Amended in Assembly June 30, 2016

Amended in Senate May 31, 2016

Amended in Senate April 26, 2016

Amended in Senate April 5, 2016

Senate BillNo. 1300


Introduced by Senator Hernandez

February 19, 2016


An act to add Article 3.91 (commencing with Section 14129) to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, relating to Medi-Cal, making an appropriation therefor, and declaring the urgency thereof, to take effect immediately.

LEGISLATIVE COUNSEL’S DIGEST

SB 1300, as amended, Hernandez. Medi-Cal: emergency medical transport providers: quality assurance fee.

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, 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 establishes a quality assurance fee program for skilled nursing and intermediate care facilities, as prescribed.

This bill, commencing July 1, 2017, and subject to federal approval, would impose a quality assurance fee for each transport provided by an emergency medical transport provider, as defined, subject to the quality assurance fee in accordance with a prescribed methodology. The bill would authorize the director to exempt categories of emergency medical transport providers from the quality assurance fee if necessary to obtain federal approval. The bill would require the Director of Health Care Services to deposit the collected quality assurance fee into the Medi-Cal Emergency Medical Transport Fund, which the bill would create in the State Treasury, to be continuously appropriated, thereby making an appropriation, to the department to be used exclusively in a specified order of priority 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, to pay for state administrative costs, and to provide funding for health care coverage for Californians. The bill, on or beforebegin delete August 15, 2016,end deletebegin insert November 15, 2016,end insert would require each emergency medical transport provider to report to the department specified data, including data on gross receipts, as defined, from the provision of emergency medical transports, as specified, in a manner and form prescribed by the department and, commencing onbegin delete October 1, 2016,end deletebegin insert January 1, 2017,end insert and each fiscal quarter thereafter, would require each emergency medical transport provider to report this data to the department. The bill would authorize the department to establish an Internet Web site for the submission of these data reports. The bill would authorize the department to require a certification by each emergency medical transport provider, under penalty of perjury, of the truth of these data reports. By expanding the scope of the crime of perjury, the bill would impose a state-mandated local program. The bill would authorize the department, upon written notice to the emergency medical transport provider, to impose a $100 per day penalty against the provider for each day that the provider fails to make a report within 5 business days of the date upon which the data report was due.begin delete The bill would provide that the failure to make a report under these provisions within 90 days of the date upon which the report was due shall be considered a violation that relates to his or her licensed activities for purposes of a specified section of the Vehicle Code, which authorizes the Commissioner of the California Highway Patrol to suspend, revoke, or take other disciplinary action against a license if the licensee violates any section of the Vehicle Code that relates to his or her licensed activities.end delete

The bill, commencing July 1, 2017, and subject to federal approval, would increase the Medi-Cal reimbursement to emergency medical transport providers for 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, as specified.

The bill would authorize the department to adopt regulations as necessary to implement these provisions, as specified.

The bill would provide that the provisions of the bill shall cease to be implemented if any of certain conditions, including withdrawal of federal approval, are satisfied.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

This bill would declare that it is to take effect immediately as an urgency statute.

Vote: 23. Appropriation: yes. Fiscal committee: yes. State-mandated local program: yes.

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

P3    1

SECTION 1.  

The Legislature finds and declares all of the
2following:

3(a) The Legislature recognizes the essential role that emergency
4medical transport providers play in serving the state’s Medi-Cal
5beneficiaries. To that end, it has been and remains the intent of the
6Legislature to improve funding for emergency medical transport
7providers and obtain all available federal funds to make
8supplemental Medi-Cal payments to emergency medical transport
9providers.

10(b) It is the intent of the Legislature to impose a quality
11assurance fee to be paid by emergency medical transport providers,
12which will be used to increase federal financial participation in
13order to increase Medi-Cal payments to emergency medical
14transport providers.

15(c) It is the intent of the Legislature to increase the Medi-Cal
16emergency medical transport reimbursement in Medi-Cal
17fee-for-service and Medi-Cal managed care by increasing the
18fee-for-service payment schedule for emergency medical transports
19to support quality improvement efforts by emergency medical
20transport providers, including, but not limited to, the provision of
21advanced life support services, as defined in Section 1797.52 of
22the Health and Safety Code.

