BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: AB 1932
A
AUTHOR: Hernandez
B
AMENDED: May 28, 2010
HEARING DATE: June 23, 2010
1
CONSULTANT:
9
Dunstan/cjt
3
2
SUBJECT
Medi-Cal: ambulance transportation services:
reimbursement: service levels
SUMMARY
Revises the Medi-Cal reimbursement rate categories for
ambulance transportation services to be consistent with
Medicare categories.
CHANGES TO EXISTING LAW
Existing federal law:
Establishes the Medicaid program to provide comprehensive
health benefits to low-income persons.
Existing state law:
Establishes the Medi-Cal program as California's Medicaid
program, administered by the Department of Health Care
Services (DHCS), which provides comprehensive health care
coverage for low-income individuals and their families;
pregnant women; elderly, blind, or disabled persons;
nursing home residents; and refugees who meet specified
Continued---
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eligibility criteria. Establishes a schedule of benefits
under the Medi-Cal program, which includes emergency and
nonemergency medical transportation.
Establishes, through regulation, maximum reimbursement
rates for medical transportation services under Medi-Cal,
and prohibits billing from exceeding charges made to the
general public.
This bill:
Revises the Medi-Cal reimbursement rate categories for
ambulance transportation services to be consistent with
Medicare categories. It authorizes DHCS to utilize the
following categories for reimbursement of ambulance
transportation services:
Advanced Life Support, Non-emergency.
Advanced Life Support Emergency.
Basic Life Support, Non-emergency.
Basic Life Support, Emergency.
Advanced Life Support, Level 2.
Specialty Care Transport.
The bill also provides that if DHCS adopts the categories
specified above then the definitions used should be those
established by the Centers for Medicare and Medicaid
Services (CMS).
FISCAL IMPACT
According to the Assembly Appropriations Committee
analysis, this bill would result in absorbable costs to
Medi-Cal and notes that this bill codifies a process
underway to adopt the use of these six levels of emergency
medical transport, per recent requirements of federal law.
This bill does not modify reimbursement for emergency
medical transport. Under current law, Medi-Cal Basic Life
Support non-emergency transportation is reimbursed at $107
and Basic Life Support emergency transportation is
reimbursed at $118 per trip.
BACKGROUND AND DISCUSSION
According to the author, AB 1932 revises the Medi-Cal
reimbursement rate categories for ambulance transportation
STAFF ANALYSIS OF ASSEMBLY BILL 1932 (Hernandez) Page
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services to be consistent with Medicare categories. The
author also states that the national fee schedule, as
proposed to be adopted by AB 1932 for state purposes,
properly aligns Medicare reimbursement of
medically-necessary ambulance services (i.e., the payment
system includes service levels, definitions and billing
codes) assuring medically appropriate and quality emergency
and non-emergency ambulance transport services are
delivered to Medicare beneficiaries.
Background
The Balanced Budget Act of 1997 added a new section to the
Social Security Act which mandated the implementation of a
national fee schedule for ambulance services furnished as a
benefit under Medicare Part B. The fee schedule is
effective for claims with dates of service on or after
April 1, 2002, and it applies to all ambulance services,
including volunteer, municipal, private, independent, and
institutional providers, i.e., hospitals, critical access
hospitals (except when it is the only ambulance service
within 35 miles), and skilled nursing facilities
On April 1, 2002, the Centers for Medicare and Medicaid
Services (CMS) implemented the national fee schedule for
the Medicare reimbursement of ambulance services. The fee
schedule was developed by a negotiated rulemaking committee
involving national experts and stakeholders on emergency
medical services, including physician medical directors,
finance and billing experts, public and private ambulance
providers, state regulators, and federal health care
financing administrators. The codes for six new Medicare
ambulance "service levels" and "definitions" were
implemented on April 1, 2002 and the phase-in of new rates
began. The Medicare ambulance fee schedule rates were
fully phased-in on January 1, 2010.
According to the Medi-Cal policy manual, Medi-Cal covers
ambulance and other medical transportation only when
ordinary public or private conveyance is medically
contra-indicated and transportation is required for
obtaining needed medical care. To receive reimbursement, a
recipient must be eligible for Medi-Cal on the date of
service.
Related bills
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AB 511 (De La Torre) establishes a quality assurance fee on
ambulance transportation services providers to increase
transportation rates paid on behalf of Medi-Cal patients.
AB 511 is in Senate Health Committee.
AB 2173 (Beall) establishes a $3 penalty on every vehicle
code violation to be matched for with federal Medicaid
funds, the resulting amount to be used to make supplemental
payments for emergency air medical transportation services
in the Medi-Cal Program.
This bill is in Senate Health Committee.
Prior legislation
AB 2257 (Hernandez) would have significantly increased and
codified Medi-Cal reimbursement rates for emergency and
non-emergency basic life support and advanced life support
transportation, including air ambulances. This bill was
held on suspense in Assembly Appropriations Committee
AB 1174 (Hernandez) was very similar to AB 2257. This bill
was held on suspense in Assembly Appropriations Committee.
Arguments in support
According to the sponsor, the California Ambulance
Association, AB 1932 would set the ambulance service
reimbursement methods of payment, but not the payment
amounts, in a manner which is consistent with the Medicare
program payment methods for ambulance services. They note
that Medicare program payment methods are intended to
recognize the different levels of service, and the
different costs associated with those services which may be
required for different patient conditions, signs and
symptoms, and driven by their local medical protocols. CAA
states that following implementation of the national
Medicare Ambulance Fee Schedule, most state Medicaid
programs have adopted the Healthcare Common Procedure
Coding System (HCPCS) that corresponds to the six levels of
ambulance service established by Medicare and that many
state Medicaid programs have definitions for each of the
various levels of service that parallel Medicare's
definitions (Medicare service levels include definitions
that accommodate state-specific regulations).
PRIOR ACTIONS
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Assembly Health 15-4
Assembly Appropriations:12-0
Assembly Floor: 69-5
POSITIONS
Support: California Ambulance Association (Sponsor)
Oppose: None received
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