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​Ground Emergency Medical Transport Quality Assurance Fee

April 22, 2019 Update:

  • New: Online Portal for Ground Emergency Medical Transportation (GEMT) Quality Assurance Fee (QAF) Payments;
  • Federal Approval of the GEMT QAF Program;
  • Additional Transport CPT Codes Subject to the QAF Assessment;
  • Updated QAF Rate; and
  • Data Submission Required by April 17, 2019 

Background

In accordance with Senate Bill (SB) 523 (Chapter 773, Statutes of 2017), DHCS established the 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 Fiscal year (FY). All providers of GEMT services are required to submit data to DHCS.
 
The data collected is used to calculate 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 add-on by June 15 of each year. 

Updates

New Online Portal for GEMT QAF Payments
An online GEMT QAF portal has been established to calculate the quarterly QAF amount due from providers. 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.
 
The first set of payment due dates for the QAF, as listed below, were determined in consultation with stakeholders. 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.
 
QAF Payment Due Dates:
 
Commencing with the quarter beginning on July 1, 2019, and continuing each quarter thereafter, 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.
 
Federal Approval of SPA 18-004
On February 7, 2019, the Centers for Medicare & Medicaid Services (CMS) approved State Plan Amendment (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 Current Procedural Terminology (CPT) Codes A0429 BLS Emergency, A0427 ALS Emergency, and A0433 ALS2, excluding any transports billed for dry runs.
 
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 be implemented retroactively to the July 1, 2018 effective date once the necessary changes have been made to the payment system.
 
To view the approved GEMT QAF SPA 18-004, please visit the 2018 Approved State Plan Amendments page.
 
GEMT QAF Rate and Assessment
FY 2018-19 QAF Rate:  $25.23
The QAF is assessed on CPT Codes A0429, A0427, and A0433, as well as CPT Codes A0434 Specialty Care Transport, and A0225 Neonatal Emergency Transport. For purposes of obtaining federal approval, CPT Codes A0434 and A0225 were added to the list of Codes subject to the QAF. With the addition of CPT Codes A0434 and A0225, the QAF rate has been recalculated and established at the amount of $25.23 per transport.
 
The QAF is assessed on each qualified emergency medical transport, regardless of payer type. 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.

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 below, 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 below, received from the provision of emergency medical transports for each FY. 
 
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
 
Data Collection Forms & Instructions: 
 
 
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, A0434 Specialty Care Transports, and A0225 Neonatal Emergency Transport].”
·         “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, A0434 Specialty Care Transports, and A0225 Neonatal Emergency Transport; as determined] by [DHCS] and any other ancillary billing codes associated with emergency medical transport[s].”
 

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)

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Last modified on: 4/30/2019 4:06 PM