Ground Emergency Medical Transport Quality Assurance Fee
Background
In accordance with
Senate Bill (SB) 523 (Chapter 773, Statues of 2017), DHCS established the Ground Emergency Medical Transport (GEMT) Quality Assurance Fee (QAF) program to provide supplemental Medi-Cal payments to GEMT providers. Using data collected from GEMT providers, DHCS calculates an annual GEMT QAF rate that will be imposed on each emergency medical transport provided by each GEMT providers subject to QAF. The QAF collected will be used to increase reimbursement to GEMT providers by application of an add-on to the fee-for-services (FFS) fee schedule rate for the affected emergency medical transport billing codes.
DHCS will post notice of the QAF and rate by June 15 of each year.
November 15, 2019 Update:
- News: Q3 2019 transport data is due by November 14, 2019
August 2, 2019 Update:
New: Q2 2019 transport data is due by August 14, 2019
New: FY 2018-19 Gross Receipt data is due by August 14, 2019
QAF Rate for Fiscal Year 2019 - 20, effective July 1, 2019
New QAF Rate for Fiscal Year (FY) 2019 - 20, effective July 1, 2019
A new QAF Rate was calculated for FY 2019 - 20, 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 2018, including codes A0429, A0427, A0433, A0225, and A0434. This rate will be in effect for transports that occur in Q1 2019 – Q4 2019. The FY 2019-20 QAF rate amount is as follows:
QAF Rate: $26.07
Federal Approval of SPA 19-0020
On September 6, 2019, the Centers for Medicare & Medicaid Services (CMS) approved SPA 19-0020 which provides a $220.80 add-on in FY 2019-20 effective July 1, 2019 for CPT Codes A0429, A0427, and A0433, and to provide the add-on to Codes A0225 and A0434.
The QAF for FY 2019-20 is assessed on CPT Codes A0429, A0427, A0433, A0434 and A0225.
FY 2019-20 QAF Payment Due Dates
As a result of the recent SPA approval, a revised QAF payment schedule for transports that occurred in Q1 through Q2 2019 has been established in consultation with stakeholders and is listed below. These due dates are subject to change.
October 1, 2019 – For transports provided in Q1 2019 (Dates of service January 1, 2019 through March 31, 2019) that were reported or should have been reported in Q2 2019
November 1, 2019 – For transports provided in Q2 2019 (Dates of service April 1, 2019 through June 30, 2019) that were reported or should have been reported in Q3 2019
Interest and penalties may be assessed if payments are not submitted by the payment due dates above.
To view the approved GEMT QAF SPA 19-0020, please visit the
2019 Approved State Plan Amendments page.
General Information
Online Portal for GEMT QAF Payments
An online GEMT QAF portal was established for providers to submit transport data and to calculate the quarterly QAF amount due. An invoice for the QAF amount due for each provider will be generated based upon the transport data submitted by providers, and will include a direct link to pay the QAF through electronic fund transfer (EFT). Providers also have the option to print an invoice and to submit their QAF payment by mail.
To access the online portal and detailed instructions, please visit the
DHCS QAF website.
FY 2018-19 QAF Payment Due Dates
The QAF payment due dates for transports that occurred in Q1 through Q4 2018 listed below were determined in consultation with stakeholders and are provided below. These due dates are subject to change. Each due date in April, May, and June 2019 below provides a link to a list of providers, by NPI, that are required to submit QAF payments for agreed upon quarters, as specified in the list, by the applicable due date.
FY 2018-19 QAF Payment Due Dates:
FY 2018-19 GEMT QAF Rate and Assessment
The QAF is assessed on each qualified emergency medical transport, regardless of payer type.
FY 2018-19 QAF Rate: $25.23
The QAF for FY 2018-19 is assessed on CPT Codes A0429, A0427, A0433, A0434 and A0225 for transports that occurred in Q1 2018 – Q4 2018. For purposes of obtaining federal approval, CPT Codes A0434 and A0225 were added to the list of Codes subject to the QAF.
Providers are required to pay the QAF retroactively to the July 1, 2018 effective date. Providers may be subject to penalties if payments are not submitted within 45 days of the payment dates outlined in the payment schedule.
Federal Approval of SPA 18-004
On February 7, 2019, the CMS approved SPA 18-004, effective July 1, 2018. SPA 18-004 provides a reimbursement rate add-on to certain GEMT services rendered on or after July 1, 2018 through June 30, 2019. Services eligible for the add-on are CPT Codes A0429 BLS Emergency, A0427 ALS Emergency, and A0433 ALS2, excluding any transports billed for dry runs.
To view the approved GEMT QAF SPA 18-004, please visit the
2019 Proposed State Plan Amendments page.
Reimbursement Rate Add-On
FY 2018-19 Add-On: $220.80
The FY 2018-19 add-on amount is $220.80, with a resulting total FFS reimbursement amount of $339.00 for CPT Codes A0429, A0427, and A0433. The reimbursement rate add-on will implement retroactively to the July 1, 2018 effective date once the necessary changes have been made to the payment system.
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.
Data Submission Required by August 14, 2019 as follows:
GEMT providers are required to submit to DHCS:
- Total number of emergency medical transports for Codes A0427, A0429, A0433, A0225, A0434, and X0300 in Q2 2019 (April 1, 2019 through June 30, 2019). This data shall be submitted through the online portal below.
- Gross Receipt received from the provision of emergency medical transports for Codes A0427, A0429, A0433, A0225, A0434, and X0300 during FY 2018-2019 (July 1, 2018 through June 30, 2019). This data shall be submitted through the GEMT QAF email box using the form below.
Data Collection Forms & Instructions:
The Q3 2019 transport data submission must be submitted through the online GEMT QAF portal. To access the online portal and detailed instructions, please visit the
DHCS QAF Website.
Gross Receipts submissions for emergency medical transport receipts for payments received between July 1, 2018 and June 30, 2019 must be submitted to the GEMT QAF inbox. Providers are to use the Gross Receipt submission form provided below in (2):
- Q3 2019 Transport Data
GEMT QAF Portal .
- GEMT QAF
Gross Receipt Submission Form.
Methodology
DHCS will utilize the data collected to develop the QAF rate annually as follows:
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
