BILL ANALYSIS                                                                                                                                                                                                    




                   Senate Appropriations Committee Fiscal Summary
                           Senator Christine Kehoe, Chair

                                           1932 (Hernandez)
          
          Hearing Date:  8/12/2010        Amended: 8/4/2010
          Consultant: Katie Johnson       Policy Vote: Health 6-0
          _________________________________________________________________ 
          ____
          BILL SUMMARY:  AB 1932 would revise ambulance transportation  
          services categories for Medi-Cal reimbursement rates to be  
          consistent with Medicare categories.
          _________________________________________________________________ 
          ____
                            Fiscal Impact (in thousands)
           Major Provisions         2010-11      2011-12       2012-13     Fund  
          Increase ambulance service      potentially $100  
          millionGeneral/*
          reimbursement rates      annually in cost pressureFederal

          *Medi-Cal costs shared 50 percent General Fund and 50 percent  
          federal funds
          _________________________________________________________________ 
          ____
          STAFF COMMENTS: SUSPENSE FILE.
          This bill would permit the Department of Health Care Services  
          (DHCS), the department that administers the Medi-Cal program, to  
          utilize the following service levels when determining billing  
          codes for emergency and nonemergency basic life and advanced  
          life support transportation and specialty care transportation:

             1)   Advanced Life Support, Nonemergency Transport.
             2)   Advanced Life Support, Emergency Transport, Level 1.
             3)   Basic Life Support, Nonemergency Transport.
             4)   Basic Life Support, Emergency Transport.
             5)   Advanced Life support, Level 2.
             6)   Specialty Care Transport.

          If DHCS were to exercise the option to utilize the above service  
          levels, this bill would require the department to adopt the  
          definitions for those ground ambulance service levels, by June  
          30, 2011, that have been established by the federal Centers for  
          Medicare and Medicaid Services (CMS). On April 1, 2002, CMS  
          implemented a national fee schedule for the Medicare  
          reimbursement of ambulance services, which included the six  
          Medicare "service levels" listed above and the phase-in of new  










          rates. State Medicaid programs are also required to conform to  
          the service levels above. This bill would specify that if DHCS  
          were to use the above service levels to determine billing codes,  
          it would be done in a cost-neutral manner.

          If DHCS were to adopt the corresponding Medicare rates for the  
          different service levels, the costs to Medi-Cal would be  
          approximately $100 million in total funds. Medi-Cal costs are  
          generally shared 50 percent General Fund and 50 percent federal  
          funds. DHCS is currently in the process of adopting the six  
          codes listed in this bill. However, unlike with the Medicare  
          implementation, there is no simultaneously planned rate  
          increase. Medi-Cal currently pays ambulance providers two base  
          reimbursement rates-non-emergency basic and advanced life  
          support at $107.16 per transport and emergency basic and  
          advanced life support at $118.20 per transport.