Bill Text: CA AB511 | 2009-2010 | Regular Session | Amended
Bill Title: Medi-Cal: ambulance transportation services providers:
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Engrossed - Dead) 2010-06-24 - In committee: Set, first hearing. Hearing canceled at the request of author. [AB511 Detail]
Download: California-2009-AB511-Amended.html
BILL NUMBER: AB 511 AMENDED
BILL TEXT
AMENDED IN SENATE DECEMBER 17, 2009
AMENDED IN SENATE JULY 15, 2009
AMENDED IN SENATE JUNE 23, 2009
AMENDED IN ASSEMBLY MAY 4, 2009
AMENDED IN ASSEMBLY APRIL 20, 2009
AMENDED IN ASSEMBLY APRIL 13, 2009
INTRODUCED BY Assembly Member De La Torre
FEBRUARY 24, 2009
An act to add and repeal Chapter 13 (commencing with Section
1799.300) of Division 2.5 of the Health and Safety Code, and to
add and repeal Article 3.9 (commencing with Section 14127.1) of
Chapter 7 of Part 3 of Division 9 of the Welfare and Institutions
Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 511, as amended, De La Torre. 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 would provide, as a condition of participation in the
Medi-Cal program, that there be imposed a quality assurance fee on
ambulance transportation services providers, to be administered by
the Director of Health Care Services. The proceeds from the fee would
be required to be deposited 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 these 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. The bill would provide that it shall remain
operative only as long as certain conditions are met and if any one
of the conditions is not met, its provisions shall become inoperative
and be repealed.
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.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no yes .
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Chapter 13 (commencing with Section
1799.300) is added to Division 2.5 of the Health and
Safety Code , to read:
CHAPTER 13. AMBULANCE TRANSPORTATION SERVICES PROVIDER QUALITY
ASSURANCE FEE
1799.300 (a) For purposes of this chapter, "ambulance
transportation services" means the transportation of sick, injured,
invalid, convalescent, infirm, or otherwise incapacitated persons by
an ambulance licensed, operated, and equipped in accordance with
applicable state or local statutes, ordinances, or regulations.
"Ambulance transportation services" shall not include transportation
of beneficiaries by passenger car, taxicabs, litter vans, wheelchair
vans, or other forms of public or private conveyances.
(b) As a condition of participation in the Medi-Cal program,
commencing July 1, 2010, for each public and private ambulance
transportation services provider that bills and receives patient care
revenue from the provision of ambulance transportation services,
there shall be imposed a quality assurance fee for each transport
provided. The fee shall not be assessed when, following evaluation of
a patient, no transport is provided. The quality assurance fee shall
be assessed on all Medi-Cal ambulance transportation services
providers except for a Medi-Cal ambulance transportation services
provider that is exempt pursuant to paragraph (2) of subdivision (a)
of Section 1799.307 and air ambulance providers.
(c) The amount of the quality assurance fee assessed on each
Medi-Cal ambulance transportation services provider shall be assessed
on a per-transport basis and shall be calculated in accordance with
the methodology outlined in subdivision (d), in the request for
federal approval required by Section 1799.307, and in regulations,
provider bulletins, or similar instructions.
(d) (1) The per-transport quality assurance fee shall be
calculated as follows:
(A) For the 2010-11 fiscal year, the total annual gross receipts
shall be projected for all ambulance transportation services
providers subject to the fee, as described in subdivision (b). This
projection shall be based on data collected from ambulance
transportation services providers, as required pursuant to Section
1799.305. The projected total annual gross receipts for these
providers shall be multiplied by 5.5 percent and the resulting sum
shall be divided by the projected total annual transports by these
providers to determine the amount to be assessed per transport during
the 2010-11 fiscal year.
(B) For the 2011-12 to 2015-16, inclusive, fiscal years, the total
annual gross receipts shall be projected for all ambulance
transportation services providers subject to the fee, as described in
subdivision (b). This projection shall be based on data collected
from ambulance transportation services providers in the prior year.
The projected total annual gross receipts for these providers shall
be multiplied by 5.5 percent and the resulting sum shall be divided
by the projected total annual transports by these providers to
determine the amount to be assessed per transport for the fiscal
year.
(2) For purposes of this section, "gross receipts" means gross
payments received as patient care revenue for ambulance
transportation services during a reporting period determined on a
cash basis of accounting.
(3) In no case shall the fees calculated pursuant to subparagraphs
(A) and (B) of paragraph (1) and collected pursuant to this chapter
exceed the amounts allowable under federal law.
