​​​​​​​​​​​​​​​​​​​​​​​​​​​​Ground Emergency Medical Transport Quality Assurance Fee

June 9, 2022 Update:

• New: GEMT QAF Rate For FY 22-23 ​, effective July 1, 2022​
  

GEMT QAF Rate for FY 2022-23, effective July 1, 2022

• ​A GEMT QAF Rate was calculated for Fiscal Year (FY) 2022-23, in accordance with SB 523. The QAF is assessed on each qualified emergency medical transport, regardless of payer type. The QAF was adjusted based on the transport data submitted for calendar year 2021 for emergency transport codes A0429, A0427, A0433, A0225, and A0434. The QAF rate in effect for FY 2021-22 will be assessed on ground emergency medical transports with dates of service beginning January 1, 2022 through December 31, 2022. DHCS intends to submit the GEMT QAF SPA 22-0040 to the Centers for Medicare and Medicaid Services (CMS) for federal approval in the third quarter of 2022.
  
• ​​​The QAF Rate for FY 2022-23 is: $34.02
  

New PP-GEMT IGT Program

​Assembly Bill (AB) 1705 (Chapter 544, Statutes of 2019) establishes a Public Provider Ground Emergency Medical Transportation Intergovernmental Transfer (PP-GEMT IGT) Program for eligible public GEMT providers.

Providers are eligible to participate in the PP-GEMT IGT program if they meet all of the following criteria:

• provide GEMT services to Medi-Cal beneficiaries
  
• are enrolled as a Medi-Cal provider for the period being claimed, and
  
• are owned or operated by the state, a city, county, city and county, fire protection, special districts, community services districts, health care district, or a federally recognized Indian tribe.
  

On or before August 14, 2021, providers are required to submit data on gross receipts received for ground emergency medical transports between July 1, 2020 through June 30, 2021. The Gross Receipt Data Submission Form must be submitted to GEMTQAF@dhcs.ca.gov by August 14, 2021. Providers are to use the Gross Receipt Data Submission Form provided below:

Gross Receipt Data Submission Form ​

GEMT QAF Rate for FY 2021 - 22, effective July 1, 2021

• A GEMT QAF Rate was calculated for Fiscal Year (FY) 2020-21, in accordance with SB 523. The QAF is assessed on each qualified emergency medical transport, regardless of payer type. The QAF was adjusted based on the transport data submitted for calendar year 2020 for emergency transport codes A0429, A0427, A0433, A0225, and A0434. The QAF rate in effect for FY 2021-22 will be assessed on ground emergency medical transports with dates of service beginning January 1, 2021 through December 31, 2021.
  
• ​The QAF Rate for FY 2021-22 is: $33.42​
  
  

A GEMT QAF Rate was calculated for FY 2020-21, in accordance with SB 523. The QAF is assessed on each qualified emergency medical transport, regardless of payer type. DHCS adjusted the QAF based on the transport data submitted for calendar year 2019 for emergency transport codes A0429, A0427, A0433, A0225, and A0434. The QAF rate in effect for FY 2020-21 will be assessed on ground emergency medical transports with dates of service beginning January 1, 2020 through December 31, 2020. The FY 2020-21 QAF rate amount is as follows: 

FY 2020-21 QAF Rate: $32.30

Federal Approval of SPA 20-0009

On October 15, 2020, the Centers for Medicare & Medicaid Services (CMS) approved State Plan Amendment (SPA) 20-0009, which authorizes DHCS to provide a $220.80 add-on in FY 2020-21 effective July 1, 2020, for Healthcare Common Procedural Coding System (HCPCS) codes A0429, A0427, A0433, A0225 and A0434.​

The QAF for FY 2020-21 is assessed on HCPCS codes A0429, A0427, A0433, A0434 and A0225. Interest and penalties may be assessed if payments are not submitted by the payment due dates. To view the approved GEMT QAF SPA 20-0009, please visit the 2020 Approved State Plan Amendments page.

HCPCS Code A0434 Policy 

Effective for dates of service on or after August 1, 2020, HCPCS code A0434 (Specialty Care Transports) is billable for non-emergency transports. The policy announcement can be found at the Medi-Cal Update website .

For transports occurring on or after August 1, 2020, only emergency medical transport services billed with HCPCS code A0434 are required to be reported for the GEMT QAF program, will be assessed the QAF, and will be eligible to receive the GEMT QAF add-on. Non-emergency transports billed with HCPCS code A0434 should not be reported for the GEMT QAF program. As instructed on page 12 of the DHCS Medi-Cal Provider Training 2018, all claims for emergency medical transport services should be billed with an "X" indicator on all emergency claim lines in Box 24C of claim form 1500. All non-emergency transports provided and billed under HCPCS code A0434 will not receive the GEMT QAF add-on.

Data Collection Process & Deadlines

GEMT providers are required to periodically submit data reports that include the following:

• The total number of emergency medical transports, as defined in statute, by payer type, including Medi-Cal FFS and Medi-Cal managed care, Medicare, dual Medicare/Medi-Cal (Medi-Medi), and all other payer types, for each calendar year quarter.
  
• The gross receipts, as defined in statue, received from the provision of emergency medical transports for each FY.

GEMT providers are required to submit data to DHCS:

Methodology

DHCS will utilize the data collected to develop the QAF rate annually as follows:

•  For FY 2018-19, the annual QAF rate was calculated using self-reported gross receipts divided by self-reported transport data plus Medi-Cal FFS and Managed Care transport data.

•  For FY 2019-20, and each subsequent FY 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 FY, and the denominator is 90% of the total projected emergency medical transports by all GEMT providers subject to the QAF.

Contact DHCS

Legislation

• SB 523 (2017)

• ​​AB 1705 (2019)​