transport during each applicable state fiscal year.(b)Aggregate fee schedule amount means the product of the fee-for-service add-on increase described in Section 14129.3 and the Medi-Cal emergency medical transports, including both fee-for-service transports paid by the department and managed care transports paid by Medi-Cal managed care health plans, utilizing the billing codes for emergency medical transport for the state fiscal year.(c)Available fee amount shall be calculated as the sum of the following:(1)The amount deposited in the Medi-Cal Emergency Medical Transport Fund established under Section 14129.2 during the applicable state fiscal year, less the amounts described in subparagraphs (A) and (B) of paragraph (2) of subdivision (f) of Section 14129.2.(2)Any federal financial participation obtained as a result of the deposit of the amount described in paragraph (1) in the Medi-Cal Emergency Medical Transport Fund, created pursuant to Section 14129.2, for the applicable state fiscal year.(d)Department means the State Department of Health Care Services.(e)Director means the Director of Health Care Services.(f)Effective state medical assistance percentage means a ratio of the aggregate expenditures from state-only sources for the Medi-Cal program divided by the aggregate expenditures from state and federal sources for the Medi-Cal program for a state fiscal year.(g)(1)Emergency medical transport means the act of transporting an individual from any point of origin to the nearest medical facility capable of meeting the emergency medical needs of the patient by an emergency medical transport provider by means of an ambulance licensed, operated, and equipped in accordance with applicable state or local statutes, ordinances, or regulations that are billed with billing codes A0429 BLS Emergency, A0427 ALS Emergency, A0434 Specialty Care Transport, A0225 Neonatal Emergency Transport, and A0433 ALS2, and any equivalent, predecessor, or successor billing codes as may be determined by the director. Emergency medical transport excludes transportation of beneficiaries by passenger car, taxicabs, litter vans, wheelchair vans, other forms of public or private conveyances, and transportation by an air ambulance provider. An emergency medical transport does not occur when, following evaluation of a patient, a transport is not provided.(2)The definition of emergency medical transport set forth in paragraph (1) shall be construed as applying whether or not those transports were initiated through a public safety answering point (PSAP) or traditional 911 dispatch system. This paragraph shall not be construed as amending or otherwise affecting the definition of ground emergency medical transports set forth in Section 14199.128 for purposes of Chapter 7.5 (commencing with Section 14199.100).(h)Gross receipts means gross payments received as patient care revenue for emergency medical transports, determined on a cash basis of accounting. Gross receipts includes all payments received as patient care revenue for emergency medical transports, including payments for billing codes A0429 BLS Emergency, A0427 ALS Emergency, and A0433 ALS2, and any equivalent, predecessor, or successor billing codes as may be determined by the director, and any other ancillary billing codes associated with emergency medical transport as may be determined by the director. Gross receipts excludes supplemental amounts received pursuant to Sections 14105.94 or 14105.945.(i)Emergency medical transport provider means any provider of emergency medical transports, except that during any Medi-Cal managed care rating period for which Section 14105.945 is implemented emergency medical transport provider shall exclude eligible providers as defined in paragraph (1) of subdivision (a) of Section 14105.945 for purposes of this article.(j)Emergency medical transport provider subject to the fee means all emergency medical transport providers who bill and receive patient care revenue from the provision of emergency medical transports, except emergency medical transport providers that are exempt pursuant to subdivision (c) of Section 14129.6.(k)Interfacility ambulance transport means an ambulance transport in which the origin and destination are both a health facility, as defined in Section 1250 of the Health and Safety Code.(l)Medi-Cal managed care health plan means a managed health care plan as that term is defined in subdivision (ab) of Section 14169.51.(m)Nonemergency ambulance transport means an ambulance transport the request for which is made other than through a 911 PSAP, and also means an ambulance transport billed with a Healthcare Common Procedure Coding System (HCPCS) code not associated with an emergency level of ambulance service.SEC. 3.Section 14129.05 is added to the Welfare and Institutions Code, immediately following Section 14129, to read:14129.05.The Medi-Cal fee-for-service reimbursement rates for nonemergency ambulance transports and for interfacility ambulance transports shall be 100 percent of the amounts set forth in the federal Medicare ambulance fee schedule established pursuant to Section 1395m of Title 42 of the United States Code for the appropriate level of service billed.SEC. 4.Section 14129.06 is added to the Welfare and Institutions Code, immediately following Section 14129.05, to read:14129.06.(a)Whenever the medical necessity of an ambulance transport needs to be certified for purposes of Medi-Cal coverage, a nonphysician may complete that certification in place of a physician, and the nonphysician may do so with a signature in electronic format or any other format, to the extent authorized by Section 410.40 of Title 42 of the Code of Federal Regulations or its successor.(b)The department shall revise and update the Medi-Cal provider manual or any guidance, as applicable, to implement subdivision (a).SEC. 5.Section 14129.2 of the Welfare and Institutions Code is amended to read:14129.2.(a)(1)Commencing with the state fiscal quarter beginning on July 1, 2018, and continuing each state fiscal quarter thereafter for which this article is implemented, there shall be imposed a quality assurance fee for each emergency medical transport provided by each emergency medical transport provider subject to the fee in accordance with this section.(2)The director shall ensure that the quality assurance fee per emergency medical transport imposed pursuant to this article is collected.(b)(1)On or before June 15, 2018, and continuing each June 15 thereafter for which this article is implemented, the director shall calculate the annual quality assurance fee rate applicable to the following state fiscal year based on the most recently collected data from emergency medical transport providers pursuant to Section 14129.1. The director may correct any identified material or significant errors in the data collected from emergency medical transport providers pursuant to Section 14129.1 for the purposes of calculating the annual quality assurance fee rate. The directors determination whether to exercise the directors discretion to correct any data pursuant to this paragraph shall not be subject to judicial review, except that an emergency medical transport provider may bring a writ of mandate under Section 1085 of the Code of Civil Procedure to rectify an abuse of discretion by the director in correcting that emergency medical transport providers data when that correction results in a greater fee amount for that provider pursuant to this section.(A)For the state fiscal year beginning on July 1, 2018, the annual quality assurance fee rate shall be calculated by multiplying the projected total annual gross receipts for all emergency medical transport providers subject to the fee by 5.1 percent, which resulting product shall be divided by the projected total annual emergency medical transports by all emergency medical transport providers subject to the fee for the state fiscal year.(B)(i)For state fiscal years beginning July 1, 2019, and continuing each state fiscal year thereafter, the annual quality assurance fee rate shall be calculated by a ratio, the numerator of which shall be the sum of: (i) the product of the projected aggregate fee schedule amount and the effective state medical assistance percentage and (ii) the amount described in subparagraph (A) of paragraph (2) of subdivision (f) for the state fiscal year, and the denominator of which shall be 90 percent of the projected total annual emergency medical transports by all emergency medical transport providers subject to the fee for the state fiscal year.(ii)Notwithstanding clause (i) or any other law, the reimbursement rate for interfacility ambulance transports, as described in Section 14129.05, in an emergency context, shall not affect the calculation of the quality assurance fee rate. Section 14129.05 shall not be construed as affecting that calculation. The calculation of the quality assurance fee rate shall be based on the methodology and reimbursement rate in effect as of January 1, 2025.(2)On or before June 15, 2018, and continuing each June 15 thereafter for which this article is implemented, the director shall publish the annual quality assurance fee rate on its internet website.(3)In no case shall the fees calculated pursuant to this subdivision and collected pursuant to this article exceed the amounts allowable under federal law. If, on or before June 15 of each year, the director makes a determination that the fees collected pursuant to this subdivision exceed the amounts allowable under federal law, the director may reduce the add-on increase to the fee-for-service payment schedule described in Section 14129.3 only to the extent necessary to reflect the amount of fees allowable under federal law in an applicable state fiscal year.(4)If, during a state fiscal year for which this article is operative, the actual or projected available fee amount exceeds or is less than the actual or projected aggregate fee schedule amount by more than 1 percent, the director shall adjust the annual quality assurance fee rate so that the available fee amount for the state fiscal year will approximately equal the aggregate fee schedule amount for the state fiscal year. The available fee amount for a state fiscal year shall be considered to equal the aggregate fee schedule amount for the state fiscal year if the difference between the available fee amount for the state fiscal year and the aggregate fee schedule amount for the state fiscal year constitutes less than 1 percent of the aggregate fee schedule amount for the state fiscal year.(c)(1)Each emergency medical transport provider subject to the fee shall remit to the department an amount equal to the annual quality assurance fee rate for the 201819 state fiscal year multiplied by the number of transports reported or that should have been reported by the emergency medical transport provider pursuant to subdivision (b) of Section 14129.1 in the quarter beginning on April 1, 2018, based on a schedule established by the director. The schedule established by the director for the fee payment described in this paragraph shall require remittance of the fee payment according to the following guidelines:(A)The director shall require an emergency medical transport provider that rendered 35,000 or more Medi-Cal fee-for-service emergency medical transports during the 201617 state fiscal year to remit the fee payment described in this paragraph on or after July 1, 2018.(B)The director shall require an emergency medical transport provider that rendered fewer than 35,000 Medi-Cal fee-for-service emergency medical transports during the 201617 state fiscal year to remit 50 percent or less of the fee payment described in this paragraph on or after August 1, 2018.(C)The director shall require an emergency medical transport provider that rendered fewer than 35,000 Medi-Cal fee-for-service emergency medical transports during the 201617 state fiscal year to remit any remaining fee payment amount described in this paragraph on or after August 15, 2018.(2)Commencing with the state fiscal quarter beginning on October 1, 2018, and continuing each state fiscal quarter thereafter, on or before the first day of each state fiscal quarter, each emergency medical transport provider subject to the fee shall remit to the department an amount equal to the annual quality assurance fee rate for the applicable state fiscal year multiplied by the number of transports reported or that should have been reported by the emergency medical transport provider pursuant to subdivision (b) of Section 14129.1 in the immediately preceding quarter.