(e) If there is a delay in the implementation of this chapter for
any reason, including a delay in any required approval of the quality
assurance fee and reimbursement methodology specified in Article 3.9
(commencing with Section 14127.1) of the Welfare and Institutions
Code by the federal Centers for Medicare and Medicaid Services, in
the 2009-10 fiscal year or in any other fiscal year, all of the
following shall apply:
(1) A Medi-Cal provider subject to the fee may be assessed the
amount the provider would be required to pay to the State Board of
Equalization if the methodology were already approved, but shall not
be required to pay the fee until the methodology is approved.
(2) The department may retroactively increase and make payment of
rates to Medi-Cal ambulance transportation services providers.
(3) The Medi-Cal rate increase referenced in paragraph (2) of
subdivision (a) of Section 1799.308 shall be paid within 30 days of
the approval of the reimbursement methodology described in Article
3.9 (commencing with Section 14127.1) of the Welfare and Institutions
Code.
1799.301. (a) The quality assurance fee, as calculated pursuant
to Section 1799.300, shall be paid by the providers subject to the
fee 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 provided in subdivision (e) of Section
1799.300.
(b) In order for the State Board of Equalization to verify the
accuracy of the quality assurance fee paid, each provider paying a
quality assurance fee shall submit with the fee paid, in a form
prescribed by the State Board of Equalization, data on the number of
transports and gross receipts from the provision of ambulance
transportation services provided during the month for which the fee
is being paid.
(c) When a provider subject to the fee fails to pay all or part of
the quality assurance fee within 60 days of the date that payment is
due, the department may deduct the unpaid fee and interest owed from
any Medi-Cal reimbursement payments owed to the provider until the
full amount of the fee and interest are recovered. Any deduction made
pursuant to this subdivision shall be made only after the department
gives the provider written notification. Any deduction made pursuant
to this subdivision may be deducted over a period of time that takes
into account the financial condition of the provider.
(d) If all or any part of the quality assurance fee remains
unpaid, the State Board of Equalization may assess a penalty on the
provider of the unpaid fee amount.
(e) The State Board of Equalization shall accept a provider's
payment even if the payment is submitted in a subsequent rate year
than the rate year in which the fee was assessed.
1799.302. (a) The Director of Health Care Services, with the
assistance of the State Board of Equalization, as described in
Sections 1799.303 and 1799.304, shall administer this chapter.
(b) The director may adopt regulations as are necessary to
implement this chapter. These regulations may be adopted as emergency
regulations in accordance with the rulemaking provisions of the
Administrative Procedure Act (Chapter 3.5 (commencing with Section
11340) of Part 1 of Division 3 of Title 2 of the Government Code).
For purposes of this chapter, the first adoption of regulations shall
be deemed an emergency and necessary for the immediate preservation
of the public peace, health and safety, or general welfare. The
regulations shall include, but need not be limited to, any
regulations necessary for any of the following purposes:
(1) The administration of this chapter, including the proper
imposition of the quality assurance fee. The costs associated with
the administration of this chapter are not to exceed the amounts
reasonably necessary to administer this chapter.
(2) The development of any forms necessary to obtain required
information from providers subject to the quality assurance fee.
(3) To provide details, definitions, formulas, and other
requirements.
(c) As an alternative to subdivision (b), and notwithstanding the
rulemaking provisions of Chapter 3.5 (commencing with Section 11340)
of Part 1 of Division 3 of Title 2 of the Government Code, the
director may implement this chapter, in whole or in part, by means of
a provider bulletin, or other similar instructions, without taking
regulatory action, provided that no such bulletin or other similar
instructions shall remain in effect after July 31, 2012. It is the
intent of the Legislature that the regulations adopted pursuant to
subdivision (b) be adopted on or before July 31, 2012.
(d) The director shall coordinate with the State Board of
Equalization to ensure that the quality assurance fee per transport
imposed pursuant to this chapter is collected pursuant to Section
1799.303.
1799.303. (a) The State Board of Equalization shall collect the
quality assurance fee imposed pursuant to this chapter in accordance
with the Fee Collection Procedures Law (Part 30 (commencing with
Section 55001) of Division 2 of the Revenue and Taxation Code). For
the purposes of this chapter, the references in the Fee Collection
Procedures Law to "feepayer" shall include an ambulance
transportation services provider subject to the quality assurance
fee, as described in subdivision (b) of Section 1799.300.
