§ 14124.164. — 14124.164. (Added by Stats. 2024, Ch. 40, Sec. 63.)

California § 14124.164.

• Jurisdiction: California
• Code WIC: Welfare and Institutions Code - WIC
• Div. 9.: DIVISION 9. PUBLIC SOCIAL SERVICES
• Part 3.: PART 3. AID AND MEDICAL ASSISTANCE
• Ch. 7.: CHAPTER 7. Basic Health Care
• Art. 3.1.: ARTICLE 3.1. Medi-Cal Provider Payment Increases and Investments Act

Text

(a)
(1)
Notwithstanding Section 51527 of Title 22 of the California Code of Regulations or any other law, for dates of service no sooner than January 1, 2025, or on the effective date of any necessary federal approvals as required by subdivision (d) of Section 14124.162, whichever is later, the department shall increase reimbursement for eligible providers rendering ground emergency medical transport services.
(2)
The department may implement the reimbursement increases described in paragraph (1) solely with respect to the per-transport rate, with respect to both the per-transport and the mileage rates, or in any other manner as deemed appropriate by the department.
(3)
This subdivision shall not apply to an eligible provider as defined in paragraph (1) of subdivision (a) of Section 14105.945.
(b)
Notwithstanding Section 51527 of Title 22 of the California Code of Regulations or any other law, for dates of service no sooner than January 1, 2025, or on the effective date of any necessary federal approvals as required by subdivision (d) of Section 14124.162, whichever is later, the department may vary the reimbursement increases described in subdivision (a), or reimbursement rates for ground emergency medical transport services, based on complexity or the geographic localities utilized by the federal Medicare Program, may categorize localities into rural tiers, and may vary the amount of the rural adjustment per tier from those utilized by the Medicare Program to reflect a California-specific index of localities and adjustment factors. Nothing in this subdivision shall be construed to require
the department to reimburse providers rendering ground emergency medical transport services the rates utilized by the Medicare Program or to replicate the rural adjustment factors, or any other factors, utilized by the Medicare Program.
(c)
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 noncontract emergency medical transport providers consistent with Section 1396u-2(b)(2)(D) of Title 42 of the United States Code. Effective upon implementation of this section, and for each state fiscal year thereafter for which this section is operative, the amounts a noncontract emergency medical transport provider could 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 resulting fee-for-service payment schedule amounts after the application of this section.
(d)
The department shall implement the reimbursement increases specified in subdivision (a) in amounts that are designed to target increased state fund expenditures of equal to the annualized amount set forth in the state fiscal year 2024–25 budget for the first year of implementation in aggregate across both the Medi-Cal fee-for-service and managed care delivery systems. The reimbursement increases established pursuant to this methodology shall continue at these levels for each year thereafter, subject to subdivision (e).
(e)
The department may annually review and revise the reimbursement increases established in accordance with subdivision (a). Any revisions shall be subject to the provisions of subdivision (d) of Section 14124.162 and take effect beginning
no sooner than January 1, 2026, and thereafter on each subsequent January 1 of the calendar year following the department's annual review.

Legislative History

Added by Stats. 2024, Ch. 40, Sec. 63. (SB 159) Effective June 29, 2024. Conditionally repealed as of January 1, 2025, pursuant to Sec. 14124.168.