Amended in Senate April 6, 2015

Senate BillNo. 534


Introduced by Senator Pan

February 26, 2015


An act to amend Section 14105.94 ofbegin insert, and to add Section 14105.941 to,end insert the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

SB 534, as amended, Pan. Medi-Cal: ground emergency medical transportation services: supplemental reimbursement.

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. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing law authorizes certain ground emergency medical transportation providers to receive supplemental Medi-Cal reimbursement in addition to the rate of payment that the provider would otherwise receive for those services. Existing law provides that participation in the supplemental reimbursement program by an eligible provider is voluntary, and requires the nonfederal share of the supplemental reimbursement to be paid only with funds from specified governmental entities.

This bill wouldbegin delete make technical, nonsubstantive changes to this provision.end deletebegin insert authorize the department to provide supplemental reimbursement under these provisions for the cost of paramedic services at a rate of payment equal to cost.end insert

begin insert

This bill would also require the department to design and implement an intergovernmental transfer (IGT) program in order to increase capitation payments to Medi-Cal managed care plans for covered ground emergency medical transportation services, as specified. The bill would require the department to implement the IGT program on January 1, 2016, or a later date if otherwise required pursuant to any necessary federal approvals obtained. The bill would provide that participation in the IGTs is voluntary on the part of the transferring entity and would require Medi-Cal managed care plans to pay 100% of any amount of increased capitation payments made to eligible providers for providing and making available ground emergency medical transportation services.

end insert

Vote: majority. Appropriation: no. Fiscal committee: begin deleteno end deletebegin insertyesend insert. State-mandated local program: no.

The people of the State of California do enact as follows:

P2    1

SECTION 1.  

Section 14105.94 of the Welfare and Institutions
2Code
is amended to read:

3

14105.94.  

(a) An eligible provider, as described in subdivision
4(b), may, in addition to the rate of payment that the provider would
5otherwise receive for Medi-Cal ground emergency medical
6transportation services, receive supplemental Medi-Cal
7reimbursement to the extent provided in this section.

8(b) A provider shall be eligible for supplemental reimbursement
9only if the provider has all of the following characteristics
10continuously during a state fiscal year:

11(1) Provides ground emergency medical transportation services
12to Medi-Cal beneficiaries.

13(2) Is a provider that is enrolled as a Medi-Cal provider for the
14period being claimed.

15(3) Is owned or operated by the state, a city, county, city and
16county, fire protection district organized pursuant to Part 2.7
17(commencing with Section 13800) of Division 12 of the Health
18and Safety Code, special district organized pursuant to Chapter 1
19(commencing with Section 58000) of Division 1 of Title 6 of the
20Government Code, community services district organized pursuant
21to Part 1 (commencing with Section 61000) of Division 3 of Title
226 of the Government Code, health care district organized pursuant
23to Chapter 1 (commencing with Section 32000) of Division 23 of
24the Health and Safety Code, or a federally recognized Indian tribe.

25(c) An eligible provider’s supplemental reimbursement pursuant
26to this section shall be calculated and paid as follows:

P3    1(1) The supplemental reimbursement to an eligible provider, as
2 described in subdivision (b), shall be equal to the amount of federal
3financial participation received as a result of the claims submitted
4pursuant to paragraph (2) of subdivision (f).

5(2) In no instance shall the amount certified pursuant to
6paragraph (1) of subdivision (e), when combined with the amount
7received from all other sources of reimbursement from the
8Medi-Cal program, exceed 100 percent of actual costs, as
9determined pursuant to the Medi-Cal State Plan, for ground
10emergency medical transportation services.

11(3) The supplemental Medi-Cal reimbursement provided by this
12section shall be distributed exclusively to eligible providers under
13a payment methodology based on ground emergency medical
14transportation services provided to Medi-Cal beneficiaries by
15eligible providers on a per-transport basis or other federally
16permissible basis.begin insert The department may, to the extent permitted
17under federal law and regulations, provide supplemental
18reimbursement for the cost of paramedic services at a rate of
19payment equal to cost.end insert
The department shall obtain approval from
20the federal Centers for Medicare and Medicaid Services for the
21payment methodology to be utilized, and shall not make any
22payment pursuant to this section prior to obtaining that approval.