(d)(1)Interest shall be assessed on quality assurance fees not paid on the date due at the greater of 10 percent per annum or the rate at which the department assesses interest on Medi-Cal program overpayments pursuant to subdivision (h) of Section 14171. Interest shall begin to accrue the day after the date the payment was due and shall be deposited in the Medi-Cal Emergency Medical Transport Fund established in subdivision (f).(2)In the event that any fee payment is more than 60 days overdue, the department may deduct the unpaid fee and interest owed from any Medi-Cal reimbursement payments owed to the emergency medical transport provider until the full amount of the fee, interest, and any penalties assessed under this article are recovered. Any deduction made pursuant to this subdivision shall be made only after the department gives the emergency medical transport 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 emergency medical transport provider.(3)In the event that any fee payment is more than 60 days overdue, a penalty equal to the interest charge described in paragraph (1) shall be assessed and due for each month for which the payment is not received after 60 days. Any funds resulting from a penalty imposed pursuant to this paragraph shall be deposited into the Medi-Cal Emergency Medical Transport Fund created pursuant to subdivision (f).(4)The director may waive a portion or all of either the interest or penalties, or both, assessed under this article in the event the director determines, in the directors sole discretion, that the emergency medical transport provider has demonstrated that imposition of the full amount of the quality assurance fee pursuant to the timelines applicable under this article has a high likelihood of creating an undue financial hardship for the provider. Waiver of some or all of the interest or penalties pursuant to this paragraph shall be conditioned on the emergency medical transport providers agreement to make fee payments on an alternative schedule developed by the department.(e)The department shall accept an emergency medical transport providers payment even if the payment is submitted in a rate year subsequent to the rate year in which the fee was assessed.(f)(1)The director shall deposit the quality assurance fees collected pursuant to this section in the Medi-Cal Emergency Medical Transport Fund, which is hereby created in the State Treasury and, notwithstanding Section 13340 of the Government Code, is continuously appropriated without regard to fiscal years to the department for the purposes specified in this article. Notwithstanding Section 16305.7 of the Government Code, the fund shall also include interest and dividends earned on moneys in the fund.(2)The moneys in the Medi-Cal Emergency Medical Transport Fund, including any interest and dividends earned on money in the fund, shall be available exclusively to enhance federal financial participation for ambulance services under the Medi-Cal program and to provide additional reimbursement to, and to support quality improvement efforts of, emergency medical transport providers, and to pay for the states administrative costs and to provide funding for health care coverage for Californians, in the following order of priority:(A)To pay for the departments staffing and administrative costs directly attributable to implementing this article, not to exceed the following amounts:(i)For the 201819 state fiscal year, one million three thousand dollars ($1,003,000), exclusive of any federal matching funds.(ii)For the 201920 state fiscal year and each state fiscal year thereafter, three hundred seventy-four thousand dollars ($374,000), exclusive of any federal matching funds.(B)To pay for the health care coverage in each applicable state fiscal year in the amount of 10 percent of the annual quality assurance fee collection amount, exclusive of any federal matching funds.(C)To make increased payments to emergency medical transport providers pursuant to this article.(g)In the event of a merger, acquisition, or similar transaction involving an emergency medical transport provider that has outstanding quality assurance fee payment obligations pursuant to this article, including any interest and penalty amounts owed, the resultant or successor emergency medical transport provider shall be responsible for paying to the department the full amount of outstanding quality assurance fee payments, including any applicable interest and penalties, attributable to the emergency medical transport provider for which it was assessed, upon the effective date of the transaction. An entity considering a merger, acquisition, or similar transaction involving an emergency medical transport provider may submit a request pursuant to Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code to ascertain the outstanding quality assurance fee payment obligations of the emergency medical transport provider pursuant to this article as of the date of the departments response to that request.SEC. 6.Section 14129.3 of the Welfare and Institutions Code is amended to read:14129.3.(a)Except as provided in subdivision (i) of Section 14105.945, commencing July 1, 2018, and for each state fiscal year thereafter for which this article is operative, reimbursement to emergency medical transport providers for emergency medical transports shall be increased by application of an add-on to the associated Medi-Cal fee-for-service payment schedule. The add-on increase to the fee-for-service payment schedule under this section shall be calculated on or before June 15, 2018, and shall remain the same for later state fiscal years for which this article is operative, to the extent the department determines federal financial participation is available and is not otherwise jeopardized. The add-on increase to the fee-for-service payment schedule under this section shall apply only to those billing codes identified in, or any equivalent, predecessor, or successor billing codes as may be determined by the director pursuant to, subdivision (g) of Section 14129. The department shall calculate the projections required by this subdivision based on the data submitted pursuant to Section 14129.1. The fee-for-service add-on shall be equal to the quotient of the available fee amount projected by the department on or before June 15, 2018, for the 201819 state fiscal year, divided by the total Medi-Cal emergency medical transports, including both fee-for-service transports paid by the department and managed care transports paid by Medi-Cal managed care health plans, utilizing these billing codes projected by the department on or before June 15, 2018, for the 201819 state fiscal year. The resulting fee-for-service payment schedule amounts after the application of this section shall be equal to the sum of the Medi-Cal fee-for-service payment schedule amount for the 201516 state fiscal year, except as described in Section 14129.05, and the add-on increase.(b)(1)Each applicable Medi-Cal managed care health plan shall satisfy its obligation under Section 438.114(c) of Title 42 of the Code of Federal Regulations for emergency medical transports and shall provide payment to noncontract emergency medical transport providers consistent with Section 1396u-2(b)(2)(D) of Title 42 of the United States Code. Effective July 1, 2018, and for each state fiscal year thereafter for which this article is operative, 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 Section 1396u-2(b)(2)(D) of Title 42 of the United States Code shall be the resulting fee-for-service payment schedule amounts after the application of this section.(2)This subdivision shall not apply to an eligible provider, as defined in paragraph (1) of subdivision (a) of Section 14105.945, 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 Section 14105.945 is implemented.(c)The increased payments required by this section shall be funded solely from the following:(1)The quality assurance fee set forth in Section 14129.2, along with any interest or other investment income earned on those funds.(2)Federal reimbursement and any other related federal funds.(d)The proceeds of the quality assurance fee set forth in Section 14129.2, the matching amount provided by the federal government, and any interest earned on those proceeds shall be used to supplement existing funding for emergency medical transports provided by emergency medical transport providers and not to supplant this funding.(e)Notwithstanding this article, the department may seek federal approval to implement any add-on increase to the fee-for-service payment schedule pursuant to this section for any state fiscal year or years, as applicable, on a time-limited basis for a fixed program period, as determined by the department.(f)Notwithstanding this article, the add-on increase to the fee-for-service payment schedule pursuant to this section shall only be required and payable for state fiscal years that a quality assurance fee payment obligation exists for emergency medical transport providers.SEC. 7.Section 14129.6 of the Welfare and Institutions Code is amended to read:14129.6.(a)(1)The department shall request any approval from the federal Centers for Medicare and Medicaid Services it deems necessary for the use of fees pursuant to this article and for the purpose of receiving associated federal matching funds.(2)In making that request, the department may seek, as it deems necessary, a request for waiver of the broad-based requirement, waiver of the uniformity requirement, or both, pursuant to paragraphs (1) and (2) of subdivision (e) of Section 433.68 of Title 42 of the Code of Federal Regulations, or a request for waiver of any other provisions of federal law or regulation necessary to implement this article.(3)This article shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available and is not otherwise jeopardized.(b)(1)The director may modify or make adjustments to any methodology, fee amount, or other provision specified in this article to the extent necessary to meet the requirements of federal law or regulations or to obtain federal approval. If the director, after consulting with affected emergency medical transport providers, determines that a modification is needed, the director shall execute a declaration stating that this determination has been made and that the actual or projected available fee amount for a state fiscal year remains approximately equal to the actual or projected aggregate fee schedule amount for each applicable state fiscal year, as defined by paragraph (4) of subdivision (b) of Section 14129.2. The director shall retain the declaration and provide a copy, within five working days of the execution of the declaration, to the fiscal and appropriate policy committees of the Legislature.(2)If a modification or adjustment is needed to meet the requirements of federal law or regulations or to obtain federal approval, the director shall recalculate and reduce the add-on amount described in Section 14129.2, as necessary, and shall not reduce the Medi-Cal fee-for-service reimbursement rates for nonemergency ambulance transports or interfacility ambulance transports, as described in Section 14129.05.(c)The director may add categories of exempt emergency medical transport providers or apply a nonuniform fee per transport to emergency medical transport providers that are subject to the fee in order to meet requirements of federal law or regulations. The director may exempt categories of emergency medical transport providers from the fee if necessary to obtain federal approval.(d)If, before June 1 preceding the start of an applicable state fiscal year, the director finds that the implementation of this article is likely no longer a benefit to the General Fund for the applicable state fiscal year, the director may decide to not implement this article for that state fiscal year. The director shall notify the appropriate fiscal and policy committees of the Legislature, and emergency medical transport providers individually and via the departments internet website of its finding pursuant to this subdivision.SEC. 8.For purposes of the Medi-Cal program, the State Department of Health Care Services shall revise and update paragraph (2) of subdivision (e) of Section 51476 of Title 22 of the California Code of Regulations in order to allow medical transportation providers to document mileage in their records through any of the following mechanisms:(a)Odometer readings at each pickup and delivery location.(b)Vehicle Global Positioning System (GPS) tracking.(c)Digital mapping software.(d)Any other mechanism identified by the department, as deemed reasonable based on ongoing technological updates.