(b) The State Board of Equalization may prescribe, adopt, and
enforce regulations relating to the collection of the quality
assurance fee per transport imposed by this chapter including, but
not limited to, provisions governing collections, reporting, and
refunds.
(c) The State Board of Equalization may prescribe, adopt, and
enforce emergency regulations as necessary to implement the
collection of the proposed quality assurance fee per transport
imposed by this chapter. Any emergency regulations prescribed,
adopted, or enforced pursuant to this section shall be adopted in
accordance with Chapter 3.5 (commencing with Section 11340) of Part 1
of Division 3 of Title 2 of the Government Code, and, for purposes
of that chapter, including Section 11349.6 of the Government Code,
the adoption of these regulations is an emergency and shall be
considered by the Office of Administrative Law as necessary for the
immediate preservation of the public peace, health and safety, and
general welfare.
1799.304. The State Board of Equalization shall deposit the
quality assurance fee collected pursuant to this chapter in the
Medi-Cal Ambulance Transportation Services Providers Fund, which is
hereby created in the State Treasury. Notwithstanding Section 16305.7
of the Government Code, the fund shall also include interest and
dividends earned on moneys in the fund.
1799.305. Commencing January 1, 2010, on a monthly basis on or
before the last day of the following month, each public and private
ambulance transportation services provider subject to the fee shall
report to the State Board of Equalization, in a form prescribed by
the State Board of Equalization, data on the number of actual
transports and gross receipts from the provision of ambulance
transportation services provided in the month.
1799.306. Moneys in the Medi-Cal Ambulance Transportation
Services Providers Fund shall, upon appropriation by the Legislature,
be available exclusively for the following purposes:
(a) To enhance federal financial participation for ambulance
transportation services under the Medi-Cal program.
(b) 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 in Section 1797.52.
1799.307. (a) (1) The department shall request approval from the
federal Centers for Medicare and Medicaid Services for the
implementation of this chapter.
(2) The director may alter the methodology specified in this
chapter, to the extent necessary to meet the requirements of federal
law or regulations or to obtain federal approval. If the director,
after consulting with affected ambulance transportation services
providers, determines that an alteration is needed, the director
shall execute a declaration stating that this determination has been
made. The director shall retain the declaration and provide a copy,
within five working days of the execution of the declaration, to the
fiscal and appropriate policy committees of the Legislature.
(3) The director may add categories of exempt ambulance
transportation services providers or apply a nonuniform fee per
transport to ambulance transportation services providers that are
subject to the fee in order to meet requirements of federal law or
regulations. The director may exempt categories of ambulance
transportation services providers from the fee, if necessary to
obtain federal approval.
(b) The department shall make retrospective adjustments, as
necessary, to the amounts calculated pursuant to Section 1799.300 in
order to ensure that the quality assurance fee for any provider in a
particular state fiscal year does not exceed 5.5 percent of the
aggregate annual net receipts derived by a provider subject to the
fee from the provision of ambulance transportation services.
1799.308. (a) This chapter shall be implemented only if, and as
long as, both of the following conditions are met:
(1) The state receives federal approval of the quality assurance
fee from the federal Centers for Medicare and Medicaid Services.
(2) Legislation is enacted during the 2009-10 Regular Session of
the Legislature that makes an appropriation from the Medi-Cal
Ambulance Transportation Services Providers Fund and from the Federal
Trust Fund to fund a Medi-Cal rate increase for ambulance
transportation services providers.
(b) This chapter shall cease to be implemented if any of the
following conditions is no longer met:
(1) The federal Centers for Medicare and Medicaid Services
continues to allow the use of the provider assessment provided in
this chapter.
(2) The Medi-Cal rate increase referenced in paragraph (2) of
subdivision (a) remains in effect.
(3) The full amount of the quality assurance fee assessed and
collected pursuant to this chapter remains available for the purposes
specified in Section 1799.306.
(c) If all of the conditions in subdivision (a) are met, this
chapter is implemented, and subsequently, any one of the conditions
in subdivision (b) is not met, on and after the date that the
director executes a declaration that makes the determination that any
condition is not met, this chapter shall become inoperative
notwithstanding that the condition or conditions subsequently may be
met.
(d) Notwithstanding subdivisions (a), (b), and (c), in the event
of a final judicial determination made by any state or federal court
that is not appealed, or by a court of appellate jurisdiction that is
not further appealed, in any action by any party, or a final
determination by the administrator of the federal Centers for
Medicare and Medicaid Services, that federal financial participation
is not available with respect to any payment made under the
methodology implemented pursuant to this chapter because the
methodology is invalid, unlawful, or contrary to any provision of
federal law or regulations, or of state law, this chapter shall
become inoperative.
