Proposition 56 Non-Emergency Medical Transportation - Supplemental Payment
Background
On November 8, 2016, California voters approved the California Healthcare, Research and Prevention Tobacco Tax Act (commonly known as Proposition 56 or Prop. 56) to increase the excise tax rate on cigarettes and tobacco products. Under Prop. 56, a specified portion of the tobacco tax revenue is allocated to DHCS for use as the nonfederal share of health care expenditures in accordance with the annual state budget process. The Centers for Medicare & Medicaid Services approved SPA 22-0009 authorizing DHCS to use Prop. 56 funds to provide supplemental payments for NEMT services
effective January 1, 2022, and SPA 23-0039 established the supplemental payments as time-limited through June 30, 2022.
Overview
For dates of service through June 30, 2022, DHCS provides supplemental reimbursement for eligible Non-Emergency Medical Transportation (NEMT) services provided to Medi-Cal beneficiaries. The supplemental reimbursement is a fixed amount provided above the base rates, for qualified NEMT services rendered during the applicable time period. The base rates for NEMT services remains unchanged during this time period. Base rates for NEMT services are the rates established by the Department of Health Care Services for each procedure code.
The supplemental payment amounts are equivalent to a 10 percent increase of the current rates for Medi-Cal Fee-for-Service (FFS) NEMT services, except for codes A0130 and A0380, which receive the equivalent of a 25 percent increase. Ground Medical Transportation and Air Medical Transportation providers are eligible for the supplemental payments. The table below reflects the codes eligible for the supplemental payment and the respective reimbursement amount.
| 93005 | $1.64 | A0424 | $1.64 | A0435 | $1.43 |
| 93041 | $0.51 | A0425 | $0.36 | A0436 | $2.21 |
| A0130 | $4.41 | A0426 | $10.72 | T2001 | $0.55 |
| A0380 | $0.33 | A0428 | $10.72 | T2005 | $2.63 |
| A0420 | $1.98 | A0430 | $127.50 | T2007 | $1.13 |
| A0120 | $1.77 | A0390 | $0.13 | | |
| A0422 | $1.00 | A0431 | $180.00 | | |
The Centers for Medicare & Medicaid Services (CMS) approved the time-limited supplemental reimbursement program for eligible services provided to Medi-Cal beneficiaries for dates of service July 1, 2019, through June 30 2022.
SPA 22-0039
The Centers for Medicare & Medicaid Services approved SPA 22-0039 on December 16, 2022, authorizing DHCS to exempt NEMT providers from the AB 97 payment reductions and increase base reimbursement for selected NEMT service reimbursement to maintain payment levels in effect on December 31, 2021, including supplemental payments or rate increases formerly funded by Proposition 56 for dates of service on or after July 1, 2022.
The table below reflects the base reimbursement rates effective for dates of service on or after July 1, 2022.
Procedure Code
|
Procedure Code Description
| Base Rate
effective July 1, 2022
|
A0130
| Non-emergency transportation: wheelchair van
| $20.30
|
A0380
| Basic Life Support (BLS) mileage (per mile) (use for wheelchair and litter van transports only)
| $1.50
|
Current Materials