Amended IN Assembly April 10, 2025 Amended IN Assembly March 24, 2025 CALIFORNIA LEGISLATURE 20252026 REGULAR SESSION Assembly Bill No. 1328Introduced by Assembly Member Michelle RodriguezFebruary 21, 2025 An act to amend Sections 14129, 14129.2, 14129.3, and 14129.6 of, to amend the heading of Article 3.91 (commencing with Section 14129) of Chapter 7 of Part 3 of Division 9 of, and to add Sections 14129.05 and 14129.06 to, add Section 14124.151 to the Welfare and Institutions Code, relating to Medi-Cal.LEGISLATIVE COUNSEL'S DIGESTAB 1328, as amended, Michelle Rodriguez. Medi-Cal reimbursements: ambulance transports. nonemergency ambulance transportation.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 or nonemergency medical or nonmedical transportation services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.This bill would require the Medi-Cal fee-for-service reimbursement rates for nonemergency ambulance transports and for interfacility ambulance transports, as defined, to be 100% of the amounts set forth in the federal Medicare ambulance fee schedule for the appropriate level of service billed, as specified.Existing law requires, with exceptions, that Medi-Cal reimbursement to providers of emergency medical transports be increased by application of an add-on to the associated Medi-Cal fee-for-service payment schedule. Under existing law, those increased payments 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.Under this bill, the reimbursement rate for interfacility ambulance transports, in an emergency context, would not affect the calculation of the quality assurance fee rate. Under the bill, the calculation of the quality assurance fee rate would be based on the methodology and reimbursement rate in effect as of January 1, 2025. The bill would make conforming changes to related provisions.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, this bill would require the director to recalculate and reduce the add-on amount as necessary, and would prohibit the director from reducing the Medi-Cal fee-for-service reimbursement rates for nonemergency ambulance transports or interfacility ambulance transports.Existing federal Medicare regulations set forth requirements for certification of the medical necessity of ambulance services, as signed by a physician or a nonphysician depending on the circumstance.Under this bill, whenever the medical necessity of an ambulance transport needs to be certified for purposes of Medi-Cal coverage, a nonphysician would be authorized to complete that certification in place of a physician, and the nonphysician would be authorized to do so with a signature in electronic format or any other format, to the extent authorized by the above-described federal regulations or their successor. The bill would require the department to revise and update the Medi-Cal provider manual or any guidance, as applicable, to implement this provision.Existing state Medi-Cal regulations require that records of medical transportation providers include, among other information, odometer readings at each pickup and delivery location.This bill would require the department to revise and update the above-described regulatory provision in order to allow medical transportation providers to document mileage in their records through other mechanisms, including vehicle Global Positioning System (GPS) tracking, digital mapping software, or another reasonable mechanism identified by the department, as specified, in addition to the option of odometer readings.Under this bill, commencing on January 1, 2026, and subject to an appropriation, Medi-Cal fee-for-service reimbursement for nonemergency ambulance transportation services, as defined, would be in an amount equal to the amount set forth in the federal Medicare ambulance fee schedule for the corresponding level of service, adjusted by the Geographic Practice Cost Index, as specified.The bill would require the department to maximize federal financial participation in implementing the above-described provision to the extent allowable. To the extent that federal financial participation is unavailable, the bill would require the department to implement the provision using state funds, as specified.Digest Key Vote: MAJORITY Appropriation: NO Fiscal Committee: YES Local Program: NO
Amended IN Assembly April 10, 2025 Amended IN Assembly March 24, 2025
Amended IN Assembly April 10, 2025
Amended IN Assembly March 24, 2025
CALIFORNIA LEGISLATURE 20252026 REGULAR SESSION
Assembly Bill
No. 1328
Introduced by Assembly Member Michelle RodriguezFebruary 21, 2025
Introduced by Assembly Member Michelle Rodriguez
February 21, 2025
An act to amend Sections 14129, 14129.2, 14129.3, and 14129.6 of, to amend the heading of Article 3.91 (commencing with Section 14129) of Chapter 7 of Part 3 of Division 9 of, and to add Sections 14129.05 and 14129.06 to, add Section 14124.151 to the Welfare and Institutions Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
## LEGISLATIVE COUNSEL'S DIGEST
AB 1328, as amended, Michelle Rodriguez. Medi-Cal reimbursements: ambulance transports. nonemergency ambulance transportation.
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 or nonemergency medical or nonmedical transportation services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.This bill would require the Medi-Cal fee-for-service reimbursement rates for nonemergency ambulance transports and for interfacility ambulance transports, as defined, to be 100% of the amounts set forth in the federal Medicare ambulance fee schedule for the appropriate level of service billed, as specified.Existing law requires, with exceptions, that Medi-Cal reimbursement to providers of emergency medical transports be increased by application of an add-on to the associated Medi-Cal fee-for-service payment schedule. Under existing law, those increased payments 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.Under this bill, the reimbursement rate for interfacility ambulance transports, in an emergency context, would not affect the calculation of the quality assurance fee rate. Under the bill, the calculation of the quality assurance fee rate would be based on the methodology and reimbursement rate in effect as of January 1, 2025. The bill would make conforming changes to related provisions.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, this bill would require the director to recalculate and reduce the add-on amount as necessary, and would prohibit the director from reducing the Medi-Cal fee-for-service reimbursement rates for nonemergency ambulance transports or interfacility ambulance transports.Existing federal Medicare regulations set forth requirements for certification of the medical necessity of ambulance services, as signed by a physician or a nonphysician depending on the circumstance.Under this bill, whenever the medical necessity of an ambulance transport needs to be certified for purposes of Medi-Cal coverage, a nonphysician would be authorized to complete that certification in place of a physician, and the nonphysician would be authorized to do so with a signature in electronic format or any other format, to the extent authorized by the above-described federal regulations or their successor. The bill would require the department to revise and update the Medi-Cal provider manual or any guidance, as applicable, to implement this provision.Existing state Medi-Cal regulations require that records of medical transportation providers include, among other information, odometer readings at each pickup and delivery location.This bill would require the department to revise and update the above-described regulatory provision in order to allow medical transportation providers to document mileage in their records through other mechanisms, including vehicle Global Positioning System (GPS) tracking, digital mapping software, or another reasonable mechanism identified by the department, as specified, in addition to the option of odometer readings.Under this bill, commencing on January 1, 2026, and subject to an appropriation, Medi-Cal fee-for-service reimbursement for nonemergency ambulance transportation services, as defined, would be in an amount equal to the amount set forth in the federal Medicare ambulance fee schedule for the corresponding level of service, adjusted by the Geographic Practice Cost Index, as specified.The bill would require the department to maximize federal financial participation in implementing the above-described provision to the extent allowable. To the extent that federal financial participation is unavailable, the bill would require the department to implement the provision using state funds, as specified.
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 or nonemergency medical or nonmedical transportation services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
This bill would require the Medi-Cal fee-for-service reimbursement rates for nonemergency ambulance transports and for interfacility ambulance transports, as defined, to be 100% of the amounts set forth in the federal Medicare ambulance fee schedule for the appropriate level of service billed, as specified.
Existing law requires, with exceptions, that Medi-Cal reimbursement to providers of emergency medical transports be increased by application of an add-on to the associated Medi-Cal fee-for-service payment schedule. Under existing law, those increased payments 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.
Under this bill, the reimbursement rate for interfacility ambulance transports, in an emergency context, would not affect the calculation of the quality assurance fee rate. Under the bill, the calculation of the quality assurance fee rate would be based on the methodology and reimbursement rate in effect as of January 1, 2025. The bill would make conforming changes to related provisions.
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, this bill would require the director to recalculate and reduce the add-on amount as necessary, and would prohibit the director from reducing the Medi-Cal fee-for-service reimbursement rates for nonemergency ambulance transports or interfacility ambulance transports.
Existing federal Medicare regulations set forth requirements for certification of the medical necessity of ambulance services, as signed by a physician or a nonphysician depending on the circumstance.
Under this bill, whenever the medical necessity of an ambulance transport needs to be certified for purposes of Medi-Cal coverage, a nonphysician would be authorized to complete that certification in place of a physician, and the nonphysician would be authorized to do so with a signature in electronic format or any other format, to the extent authorized by the above-described federal regulations or their successor. The bill would require the department to revise and update the Medi-Cal provider manual or any guidance, as applicable, to implement this provision.
Existing state Medi-Cal regulations require that records of medical transportation providers include, among other information, odometer readings at each pickup and delivery location.
This bill would require the department to revise and update the above-described regulatory provision in order to allow medical transportation providers to document mileage in their records through other mechanisms, including vehicle Global Positioning System (GPS) tracking, digital mapping software, or another reasonable mechanism identified by the department, as specified, in addition to the option of odometer readings.
Under this bill, commencing on January 1, 2026, and subject to an appropriation, Medi-Cal fee-for-service reimbursement for nonemergency ambulance transportation services, as defined, would be in an amount equal to the amount set forth in the federal Medicare ambulance fee schedule for the corresponding level of service, adjusted by the Geographic Practice Cost Index, as specified.
The bill would require the department to maximize federal financial participation in implementing the above-described provision to the extent allowable. To the extent that federal financial participation is unavailable, the bill would require the department to implement the provision using state funds, as specified.