23(d) (1) It is the Legislature’s intent in enacting this section to
24provide the supplemental reimbursement described in this section
25without any expenditure from the General Fund. An eligible
26provider, as a condition of receiving supplemental reimbursement
27pursuant to this section, shall enter into, and maintain, an agreement
28with the department for the purposes of implementing this section
29and reimbursing the department for the costs of administering this
30section.

31(2) The nonfederal share of the supplemental reimbursement
32submitted to the federal Centers for Medicare and Medicaid
33Services for purposes of claiming federal financial participation
34shall be paid only with funds from the governmental entities
35described in paragraph (3) of subdivision (b) and certified to the
36state as provided in subdivision (e).

37(e) Participation in the program by an eligible provider described
38in this section is voluntary. If an applicable governmental entity
39elects to seek supplemental reimbursement pursuant to this section
40on behalf of an eligible provider owned or operated by the entity,
P4    1as described in paragraph (3) of subdivision (b), the governmental
2entity shall do all of the following:

3(1) Certify, in conformity with the requirements of Section
4433.51 of Title 42 of the Code of Federal Regulations, that the
5claimed expenditures for the ground emergency medical
6 transportation services are eligible for federal financial
7participation.

8(2) Provide evidence supporting the certification as specified
9by the department.

10(3) Submit data as specified by the department to determine the
11appropriate amounts to claim as expenditures qualifying for federal
12financial participation.

13(4) Keep, maintain, and have readily retrievable, any records
14specified by the department to fully disclose reimbursement
15amounts to which the eligible provider is entitled, and any other
16records required by the federal Centers for Medicare and Medicaid
17Services.

18(f) (1) The department shall promptly seek any necessary federal
19approvals for the implementation of this section. The department
20may limit the program to those costs that are allowable
21expenditures under Title XIX of the federal Social Security Act
22(42 U.S.C. Sec. 1396 et seq.). If federal approval is not obtained
23for implementation of this section, this section shall not be
24implemented.

25(2) The department shall submit claims for federal financial
26participation for the expenditures for the services described in
27subdivision (e) that are allowable expenditures under federal law.

28(3) The department shall, on an annual basis, submit any
29necessary materials to the federal government to provide assurances
30that claims for federal financial participation will include only
31those expenditures that are allowable under federal law.

32(g) (1) If either a final judicial determination is made by any
33court of appellate jurisdiction or a final determination is made by
34the administrator of the federal Centers for Medicare and Medicaid
35Services that the supplemental reimbursement provided for in this
36section must be made to any provider not described in this section,
37the director shall execute a declaration stating that the
38determination has been made and on that date this section shall
39become inoperative.

P5    1(2) The declaration executed pursuant to this subdivision shall
2be retained by the director, provided to the fiscal and appropriate
3policy committees of the Legislature, the Secretary of State, the
4Secretary of the Senate, the Chief Clerk of the Assembly, and the
5Legislative Counsel, and posted on the department’s Internet Web
6site.

7(h) Notwithstanding Chapter 3.5 (commencing with Section
811340) of Part 1 of Division 3 of Title 2 of the Government Code,
9the department may implement and administer this section by
10means of provider bulletins, or similar instructions, without taking
11regulatory action.

12begin insert

begin insertSEC. 2.end insert  

end insert

begin insertSection 14105.941 is added to the end insertbegin insertWelfare and
13Institutions Code
end insert
begin insert, end insertimmediately following Section 14105.94begin insert, to
14read:end insert

begin insert
15

begin insert14105.941.end insert  

(a) The department shall design and implement,
16in consultation with eligible providers as described in subdivision
17(b), an intergovernmental transfer program relating to Medi-Cal
18managed care, ground emergency medical transport services in
19order to increase capitation payments for the purpose of increasing
20reimbursement to eligible providers.

