BILL NUMBER: AB 678	CHAPTERED
	BILL TEXT

	CHAPTER  397
	FILED WITH SECRETARY OF STATE  OCTOBER 2, 2011
	APPROVED BY GOVERNOR  OCTOBER 2, 2011
	PASSED THE SENATE  SEPTEMBER 1, 2011
	PASSED THE ASSEMBLY  SEPTEMBER 6, 2011
	AMENDED IN SENATE  AUGUST 15, 2011
	AMENDED IN ASSEMBLY  MAY 27, 2011
	AMENDED IN ASSEMBLY  MARCH 25, 2011

INTRODUCED BY   Assembly Member Pan
   (Principal coauthor: Senator Steinberg)

                        FEBRUARY 17, 2011

   An act to add Section 14105.94 to the Welfare and Institutions
Code, relating to Medi-Cal, and declaring the urgency thereof, to
take effect immediately.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 678, Pan. Medi-Cal: supplemental provider reimbursement.
   Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services,
pursuant to which medical benefits are provided to public assistance
recipients and certain other low-income persons. The Medi-Cal program
is, in part, governed and funded by federal Medicaid Program
provisions. Existing law provides for a schedule of benefits under
the Medi-Cal program, which includes medical transportation, and
authorizes the department to prescribe polices and regulations as
necessary to carry out the Medi-Cal program, including setting rates
for payment of services.
   This bill would provide that an eligible provider, as described,
may receive supplemental Medi-Cal reimbursement, in addition to the
rate of payment that the provider would otherwise receive, for
Medi-Cal ground emergency medical transportation services and that
the supplemental reimbursement shall be equal to the amount of
federal financial participation the department receives as a result
of claims submitted for expenditures for services, as specified. This
bill would require the department to promptly seek any necessary
federal approvals for the implementation of these provisions,
including obtaining approval from the federal Centers for Medicare
and Medicaid Services for the specified payment methodology to be
used to distribute the supplemental reimbursement.
   This bill would declare that it is to take effect immediately as
an urgency statute.


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

  SECTION 1.  Section 14105.94 is added to the Welfare and
Institutions Code, to read:
   14105.94.  (a) An eligible provider, as described in subdivision
(b), may, in addition to the rate of payment that the provider would
otherwise receive for Medi-Cal ground emergency medical
transportation services, receive supplemental Medi-Cal reimbursement
to the extent provided in this section.
   (b) A provider shall be eligible for supplemental reimbursement
only if the provider has all of the following characteristics
continuously during a state fiscal year:
   (1) Provides ground emergency medical transportation services to
Medi-Cal beneficiaries.
   (2) Is a provider that is enrolled as a Medi-Cal provider for the
period being claimed.
   (3) Is owned or operated by the state, a city, county, city and
county, fire protection district organized pursuant to Part 2.7
(commencing with Section 13800) of Division 12 of the Health and
Safety Code, special district organized pursuant to Chapter 1
(commencing with Section 58000) of Division 1 of Title 6 of the
Government Code, community services district organized pursuant to
Part 1 (commencing with Section 61000) of Division 3 of Title 6 of
the Government Code, health care district organized pursuant to
Chapter 1 (commencing with Section 32000) of Division 23 of the
Health and Safety Code, or a federally recognized Indian tribe.
   (c) An eligible provider's supplemental reimbursement pursuant to
this section shall be calculated and paid as follows:
   (1) The supplemental reimbursement to an eligible provider, as
described in subdivision (b), shall be equal to the amount of federal
financial participation received as a result of the claims submitted
pursuant to paragraph (2) of subdivision (f).
   (2) In no instance shall the amount certified pursuant to
paragraph (1) of subdivision (e), when combined with the amount
received from all other sources of reimbursement from the Medi-Cal
program, exceed 100 percent of actual costs, as determined pursuant
to the Medi-Cal State Plan, for ground emergency medical
transportation services.
   (3) The supplemental Medi-Cal reimbursement provided by this
section shall be distributed exclusively to eligible providers under
a payment methodology based on ground emergency medical
transportation services provided to Medi-Cal beneficiaries by
eligible providers on a per-transport basis or other federally
permissible basis. The department shall obtain approval from the
federal Centers for Medicare and Medicaid Services for the payment
methodology to be utilized, and may not make any payment pursuant to
this section prior to obtaining that approval.
   (d) (1) It is the Legislature's intent in enacting this section to
provide the supplemental reimbursement described in this section
without any expenditure from the General Fund. An eligible provider,
as a condition of receiving supplemental reimbursement pursuant to
this section, shall enter into, and maintain, an agreement with the
department for the purposes of implementing this section and
reimbursing the department for the costs of administering this
section.
   (2) The nonfederal share of the supplemental reimbursement
submitted to the federal Centers for Medicare and Medicaid Services
for purposes of claiming federal financial participation shall be
paid only with funds from the governmental entities described in
paragraph (3) of subdivision (b) and certified to the state as
provided in subdivision (e).
   (e) Participation in the program by an eligible provider described
in this section is voluntary. If an applicable governmental entity
elects to seek supplemental reimbursement pursuant to this section on
behalf of an eligible provider owned or operated by the entity, as
described in paragraph (3) of subdivision (b), the governmental
entity shall do all of the following:
   (1) Certify, in conformity with the requirements of Section 433.51
of Title 42 of the Code of Federal Regulations, that the claimed
expenditures for the ground emergency medical transportation services
are eligible for federal financial participation.
   (2) Provide evidence supporting the certification as specified by
the department.
   (3) Submit data as specified by the department to determine the
appropriate amounts to claim as expenditures qualifying for federal
financial participation.
   (4) Keep, maintain, and have readily retrievable, any records
specified by the department to fully disclose reimbursement amounts
to which the eligible provider is entitled, and any other records
required by the federal Centers for Medicare and Medicaid Services.
   (f) (1) The department shall promptly seek any necessary federal
approvals for the implementation of this section. The department may
limit the program to those costs that are allowable expenditures
under Title XIX of the federal Social Security Act (42 U.S.C. 1396 et
seq.). If federal approval is not obtained for implementation of
this section, this section shall not be implemented.
   (2) The department shall submit claims for federal financial
participation for the expenditures for the services described in
subdivision (e) that are allowable expenditures under federal law.
   (3) The department shall, on an annual basis, submit any necessary
materials to the federal government to provide assurances that
claims for federal financial participation will include only those
expenditures that are allowable under federal law.
   (g) (1) If either a final judicial determination is made by any
court of appellate jurisdiction or a final determination is made by
the administrator of the federal Centers for Medicare and Medicaid
Services that the supplemental reimbursement provided for in this
section must be made to any provider not described in this section,
the director shall execute a declaration stating that the
determination has been made and on that date this section shall
become inoperative.
   (2) The declaration executed pursuant to this subdivision shall be
retained by the director, provided to the fiscal and appropriate
policy committees of the Legislature, the Secretary of State, the
Secretary of the Senate, the Chief Clerk of the Assembly, and the
Legislative Counsel, and posted on the department's Internet Web
site.
   (h) Notwithstanding Chapter 3.5 (commencing with Section 11340) of
Part 1 of Division 3 of Title 2 of the Government Code, the
department may implement and administer this section by means of
provider bulletins, or similar instructions, without taking
regulatory action.
  SEC. 2.  This act is an urgency statute necessary for the immediate
preservation of the public peace, health, or safety within the
meaning of Article IV of the Constitution and shall go into immediate
effect. The facts constituting the necessity are:
   In order for statutory changes relating to the Medi-Cal program to
be implemented as soon as possible, it is necessary that this act
take effect immediately.