1799.309. This chapter shall become inoperative on the earlier of
the date it becomes inoperative pursuant to Section 1799.308 or July
1, 2016, and, as of January 1, 2017, is repealed, unless a later
enacted statute, that becomes operative on or before January 1, 2017,
deletes or extends the dates on which it becomes inoperative and is
repealed.
SEC. 2. Article 3.9 (commencing with Section 1412
7.1) is added to Chapter 7 of Part 3 of Division 9 of the
Welfare and Institutions Code , to read:
Article 3.9. Medi-Cal Ambulance Transportation Reimbursement
Act
14127.1. This article shall be known, and may be cited, as the
Medi-Cal Ambulance Transportation Reimbursement Act.
14127.2. (a) It is the intent of the Legislature to increase the
Medi-Cal ambulance transportation reimbursement to support quality
improvement efforts by ambulance transportation services providers,
including, but not limited to, the provision of advanced life support
services, as defined in Section 1797.52.
(b) For purposes of this article, "ambulance transportation
services" means the transportation of sick, injured, invalid,
convalescent, infirm, or otherwise incapacitated persons by an
ambulance licensed, operated, and equipped in accordance with
applicable state or local statutes, ordinances, or regulations.
"Ambulance transportation services" shall not include transportation
of beneficiaries by passenger car, taxicabs, litter vans, wheelchair
vans, or other forms of public or private conveyances.
(c) (1) Commencing August 1, 2010, Medi-Cal reimbursement for
ambulance transportation services shall be the amount equal to that
established by the federal Medicare Program for the same service,
utilizing applicable Medicare standards, definitions, and
regional-specific modifiers. This reimbursement rate shall be
effective commencing on August 1, 2010, and shall be paid on the
later of the following dates:
(A) The first day of the month following federal approval of the
reimbursement methodology established by this article.
(B) Sixty days following the initial assessment of the quality
assurance fee imposed pursuant to Section 1799.300 of the Health and
Safety Code.
(2) The department may retroactively increase and make payments of
increased rates to Medi-Cal ambulance transportation services
providers as necessary to implement this subdivision.
(d) For managed health care plans that contract with the
department pursuant to this chapter, Chapter 8 (commencing with
Section 14200), and Chapter 8.75 (commencing with Section 14590),
payments shall be increased by the actuarial equivalent amount of the
payment increase, based on projections by the department, as a
result of implementation of subdivision (b), pursuant to contract
amendments or change orders effective on August 1, 2010. Under the
contract amendment or change order, a managed health care plan shall
be required to expend, in the form of additional payments to
ambulance transportation services providers, 100 percent of any
increased payment it receives under this subdivision. Any delegation
or attempted delegation by a managed health care plan of its
obligation to make the additional payments under this subdivision
shall not relieve the managed health care plan from its obligation to
make the payments. Managed health care plans shall submit
documentation as the department may require to demonstrate compliance
with this subdivision.
(e) The reimbursement rate set forth in subdivisions (b) and (c)
shall continue as long as the quality assurance transport fees
imposed pursuant to Section 1799.300 of the Health and Safety Code is
in effect.
(f) The department shall request approval from the federal Centers
for Medicare and Medicaid Services for the implementation of this
article.
14127.3. This article shall become inoperative on the earlier of
the date that Chapter 13 (commencing with Section 1799.300) of
Division of 2.5 of the Health and Safety Code becomes inoperative
pursuant to Section 1799.308 of the Health and Safety Code or July 1,
2016, and, as of January 1, 2017, is repealed, unless a later
enacted statute, that becomes operative on or before January 1, 2017,
deletes or extends the dates on which it becomes inoperative and is
repealed.
SEC. 3. No reimbursement is required by this act
pursuant to Section 6 of Article XIII B of the California
Constitution because the only costs that may be incurred by a local
agency or school district will be incurred because this act creates a
new crime or infraction, eliminates a crime or infraction, or
changes the penalty for a crime or infraction, within the meaning of
Section 17556 of the Government Code, or changes the definition of a
crime within the meaning of Section 6 of Article XIII B of the
California Constitution. All matter deleted in this version of
the bill appears in the bill as amended in the Senate, July 15, 2009.
(JR11)