## Digest Key
## Bill Text
The people of the State of California do enact as follows:SECTION 1. Section 14124.151 is added to the Welfare and Institutions Code, immediately following Section 14124.15, to read:14124.151. (a) (1) Commencing on January 1, 2026, subject to an appropriation made by the Legislature to fund, in whole or in part, the reimbursement levels described in this subdivision, Medi-Cal fee-for-service reimbursement for nonemergency ambulance transportation services shall be in an amount equal to the amount set forth in the federal Medicare ambulance fee schedule established pursuant to Section 1395m of Title 42 of the United States Code, for the corresponding level of service.(2) The reimbursement described in paragraph (1) shall be adjusted by the Geographic Practice Cost Index under the federal Centers for Medicare and Medicaid Services, specific to the area of California in which the services are provided.(b) (1) The department shall maximize federal financial participation in implementing this section to the extent allowable. For purposes of implementing this section, the department shall claim federal financial participation to the extent that the department determines it is available.(2) To the extent that federal financial participation is unavailable, the department shall implement this section using state funds, if appropriated as described in subdivision (a).(3) It is the intent of the Legislature that the appropriation described in subdivision (a) be sufficient to fund the reimbursement levels in whole.(c) 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 department may implement, interpret, or make specific this section, in whole or in part, by means of plan letters, plan or provider bulletins, or similar instructions without taking any further regulatory action.(d) For purposes of this section, nonemergency ambulance transportation services means nonemergency medical transportation services, as described in Section 51323 of Title 22 of the California Code of Regulations, that are conducted by ground ambulance. The term nonemergency ambulance transportation services does not include emergency medical transport services, as defined in subdivision (g) of Section 14129.SECTION 1.The heading of Article 3.91 (commencing with Section 14129) of Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code is amended to read:3.91.Medi-Cal Emergency and Nonemergency Medical Transportation Reimbursement ActSEC. 2.Section 14129 of the Welfare and Institutions Code is amended to read:14129.For purposes of this article, the following definitions apply:(a)Annual quality assurance fee rate means the quality assurance fee assessed on each emergency medical transport during each applicable state fiscal year.(b)Aggregate fee schedule amount means the product of the fee-for-service add-on increase described in Section 14129.3 and the Medi-Cal emergency medical transports, including both fee-for-service transports paid by the department and managed care transports paid by Medi-Cal managed care health plans, utilizing the billing codes for emergency medical transport for the state fiscal year.(c)Available fee amount shall be calculated as the sum of the following:(1)The amount deposited in the Medi-Cal Emergency Medical Transport Fund established under Section 14129.2 during the applicable state fiscal year, less the amounts described in subparagraphs (A) and (B) of paragraph (2) of subdivision (f) of Section 14129.2.(2)Any federal financial participation obtained as a result of the deposit of the amount described in paragraph (1) in the Medi-Cal Emergency Medical Transport Fund, created pursuant to Section 14129.2, for the applicable state fiscal year.(d)Department means the State Department of Health Care Services.(e)Director means the Director of Health Care Services.(f)Effective state medical assistance percentage means a ratio of the aggregate expenditures from state-only sources for the Medi-Cal program divided by the aggregate expenditures from state and federal sources for the Medi-Cal program for a state fiscal year.(g)(1)Emergency medical transport means the act of transporting an individual from any point of origin to the nearest medical facility capable of meeting the emergency medical needs of the patient by an emergency medical transport provider by means of an ambulance licensed, operated, and equipped in accordance with applicable state or local statutes, ordinances, or regulations that are billed with billing codes A0429 BLS Emergency, A0427 ALS Emergency, A0434 Specialty Care Transport, A0225 Neonatal Emergency Transport, and A0433 ALS2, and any equivalent, predecessor, or successor billing codes as may be determined by the director. Emergency medical transport excludes transportation of beneficiaries by passenger car, taxicabs, litter vans, wheelchair vans, other forms of public or private conveyances, and transportation by an air ambulance provider. An emergency medical transport does not occur when, following evaluation of a patient, a transport is not provided.(2)The definition of emergency medical transport set forth in paragraph (1) shall be construed as applying whether or not those transports were initiated through a public safety answering point (PSAP) or traditional 911 dispatch system. This paragraph shall not be construed as amending or otherwise affecting the definition of ground emergency medical transports set forth in Section 14199.128 for purposes of Chapter 7.5 (commencing with Section 14199.100).(h)Gross receipts means gross payments received as patient care revenue for emergency medical transports, determined on a cash basis of accounting. Gross receipts includes all payments received as patient care revenue for emergency medical transports, including payments for billing codes A0429 BLS Emergency, A0427 ALS Emergency, and A0433 ALS2, and any equivalent, predecessor, or successor billing codes as may be determined by the director, and any other ancillary billing codes associated with emergency medical transport as may be determined by the director. Gross receipts excludes supplemental amounts received pursuant to Sections 14105.94 or 14105.945.(i)Emergency medical transport provider means any provider of emergency medical transports, except that during any Medi-Cal managed care rating period for which Section 14105.945 is implemented emergency medical transport provider shall exclude eligible providers as defined in paragraph (1) of subdivision (a) of Section 14105.945 for purposes of this article.(j)Emergency medical transport provider subject to the fee means all emergency medical transport providers who bill and receive patient care revenue from the provision of emergency medical transports, except emergency medical transport providers that are exempt pursuant to subdivision (c) of Section 14129.6.(k)Interfacility ambulance transport means an ambulance transport in which the origin and destination are both a health facility, as defined in Section 1250 of the Health and Safety Code.(l)Medi-Cal managed care health plan means a managed health care plan as that term is defined in subdivision (ab) of Section 14169.51.(m)Nonemergency ambulance transport means an ambulance transport the request for which is made other than through a 911 PSAP, and also means an ambulance transport billed with a Healthcare Common Procedure Coding System (HCPCS) code not associated with an emergency level of ambulance service.SEC. 3.Section 14129.05 is added to the Welfare and Institutions Code, immediately following Section 14129, to read:14129.05.The Medi-Cal fee-for-service reimbursement rates for nonemergency ambulance transports and for interfacility ambulance transports shall be 100 percent of the amounts set forth in the federal Medicare ambulance fee schedule established pursuant to Section 1395m of Title 42 of the United States Code for the appropriate level of service billed.SEC. 4.Section 14129.06 is added to the Welfare and Institutions Code, immediately following Section 14129.05, to read:14129.06.(a)Whenever the medical necessity of an ambulance transport needs to be certified for purposes of Medi-Cal coverage, a nonphysician may complete that certification in place of a physician, and the nonphysician may do so with a signature in electronic format or any other format, to the extent authorized by Section 410.40 of Title 42 of the Code of Federal Regulations or its successor.(b)The department shall revise and update the Medi-Cal provider manual or any guidance, as applicable, to implement subdivision (a).SEC. 5.Section 14129.2 of the Welfare and Institutions Code is amended to read:14129.2.(a)(1)Commencing with the state fiscal quarter beginning on July 1, 2018, and continuing each state fiscal quarter thereafter for which this article is implemented, there shall be imposed a quality assurance fee for each emergency medical transport provided by each emergency medical transport provider subject to the fee in accordance with this section.(2)The director shall ensure that the quality assurance fee per emergency medical transport imposed pursuant to this article is collected.(b)(1)On or before June 15, 2018, and continuing each June 15 thereafter for which this article is implemented, the director shall calculate the annual quality assurance fee rate applicable to the following state fiscal year based on the most recently collected data from emergency medical transport providers pursuant to Section 14129.1. The director may correct any identified material or significant errors in the data collected from emergency medical transport providers pursuant to Section 14129.1 for the purposes of calculating the annual quality assurance fee rate. The directors determination whether to exercise the directors discretion to correct any data pursuant to this paragraph shall not be subject to judicial review, except that an emergency medical transport provider may bring a writ of mandate under Section 1085 of the Code of Civil Procedure to rectify an abuse of discretion by the director in correcting that emergency medical transport providers data when that correction results in a greater fee amount for that provider pursuant to this section.(A)For the state fiscal year beginning on July 1, 2018, the annual quality assurance fee rate shall be calculated by multiplying the projected total annual gross receipts for all emergency medical transport providers subject to the fee by 5.1 percent, which resulting product shall be divided by the projected total annual emergency medical transports by all emergency medical transport providers subject to the fee for the state fiscal year.(B)(i)For state fiscal years beginning July 1, 2019, and continuing each state fiscal year thereafter, the annual quality assurance fee rate shall be calculated by a ratio, the numerator of which shall be the sum of: (i) the product of the projected aggregate fee schedule amount and the effective state medical assistance percentage and (ii) the amount described in subparagraph (A) of paragraph (2) of subdivision (f) for the state fiscal year, and the denominator of which shall be 90 percent of the projected total annual emergency medical transports by all emergency medical transport providers subject to the fee for the state fiscal year.(ii)Notwithstanding clause (i) or any other law, the reimbursement rate for interfacility ambulance transports, as described in Section 14129.05, in an emergency context, shall not affect the calculation of the quality assurance fee rate. Section 14129.05 shall not be construed as affecting that calculation. The calculation of the quality assurance fee rate shall be based on the methodology and reimbursement rate in effect as of January 1, 2025.(2)On or before June 15, 2018, and continuing each June 15 thereafter for which this article is implemented, the director shall publish the annual quality assurance fee rate on its internet website.(3)In no case shall the fees calculated pursuant to this subdivision and collected pursuant to this article exceed the amounts allowable under federal law. If, on or before June 15 of each year, the director makes a determination that the fees collected pursuant to this subdivision exceed the amounts allowable under federal law, the director may reduce the add-on increase to the fee-for-service payment schedule described in Section 14129.3 only to the extent necessary to reflect the amount of fees allowable under federal law in an applicable state fiscal year.(4)If, during a state fiscal year for which this article is operative, the actual or projected available fee amount exceeds or is less than the actual or projected aggregate fee schedule amount by more than 1 percent, the director shall adjust the annual quality assurance fee rate so that the available fee amount for the state fiscal year will approximately equal the aggregate fee schedule amount for the state fiscal year. The available fee amount for a state fiscal year shall be considered to equal the aggregate fee schedule amount for the state fiscal year if the difference between the available fee amount for the state fiscal year and the aggregate fee schedule amount for the state fiscal year constitutes less than 1 percent of the aggregate fee schedule amount for the state fiscal year.(c)(1)Each emergency medical transport provider subject to the fee shall remit to the department an amount equal to the annual quality assurance fee rate for the 201819 state fiscal year multiplied by the number of transports reported or that should have been reported by the emergency medical transport provider pursuant to subdivision (b) of Section 14129.1 in the quarter beginning on April 1, 2018, based on a schedule established by the director. The schedule established by the director for the fee payment described in this paragraph shall require remittance of the fee payment according to the following guidelines:(A)The director shall require an emergency medical transport provider that rendered 35,000 or more Medi-Cal fee-for-service emergency medical transports during the 201617 state fiscal year to remit the fee payment described in this paragraph on or after July 1, 2018.