Medi-Cal: ambulance transportation services providers: quality assurance fees.

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 establishes a quality assurance fee program for skilled nursing and intermediate care facilities, as prescribed. This bill, as a condition of participation in the Medi-Cal program, commencing July 1, 2010, would impose on each public and private ambulance transportation services provider that bills and receives patient care revenue from the provision of ambulance transportation services, as defined, except as provided, a quality assurance fee for each transport provided, as specified. This bill would require the quality assurance fee to be paid by providers to the State Board of Equalization on a monthly basis on or before the last day of the month following the month for which the fee was imposed, except as specified. The Fee Collection Procedures Law, the violation of which is a crime, provides procedures for the collection of certain fees and surcharges. The bill would require the State Board of Equalization to collect the quality assurance fee in accordance with the Fee Collection Procedures Law. Because the Fee Collection Procedures Law would apply to the collection of the fee, the violation of which is a crime, it would impose a state-mandated local program. This bill would require the State Board of Equalization to deposit the quality assurance fee collected into the Medi-Cal Ambulance Transportation Services Providers Fund, which the bill would create. The bill would provide that moneys in the fund shall, upon appropriation by the Legislature, be available exclusively to enhance federal financial participation for ambulance transportation services under the Medi-Cal program or to provide additional reimbursement to, and to support quality improvement efforts of, ambulance transportation services providers, including increased reimbursement for, and improvement of the quality of, the provision of advanced life support services, as defined. The bill would provide that the above-described provisions are to be implemented only if, and as long as, the state receives federal approval for the fee and legislation is enacted during the 2009–10 Regular Session of the Legislature that makes an appropriation from the fund and from the Federal Trust Fund to fund a Medi-Cal rate increase for ambulance transportation services providers. This bill, commencing August 1, 2010, to July 1, 2016, inclusive, would provide that Medi-Cal reimbursement for ambulance transportation services shall be the amount equal to that established by the federal Medicare Program for the same services, utilizing applicable Medicare standards, definitions, and regional-specific modifiers. This bill would require the department to request approval from the federal Centers for Medicare and Medicaid Services (CMS) for the above-described provisions. This bill would provided that if there is a delay in the implementation of the above-described provisions for any reason, including a delay in the approval of the quality assurance fee and reimbursement methodology by CMS, a provider subject to the fee may be assessed the amount the provider would be required to pay if the methodology were already approved, but shall not be required to pay the fee until the methodology is approved and the department may retroactively increase and make payments of rates to Medi-Cal ambulance transportation services providers. The bill would provide that the provisions of the bill shall cease to be implemented if any of certain conditions, including continued federal approval, is no longer met. The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement. This bill would provide that no reimbursement is required by this act for a specified reason.