P4    1(d) It is the further intent of the Legislature that the increased
2fee-for-service and Medi-Cal managed care payment schedule
3amounts pursuant to this article shall not result in any expenditure
4from the General Fund.

5

SEC. 2.  

Article 3.91 (commencing with Section 14129) is
6added to Chapter 7 of Part 3 of Division 9 of the Welfare and
7Institutions Code
, to read:

8 

9Article 3.91.  Medi-Cal Emergency Medical Transportation
10Reimbursement Act
11

 

12

14129.  

For purposes of this article, the following definitions
13shall apply:

14(a) “Annual quality assurance fee rate” means the quality
15assurance fee assessed on each emergency medical transport
16applicable to each state fiscal year.

17(b) “Aggregate fee schedule increase amount” means the product
18of the quotient described in paragraph (2) of subdivision (a) of
19Section 14129.3 and the Medi-Cal emergency medical transports,
20including both fee-for-service transports paid by the department
21and managed care transports paid by Medi-Cal managed care health
22plans, utilizing the billing codes for emergency medical transport
23for the state fiscal year.

24(c) “Available fee amount” shall be calculated as the sum of the
25following:

26 (1) The amount deposited in the Medi-Cal Emergency
27Transportation Fund established under Section 14129.2 during the
28applicable state fiscal year, less the amounts described in
29subparagraphs (A) and (B) of paragraph (2) of subdivision (f) of
30Section 14129.2.

31(2) Any federal financial participation obtained as a result of
32the deposit of the amount described in paragraph (1) in the
33Medi-Cal Emergency Transportation Fund for the applicable fiscal
34year.

35(d) “Department” means the State Department of Health Care
36Services.

37(e) “Director” means the Director of Health Care Services.

38(f) “Effective state medical assistance percentage” means a ratio
39of the aggregate expenditures from state-only sources for the
40Medi-Cal program divided by the aggregate expenditures from
P5    1state and federal sources for the Medi-Cal program for a state fiscal
2year.

3(g) “Emergency medical transport” means the act of transporting
4an individual from any point of origin to the nearest medical facility
5capable of meeting the emergency medical needs of the patient by
6an ambulance licensed, operated, and equipped in accordance with
7applicable state or local statutes, ordinances, or regulations that
8are billed with billing codes A0429 BLS Emergency, A0427 ALS
9Emergency, and A0433 ALS2, and any equivalent, predecessor,
10or successor billing codes as may be determined by the director.
11“Emergency medical transports” shall not include transportation
12of beneficiaries by passenger car, taxicabs, litter vans, wheelchair
13vans, or other forms of public or private conveyances, nor shall it
14include transportation by an air ambulance provider. An
15“emergency medical transport” does not occur when, following
16evaluation of a patient, a transport is not provided.

17(h) “Gross receipts” means gross payments received as patient
18care revenue for emergency medical transports, determined on a
19cash basis of accounting, excluding supplemental amounts received
20pursuant to Section 14105.94.

21(i) “Emergency medical transport provider” means any provider
22of emergency medical transports.

23(j) “Emergency medical transport provider subject to the fee”
24means all emergency medical transport providers that bill and
25 receive patient care revenue from the provision of emergency
26medical transports, except emergency medical transport providers
27that are exempt pursuant to subdivision (c) of Section 14129.6.

28(k) “Medi-Cal managed care health plan” means a “managed
29health care plan” as that term is defined in subdivision (ab) of
30Section 14169.51.

31

14129.1.  

(a) On or beforebegin delete August 15, 2016,end deletebegin insert November 15,
322016,end insert
each emergency medical transport provider shall report to
33the department data on the number of actual emergency medical
34transports by payor type, including, without limitation, Medi-Cal
35fee-for-service emergency medical transports and Medi-Cal
36managed care emergency medical transports, and gross receipts
37from the provision of emergency medical transports provided in
38each quarter from July 1, 2015, tobegin delete June 30, 2016,end deletebegin insert October 31,
392016,end insert
inclusive, in a manner and format prescribed by the
40department.

