​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Public Provider Ground Emergency Medical Transportation Intergovernmental Transfer Program​ ​- Assembly Bill 1705

​Background

​​​In accordance with Assembly Bill (AB) 1705 (Chapter 544, Statutes of 2019), the Department of Health Care Services (DHCS) developed the Public Provider Ground Emergency Medical Transport (PP-GEMT) Program to provide increased reimbursements, by application of an add-on increase, to ground emergency medical transports (GEMT) provided by eligible non-contracted public GEMT providers. The non-federal share collected will be used to provide an add-on increase to the fee-for-services (FFS) fee schedule rate for the affected GEMT codes and a rating increment that will be applied to primary capitation rates for contracted Medi-Cal Plans.​

​PP-GEMT Add-On:

The PP-GEMT Program will provide an add-on increase to the Medi-Cal FFS fee schedule rate of GEMT transports billed with the following procedure codes:

 
DHCS will calculate an initial statewide add-on increase amount based on the difference between: (a) the weighted average reimbursement paid pursuant to the applicable base Medi-Cal FFS payment fee schedule for an emergency medical transport, and (b) the weighted average cost directly associated with providing a Medi-Cal emergency medical transport under the Medi-Cal program by an eligible provider. The average cost data will be drawn from the most recently audited cost reports of eligible providers available at the time the add-on amount is developed. The add-on increase is subject to federal approval of the State Plan Amendment (SPA) by the Centers for Medicare and Medicaid Services (CMS). To view the most recent SPA Public Notice, please visit: SPA Public Notices.

For information regarding the most recent SPA submissions please visit Pending SPAs.

To view the most recent SPA Approvals, please visit: Approved SPAs

Effective January 1, 2023, public providers will no longer be assessed the Quality Assurance Fee (QAF) and will not be eligible to receive the associated add-on pursuant to the GEMT QAF Program, but will be eligible to receive a reimbursement add-on under the PP-GEMT Program. Additionally, public GEMT providers will no longer be eligible to participate in the GEMT Certified Public Expenditures Program.

For additional information on the GEMT QAF Program closeout, please visit the GEMT QAF webpage: https://www.dhcs.ca.gov/provgovpart/Pages/GEMTQAF.aspx.

If you have any questions, please contact GEMT QAF at: GEMTQAF@dhcs.ca.gov.

• ​​GEMT QAF and CPE Closeout​
  

​​Program Reimbursement Eligibility

Providers may be eligible to receive the PP-GEMT add-on if the provider continually meets all the following requirements during the entirety of any Medi-Cal managed care rating period. For full details regarding eligibility, please refer to Welfare and Institutions Code (WIC) section 14105.945.

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

Fee-for-service delivery system:

• The PP-GEMT add-on will be provided on a per-transport basis at the time the providers receive reimbursement for the base transport through DHCS' Medi-Cal Fiscal Intermediary.

Managed care delivery system:

• Managed care plans (MCPs) are required to reimburse eligible claims at the FFS rate including any applicable FFS “add-on amount" (i.e., “Rogers Rates") as referenced in the table above.

Please note: Eligibility for reimbursement is different from eligibility as a funding entity, as any governmental entity may be eligible to voluntarily fund the PP-GEMT Program through an intergovernmental transfer (IGT). Please see the IGT Certification form below for further details.

List of Public CA GEMT Providers (Updated April 11, 2024)*

*This list will be updated prior to each new rating period. This list is representative of entities that may make up the majority of public providers, but it is not all-inclusive and may include some providers who are either not, or no longer are, providing GEMT services. As such, this list is intended to be part of the public provider identification process in order to ensure providers receive timely reimbursement of the PP-GEMT add-on. For the avoidance of doubt, the responsibility of identifying a provider's “public status" is that of the MCP. As such, this list should be used as a reference but should not replace MCP policies and procedures used to ensure that eligible public providers are identified and reimbursed appropriately.​

​​​Calendar Year 2024 Rating Period Invoice and Due Date Schedule:

In the event that DHCS determines that the projected amount of voluntary contributions is not sufficient to support implementation of the Program, the Program would end. The PP-GEMT Program would cease to be operative on the first day of the Medi-Cal managed care rating period beginning on or after the date of such determination. Public providers would revert to reimbursement under existing programs.

​​Forms:

• Example IGT Certification Form​​
  

PP-GEMT Provider Resources

• ​Frequently Asked Questions
  
• Managed Care Reconciliation Methodology​​
  

​Contact DHCS:

To join the AB1705 ListServe, submit questions or comments, or to onboard as a participating funding entity, please email the DHCS PP-GEMT Program inbox: AB1705@dhcs.ca.gov.

​Policy:

​PP-GEMT Program Policy Letter

• ​PP-GEMT policy letter (Forthcoming Link)