Medi-Cal reimbursements: nonemergency ambulance and other transportation.

The effective date for Medi-Cal fee-for-service reimbursement of nonemergency ambulance transportation services (set at 80% of the Medicare ambulance fee schedule adjusted by Geographic Practice Cost Index) was delayed from July 1, 2026 to July 1, 2027.

The effective date for the Medi-Cal managed care directed payment program for nonemergency ambulance transportation services was also delayed from July 1, 2026 to July 1, 2027.

The effective date for both the fee-for-service reimbursement rate (80% of Medicare ambulance fee schedule) and the managed care directed payment program was changed from January 1, 2026 to July 1, 2027.

The legislative digest description of the directed payment program was reworded to remove redundant language ('for Medi-Cal managed care in order to follow a similar treatment to'), now simply stating the department shall establish a directed payment program for nonemergency ambulance transportation services with rates at least equal to fee-for-service reimbursement.

The effective date for both the fee-for-service reimbursement rate changes and the managed care directed payment program was moved from January 1, 2026 to July 1, 2026.

The managed care directed payment requirement was changed from setting rates 'equal to' the fee-for-service amount to 'at least' the fee-for-service amount, giving managed care plans a floor rather than a fixed rate.

New Section 14124.152 allows either a physician or a nonphysician authorized under federal regulations (Section 410.40 of Title 42 CFR) to certify medical necessity for nonemergency ambulance transportation, broadening who can approve these services beyond physicians alone.

New Section 14124.153 authorizes medical transportation providers to document mileage using GPS tracking, digital mapping software or applications, or other department-identified mechanisms in addition to the existing requirement of odometer readings at pickup and delivery locations.

The bill's scope expanded from a single new section (14124.151) covering ambulance reimbursement rates to three new sections (14124.151, 14124.152, and 14124.153) covering reimbursement rates, medical necessity certification, and mileage documentation methods.

Medi-Cal fee-for-service reimbursement for nonemergency ambulance transportation services was reduced from 100% of the federal Medicare ambulance fee schedule (adjusted by Geographic Practice Cost Index) to 80% of that amount, effective January 1, 2026.

Corrected duplicate word 'provision provisions' to 'provisions' in two places and corrected 'reimbursement levels rates' to 'reimbursement rates' in the summary section.

Removed amendments to Sections 14129, 14129.2, 14129.3, and 14129.6 of the Welfare and Institutions Code, which had covered definitions for emergency/interfacility/nonemergency ambulance transports, quality assurance fee calculation changes, add-on reimbursement provisions, and federal approval/modification authority.

Removed new Section 14129.05, which would have set Medi-Cal fee-for-service reimbursement for nonemergency AND interfacility ambulance transports at 100% of the federal Medicare ambulance fee schedule.

Removed new Section 14129.06, which would have authorized nonphysicians to certify medical necessity for ambulance transports in place of physicians, with electronic or other format signatures permitted.

Added new paragraph (a)(3) to Section 14124.151 requiring the department to establish a Medi-Cal managed care directed payment program under federal authority (Section 438.6(c) of Title 42 CFR) to increase reimbursement rates for nonemergency ambulance transportation services in managed care, commencing January 1, 2026, subject to appropriation.

Removed a provision requiring the department to update regulations to allow medical transportation providers to document mileage via GPS tracking, digital mapping software, or other mechanisms in addition to odometer readings.

Changed the term 'reimbursement levels' to 'reimbursement rates' in the appropriation language of Section 14124.151(a)(1), a minor wording adjustment.

New Section 14124.151 requires Medi-Cal fee-for-service reimbursement for nonemergency ambulance transportation services to equal the federal Medicare ambulance fee schedule for the corresponding level of service, adjusted by the Geographic Practice Cost Index specific to the area of California where services are provided, commencing January 1, 2026.

The new section is subject to a legislative appropriation and states it is the intent of the Legislature that the appropriation be sufficient to fund the reimbursement levels in whole. The department must maximize federal financial participation and use state funds if FFP is unavailable.

Fiscal committee review changed from 'no' to 'yes,' indicating the bill now triggers fiscal analysis due to the new appropriation-dependent reimbursement obligation.

The new section authorizes the department to implement, interpret, or make specific the provision by plan letters, provider bulletins, or similar instructions without taking further regulatory action, bypassing standard rulemaking procedures under Government Code Chapter 3.5.

New definition of 'nonemergency ambulance transportation services' as nonemergency medical transportation services conducted by ground ambulance (per 22 CCR Section 51323), explicitly excluding emergency medical transport services as defined in Section 14129(g).

The bill digest and title description removed the phrase 'nonemergency interfacility transfers' as a standalone policy objective, narrowing the stated focus to 'ambulance transports' and 'nonemergency ambulance transportation.'

The bill expanded from a single intent statement into a full operational statute with definitions, reimbursement rate mandates, fee calculation rules, certification requirements, and regulatory updates. The article was renamed to 'Medi-Cal Emergency and Nonemergency Medical Transportation Reimbursement Act.'

New Section 14129.05 requires Medi-Cal fee-for-service reimbursement rates for nonemergency ambulance transports and interfacility ambulance transports to equal 100 percent of the federal Medicare ambulance fee schedule for the appropriate level of service billed.

New Section 14129.06 authorizes a nonphysician to certify medical necessity of an ambulance transport for Medi-Cal coverage in place of a physician, and permits electronic signatures or any other format authorized by federal regulations (42 CFR 410.40).

Section 14129.2 was amended to specify that the reimbursement rate for interfacility ambulance transports in an emergency context shall not affect the quality assurance fee rate calculation, which must be based on the methodology and reimbursement rate in effect as of January 1, 2025.

Section 14129.6 was amended to add a new provision requiring that if modifications are needed to meet federal requirements, the director must recalculate and reduce the add-on amount but is prohibited from reducing the Medi-Cal fee-for-service reimbursement rates for nonemergency ambulance transports or interfacility ambulance transports.

New Section 8 requires the department to update regulations to allow medical transportation providers to document mileage through GPS tracking, digital mapping software, or other reasonable mechanisms in addition to odometer readings.

Section 14129 was rewritten with comprehensive definitions including 'interfacility ambulance transport' (transport where both origin and destination are health facilities) and 'nonemergency ambulance transport' (transport not requested through 911 PSAP and billed with non-emergency HCPCS codes).