P6    1(b) Commencing with the fiscal quarter beginning onbegin delete October
21, 2016,end delete
begin insert January 1, 2017,end insert and each fiscal quarter thereafter, on or
3before the 45th day of the quarter, each emergency medical
4transport provider shall report to the department data on the number
5of actual emergency medical transports by payor type, including,
6without limitation, Medi-Cal fee-for-service emergency medical
7 transports and Medi-Cal managed care emergency medical
8transports, and gross receipts from the provision of emergency
9medical transports provided in the quarter preceding the quarter
10in which the report is due, in a manner and format prescribed by
11the department.

12(c) The department may establish an Internet Web site for the
13submission of reports required by this section.

14(d) The department may require a certification by each
15emergency medical transport under penalty of perjury of the truth
16of the reports required under this section. Upon written notice to
17an emergency medical transport provider, the department may
18impose a penalty of one hundred dollars ($100) per day against an
19emergency medical transport provider for every day that an
20 emergency medical transport provider fails to make a report
21required by this section within five days of the date upon which
22the report was due.begin delete If an emergency medical transport provider
23has not made a report as required by this section within 90 days
24of the date upon which the report was due, the failure to make the
25report shall be considered a violation of a section of the Vehicle
26Code that relates to the emergency medical transport provider’s
27licensed activities for the purposes of Section 2542 of the Vehicle
28Code.end delete

29

14129.2.  

(a) Commencing with the state fiscal quarter
30beginning on July 1, 2017, and continuing each state fiscal quarter
31thereafter, there shall be imposed a quality assurance fee for each
32emergency medical transport provided by each emergency medical
33transport provider subject to the fee in accordance with this section.

34(b) (1) On or before June 15, 2017, and each June 15 thereafter,
35the director shall calculate the annual quality assurance fee rate
36applicable to the following state fiscal year based on the most
37recently collected data collected from emergency medical transport
38providers pursuant to Section 14129.1, and publish the annual
39quality assurance fee rate on its Internet Web site. In no case shall
40the fees calculated pursuant to this subdivision and collected
P7    1pursuant to this article exceed the amounts allowable under federal
2law.

3(A) For state fiscal year 2017-18, the annual quality assurance
4fee rate shall be calculated by multiplying the projected total annual
5gross receipts for all emergency medical transport providers subject
6to the fee by 5.5 percent, which resulting product shall be divided
7by the projected total annual emergency medical transports by all
8emergency medical transport providers subject to the fee for the
9state fiscal year.

10(B) For state fiscal years 2018-19 and thereafter, the annual
11quality assurance fee rate shall be calculated by a ratio, the
12numerator of which shall be the sum of the product of the projected
13aggregate fee schedule amount and the effective state medical
14 assistance percentage, and the amount described in subparagraph
15(A) of paragraph (2) of subdivision (f), and the denominator of
16which shall be 95 percent of the projected total annual emergency
17medical transports by all emergency medical transport providers
18subject to the fee for the state fiscal year.

19(2) On or before June 15, 2017, and each June 15 thereafter, the
20director shall publish the annual quality assurance fee rate on its
21Internet Web site.

22(3) In no case shall the fees calculated pursuant to this
23subdivision and collected pursuant to this article exceed the
24amounts allowable under federal law.

25(4) If, during a state fiscal year, the actual or projected available
26fee amount exceeds or is less than the actual or projected aggregate
27fee schedule amount by more than 1 percent, the director shall
28adjust the annual quality assurance fee rate so that the available
29fee amount for the state fiscal year will approximately equal the
30aggregate fee schedule amount for the state fiscal year. The
31available fee amount for a state fiscal year will be considered to
32equal the aggregate fee schedule amount for the state fiscal year
33if the difference between the available fee amount for the state
34fiscal year and the aggregate fee schedule amount for the state
35fiscal year constitutes less than 1 percent of the aggregate fee
36schedule amount for the state fiscal year.

