BILL NUMBER: AB 678 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MARCH 25, 2011
INTRODUCED BY Assembly Member Pan
( Principal coauthor: Senator
Steinberg )
FEBRUARY 17, 2011
An act to amend Section 14132.72 of add
Section 14105.94 to the Welfare and Institutions Code, relating
to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 678, as amended, Pan. Medi-Cal: telemedicine.
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. Existing
law recognizes telemedicine as a legitimate means by which an
individual may receive medical services under the Medi-Cal program.
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 make a technical, nonsubstantive change.
Vote: majority. Appropriation: no. Fiscal committee: no
yes . State-mandated local program: no.
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 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) 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) This section shall become inoperative in the event, and on the
date, of a final judicial determination by any court of appellate
jurisdiction or a final determination by the administrator of the
federal Centers for Medicare and Medicaid Services that the
supplemental reimbursement provided in this section must be made to
any provider not described in this section.
(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.
SECTION 1. Section 14132.72 of the Welfare and
Institutions Code is amended to read:
14132.72. (a) It is the intent of the Legislature to recognize
the practice of telemedicine as a legitimate means by which an
individual may receive medical services from a health care provider,
without person-to-person contact with the provider.
(b) For the purposes of this section, "telemedicine" and
"interactive" are defined as those terms are defined in subdivision
(a) of Section 2290.5 of the Business and Professions Code.
(c) (1) Commencing July 1, 1997, face-to-face contact between a
health care provider and a patient shall not be required under the
Medi-Cal program for services appropriately provided through
telemedicine, subject to reimbursement policies developed by the
Medi-Cal program to compensate licensed health care providers who
provide health care services, that are otherwise covered by the
Medi-Cal program, through telemedicine. The audio and visual
telemedicine system used shall, at a minimum, have the capability of
meeting the procedural definition of the Current Procedural
Terminology Fourth Edition (CPT-4) codes which represent the service
provided through telemedicine. The telecommunications equipment shall
be of a level of quality to adequately complete all necessary
components to document the level of service for the CPT-4 code
billed. If a peripheral diagnostic scope is required to assess the
patient, it shall provide adequate resolution or audio quality for
decisionmaking.
(2) The department shall report to the appropriate committees of
the Legislature, by January 1, 2000, on the application of
telemedicine to provide home health care; emergency care; critical
and intensive care, including neonatal care; psychiatric evaluation;
psychotherapy; and medical management as potential Medi-Cal benefits.
(d) The Medi-Cal program shall not be required to pay for
consultation provided by the health care provider by telephone or
facsimile machines.
(e) The Medi-Cal program shall pursue private or federal funding
to conduct an evaluation of the cost-effectiveness and quality of
health care provided through telemedicine by those providers who are
reimbursed for telemedicine services by the program.