Amended in Senate April 21, 2014

Senate Bill No. 1374

Introduced by Senator Hernandez

February 21, 2014

An act to begin insert add Article 5. end insert begin insert 8 (commencing with Section 1418 end insert begin insert 8) to Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions Code, end insert relating to Medi-Cal.

LEGISLATIVE COUNSEL’S DIGEST

SB 1374, as amended, Hernandez. Medi-Cal: begin delete ambulance services. end delete begin insert ground ambulance rates. end insert

Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care begin delete services. Existing law prohibits a city or county from establishing equipment and personnel standards for the furnishing of nonemergency medical transportation services for eligible Medi-Cal beneficiaries that are in conflict with equipment and personnel standards for reimbursement established by the department. end delete begin insert services, including medical transportation services. Existing law and regulations prescribe various requirements governing payment policies and reimbursement rates for these services. end insert

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This bill would state findings and declarations of the Legislature relative to ambulance services. The bill would express the intent of the Legislature to enact legislation to ensure the continued viability of emergency medical systems throughout the state by establishing payment definitions and policies for the Medi-Cal program, as related to ambulance services that meet nationally recognized standards. The bill would also express the intent of the Legislature to enact legislation to establish Medi-Cal reimbursement rates for essential emergency and nonemergency ambulance services that will cover, at a minimum, the actual costs of providing those services, and to enact legislation to ensure the provision of essential medically necessary emergency and nonemergency ambulance response and transportation services to the citizens of California.

end delete begin insert

This bill would require the department, by July 1, 2015, to adopt regulations establishing the Medi-Cal reimbursement rate for ground ambulance services using one of 2 specified methodologies.

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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

The Legislature finds and declares all of the
following:

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(a) Regarding Medi-Cal payment rates for ground ambulance
services, the State Plan under Title XIX of the federal Social
Security Act for California requires 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 to be
reimbursed 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.

end insert begin insert

(b) Current law requires ground ambulance services provided
to state prison inmates to be reimbursed at a rate that does not
exceed 120 percent of the Medicare Ambulance Fee Schedule
(Section 5023.5 of the Penal Code).

end insert begin insert

(c) Current law requires ground ambulance services provided
under the state workers’ compensation program to be reimbursed
at a rate that does not exceed 120 percent of the Medicare
Ambulance Fee Schedule (Section 9789.70 of Title 8 of the
California Code of Regulations).

end insert begin insert

(d) Emergency medical services systems are a critical safety
net service relied upon by the entire California population.

end insert begin insert

(e) 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.

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(f) Independent government cost studies indicate that 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.

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begin insert

begin insert SEC. 2. end insert   

end insert

begin insert Article 5.8 (commencing with Section 14188) is added
to Chapter 7 of Part 3 of Division 9 of the end insert begin insert Welfare and Institutions
Code end insert begin insert , to read: end insert

begin insert

 

Article begin insert 5.8. end insert   Ground Ambulance Services

 

begin insert 14188. end insert   

(a) No later than July 1, 2015, 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 by 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
____ 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.

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SECTION 1.  

(a) The Legislature finds and declares the
following:

(1) Ambulance services play a vital role in providing quality
health care and are a critical component of the public safety first
response in times of natural or man-made disasters.

(2) With the passage of the Emergency Medical Services System
and the Prehospital Emergency Medical Care Personnel Act in
1980, the intent of the Legislature has been to maintain and
promote the development of emergency medical technician
paramedic programs where appropriate throughout the state, and
to initiate EMT II limited advanced life support programs only
where geography, population density, and resources would not
make the establishment of a paramedic program feasible.

(b) It is the intent of the Legislature to enact legislation to ensure
the continued viability of emergency medical systems throughout
the state by establishing payment definitions and policies for the
Medi-Cal program, as related to ambulance services that meet
nationally recognized standards.

(c) It is the intent of the Legislature to enact legislation to
establish Medi-Cal reimbursement rates for essential emergency
and nonemergency ambulance services that will cover, at a
minimum, the actual costs of providing those services.

(d) It is the intent of the Legislature to enact legislation to ensure
the provision of essential medically necessary emergency and
nonemergency ambulance response and transportation services to
the citizens of California.

end delete