BILL ANALYSIS �
AB 678
Page 1
ASSEMBLY THIRD READING
AB 678 (Pan)
As Amended May 27, 2011
Majority vote
HEALTH 18-0 APPROPRIATIONS 17-0
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|Ayes:|Monning, Logue, Ammiano, |Ayes:|Fuentes, Harkey, |
| |Atkins, Bonilla, Eng, | |Blumenfield, Bradford, |
| |Garrick, Gordon, Hayashi, | |Charles Calderon, Campos, |
| |Roger Hern�ndez, | |Davis, Donnelly, Gatto, |
| |Bonnie Lowenthal, | |Hall, Hill, Lara, |
| |Mansoor, Mitchell, | |Mitchell, Nielsen, Norby, |
| |Nestande, Pan, Silva, | |Solorio, Wagner |
| |Knight, Williams | | |
| | | | |
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SUMMARY : Establishes a supplemental payment program for
governmental entity providers of Medi-Cal emergency medical
transportation services. Specifically, this bill :
1)Authorizes a provider of emergency medical transportation
services to Medi-Cal enrollees to be eligible for supplemental
payments if the provider is owned or operated by the state, a
city, county, or city and county, fire protection district or
other local governmental entity and is certified to provide
services in the Medi-Cal Program.
2)Specifies that the supplemental reimbursement is based on the
amount of federal financial participation (FFP) received for
eligible certified public expenditures (CPEs) and that total
reimbursement, including the supplemental payments may not
exceed actual costs.
3)Provides that distribution of the supplemental payments shall
be based on ground emergency medical transportation services
as determined by the Medi-Cal State Plan on a per-transport or
other federally permissible basis.
4)Requires the nonfederal share to be paid by local governmental
entities and prohibits General Fund expenditures.
5)Requires the provider to pay the administrative costs to the
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Department of Health Care Services (DHCS).
6)Requires participating governmental entities to maintain
records, submit data, and provide certifications regarding
expenditures as required by the federal Centers for Medicare
and Medicaid Services (CMS).
7)Requires DHCS to seek federal approval and conditions
implementation on approval.
8)Provides the supplemental payment program shall be inoperative
if there is a judicial or CMS determination that payments must
be made to any other providers.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, ongoing DHCS administrative costs of approximately
$300,000 (50% General Fund, 50% federal funds) would be
reimbursed by the local entities who participate in the program.
COMMENTS : According to the author, local fire departments, as a
first responder, are transporting Medi-Cal patients at an ever
increasing rate as the health system continues to deteriorate.
The author states that Medi-Cal reimbursement rates for
ambulance services, as in many other categories, have not kept
pace with the cost of providing the services. The author
further points out fire departments are an essential part of the
health care safety net and are unique because of the mandate to
respond, treat and transport all emergency patients without
exception and without regard to a patient's ability to pay. The
purpose of this bill is to enact a mechanism to provide
supplemental payments for unreimbursed expenses incurred by
these local agencies without cost to the General Fund.
CPEs are one of several mechanisms that a state may employ to
obtain FFP and make supplemental payments to Medi-Cal providers
without cost to the state General Fund. Under a CPE
arrangement, government providers certify their Medicaid
expenditures to the state, and the state then obtains federal
reimbursement on the basis of these CPEs. Medicaid law allows
states to finance the nonfederal share of payments with CPEs as
long as the funds are derived from state or local tax revenue
and certified by units of local or state government as eligible
for federal reimbursement. States are responsible for ensuring
that expenditures are eligible for federal reimbursement by
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reviewing standard cost reports filed annually by each
government provider. In no event may the reimbursement rate
exceed the equivalent Medicare rate.
According to DHCS, the Medi-Cal base rate for Basic Life Support
(BLS) ambulance services for daytime calls was $118.20 in 1999.
Non-emergency transportation for one patient was $107.16 in
1999. Mileage was $3.18 per mile in 1997, and was increased to
the $3.55 in 1999. In 2008, AB 5 X3 (Budget Committee), Chapter
3, Statutes of 2008, Third Extraordinary Session, reduced
specified Medi-Cal provider rates (including ground ambulance
rates) by 10% effective July 1, 2008. Later in 2008, AB 1183
(Budget Committee), Chapter 758, Statutes of 2008, repealed the
10% rate reduction, and instead reduced Medi-Cal rates by 1%,
effective March 1, 2009. The 1% reduction will end May 31, 2011
pursuant to the recently enacted health budget trailer bill of
2011, AB 97 (Budget Committee), Chapter 3, Statutes of 2011.
Instead of a 1% reduction, effective June 1, 2011, specified
Medi-Cal provider rates will be reduced by 10% for dates of
services on and after June 1, 2011, subject to federal approval,
FFP, and the reduction meeting federal Medicaid requirements.
If the Director of DHCS determines that the payments do not
comply with federal Medicaid requirements or that FFP is not
available with respect to any payment that is reduced, the
director retains the discretion to not implement the particular
payment reduction and to adjust the payment as necessary to
comply with federal Medicaid requirements. If the 10% Medi-Cal
rate reduction in AB 97 (Budget Committee) takes effect for
ground ambulance rates, rates will be 10% lower than Medi-Cal
rates in 1999. By comparison to Medi-Cal, the Medicare rate for
BLS is $247.72 and the industry estimates the actual cost at
over $350.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097
FN: 0001120