Amended in Assembly April 7, 2014

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 14105.94 of the Welfare and Institutions Code, relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

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

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.

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 begin insert (IGTs) end insert that conform with federal law. begin insert The bill would provide specific timeframes for the implementation of these provisions. end insert

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.  

Section 14105.94 of the Welfare and Institutions
Code is amended 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 fee-for-service or managed care 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. 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 begin delete transfers, end delete begin insert transfers (IGTs), end insert as long
as the begin delete intergovernmental transfers end delete begin insert IGTs end insert are in conformity with
federal law. begin insert If a governmental entity elects to include IGTs as the
nonfederal share of expenditures, the IGT funds shall be submitted
no later than November 1 of each year. 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.
begin insert If the state receives IGT funds as described in subdivision (e), the
department shall certify the IGT funds as the nonfederal share of
expenditures end insert begin insert within 60 days of receiving the IGT funds. The
Controller shall transfer the federal financial participation
received as a result of claims for expenditures using IGT funds to
the department within 10 days of receiving the federal financial
participation. end insert

(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.

begin insert

(g) (1) The department shall distribute supplemental
reimbursement for eligible ground emergency medical
transportation providers for services provided to Medi-Cal
managed care beneficiaries to managed care plans within 15 days
of receiving the federal financial participation.

end insert begin insert

(2) Each managed care plan shall, within 30 days of receiving
funds under paragraph (1), distribute 100 percent of the funds
received to the eligible ground emergency medical transportation
providers in accordance with subdivision (c).

end insert begin delete

(g)

end delete

begin insert ( end insert begin insert h) end insert  (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.

begin delete

(h)

end delete

begin insert ( end insert begin insert i) end insert  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.