37(c) (1) Each emergency medical transport provider subject to
38the fee shall remit to the department an amount equal to the annual
39quality assurance fee rate for the 2017-18 state fiscal year
40multiplied by the number of transports reported or that should have
P8    1been reported by the emergency medical transport provider
2pursuant to subdivision (b) of Section 14129.1 in the quarter
3commencing April 1, 2017, based on a schedule established by
4the director. The schedule established by the director for the fee
5payment described in this paragraph shall not require payment of
6any of the fee payment prior to July 1, 2017, and shall not require
7payment of more than 50 percent of the fee payment prior to
8August 1, 2017.

9(2) Commencing with the state fiscal quarter beginning on
10October 1, 2017, and each state fiscal quarter thereafter, on or
11before the first day of each state fiscal quarter, each emergency
12medical transport provider subject to the fee shall remit to the
13department an amount equal to the annual quality assurance fee
14rate for the applicable state fiscal year multiplied by the number
15of transports reported or that should have been reported by the
16emergency medical transport provider pursuant to subdivision (b)
17of Section 14129.1 in the immediately preceding quarter.

18(d) (1) Interest shall be assessed on quality assurance fees not
19paid on the date due at the greater of 10 percent per annum or the
20rate at which the department assesses interest on Medi-Cal program
21overpayments to hospitals that are not repaid when due. Interest
22 shall begin to accrue the day after the date the payment was due
23and shall be deposited in the Medi-Cal Emergency Medical
24Transport Fund established in subdivision (f).

25(2) In the event that any fee payment is more than 60 days
26overdue, the department may deduct the unpaid fee and interest
27owed from any Medi-Cal reimbursement payments owed to the
28provider until the full amount of the fee and interest are recovered.
29Any deduction made pursuant to this subdivision shall be made
30only after the department gives the provider written notification.
31Any deduction made pursuant to this subdivision may be deducted
32 over a period of time that takes into account the financial condition
33of the provider.

34(3) In the event that any fee payment is more than 60 days
35overdue, a penalty equal to the interest charge described in
36paragraph (1) shall be assessed and due for each month for which
37the payment is not received after 60 days.

38(e) The department shall accept an emergency medical transport
39provider’s payment even if the payment is submitted in a rate year
40subsequent to the rate year in which the fee was assessed.

P9    1(f) (1) The director shall deposit the quality assurance fee
2collected pursuant to this section in the Medi-Cal Emergency
3Medical Transport Fund, which is hereby created in the State
4Treasury and, notwithstanding Section 13440 of the Government
5Code, is continuously appropriated without regard to fiscal years
6to the department for the purposes specified in this article.
7Notwithstanding Section 16305.7 of the Government Code, the
8fund shall also include interest and dividends earned on moneys
9in the fund.

10(2) The moneys in the Medi-Cal Emergency Medical Transport
11Fund, including any interest and dividends earned on money in
12the fund, shall be available exclusively to enhance federal financial
13participation for ambulance services under the Medi-Cal program
14and to provide additional reimbursement to, and to support quality
15improvement efforts of, emergency medical transport providers,
16as well as to pay for the state’s administrative costs and to provide
17funding for health care coverage for Californians, in the following
18order of priority:

19(A) To pay for the department’s staffing and administrative
20costs directly attributable to implementing this article, not to exceed
21three hundred fifty thousand dollars ($350,000) for each fiscal
22year, exclusive of any federal matching funds.

23(B) To pay for the health care coverage in each fiscal year in
24the amount of 10 percent of the projected quality assurance fee
25revenue for that fiscal year, as calculated by the department on or
26before June 15 preceding that fiscal year, exclusive of any federal
27matching funds.

28(C) To make increased payments to emergency medical transport
29providers pursuant to this article.

30

14129.3.  

(a) Effective July 1, 2017, the Medi-Cal
31fee-for-service payment schedule governing reimbursement to
32emergency medical transport providers for emergency medical
33transports shall be increased. The department shall calculate the
34projections required by this subdivision based on the data submitted
35pursuant to Section 14129.1. The resulting fee-for-service payment
36schedule amounts after the application of this section shall be equal
37to the sum of both of the following:

38(1) The Medi-Cal fee-for-service payment schedule amount for
39the state fiscal year 2015-16.

