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​Ground Emergency Medical Transport Quality Assurance Fee

July 2, 2018 Update: Payment of the Quality Assurance Fee and Reimbursement Rate Add-On

The Department of Health Care Services (DHCS) has not yet obtained federal approval for the Fiscal Year (FY) 2018-19 Ground Emergency Medical Transport (GEMT) Quality Assurance Fee (QAF) Program and add-on.  Until federal approval is obtained, providers will be assessed, but are not required to pay the QAF, and will not receive the add-on. Once federal approval is obtained, QA fees must be paid retroactively to the approved effective date, which is tentatively July 1, 2018. The rate add-ons will be implemented retroactively to the effective date once the appropriate changes have been made to the payment system.
 
The QAF rate and add-on amount to the Medi-Cal Fee-for-Service (FFS) fee schedule rates for the affected emergency medical transport billing codes, as defined below. The QAF is assessed on each qualified emergency medical transport, regardless of payer. The add-on will be provided in addition to the Medi-Cal FFS fee schedule rates for the affected emergency medical transport billing codes. The FY 2018-19 QAF rate and add-on amount are as follows:
 
Add-on Amount: $220.80
QAF Rate: $24.80
 
The resulting FY 2018-19 total FFS reimbursement amount will be $339.00 for Codes A0429, A0427, and A0433. 

Background

In accordance with Senate Bill (SB) 523 (Chapter 773, Statutes of 2017), DHCS established the Ground Emergency Medical Transport Provider (GEMT) QAF program.  SB 523 authorizes DHCS to collect from GEMT providers the following data: (1) on a quarterly basis, the number of emergency medical transports, by payer type, and (2) on an annual basis, gross receipts received from the provision of emergency medical transports per FY.  All providers of GEMT services are required to submit data to DHCS.
 
The data collected will be used to calculate an annual GEMT QAF rate that will be imposed on each “emergency medical transport,” as defined below, provided by each GEMT provider subject to the QAF.  The QAF collected will be used to increase reimbursement to GEMT providers by application of an add-on to the FFS fee schedule rate for the affected emergency medical transport billing codes.  
 
Upon federal approval, DHCS will implement the GEMT QAF and provide the add-on to the FFS fee schedule rate for the affected emergency medical transport billing codes, with proposed effective date of July 1, 2018.  DHCS will post notice of the QAF and rate add-on  by June 15, 2018, for FY 2018-19, and each June 15 thereafter should the GEMT QAF Program be extended into subsequent FYs.
 
GEMT providers will be required to remit the QAF for each emergency medical transport provided during the quarter beginning April 1, 2018, based on the following schedule:
  • For GEMT providers that rendered 35,000 or more Medi-Cal FFS emergency medical transports during FY 2016–17, 100 percent of the QAF is tentatively due on July 1, 2018, pending federal approval.
  • For GEMT providers that rendered fewer than 35,000 Medi-Cal FFS emergency medical transports during the FY 2016–17, 50 percent of the QAF is tentatively due on August 1, 2018, and the remaining 50 percent is tentatively due on August 15, 2018, pending federal approval.
 
Commencing with the state fiscal quarter beginning on October 1, 2018, and each quarter thereafter, on or before the first day of each state fiscal quarter, each GEMT provider will remit to DHCS the QAF on emergency medical transports provided in the immediately preceding quarter.

Data Collection Process & Deadlines

Following the initial data collection (see “Initial Data Collection Deadline” section), providers will be required to submit data reports that include the following:
  • The total number of emergency medical transports by payer type, including Medi-Cal FFS and Medi-Cal managed care ground emergency medical transports, and all other payer types, for the quarter beginning October 1, 2017, and each quarter thereafter. The data reports must be submitted to DHCS on or before the 45th day after the last day of the applicable quarter.
  • The gross receipts received from the provision of emergency medical transports, for FY 2017-18, and each FY thereafter. The data reports must be submitted to DHCS on or before the 45th day after the last day of the applicable FY.
 
Data Collection Forms & Instructions:  1)  GEMTQAF_TransportForm_Q22018.xls    2)  GEMTQAF_GrossReceipt_Q22018.xls
 
The data to be included in the reports are described below:
  • An “emergency medical transport” is defined as “the act of transporting an individual from any point of origin to the nearest medical facility capable of meeting the emergency medical needs of the patient by an ambulance licensed, operated, and equipped in accordance with applicable state or local statutes, ordinances, or regulations that are billed with billing codes A0429 BLS Emergency, A0427 ALS Emergency, and A0433 ALS2, and any equivalent, predecessor, or successor billing codes [X0030].”
  • “Gross receipts” are defined by statute as “gross payments received as patient care revenue for emergency medical transports, determined on a cash basis of accounting, [and] shall include all payments received as patient care revenue for emergency medical transports billed with billing codes A0429 BLS Emergency, A0427 ALS Emergency, and A0433 ALS2, and any equivalent, predecessor, or successor billing codes [X0030; determined] by [DHCS] and any other ancillary billing codes associated with emergency medical transport[s].”
 

Initial Data Collective Deadline 

On or before November 15, 2017, providers were required to provide DHCS data reports to include the following:
  • The total number of emergency medical transports by payer type, including Medi-Cal FFS and Medi-Cal managed care ground emergency medical transports, and all other payer types, for the quarter beginning July 1, 2015 through the quarter beginning July 1, 2017 period.
  • The gross receipts received from the provision of emergency medical transports, for FYs 2015-16 and 2016-17.

Methodology

DHCS will utilize the data collected to develop the QAF rate annually as follows:
  • For State Fiscal Year (SFY) 2017-18, commencing on July 1, 2018, the annual QAF rate shall be calculated using 5.1% of the projected total annual gross receipts for all GEMT providers subject to the fee, divided by the projected total annual emergency medical transports by all emergency medical transport providers subject to the fee.
  • For SFY 2018-19, and each subsequent SFY thereafter, the annual QAF rate shall be calculated by a ratio, the numerator of which is the sum of the projected aggregate fee schedule amount multiplied by the state medical assistance percentage and a portion of the administrative costs for the SFY, and the denominator is 90% of the total projected emergency medical transports by all GEMT providers subject to the QAF.

Contact DHCS

Questions or comments can be submitted to the DHCS GEMT QAF email box: GEMTQAF@dhcs.ca.gov.

Legislation

 

Last modified on: 8/7/2018 1:52 PM