Medi-Cal reimbursements: nonemergency ambulance and other transportation.

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, including emergency or nonemergency medical or nonmedical transportation services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Under this bill, commencing on July 1, 2027, and subject to an appropriation, Medi-Cal fee-for-service reimbursement for nonemergency ambulance transportation services, as defined, would be in an amount equal to 80% of the amount set forth in the federal Medicare ambulance fee schedule for the corresponding level of service, adjusted by the Geographic Practice Cost Index, as specified. The bill would require the department to establish a Medi-Cal managed care directed payment program for nonemergency ambulance transportation services, with the reimbursement rates set in an amount equal to at least the amount set forth under fee-for-service reimbursement. The bill would require the department to maximize federal financial participation in implementing the above-described provisions to the extent allowable. To the extent that federal financial participation is unavailable, the bill would require the department to implement the provisions using state funds, as specified. Under the bill, whenever the medical necessity of nonemergency ambulance transportation services needs to be certified for purposes of Medi-Cal coverage, either a physician or a nonphysician authorized under certain federal regulations would be permitted to complete that certification, as specified. The bill would require the department to revise and update the Medi-Cal provider manual or any guidance, as applicable, to implement this provision. Existing Medi-Cal regulations require that records of medical transportation providers include, among other information, odometer readings at each pickup and delivery location. Under this bill, for purposes of documenting mileage in their records under the Medi-Cal program, medical transportation providers would be authorized to utilize vehicle Global Positioning System (GPS) tracking, digital mapping software or applications, or another reasonable mechanism identified by the department, as specified, in addition to the above-described odometer readings. The bill would require the department to revise and update any corresponding regulations, including the above-described provision.