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.
The add-on amount is $220.80 and will be provided for eligible emergency Medi-Cal GEMT transports billed with HCPCS codes A0427, A0429, A0433, A0225, and A0434.
As described further below, the QAF Rate for FY 2025-26: is $36.74.
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.
-
Quarterly transport data must be submitted through the online portal below on or before the 45th day after the last day of the applicable quarter.
- The gross receipts, as defined in statute, received from the provision of emergency medical transports for each Fiscal Year (FY).
- Gross receipts data must be submitted through the specific FY form found below on or before the 45th day after the last day of the applicable state fiscal year.
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.
DHCS will post notice of the QAF rate by June 15 of each year.
FY 2024-25
GEMT QAF SPA Approval and Payment Schedule FY 2024-25:
The Centers for Medicare & Medicaid Services (CMS) approved SPA 24-0025 to continue the GEMT QAF Program for FY 2024-25. Below is the QAF payment schedule DHCS established for collecting the quarterly QAF assessments, beginning with the July 1, 2024, state fiscal quarter.
QAF Assessment Due
| QAF Payment Due Date (Revised)
| Reporting Period
| Transport Date of Service
|
July 1, 2024
| March 3, 2025
(Revised)
| Apr - Jun 2024
| Jan - Mar 2024
|
October 1, 2024
| April 1, 2025
(Revised)
| July - Sept 2024
| Apr - Jun 2024
|
January 1, 2025
| May 1, 2025
(Revised)
| Oct - Dec 2024
| Jul - Sept 2024
|
April 1, 2025
| June 2, 2025
(Revised)
| Jan - Mar 2025
| Oct - Dec 2024
|
GEMT QAF Rate for FY 2025-26, effective July 1, 2025
A GEMT QAF Rate was calculated for Fiscal Year (FY) 2025-26, 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 2024 for emergency transport codes A0429, A0427, A0433, A0225, and A0434. The QAF rate in effect for FY 2025-26 will be assessed on ground emergency medical transports with dates of service beginning January 1, 2025 through December 31, 2025. DHCS intends to submit the GEMT QAF SPA 25-0003 to the Centers for Medicare and Medicaid Services (CMS) for federal approval in the third quarter of 2025.
- The QAF Rate for FY 2025-26 is: $36.74
Gross Receipt Data Submission
On or before August 14, 2024,
providers are required to submit data on gross receipts received for ground
emergency medical transports between July 1, 2023 through June 30, 2024. The
Gross Receipt Data Submission Form must be submitted to GEMTQAF@dhcs.ca.gov by
August 14, 2024. Providers are to use the Gross Receipt Data Submission Form
provided below:
Gross Receipt Data Submission Form
PP-GEMT IGT Program
In accordance with Assembly Bill (AB) 1705 (Chapter 544, Statutes of 2019), the Department of Health Care Services (DHCS) establishes the Public Provider Ground Emergency Medical Transportation (PP-GEMT) Intergovernmental Transfer (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.
The PP-GEMT IGT Program provides an add-on increase to the associated Medi-Cal fee-for-service fee schedule of emergency medical transports billed with the following codes: A0429, A0427, A0433, A0225, and A0434, for eligible providers.
The Centers for Medicare & Medicaid Services (CMS) approved State Plan Amendment (SPA) 22-0015 on December 21, 2022 establishing the PP-GEMT IGT Program. Effective January 1, 2023, public providers as defined in AB 1705 are no longer eligible to participate in the GEMT QAF program and have transitioned to the new PP-GEMT IGT program. Public providers are no longer assessed the QAF prospectively and are not eligible to receive the add-on through the GEMT QAF program.
FY 2020-21
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.
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.
Contact DHCS
Legislation