21(b) A provider shall be eligible for increased reimbursement
22pursuant to this section only if the provider meets both of the
23following conditions in an applicable state fiscal year:

24(1) Provides ground emergency medical transport services to
25Medi-Cal managed care enrollees pursuant to a contract or other
26arrangement with a Medi-Cal managed care plan.

27(2) Is owned or operated by the state, a city, county, city and
28county, fire protection district organized pursuant to Part 2.7
29(commencing with Section 13800) of Division 12 of the Health
30and Safety Code, special district organized pursuant to Chapter
311 (commencing with Section 58000) of Division 1 of Title 6 of the
32Government Code, community services district organized pursuant
33to Part 1 (commencing with Section 61000) of Division 3 of Title
346 of the Government Code, health care district organized pursuant
35to Chapter 1 (commencing with Section 32000) of Division 23 of
36the Health and Safety Code, or a federally recognized Indian tribe.

37(c) (1) To the extent intergovernmental transfers are voluntarily
38made by, and accepted from, an eligible provider described in
39subdivision (b), or a governmental entity affiliated with an eligible
40provider, the department shall make increased capitation payments
P6    1to applicable Medi-Cal managed care plans for covered ground
2emergency medical transportation services.

3(2) The increased capitation payments made pursuant to this
4section shall be in amounts actuarially equivalent to the
5supplemental fee-for-service payments available for eligible
6providers pursuant to Section 14105.94, to the extent permissible
7under federal law.

8(3) Except as provided in subdivision (f), all funds associated
9with intergovernmental transfers made and accepted pursuant to
10this section shall be used to fund additional payments to eligible
11providers.

12(4) Medi-Cal managed care plans shall pay 100 percent of any
13amount of increased capitation payments made pursuant to this
14section to eligible providers for providing and making available
15ground emergency medical transportation services pursuant to a
16contract or other arrangement with a Medi-Cal managed care
17plan.

18(d) The intergovernmental transfer program developed pursuant
19to this section shall be implemented on January 1, 2016, or a later
20date if otherwise required pursuant to any necessary federal
21approvals obtained, and only to the extent intergovernmental
22transfers from the eligible provider, or the governmental entity
23with which it is affiliated, are provided for this purpose. To the
24extent permitted by federal law, the department may implement
25the intergovernmental transfer program and increased capitation
26payments pursuant to this section on a retroactive basis as needed.

27(e) Participation in the intergovernmental transfers under this
28section is voluntary on the part of the transferring entities for
29purposes of all applicable federal laws.

30(f) This section shall be implemented without any additional
31expenditure from the General Fund. As a condition of participation
32under this section, each eligible provider as described in
33subdivision (b), or the governmental entity affiliated with an
34eligible provider, shall agree to reimburse the department for any
35costs associated with implementing this section. Intergovernmental
36transfers described in this section are not subject to the
37administrative fee assessed under paragraph (1) of subdivision
38(d) of Section 14301.4.

39(g) As a condition of participation under this section, Medi-Cal
40managed care plans, eligible providers as described in subdivision
P7    1(b), and governmental entities affiliated with eligible providers
2shall agree to comply with any requests for information or similar
3data requirements imposed by the department for purposes of
4obtaining supporting documentation necessary to claim federal
5funds or to obtain federal approvals.

6(h) This section shall be implemented only if and to the extent
7federal financial participation is available and is not otherwise
8jeopardized, and any necessary federal approvals have been
9obtained.

10(i) To the extent that the director determines that the payments
11made pursuant to this section do not comply with federal Medicaid
12requirements, the director retains the discretion to return or not
13accept an intergovernmental transfer, and may adjust payments
14pursuant to this section as necessary to comply with federal
15Medicaid requirements.

16(j) To the extent federal approval is obtained, the increased
17capitation payments under this section may commence for dates
18of service on or after January 1, 2016.

19(k) Notwithstanding Chapter 3.5 (commencing with Section
2011340) of Part 1 of Division 3 of Title 2 of the Government Code,
21the department may implement, interpret, or make specific this
22section by means of all-county letters, plan letters, plan or provider
23bulletins, or similar instructions, without taking regulatory action.

end insert


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