​Ground Emergency Medical Transport Quality Assurance Fee

Background

In accordance with Senate Bill (SB) 523 (Chapter 773, Statutes 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 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 fee-for-service (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. 

June 27, 2019 Update:

  • New QAF Rate for Fiscal Year 2019 - 20, effective July 1, 2019 
  • Q1 2019 QAF payment due dates contingent on federal approval of SPA 19-0020
 

      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   

 

      Please note that no QAF payments are due at this time for FY 2019-20.

 

      Contingent on federal approval of SPA 19-0020 for the FY 2019-20, commencing with the quarter beginning on July 1, 2019, on or before the first day of each quarter, each provider subject to the fee shall remit to DHCS the QAF amount due for the transports reported in the immediately preceding quarter. Following SPA approval, DHCS will update this website to notify providers they can begin making FY 2019-20 QAF payments and to provide any applicable payment deadlines.

 

      Proposed SPA 19-0020 and Reimbursement Rate Add-On for FY 2019-20

      DHCS plans on submitting SPA 19-0020 to CMS for approval to continue the $220.80 add-on in FY 2019-20 for CPT Codes A0429, A0427, and A0433, and to provide the add-on to Codes A0225 and A0434. Updates will be provided on this website after federal approval is received for SPA 19-0020.

 

      To view the public notice for GEMT QAF SPA 19-0020, please visit the 2019 Proposed 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 Centers for Medicare & Medicaid Services (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 2018 Approved 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

Data Collection Forms & Instructions: 

Beginning with the Q1 2019 data submission, transport data must be submitted through the online GEMT QAF portal.

To access the online portal and detailed instructions, please visit the DHCS QAF website

 

Data Submission Required by May 15, 2019, as follows:

GEMT providers are required to submit to DHCS the total number of emergency medical transports for Codes A0427, A0429, A0433, A0225, and A0434 in Q1 2019 (January 1 through March 31, 2019)

 
Data Submission Required by April 17, 2019, as follows:
GEMT providers are required to submit to DHCS emergency medical transport data for the following quarters:
 

Total number of emergency medical transports for Codes A0427, A0429, A0433, A0225, and A0434 in quarter 4:

·         Q4: October 1, 2018 through December 31, 2018

 

Total number of emergency medical transports for Codes A0225 and A0434 provided in the following quarters:

·         Q2: April 1, 2018 through June 30, 2018

·         Q3: July 1, 2018 through September 30, 2018
 

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 statute, received from the provision of emergency medical transports for each FY. 

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

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

Legislation

 ·         SB 523 (2017)​​

Last modified date: 7/2/2019 2:11 PM