(B)The director shall require an emergency medical transport provider that rendered fewer than 35,000 Medi-Cal fee-for-service emergency medical transports during the 201617 state fiscal year to remit 50 percent or less of the fee payment described in this paragraph on or after August 1, 2018.(C)The director shall require an emergency medical transport provider that rendered fewer than 35,000 Medi-Cal fee-for-service emergency medical transports during the 201617 state fiscal year to remit any remaining fee payment amount described in this paragraph on or after August 15, 2018.(2)Commencing with the state fiscal quarter beginning on October 1, 2018, and continuing each state fiscal quarter thereafter, on or before the first day of each state fiscal quarter, each emergency medical transport provider subject to the fee shall remit to the department an amount equal to the annual quality assurance fee rate for the applicable state fiscal year multiplied by the number of transports reported or that should have been reported by the emergency medical transport provider pursuant to subdivision (b) of Section 14129.1 in the immediately preceding quarter.(d)(1)Interest shall be assessed on quality assurance fees not paid on the date due at the greater of 10 percent per annum or the rate at which the department assesses interest on Medi-Cal program overpayments pursuant to subdivision (h) of Section 14171. Interest shall begin to accrue the day after the date the payment was due and shall be deposited in the Medi-Cal Emergency Medical Transport Fund established in subdivision (f).(2)In the event that any fee payment is more than 60 days overdue, the department may deduct the unpaid fee and interest owed from any Medi-Cal reimbursement payments owed to the emergency medical transport provider until the full amount of the fee, interest, and any penalties assessed under this article are recovered. Any deduction made pursuant to this subdivision shall be made only after the department gives the emergency medical transport 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 emergency medical transport provider.(3)In the event that any fee payment is more than 60 days overdue, a penalty equal to the interest charge described in paragraph (1) shall be assessed and due for each month for which the payment is not received after 60 days. Any funds resulting from a penalty imposed pursuant to this paragraph shall be deposited into the Medi-Cal Emergency Medical Transport Fund created pursuant to subdivision (f).(4)The director may waive a portion or all of either the interest or penalties, or both, assessed under this article in the event the director determines, in the directors sole discretion, that the emergency medical transport provider has demonstrated that imposition of the full amount of the quality assurance fee pursuant to the timelines applicable under this article has a high likelihood of creating an undue financial hardship for the provider. Waiver of some or all of the interest or penalties pursuant to this paragraph shall be conditioned on the emergency medical transport providers agreement to make fee payments on an alternative schedule developed by the department.(e)The department shall accept an emergency medical transport providers payment even if the payment is submitted in a rate year subsequent to the rate year in which the fee was assessed.(f)(1)The director shall deposit the quality assurance fees collected pursuant to this section in the Medi-Cal Emergency Medical Transport Fund, which is hereby created in the State Treasury and, notwithstanding Section 13340 of the Government Code, is continuously appropriated without regard to fiscal years to the department for the purposes specified in this article. Notwithstanding Section 16305.7 of the Government Code, the fund shall also include interest and dividends earned on moneys in the fund.(2)The moneys in the Medi-Cal Emergency Medical Transport Fund, including any interest and dividends earned on money in the fund, shall be available exclusively to enhance federal financial participation for ambulance services under the Medi-Cal program and to provide additional reimbursement to, and to support quality improvement efforts of, emergency medical transport providers, and to pay for the states administrative costs and to provide funding for health care coverage for Californians, in the following order of priority:(A)To pay for the departments staffing and administrative costs directly attributable to implementing this article, not to exceed the following amounts:(i)For the 201819 state fiscal year, one million three thousand dollars ($1,003,000), exclusive of any federal matching funds.(ii)For the 201920 state fiscal year and each state fiscal year thereafter, three hundred seventy-four thousand dollars ($374,000), exclusive of any federal matching funds.(B)To pay for the health care coverage in each applicable state fiscal year in the amount of 10 percent of the annual quality assurance fee collection amount, exclusive of any federal matching funds.(C)To make increased payments to emergency medical transport providers pursuant to this article.(g)In the event of a merger, acquisition, or similar transaction involving an emergency medical transport provider that has outstanding quality assurance fee payment obligations pursuant to this article, including any interest and penalty amounts owed, the resultant or successor emergency medical transport provider shall be responsible for paying to the department the full amount of outstanding quality assurance fee payments, including any applicable interest and penalties, attributable to the emergency medical transport provider for which it was assessed, upon the effective date of the transaction. An entity considering a merger, acquisition, or similar transaction involving an emergency medical transport provider may submit a request pursuant to Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code to ascertain the outstanding quality assurance fee payment obligations of the emergency medical transport provider pursuant to this article as of the date of the departments response to that request.SEC. 6.Section 14129.3 of the Welfare and Institutions Code is amended to read:14129.3.(a)Except as provided in subdivision (i) of Section 14105.945, commencing July 1, 2018, and for each state fiscal year thereafter for which this article is operative, reimbursement to emergency medical transport providers for emergency medical transports shall be increased by application of an add-on to the associated Medi-Cal fee-for-service payment schedule. The add-on increase to the fee-for-service payment schedule under this section shall be calculated on or before June 15, 2018, and shall remain the same for later state fiscal years for which this article is operative, to the extent the department determines federal financial participation is available and is not otherwise jeopardized. The add-on increase to the fee-for-service payment schedule under this section shall apply only to those billing codes identified in, or any equivalent, predecessor, or successor billing codes as may be determined by the director pursuant to, subdivision (g) of Section 14129. The department shall calculate the projections required by this subdivision based on the data submitted pursuant to Section 14129.1. The fee-for-service add-on shall be equal to the quotient of the available fee amount projected by the department on or before June 15, 2018, for the 201819 state fiscal year, divided by the total Medi-Cal emergency medical transports, including both fee-for-service transports paid by the department and managed care transports paid by Medi-Cal managed care health plans, utilizing these billing codes projected by the department on or before June 15, 2018, for the 201819 state fiscal year. The resulting fee-for-service payment schedule amounts after the application of this section shall be equal to the sum of the Medi-Cal fee-for-service payment schedule amount for the 201516 state fiscal year, except as described in Section 14129.05, and the add-on increase.(b)(1)Each applicable Medi-Cal managed care health plan shall satisfy its obligation under Section 438.114(c) of Title 42 of the Code of Federal Regulations for emergency medical transports and shall provide payment to noncontract emergency medical transport providers consistent with Section 1396u-2(b)(2)(D) of Title 42 of the United States Code. Effective July 1, 2018, and for each state fiscal year thereafter for which this article is operative, 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 Section 1396u-2(b)(2)(D) of Title 42 of the United States Code shall be the resulting fee-for-service payment schedule amounts after the application of this section.(2)This subdivision shall not apply to an eligible provider, as defined in paragraph (1) of subdivision (a) of Section 14105.945, 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 Section 14105.945 is implemented.(c)The increased payments required by this section shall be funded solely from the following:(1)The quality assurance fee set forth in Section 14129.2, along with any interest or other investment income earned on those funds.(2)Federal reimbursement and any other related federal funds.(d)The proceeds of the quality assurance fee set forth in Section 14129.2, the matching amount provided by the federal government, and any interest earned on those proceeds shall be used to supplement existing funding for emergency medical transports provided by emergency medical transport providers and not to supplant this funding.(e)Notwithstanding this article, the department may seek federal approval to implement any add-on increase to the fee-for-service payment schedule pursuant to this section for any state fiscal year or years, as applicable, on a time-limited basis for a fixed program period, as determined by the department.(f)Notwithstanding this article, the add-on increase to the fee-for-service payment schedule pursuant to this section shall only be required and payable for state fiscal years that a quality assurance fee payment obligation exists for emergency medical transport providers.SEC. 7.Section 14129.6 of the Welfare and Institutions Code is amended to read:14129.6.(a)(1)The department shall request any approval from the federal Centers for Medicare and Medicaid Services it deems necessary for the use of fees pursuant to this article and for the purpose of receiving associated federal matching funds.(2)In making that request, the department may seek, as it deems necessary, a request for waiver of the broad-based requirement, waiver of the uniformity requirement, or both, pursuant to paragraphs (1) and (2) of subdivision (e) of Section 433.68 of Title 42 of the Code of Federal Regulations, or a request for waiver of any other provisions of federal law or regulation necessary to implement this article.(3)This article shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available and is not otherwise jeopardized.(b)(1)The director may modify or make adjustments to any methodology, fee amount, or other provision specified in this article to the extent necessary to meet the requirements of federal law or regulations or to obtain federal approval. If the director, after consulting with affected emergency medical transport providers, determines that a modification is needed, the director shall execute a declaration stating that this determination has been made and that the actual or projected available fee amount for a state fiscal year remains approximately equal to the actual or projected aggregate fee schedule amount for each applicable state fiscal year, as defined by paragraph (4) of subdivision (b) of Section 14129.2. The director shall retain the declaration and provide a copy, within five working days of the execution of the declaration, to the fiscal and appropriate policy committees of the Legislature.(2)If a modification or adjustment is needed to meet the requirements of federal law or regulations or to obtain federal approval, the director shall recalculate and reduce the add-on amount described in Section 14129.2, as necessary, and shall not reduce the Medi-Cal fee-for-service reimbursement rates for nonemergency ambulance transports or interfacility ambulance transports, as described in Section 14129.05.(c)The director may add categories of exempt emergency medical transport providers or apply a nonuniform fee per transport to emergency medical transport providers that are subject to the fee in order to meet requirements of federal law or regulations. The director may exempt categories of emergency medical transport providers from the fee if necessary to obtain federal approval.(d)If, before June 1 preceding the start of an applicable state fiscal year, the director finds that the implementation of this article is likely no longer a benefit to the General Fund for the applicable state fiscal year, the director may decide to not implement this article for that state fiscal year. The director shall notify the appropriate fiscal and policy committees of the Legislature, and emergency medical transport providers individually and via the departments internet website of its finding pursuant to this subdivision.SEC. 8.For purposes of the Medi-Cal program, the State Department of Health Care Services shall revise and update paragraph (2) of subdivision (e) of Section 51476 of Title 22 of the California Code of Regulations in order to allow medical transportation providers to document mileage in their records through any of the following mechanisms:(a)Odometer readings at each pickup and delivery location.(b)Vehicle Global Positioning System (GPS) tracking.(c)Digital mapping software.(d)Any other mechanism identified by the department, as deemed reasonable based on ongoing technological updates.
