Bill Text: CA AB2450 | 2019-2020 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Air ambulance services.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Passed) 2020-09-09 - Chaptered by Secretary of State - Chapter 52, Statutes of 2020. [AB2450 Detail]

Download: California-2019-AB2450-Amended.html

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Amended  IN  Assembly  May 04, 2020

CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill

No. 2450

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Introduced by Assembly Member Grayson

February 19, 2020

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An act to amend Section 1371.55 of the Health and Safety Code, and to amend Section 10126.65 of the Insurance add Section 14124.16 to the Welfare and Institutions Code, relating to air ambulance services.

LEGISLATIVE COUNSEL'S DIGEST

AB 2450, as amended, Grayson. Air ambulance services.

Existing law establishes 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 an eligible provider to receive increased reimbursement, by application of an add-on increase to the associated Medi-Cal fee-for-service payment schedule, for emergency medical transports provided to applicable Medi-Cal beneficiaries, but excludes air ambulances from that increased reimbursement.

This bill would require the department to set and maintain supplemental Medi-Cal payments for air ambulance services provided by fixed or rotary wing aircraft according to a specified payment schedule. The bill would limit the amounts a noncontracting emergency medical transport provider may collect if the beneficiary received medical assistance other than through enrollment in a Medi-Cal managed care health plan to the sum of the supplemental payments and existing fee-for-service payment schedule amounts after the application of the bill’s specified supplemental Medi-Cal payment schedule.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care. Existing law also provides for the regulation of health insurers by the Department of Insurance. Existing law requires that health care service plan contracts and health insurance policies provide coverage for certain services and treatments, including emergency medical transportation services. Existing law requires a health care service plan contract or a health insurance policy issued, amended, or renewed on or after January 1, 2020, to provide, among other things, that if an enrollee, insured, or subscriber receives covered services from a noncontracting air ambulance provider, the individual will pay no more than the same cost sharing that the individual would pay for the same covered services received from a contracting air ambulance provider, referred to as the in-network cost-sharing amount.

This bill would make technical, nonsubstantive changes to those provisions.

Digest Key

Vote: MAJORITY   Appropriation: NO   Fiscal Committee: NOYES   Local Program: NO  

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Bill Text

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

SECTION 1.

 Section 14124.16 is added to the Welfare and Institutions Code, to read:

14124.16.

 (a) The department shall set and maintain supplemental Medi-Cal payments for air ambulance services provided by fixed or rotary wing aircraft as follows for the following common procedure terminology (CPT) codes:

A0431	Rotary Wing Transport	$4,022.22
A0436	Rotary Wing Air Mileage	$17.57
A0430	Fixed Wing Air Transport	$3,705.40
A0435	Fixed Wing Air Mileage	$0.45

(b) Each applicable Medi-Cal managed care health plan shall satisfy its obligation under Section 438.114(c) of Title 42 of the Code of Federal Regulations for emergency medical transports and shall provide payment to noncontracting emergency medical transport providers consistent with Section 1396u-2(b)(2)(D) of Title 42 of the United States Code. Commencing in the fiscal year beginning July 1, 2020, and for each state fiscal year thereafter for which this section is operative, the amounts a noncontracting emergency medical transport provider may collect if the beneficiary received medical assistance other than through enrollment in a Medi-Cal managed care health plan pursuant to Section 1396u-2(b)(2)(D) of Title 42 of the United States Code shall be the sum of the supplemental payments and existing fee-for-service payment schedule amounts after the application of this section.

SECTION 1.Section 1371.55 of the Health and Safety Code is amended to read:

1371.55.

(a)(1)Notwithstanding Section 1367.11, a health care service plan contract issued, amended, or renewed on or after January 1, 2020, shall provide that if an enrollee receives covered services from a noncontracting air ambulance provider, the enrollee shall pay no more than the same cost-sharing amount that the enrollee would pay for the same covered services received from a contracting air ambulance provider. This amount shall be referred to as the “in-network cost-sharing amount.”

(2)An enrollee shall not owe the noncontracting provider more than the in-network cost-sharing amount for services subject to this section. At the time of payment by the plan to the noncontracting provider, the plan shall inform both the enrollee and the noncontracting provider of the in-network cost-sharing amount owed by the enrollee.

(b)The following shall apply for purposes of this section:

(1)Any cost sharing paid by the enrollee for the services subject to this section shall count toward the limit on annual out-of-pocket expenses established pursuant to Section 1367.006.

(2)Cost sharing arising from services subject to this section shall be counted toward any deductible in the same manner as cost sharing would be attributed to a contracting provider.

(3)The cost sharing paid by the enrollee pursuant to this section shall satisfy the enrollee’s obligation to pay cost sharing for the health service.

(c)A noncontracting provider may advance to collections only the in-network cost-sharing amount, as determined by the plan pursuant to subdivision (a), that the enrollee failed to pay.

(d)A health care service plan or a provider may seek relief in any court for the purpose of resolving a payment dispute. A provider is not prohibited from using a health care service plan’s existing dispute resolution processes.

(e)Air ambulance service providers remain subject to the balance billing protections for Medi-Cal beneficiaries pursuant to Section 14019.4 of the Welfare and Institutions Code.

SEC. 2.Section 10126.65 of the Insurance Code is amended to read:

10126.65.

(a)(1)Notwithstanding Section 10352, a health insurance policy issued, amended, or renewed on or after January 1, 2020, shall provide that if an insured or subscriber receives covered services from a noncontracting air ambulance provider, the insured or subscriber shall pay no more than the same cost sharing that the insured or subscriber would pay for the same covered services received from a contracting air ambulance provider. This amount shall be referred to as the “in-network cost-sharing amount.”

(2)A subscriber or insured shall not owe the noncontracting provider more than the in-network cost-sharing amount for services subject to this section. At the time of payment by the insurer to the noncontracting provider, the insurer shall inform both the insured or subscriber and the noncontracting provider of the in-network cost-sharing amount owed by the insured or subscriber.

(b)The following shall apply for purposes of this section:

(1)Any cost sharing paid by the insured or subscriber for the services subject to this section shall count toward the limit on annual out-of-pocket expenses established pursuant to Section 10112.28.

(2)Cost sharing arising from services subject to this section shall be counted toward any deductible in the same manner as cost sharing would be attributed to a contracting provider.

(3)The cost sharing paid by the insured or subscriber pursuant to this section shall satisfy the insured’s or subscriber’s obligation to pay cost sharing for the health service.

(c)A noncontracting provider may advance to collections only the in-network cost-sharing amount, as determined by the insurer pursuant to subdivision (a), that the insured or subscriber failed to pay.

(d)A health insurer or a provider may seek relief in any court for the purpose of resolving a payment dispute. A provider is not prohibited from using a health insurer’s existing dispute resolution processes.