BILL NUMBER: SB 359	INTRODUCED
	BILL TEXT


INTRODUCED BY   Senator Hernandez

                        FEBRUARY 15, 2011

   An act to add Article 5.7 (commencing with Section 14186) to
Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions
Code, relating to Medi-Cal.



	LEGISLATIVE COUNSEL'S DIGEST


   SB 359, as introduced, Hernandez. Medi-Cal: ground ambulance
rates.
   Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services, under
which health care services, including medical transportation
services, are provided to qualified low-income persons. The Medi-Cal
program is partially governed and funded under federal Medicaid
provisions. Existing law and regulations prescribe various
requirements governing payment policies and reimbursement rates for
these services.
   This bill would require the department, by July 1, 2012, to adopt
regulations establishing the Medi-Cal reimbursement rate for ground
ambulance services using one of 2 specified methodologies.
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  The Legislature finds and declares all of the
following:
   (a) The State Department of Health Care Services is required to
adhere to the current regulations establishing Medi-Cal payment rates
for ground ambulance services and the department is currently not in
compliance with those regulations.
   (b) Regarding Medi-Cal payment rates for ground ambulance
services, the State Plan under Title XIX of the federal Social
Security Act for the State of California requires that reimbursement
for each of the other types of care or service listed in Section
1396d of Title 42 of the United States Code that are included in the
program under the plan will be at the lesser of usual charges or the
limits specified in Article 7 (commencing with Section 51501) of
Chapter 3 of Division 3 of Title 22 of the California Code of
Regulations.
   (c) In establishing the evidentiary base, the Ninth Circuit Court
of Appeals has ordered the department to consider the costs of
providing the service.
   (d) Current law requires ground ambulance services provided to
state prison inmates to be reimbursed at the maximum rate of 120
percent of the Medicare Ambulance Fee Schedule (Sec. 5023.5, Pen.
C.).
   (e) Current law requires ground ambulance services provided under
the state workers compensation program to be reimbursed at the
maximum rate of 120 percent of the Medicare Ambulance Fee Schedule (8
Cal. Code Regs. 9789.70).
   (f) Emergency medical services systems are a critical safety net
service relied upon by the entire California population.
   (g) Ninety percent of Medi-Cal ground ambulance transports are
emergencies. Ground ambulance safety net providers cannot legally or
morally refuse to respond to emergency medical requests for service
and cannot refuse medically necessary emergency medical treatment and
transport.
   (h) Independent government cost studies indicate current Medi-Cal
payment rates cover just one quarter of the average cost of ground
ambulance service. Severe below-cost Medi-Cal payment rates threaten
to collapse the entire 911 emergency medical system safety net in
California.
  SEC. 2.  Article 5.7 (commencing with Section 14186) is added to
Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions
Code, to read:

      Article 5.7.  Ground Ambulance Services


   14186.  (a) No later than July 1, 2012, the department shall adopt
regulations establishing the Medi-Cal reimbursement rate for ground
ambulance services, based upon existing statutes, regulations, and
case law.
   (b) In establishing the rates as required in subdivision (a), the
department shall use one of the following methodologies:
   (1) Establish payment rates through regulation based on the
methodology required by the courts including doing all of the
following:
   (A) Develop a rate study or establish a cost-based evidentiary
base that results in proposed rates.
   (B) Present the proposed rates at a public hearing.
   (C) Combine public input and the evidentiary base for a final
adopted regulation.
   (2) Establish payment rates for ground ambulance services at 120
percent of the current Medicare Ambulance Fee Schedule and designate
the ambulance cost study conducted by the federal Government
Accountability Office (GAO-07-383) as the evidentiary base.