The people of the State of California do enact as follows:
## The people of the State of California do enact as follows:
SECTION 1. Section 14124.151 is added to the Welfare and Institutions Code, immediately following Section 14124.15, to read:14124.151. (a) (1) Commencing on January 1, 2026, subject to an appropriation made by the Legislature to fund, in whole or in part, the reimbursement levels described in this subdivision, Medi-Cal fee-for-service reimbursement for nonemergency ambulance transportation services shall be in an amount equal to the amount set forth in the federal Medicare ambulance fee schedule established pursuant to Section 1395m of Title 42 of the United States Code, for the corresponding level of service.(2) The reimbursement described in paragraph (1) shall be adjusted by the Geographic Practice Cost Index under the federal Centers for Medicare and Medicaid Services, specific to the area of California in which the services are provided.(b) (1) The department shall maximize federal financial participation in implementing this section to the extent allowable. For purposes of implementing this section, the department shall claim federal financial participation to the extent that the department determines it is available.(2) To the extent that federal financial participation is unavailable, the department shall implement this section using state funds, if appropriated as described in subdivision (a).(3) It is the intent of the Legislature that the appropriation described in subdivision (a) be sufficient to fund the reimbursement levels in whole.(c) 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 department may implement, interpret, or make specific this section, in whole or in part, by means of plan letters, plan or provider bulletins, or similar instructions without taking any further regulatory action.(d) For purposes of this section, nonemergency ambulance transportation services means nonemergency medical transportation services, as described in Section 51323 of Title 22 of the California Code of Regulations, that are conducted by ground ambulance. The term nonemergency ambulance transportation services does not include emergency medical transport services, as defined in subdivision (g) of Section 14129.
SECTION 1. Section 14124.151 is added to the Welfare and Institutions Code, immediately following Section 14124.15, to read:
### SECTION 1.
14124.151. (a) (1) Commencing on January 1, 2026, subject to an appropriation made by the Legislature to fund, in whole or in part, the reimbursement levels described in this subdivision, Medi-Cal fee-for-service reimbursement for nonemergency ambulance transportation services shall be in an amount equal to the amount set forth in the federal Medicare ambulance fee schedule established pursuant to Section 1395m of Title 42 of the United States Code, for the corresponding level of service.(2) The reimbursement described in paragraph (1) shall be adjusted by the Geographic Practice Cost Index under the federal Centers for Medicare and Medicaid Services, specific to the area of California in which the services are provided.(b) (1) The department shall maximize federal financial participation in implementing this section to the extent allowable. For purposes of implementing this section, the department shall claim federal financial participation to the extent that the department determines it is available.(2) To the extent that federal financial participation is unavailable, the department shall implement this section using state funds, if appropriated as described in subdivision (a).(3) It is the intent of the Legislature that the appropriation described in subdivision (a) be sufficient to fund the reimbursement levels in whole.(c) 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 department may implement, interpret, or make specific this section, in whole or in part, by means of plan letters, plan or provider bulletins, or similar instructions without taking any further regulatory action.(d) For purposes of this section, nonemergency ambulance transportation services means nonemergency medical transportation services, as described in Section 51323 of Title 22 of the California Code of Regulations, that are conducted by ground ambulance. The term nonemergency ambulance transportation services does not include emergency medical transport services, as defined in subdivision (g) of Section 14129.
14124.151. (a) (1) Commencing on January 1, 2026, subject to an appropriation made by the Legislature to fund, in whole or in part, the reimbursement levels described in this subdivision, Medi-Cal fee-for-service reimbursement for nonemergency ambulance transportation services shall be in an amount equal to the amount set forth in the federal Medicare ambulance fee schedule established pursuant to Section 1395m of Title 42 of the United States Code, for the corresponding level of service.(2) The reimbursement described in paragraph (1) shall be adjusted by the Geographic Practice Cost Index under the federal Centers for Medicare and Medicaid Services, specific to the area of California in which the services are provided.(b) (1) The department shall maximize federal financial participation in implementing this section to the extent allowable. For purposes of implementing this section, the department shall claim federal financial participation to the extent that the department determines it is available.(2) To the extent that federal financial participation is unavailable, the department shall implement this section using state funds, if appropriated as described in subdivision (a).(3) It is the intent of the Legislature that the appropriation described in subdivision (a) be sufficient to fund the reimbursement levels in whole.(c) 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 department may implement, interpret, or make specific this section, in whole or in part, by means of plan letters, plan or provider bulletins, or similar instructions without taking any further regulatory action.(d) For purposes of this section, nonemergency ambulance transportation services means nonemergency medical transportation services, as described in Section 51323 of Title 22 of the California Code of Regulations, that are conducted by ground ambulance. The term nonemergency ambulance transportation services does not include emergency medical transport services, as defined in subdivision (g) of Section 14129.
14124.151. (a) (1) Commencing on January 1, 2026, subject to an appropriation made by the Legislature to fund, in whole or in part, the reimbursement levels described in this subdivision, Medi-Cal fee-for-service reimbursement for nonemergency ambulance transportation services shall be in an amount equal to the amount set forth in the federal Medicare ambulance fee schedule established pursuant to Section 1395m of Title 42 of the United States Code, for the corresponding level of service.(2) The reimbursement described in paragraph (1) shall be adjusted by the Geographic Practice Cost Index under the federal Centers for Medicare and Medicaid Services, specific to the area of California in which the services are provided.(b) (1) The department shall maximize federal financial participation in implementing this section to the extent allowable. For purposes of implementing this section, the department shall claim federal financial participation to the extent that the department determines it is available.(2) To the extent that federal financial participation is unavailable, the department shall implement this section using state funds, if appropriated as described in subdivision (a).(3) It is the intent of the Legislature that the appropriation described in subdivision (a) be sufficient to fund the reimbursement levels in whole.(c) 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 department may implement, interpret, or make specific this section, in whole or in part, by means of plan letters, plan or provider bulletins, or similar instructions without taking any further regulatory action.(d) For purposes of this section, nonemergency ambulance transportation services means nonemergency medical transportation services, as described in Section 51323 of Title 22 of the California Code of Regulations, that are conducted by ground ambulance. The term nonemergency ambulance transportation services does not include emergency medical transport services, as defined in subdivision (g) of Section 14129.
14124.151. (a) (1) Commencing on January 1, 2026, subject to an appropriation made by the Legislature to fund, in whole or in part, the reimbursement levels described in this subdivision, Medi-Cal fee-for-service reimbursement for nonemergency ambulance transportation services shall be in an amount equal to the amount set forth in the federal Medicare ambulance fee schedule established pursuant to Section 1395m of Title 42 of the United States Code, for the corresponding level of service.
(2) The reimbursement described in paragraph (1) shall be adjusted by the Geographic Practice Cost Index under the federal Centers for Medicare and Medicaid Services, specific to the area of California in which the services are provided.
(b) (1) The department shall maximize federal financial participation in implementing this section to the extent allowable. For purposes of implementing this section, the department shall claim federal financial participation to the extent that the department determines it is available.
(2) To the extent that federal financial participation is unavailable, the department shall implement this section using state funds, if appropriated as described in subdivision (a).
(3) It is the intent of the Legislature that the appropriation described in subdivision (a) be sufficient to fund the reimbursement levels in whole.
(c) 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 department may implement, interpret, or make specific this section, in whole or in part, by means of plan letters, plan or provider bulletins, or similar instructions without taking any further regulatory action.
(d) For purposes of this section, nonemergency ambulance transportation services means nonemergency medical transportation services, as described in Section 51323 of Title 22 of the California Code of Regulations, that are conducted by ground ambulance. The term nonemergency ambulance transportation services does not include emergency medical transport services, as defined in subdivision (g) of Section 14129.
