BILL NUMBER: AB 1174	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  APRIL 2, 2009

INTRODUCED BY   Assembly Member Hernandez
   (Coauthors: Assembly Members  Beall  
  and Ma   Beall,   Chesbro,
  and Ma  )
    (   Coauthor:   Senator   Wiggins
  ) 

                        FEBRUARY 27, 2009

   An act to add Article 5.7 (commencing with Section 14186) to
Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions
Code, relating to Medi-Cal.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 1174, as amended, Hernandez. Medi-Cal: ambulance transportation
services.
   Existing law provides for 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 ambulance transportation services. Existing law
and regulations prescribe various requirements governing payment
policies and reimbursement rates for these services.
   This bill would enact the Ambulance Payment Reform Act of 2009,
which would, notwithstanding any other provision of law, provide that
emergency basic life support and advanced life support services are
covered under the Medi-Cal program when, as determined by the
department, a patient could reasonably expect that an absence of
immediate medical attention would result in significant adverse
health effects, as provided. The bill would require the department to
develop rates for specified emergency and nonemergency ambulance
transportation services, but would prohibit these rates from
exceeding the amount charged for these services to the general
public. The bill would also require the department to adjust the
rates each year in accordance with the California Consumer Price
Index.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  The Legislature finds and declares all of the
following:
   (a) It is the intent of this act to ensure the provision of
essential medically necessary emergency and nonemergency ambulance
response and transportation services to the citizens of the State of
California.
   (b) This act recognizes the vital role of ambulance services in
the provision of quality health care and as a critical component of
the public safety first response in times of natural or man-made
disasters.
   (c) With the passage of the Emergency Medical Services System and
the Prehospital Emergency Medical Care Personnel Act in 1980, the
intent of the Legislature has been to maintain and promote the
development of EMT P paramedic programs where appropriate throughout
the state and to initiate EMT II limited advanced life support
programs only where geography, population density, and resources
would not make the establishment of a paramedic program feasible.
   (d) This act will ensure the continued viability of EMS systems
throughout the state of California by establishing payment
definitions and policies for the Medi-Cal Program, as related to
ambulance services, that meet nationally recognized standards.
   (e) This act will establish Medi-Cal reimbursement rates for
essential emergency and nonemergency ambulance services that would at
a minimum cover the actual costs of providing services.
  SEC. 2.  Article 5.7 (commencing with Section 14186) is added to
Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions
Code, to read:

      Article 5.7.  Ambulance Payment Reform Act of 2009


   14186.  Notwithstanding any other provision of law, emergency
basic life support and advanced life support services are covered
under the Medi-Cal program, in accordance with Section 14186.1, when,
as determined by the department, a patient could reasonably expect
that an absence of immediate medical attention would do at least one
of the following:
   (a) Place the person's health in serious jeopardy.
   (b) Create a serious impairment to bodily function.
   (c) Result in a serious dysfunction in any bodily organ or part.
   14186.1.  (a) Notwithstanding any other provision of law,
reimbursement for emergency and nonemergency basic life and advanced
life support transportation shall be made in accordance with this
section, but at no time shall rates exceed charges made to the
general public.
   (b) Maximum reimbursement rates for ambulance transportation
services shall be as follows:
Ground Mileage, Per Mile  ____  $7 
Advanced Life Support,    ____   $369.15 
Nonemergency Transport
Advanced Life Support,
Emergency Transport,      ____   $584.49 
Level 1
Basic Life Support,       ____   $307.62 
Nonemergency Transport
Basic Life Support,       ____   $492.20 
Emergency Transport
Advanced Life Support,    ____   $845.97 
Level 2
Specialty Care Transport  ____   $999.78 


   (c) The department shall adjust the rates described in subdivision
(b) each year in accordance with the most recently determined annual
change in the California Consumer Price Index. 
   (d) For purposes of this section, the following definitions shall
apply:  
   (1) "Advanced Life Support, Level 2" means either one of the
following:  
   (A) Transportation by ground ambulance vehicle, medically
necessary supplies and services, and the administration of at least
three medications by intravenous push/bolus or by continuous
infusion, excluding crystalloid, hypotonic, isotonic, and hypertonic
solutions such as dextrose, normal saline, and Ringer's solution.
 
   (B) Transportation, medically necessary supplies and services, and
the provision of at least one of the following advanced life support
procedures:  
   (i) Manual defibrillation/cardioversion.  
   (ii) Endotracheal intubation.  
   (iii) Central venous line.  
   (iv) Cardiac pacing.  
   (v) Chest decompression.  
   (vi) Surgical airway.  
   (vii) Intraosseous line.  
   (2) "Specialty Care Transport" means interfacility transportation
of a critically injured or ill beneficiary by a ground ambulance
vehicle, including medically necessary supplies and services, at a
level of service beyond the scope of an emergency medical
technician-paramedic, as defined in Section 1797.84 of the Health and
Safety Code. Specialty Care Transport is necessary when a
beneficiary's condition requires ongoing care that must be furnished
by one or more health professionals in an appropriate specialty area,
including, but not limited to, nursing, emergency medicine,
respiratory care, cardiovascular care, or a paramedic with additional
training.