For City Council Meeting [April 23, 2019]
TO: Honorable Mayor and City Council
APPROVAL: Sean Grayson, Interim City Administrator
FROM: Brian Park, Interim Fire Chief
Title
Request City Council to Approve Quarterly Ground Emergency Medical Services Quality Assurance Fee Payments (GEMT-QAF) to the Department of Healthcare Services (DHCS) to allow continued participation in the Medi-Cal Ground Emergency Medical Transportation (GEMT) Supplemental Reimbursement Program.
(ACTION)
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BACKGROUND:
On October 2, 2011, the California State Legislature passed Assembly Bill 678, which is a Certified Public Expenditure (CPE) Program for California's publicly owned or operated ambulance service providers. This program provides supplemental reimbursement for eligible Ground Emergency Medical Transportation (GEMT) providers that meet specified requirements and provide GEMT services to Medi-Cal beneficiaries. On October 13, 2017 the California Governor signed SB 523 (attachment 1) into law authorizing DHCS to establish the GEMT-QAF program.
The GEMT-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. DHCS will establish a QAF payment schedule in consultation with GEMT providers, and will publish the payment schedule on the GEMT QAF webpage once final. Providers may be subject to penalties if payments have not been submitted within 45 days of the payment dates included in the posted payment schedule (attachment 2). In addition, the QAF rate has been calculated and established at the amount of $25.23 per transport for each quarter for FY 2018-2019.
The Centers for Medicare and Medicaid Services (CMS) approved California State Plan Amendment (SPA) 18-004 (attachment 3), which was submitted to CMS on July 11, 2018 and approved February 7, 2019. SPA 18-004 implements a one-year Quality Assurance Fee (QAF) program and reimbursement rate add-on for...
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