For purposes of this article, the following definitions apply:
(a)Annual quality assurance fee rate means the quality assurance fee assessed on each emergency medical transport during each applicable state fiscal year.
(b)Aggregate fee schedule amount means the product of the fee-for-service add-on increase described in Section 14129.3 and the Medi-Cal emergency medical transports, including both fee-for-service transports paid by the department and managed care transports paid by Medi-Cal managed care health plans, utilizing the billing codes for emergency medical transport for the state fiscal year.
(c)Available fee amount shall be calculated as the sum of the following:
(1)The amount deposited in the Medi-Cal Emergency Medical Transport Fund established under Section 14129.2 during the applicable state fiscal year, less the amounts described in subparagraphs (A) and (B) of paragraph (2) of subdivision (f) of Section 14129.2.
(2)Any federal financial participation obtained as a result of the deposit of the amount described in paragraph (1) in the Medi-Cal Emergency Medical Transport Fund, created pursuant to Section 14129.2, for the applicable state fiscal year.
(d)Department means the State Department of Health Care Services.
(e)Director means the Director of Health Care Services.
(f)Effective state medical assistance percentage means a ratio of the aggregate expenditures from state-only sources for the Medi-Cal program divided by the aggregate expenditures from state and federal sources for the Medi-Cal program for a state fiscal year.
(g)(1)Emergency medical transport means the act of transporting an individual from any point of origin to the nearest medical facility capable of meeting the emergency medical needs of the patient by an emergency medical transport provider by means of an ambulance licensed, operated, and equipped in accordance with applicable state or local statutes, ordinances, or regulations that are billed with billing codes A0429 BLS Emergency, A0427 ALS Emergency, A0434 Specialty Care Transport, A0225 Neonatal Emergency Transport, and A0433 ALS2, and any equivalent, predecessor, or successor billing codes as may be determined by the director. Emergency medical transport excludes transportation of beneficiaries by passenger car, taxicabs, litter vans, wheelchair vans, other forms of public or private conveyances, and transportation by an air ambulance provider. An emergency medical transport does not occur when, following evaluation of a patient, a transport is not provided.
(2)The definition of emergency medical transport set forth in paragraph (1) shall be construed as applying whether or not those transports were initiated through a public safety answering point (PSAP) or traditional 911 dispatch system. This paragraph shall not be construed as amending or otherwise affecting the definition of ground emergency medical transports set forth in Section 14199.128 for purposes of Chapter 7.5 (commencing with Section 14199.100).
(h)Gross receipts means gross payments received as patient care revenue for emergency medical transports, determined on a cash basis of accounting. Gross receipts includes all payments received as patient care revenue for emergency medical transports, including payments for billing codes A0429 BLS Emergency, A0427 ALS Emergency, and A0433 ALS2, and any equivalent, predecessor, or successor billing codes as may be determined by the director, and any other ancillary billing codes associated with emergency medical transport as may be determined by the director. Gross receipts excludes supplemental amounts received pursuant to Sections 14105.94 or 14105.945.
(i)Emergency medical transport provider means any provider of emergency medical transports, except that during any Medi-Cal managed care rating period for which Section 14105.945 is implemented emergency medical transport provider shall exclude eligible providers as defined in paragraph (1) of subdivision (a) of Section 14105.945 for purposes of this article.
(j)Emergency medical transport provider subject to the fee means all emergency medical transport providers who bill and receive patient care revenue from the provision of emergency medical transports, except emergency medical transport providers that are exempt pursuant to subdivision (c) of Section 14129.6.
(k)Interfacility ambulance transport means an ambulance transport in which the origin and destination are both a health facility, as defined in Section 1250 of the Health and Safety Code.
(l)Medi-Cal managed care health plan means a managed health care plan as that term is defined in subdivision (ab) of Section 14169.51.
(m)Nonemergency ambulance transport means an ambulance transport the request for which is made other than through a 911 PSAP, and also means an ambulance transport billed with a Healthcare Common Procedure Coding System (HCPCS) code not associated with an emergency level of ambulance service.
The Medi-Cal fee-for-service reimbursement rates for nonemergency ambulance transports and for interfacility ambulance transports shall be 100 percent of the amounts set forth in the federal Medicare ambulance fee schedule established pursuant to Section 1395m of Title 42 of the United States Code for the appropriate level of service billed.
(a)Whenever the medical necessity of an ambulance transport needs to be certified for purposes of Medi-Cal coverage, a nonphysician may complete that certification in place of a physician, and the nonphysician may do so with a signature in electronic format or any other format, to the extent authorized by Section 410.40 of Title 42 of the Code of Federal Regulations or its successor.
(b)The department shall revise and update the Medi-Cal provider manual or any guidance, as applicable, to implement subdivision (a).
(a)(1)Commencing with the state fiscal quarter beginning on July 1, 2018, and continuing each state fiscal quarter thereafter for which this article is implemented, there shall be imposed a quality assurance fee for each emergency medical transport provided by each emergency medical transport provider subject to the fee in accordance with this section.
(2)The director shall ensure that the quality assurance fee per emergency medical transport imposed pursuant to this article is collected.
(b)(1)On or before June 15, 2018, and continuing each June 15 thereafter for which this article is implemented, the director shall calculate the annual quality assurance fee rate applicable to the following state fiscal year based on the most recently collected data from emergency medical transport providers pursuant to Section 14129.1. The director may correct any identified material or significant errors in the data collected from emergency medical transport providers pursuant to Section 14129.1 for the purposes of calculating the annual quality assurance fee rate. The directors determination whether to exercise the directors discretion to correct any data pursuant to this paragraph shall not be subject to judicial review, except that an emergency medical transport provider may bring a writ of mandate under Section 1085 of the Code of Civil Procedure to rectify an abuse of discretion by the director in correcting that emergency medical transport providers data when that correction results in a greater fee amount for that provider pursuant to this section.
(A)For the state fiscal year beginning on July 1, 2018, the annual quality assurance fee rate shall be calculated by multiplying the projected total annual gross receipts for all emergency medical transport providers subject to the fee by 5.1 percent, which resulting product shall be divided by the projected total annual emergency medical transports by all emergency medical transport providers subject to the fee for the state fiscal year.
(B)(i)For state fiscal years beginning July 1, 2019, and continuing each state fiscal year thereafter, the annual quality assurance fee rate shall be calculated by a ratio, the numerator of which shall be the sum of: (i) the product of the projected aggregate fee schedule amount and the effective state medical assistance percentage and (ii) the amount described in subparagraph (A) of paragraph (2) of subdivision (f) for the state fiscal year, and the denominator of which shall be 90 percent of the projected total annual emergency medical transports by all emergency medical transport providers subject to the fee for the state fiscal year.
(ii)Notwithstanding clause (i) or any other law, the reimbursement rate for interfacility ambulance transports, as described in Section 14129.05, in an emergency context, shall not affect the calculation of the quality assurance fee rate. Section 14129.05 shall not be construed as affecting that calculation. The calculation of the quality assurance fee rate shall be based on the methodology and reimbursement rate in effect as of January 1, 2025.
(2)On or before June 15, 2018, and continuing each June 15 thereafter for which this article is implemented, the director shall publish the annual quality assurance fee rate on its internet website.
(3)In no case shall the fees calculated pursuant to this subdivision and collected pursuant to this article exceed the amounts allowable under federal law. If, on or before June 15 of each year, the director makes a determination that the fees collected pursuant to this subdivision exceed the amounts allowable under federal law, the director may reduce the add-on increase to the fee-for-service payment schedule described in Section 14129.3 only to the extent necessary to reflect the amount of fees allowable under federal law in an applicable state fiscal year.
(4)If, during a state fiscal year for which this article is operative, the actual or projected available fee amount exceeds or is less than the actual or projected aggregate fee schedule amount by more than 1 percent, the director shall adjust the annual quality assurance fee rate so that the available fee amount for the state fiscal year will approximately equal the aggregate fee schedule amount for the state fiscal year. The available fee amount for a state fiscal year shall be considered to equal the aggregate fee schedule amount for the state fiscal year if the difference between the available fee amount for the state fiscal year and the aggregate fee schedule amount for the state fiscal year constitutes less than 1 percent of the aggregate fee schedule amount for the state fiscal year.
(c)(1)Each emergency medical transport provider subject to the fee shall remit to the department an amount equal to the annual quality assurance fee rate for the 201819 state fiscal year multiplied by the number of transports reported or that should have been reported by the emergency medical transport provider pursuant to subdivision (b) of Section 14129.1 in the quarter beginning on April 1, 2018, based on a schedule established by the director. The schedule established by the director for the fee payment described in this paragraph shall require remittance of the fee payment according to the following guidelines:
(A)The director shall require an emergency medical transport provider that rendered 35,000 or more Medi-Cal fee-for-service emergency medical transports during the 201617 state fiscal year to remit the fee payment described in this paragraph on or after July 1, 2018.
(B)The director shall require an emergency medical transport provider that rendered fewer than 35,000 Medi-Cal fee-for-service emergency medical transports during the 201617 state fiscal year to remit 50 percent or less of the fee payment described in this paragraph on or after August 1, 2018.
(C)The director shall require an emergency medical transport provider that rendered fewer than 35,000 Medi-Cal fee-for-service emergency medical transports during the 201617 state fiscal year to remit any remaining fee payment amount described in this paragraph on or after August 15, 2018.
(2)Commencing with the state fiscal quarter beginning on October 1, 2018, and continuing each state fiscal quarter thereafter, on or before the first day of each state fiscal quarter, each emergency medical transport provider subject to the fee shall remit to the department an amount equal to the annual quality assurance fee rate for the applicable state fiscal year multiplied by the number of transports reported or that should have been reported by the emergency medical transport provider pursuant to subdivision (b) of Section 14129.1 in the immediately preceding quarter.
