Amended in Assembly March 28, 2014

California Legislature—2013–14 Regular Session

Assembly Bill No. 2577

Introduced by Assembly Members Cooley and Pan

February 21, 2014

An act to amend Section begin delete 10000 end delete begin insert 14105.94 end insert of the Welfare and Institutions Code, relating to begin delete public social services end delete begin insert Medi-Cal end insert .

LEGISLATIVE COUNSEL’S DIGEST

AB 2577, as amended, Cooley. begin delete Public social services. end delete begin insert Medi-Cal: ground emergency transportation services: supplemental reimbursement. end insert

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Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, and under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid Program provisions. Existing law authorizes certain ground emergency medical transportation providers to receive supplemental Medi-Cal reimbursement in addition to the rate of payment the provider would otherwise receive for those services. Existing law provides that participation in the supplemental reimbursement program by an eligible provider is voluntary, and requires the nonfederal share of the supplemental reimbursement to be paid only with funds from specified governmental entities.

end insert begin insert

This bill would include, as eligible providers, those that provide ground emergency medical transportation to Medi-Cal fee-for-service or managed care beneficiaries. The bill would also authorize the governmental entities to include, as the nonfederal share of expenditures for ground emergency medical transportation services, and in collaboration with the department, voluntary intergovernmental transfers that conform with federal law.

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Existing law establishes various programs for delivery of care, assistance, and services to people in need and declares the intent that aid be administered and services be provided promptly and humanely.

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This bill would make a technical, nonsubstantive change.

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Vote: majority. Appropriation: no. Fiscal committee:  begin delete no end delete begin insert yes end insert . State-mandated local program: no.

The people of the State of California do enact as follows:

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begin insert SECTION 1. end insert   

end insert

begin insert Section 14105.94 of the end insert begin insert Welfare and Institutions
Code end insert begin insert is amended to read: end insert

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 begin insert fee-for-service or managed care end insert 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 exclusively to eligible providers 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) Participation in the program by an eligible provider described
in this section is voluntary. 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. begin insert The governmental entity may elect to include, in
collaboration with the department, and as the nonfederal share
of expenditures for ground emergency medical transportation
services, voluntary intergovernmental transfers, as long as the
intergovernmental transfers are in conformity with federal law. end insert

(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) (1) If either a final judicial determination is made by any
court of appellate jurisdiction or a final determination is made by
the administrator of the federal Centers for Medicare and Medicaid
Services that the supplemental reimbursement provided for in this
section must be made to any provider not described in this section,
the director shall execute a declaration stating that the
determination has been made and on that date this section shall
become inoperative.

(2) The declaration executed pursuant to this subdivision shall
be retained by the director, provided to the fiscal and appropriate
policy committees of the Legislature, the Secretary of State, the
Secretary of the Senate, the Chief Clerk of the Assembly, and the
Legislative Counsel, and posted on the department’s Internet Web
site.

(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.

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SECTION 1.  

Section 10000 of the Welfare and Institutions
Code is amended to read:

10000.  

The purpose of this division is to provide for protection,
care, and assistance to the people of the state in need thereof, and
to promote the welfare and happiness of all of the people of the
state by providing appropriate aid and services to all of its needy
and distressed. It is the intent of the Legislature that aid shall be
administered and services provided promptly and humanely, with
due regard for the preservation of family life, and without
discrimination on account of ancestry, marital status, political
affiliation, or any characteristic listed or defined in Section 11135
of the Government Code. That aid shall be so administered and
services so provided, to the extent not in conflict with federal law,
as to encourage self-respect, self-reliance, and the desire to be a
good citizen, useful to society.

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