P10   1(2) The quotient of the projected available fee amount for the
2state fiscal year 2017-18, divided by the total projected Medi-Cal
3emergency medical transports, including both fee-for-service
4transports paid by the department and managed care transports
5paid by Medi-Cal managed care health plans, utilizing these billing
6codes for the state fiscal year 2017-18.

7(b) Each Medi-Cal managed care health plan shall satisfy its
8obligation under Section 438.114(c) of Title 42 of the Code of
9Federal Regulations for emergency medical transports by providing
10payment to emergency medical transport providers that is equal
11to the amount of payment described in Section 1396u-2(b)(2)(D)
12of Title 42 of the United States Code.

13(c) The fee-for-service and Medi-Cal managed care payment
14schedule increase established pursuant to this section shall be
15funded solely from the following:

16(1) The quality assurance fee set forth in Section 14129.2, along
17with any interest or other investment income thereon.

18(2) Federal reimbursement and any other related federal funds.

19(d) The proceeds of the quality assurance fee set forth in Section
2014129.2, the matching amount provided by the federal government,
21and any interest earned on those proceeds shall be used to
22supplement existing funding for emergency medical transports
23provided by emergency transport providers and not supplant this
24funding.

25

14129.4.  

If there is a delay in the implementation of this article
26for any reason, including a delay in any required approval of the
27quality assurance fee and reimbursement methodology specified
28by the federal Centers for Medicare and Medicaid Services, all of
29the following shall apply:

30(a) An emergency transport provider subject to the fee may be
31assessed the amount the provider would be required to pay to the
32department if the fee-for-service payment schedule increases
33described in Section 14129.3 were already approved, but shall not
34be required to pay the fee until the fee-for-service payment
35schedule increases described in Section 14129.3 are approved. The
36director shall establish a schedule for payment of retroactive fees
37pursuant to this subdivision in consultation with emergency medical
38transport providers to minimize the disruption to the cashflow of
39emergency medical transport providers.

P11   1(b) The department may retroactively increase and make
2payment of supplemental rates to emergency medical transport
3providers pursuant to Section 14129.3.

4

14129.5.  

(a) The director shall administer this article.

5(b) The director may adopt regulations as are necessary to
6implement this article. These regulations may be adopted as
7emergency regulations in accordance with the rulemaking
8provisions of the Administrative Procedure Act (Chapter 3.5
9(commencing with Section 11340) of Part 1 of Division 3 of Title
102 of the Government Code). For purposes of this article, the first
11adoption of regulations shall be deemed an emergency and
12necessary for the immediate preservation of the public peace, health
13and safety, or general welfare. The regulations shall include, but
14need not be limited to, any regulations necessary for any of the
15following purposes:

16(1) The administration of this article, including the proper
17imposition of the quality assurance fee and process for its
18collection, reporting, and refunds. The costs associated with the
19administration of this article are not to exceed the amounts
20reasonably necessary to administer this article.

21(2) The development of any forms necessary to obtain required
22information from providers subject to the quality assurance fee.

23(3) The provision of details, definitions, formulas, and other
24requirements.

25(c) As an alternative to subdivision (b), and notwithstanding
26the rulemaking provisions of the Administrative Procedure Act
27(Chapter 3.5 (commencing with Section 11340) of Part 1 of
28Division 3 of Title 2 of the Government Code), the director may
29implement this article, in whole or in part, by means of a provider
30 bulletin, or other similar instructions, without taking regulatory
31action, provided that no such bulletin or other similar instructions
32shall remain in effect after June 30, 2018. It is the intent of the
33Legislature that the regulations adopted pursuant to subdivision
34(b) be adopted on or before June 30, 2018.

35(d) The director shall ensure that the quality assurance fee per
36transport imposed pursuant to this article is collected.

37

14129.6.  