(d)(1)Interest shall be assessed on quality assurance fees not paid on the date due at the greater of 10 percent per annum or the rate at which the department assesses interest on Medi-Cal program overpayments pursuant to subdivision (h) of Section 14171. Interest shall begin to accrue the day after the date the payment was due and shall be deposited in the Medi-Cal Emergency Medical Transport Fund established in subdivision (f).
(2)In the event that any fee payment is more than 60 days overdue, the department may deduct the unpaid fee and interest owed from any Medi-Cal reimbursement payments owed to the emergency medical transport provider until the full amount of the fee, interest, and any penalties assessed under this article are recovered. Any deduction made pursuant to this subdivision shall be made only after the department gives the emergency medical transport 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 emergency medical transport provider.
(3)In the event that any fee payment is more than 60 days overdue, a penalty equal to the interest charge described in paragraph (1) shall be assessed and due for each month for which the payment is not received after 60 days. Any funds resulting from a penalty imposed pursuant to this paragraph shall be deposited into the Medi-Cal Emergency Medical Transport Fund created pursuant to subdivision (f).
(4)The director may waive a portion or all of either the interest or penalties, or both, assessed under this article in the event the director determines, in the directors sole discretion, that the emergency medical transport provider has demonstrated that imposition of the full amount of the quality assurance fee pursuant to the timelines applicable under this article has a high likelihood of creating an undue financial hardship for the provider. Waiver of some or all of the interest or penalties pursuant to this paragraph shall be conditioned on the emergency medical transport providers agreement to make fee payments on an alternative schedule developed by the department.
(e)The department shall accept an emergency medical transport providers payment even if the payment is submitted in a rate year subsequent to the rate year in which the fee was assessed.
(f)(1)The director shall deposit the quality assurance fees collected pursuant to this section in the Medi-Cal Emergency Medical Transport Fund, which is hereby created in the State Treasury and, notwithstanding Section 13340 of the Government Code, is continuously appropriated without regard to fiscal years to the department for the purposes specified in this article. Notwithstanding Section 16305.7 of the Government Code, the fund shall also include interest and dividends earned on moneys in the fund.
(2)The moneys in the Medi-Cal Emergency Medical Transport Fund, including any interest and dividends earned on money in the fund, shall be available exclusively to enhance federal financial participation for ambulance services under the Medi-Cal program and to provide additional reimbursement to, and to support quality improvement efforts of, emergency medical transport providers, and to pay for the states administrative costs and to provide funding for health care coverage for Californians, in the following order of priority:
(A)To pay for the departments staffing and administrative costs directly attributable to implementing this article, not to exceed the following amounts:
(i)For the 201819 state fiscal year, one million three thousand dollars ($1,003,000), exclusive of any federal matching funds.
(ii)For the 201920 state fiscal year and each state fiscal year thereafter, three hundred seventy-four thousand dollars ($374,000), exclusive of any federal matching funds.
(B)To pay for the health care coverage in each applicable state fiscal year in the amount of 10 percent of the annual quality assurance fee collection amount, exclusive of any federal matching funds.
(C)To make increased payments to emergency medical transport providers pursuant to this article.
(g)In the event of a merger, acquisition, or similar transaction involving an emergency medical transport provider that has outstanding quality assurance fee payment obligations pursuant to this article, including any interest and penalty amounts owed, the resultant or successor emergency medical transport provider shall be responsible for paying to the department the full amount of outstanding quality assurance fee payments, including any applicable interest and penalties, attributable to the emergency medical transport provider for which it was assessed, upon the effective date of the transaction. An entity considering a merger, acquisition, or similar transaction involving an emergency medical transport provider may submit a request pursuant to Division 10 (commencing with Section 7920.000) of Title 1 of the Government Code to ascertain the outstanding quality assurance fee payment obligations of the emergency medical transport provider pursuant to this article as of the date of the departments response to that request.
(a)Except as provided in subdivision (i) of Section 14105.945, commencing July 1, 2018, and for each state fiscal year thereafter for which this article is operative, reimbursement to emergency medical transport providers for emergency medical transports shall be increased by application of an add-on to the associated Medi-Cal fee-for-service payment schedule. The add-on increase to the fee-for-service payment schedule under this section shall be calculated on or before June 15, 2018, and shall remain the same for later state fiscal years for which this article is operative, to the extent the department determines federal financial participation is available and is not otherwise jeopardized. The add-on increase to the fee-for-service payment schedule under this section shall apply only to those billing codes identified in, or any equivalent, predecessor, or successor billing codes as may be determined by the director pursuant to, subdivision (g) of Section 14129. The department shall calculate the projections required by this subdivision based on the data submitted pursuant to Section 14129.1. The fee-for-service add-on shall be equal to the quotient of the available fee amount projected by the department on or before June 15, 2018, for the 201819 state fiscal year, divided by the total Medi-Cal emergency medical transports, including both fee-for-service transports paid by the department and managed care transports paid by Medi-Cal managed care health plans, utilizing these billing codes projected by the department on or before June 15, 2018, for the 201819 state fiscal year. The resulting fee-for-service payment schedule amounts after the application of this section shall be equal to the sum of the Medi-Cal fee-for-service payment schedule amount for the 201516 state fiscal year, except as described in Section 14129.05, and the add-on increase.
(b)(1)Each applicable Medi-Cal managed care health plan shall satisfy its obligation under Section 438.114(c) of Title 42 of the Code of Federal Regulations for emergency medical transports and shall provide payment to noncontract emergency medical transport providers consistent with Section 1396u-2(b)(2)(D) of Title 42 of the United States Code. Effective July 1, 2018, and for each state fiscal year thereafter for which this article is operative, 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 Section 1396u-2(b)(2)(D) of Title 42 of the United States Code shall be the resulting fee-for-service payment schedule amounts after the application of this section.
(2)This subdivision shall not apply to an eligible provider, as defined in paragraph (1) of subdivision (a) of Section 14105.945, 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 Section 14105.945 is implemented.
(c)The increased payments required by this section shall be funded solely from the following:
(1)The quality assurance fee set forth in Section 14129.2, along with any interest or other investment income earned on those funds.
(2)Federal reimbursement and any other related federal funds.
(d)The proceeds of the quality assurance fee set forth in Section 14129.2, the matching amount provided by the federal government, and any interest earned on those proceeds shall be used to supplement existing funding for emergency medical transports provided by emergency medical transport providers and not to supplant this funding.
(e)Notwithstanding this article, the department may seek federal approval to implement any add-on increase to the fee-for-service payment schedule pursuant to this section for any state fiscal year or years, as applicable, on a time-limited basis for a fixed program period, as determined by the department.
(f)Notwithstanding this article, the add-on increase to the fee-for-service payment schedule pursuant to this section shall only be required and payable for state fiscal years that a quality assurance fee payment obligation exists for emergency medical transport providers.
(a)(1)The department shall request any approval from the federal Centers for Medicare and Medicaid Services it deems necessary for the use of fees pursuant to this article and for the purpose of receiving associated federal matching funds.
(2)In making that request, the department may seek, as it deems necessary, a request for waiver of the broad-based requirement, waiver of the uniformity requirement, or both, pursuant to paragraphs (1) and (2) of subdivision (e) of Section 433.68 of Title 42 of the Code of Federal Regulations, or a request for waiver of any other provisions of federal law or regulation necessary to implement this article.
(3)This article shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available and is not otherwise jeopardized.
(b)(1)The director may modify or make adjustments to any methodology, fee amount, or other provision specified in this article to the extent necessary to meet the requirements of federal law or regulations or to obtain federal approval. If the director, after consulting with affected emergency medical transport providers, determines that a modification is needed, the director shall execute a declaration stating that this determination has been made and that the actual or projected available fee amount for a state fiscal year remains approximately equal to the actual or projected aggregate fee schedule amount for each applicable state fiscal year, as defined by paragraph (4) of subdivision (b) of Section 14129.2. The director shall retain the declaration and provide a copy, within five working days of the execution of the declaration, to the fiscal and appropriate policy committees of the Legislature.
(2)If a modification or adjustment is needed to meet the requirements of federal law or regulations or to obtain federal approval, the director shall recalculate and reduce the add-on amount described in Section 14129.2, as necessary, and shall not reduce the Medi-Cal fee-for-service reimbursement rates for nonemergency ambulance transports or interfacility ambulance transports, as described in Section 14129.05.
(c)The director may add categories of exempt emergency medical transport providers or apply a nonuniform fee per transport to emergency medical transport providers that are subject to the fee in order to meet requirements of federal law or regulations. The director may exempt categories of emergency medical transport providers from the fee if necessary to obtain federal approval.
(d)If, before June 1 preceding the start of an applicable state fiscal year, the director finds that the implementation of this article is likely no longer a benefit to the General Fund for the applicable state fiscal year, the director may decide to not implement this article for that state fiscal year. The director shall notify the appropriate fiscal and policy committees of the Legislature, and emergency medical transport providers individually and via the departments internet website of its finding pursuant to this subdivision.
For purposes of the Medi-Cal program, the State Department of Health Care Services shall revise and update paragraph (2) of subdivision (e) of Section 51476 of Title 22 of the California Code of Regulations in order to allow medical transportation providers to document mileage in their records through any of the following mechanisms:
(a)Odometer readings at each pickup and delivery location.
(b)Vehicle Global Positioning System (GPS) tracking.
(c)Digital mapping software.
(d)Any other mechanism identified by the department, as deemed reasonable based on ongoing technological updates.