(a) The department shall request approval from the
38federal Centers for Medicare and Medicaid Services for the use
39of fees collected pursuant to this article for the purpose of receiving
40federal matching funds.

P12   1(b) The director may alter the methodology specified in this
2article to the extent necessary to meet the requirements of federal
3law or regulations or to obtain federal approval. If the director,
4after consulting with affected emergency medical transport
5providers, determines that an alteration is needed, the director shall
6execute a declaration stating that this determination has been made.
7The director shall retain the declaration and provide a copy, within
8five working days of the execution of the declaration, to the fiscal
9and appropriate policy committees of the Legislature.

10(c) The director may add categories of exempt emergency
11medical transport providers or apply a nonuniform fee per transport
12to emergency medical transport providers that are subject to the
13fee in order to meet requirements of federal law or regulations.
14The director may exempt categories of emergency medical
15transport providers from the fee if necessary to obtain federal
16approval.

17

14129.7.  

(a) This article shall be implemented only if, and as
18long as, both of the following conditions are met:

19(1) The state receives federal approval of the quality assurance
20fee from the federal Centers for Medicare and Medicaid Services.

21(2) The state receives federal approval for the increased
22fee-for-service payment schedule increases described in subdivision
23(a) of Section 14129.3.

24(b) This article shall cease to be implemented if one of the
25following conditions is satisfied:

26(1) The federal Centers for Medicare and Medicaid Services no
27longer allows the use of the provider assessment provided in this
28article.

29(2) The Medi-Cal fee-for-service payment schedule increase
30described in subdivision (a) of Section 14129.3 no longer remains
31in effect.

32(3) The quality assurance fee assessed and collected pursuant
33to this article is no longer available for the purposes specified in
34this article.

35(4) A final judicial determination by the California Supreme
36Court or any California Court of Appeal that the revenues collected
37pursuant to this article that are deposited in the Medi-Cal
38Emergency Medical Transport Fund are either of the following:

39(A) “General Fund proceeds of taxes appropriated pursuant to
40Article XIII B of the California Constitution,” as used in
P13   1subdivision (b) of Section 8 of Article XVI of the California
2Constitution.

3(B) “Allocated local proceeds of taxes,” as used in subdivision
4(b) of Section 8 of Article XVI of the California Constitution.

5(c) If all of the conditions in subdivision (a) are met, this article
6is implemented. If, subsequently, any one of the conditions in
7subdivision (b) is met, this article shall become inoperative
8notwithstanding that the condition or conditions subsequently may
9be met.

10(d) Notwithstanding subdivisions (a), (b), and (c), in the event
11of a final judicial determination made by any state or federal court
12that is not appealed, or by a court of appellate jurisdiction that is
13not further appealed, in any action by any party, or a final
14determination by the administrator of the federal Centers for
15Medicare and Medicaid Services, that federal financial participation
16is not available with respect to any payment made under the
17methodology implemented pursuant to this article because the
18methodology is invalid, unlawful, or contrary to any provision of
19federal law or regulations or of state law, this article shall become
20inoperative.

21

SEC. 3.  

No reimbursement is required by this act pursuant to
22Section 6 of Article XIII B of the California Constitution because
23the only costs that may be incurred by a local agency or school
24district will be incurred because this act creates a new crime or
25infraction, eliminates a crime or infraction, or changes the penalty
26for a crime or infraction, within the meaning of Section 17556 of
27the Government Code, or changes the definition of a crime within
28the meaning of Section 6 of Article XIII B of the California
29Constitution.

30

SEC. 4.  

This act is an urgency statute necessary for the
31immediate preservation of the public peace, health, or safety within
32the meaning of Article IV of the Constitution and shall go into
33immediate effect. The facts constituting the necessity are:

34In order to make the necessary changes to increase Medi-Cal
35payments to emergency ambulance providers and to improve
36access, at the earliest possible time, to allow this act to be operative
37as soon as approval from the federal Centers for Medicare and
P14   1Medicaid Services is obtained by the State Department of Health
2Care Services, it is necessary that this act take effect immediately.



O

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