Medi-Cal reimbursements: nonemergency ambulance and other transportation.

Plain English Breakdown

The bill's effective date is not specified in the official source material.

Medi-Cal Reimbursements for Nonemergency Ambulance Services

This law changes how Medi-Cal pays for nonemergency ambulance and other medical transportation services, setting new rates based on federal Medicare standards and allowing the use of GPS to track mileage.

What This Bill Does

• Sets new rules for paying ambulance companies that transport people who need nonemergency medical care.
• Requires the state health department to set payment rates based on federal Medicare standards adjusted by the Geographic Practice Cost Index.
• Allows doctors or other healthcare workers authorized under federal regulations to decide if a patient needs an ambulance for nonemergency situations.
• Permits transportation providers to use GPS and digital maps to track mileage instead of just using odometer readings.

Who It Names or Affects

• People who receive Medi-Cal health care services
• Ambulance companies that provide nonemergency medical transport
• Healthcare workers authorized under federal regulations to decide if a patient needs an ambulance

Terms To Know

Medi-Cal

A government program that helps low-income people pay for health care.

Geographic Practice Cost Index (GPCI)

A measure used to adjust payment rates based on the cost of living in different areas.

Limits and Unknowns

• The bill needs money from the state budget to work.
• It is not clear how much this will cost or if there are enough federal funds available.

Official Summary Text

AB 1328, as amended, Michelle Rodriguez.
Medi-Cal reimbursements: nonemergency ambulance and other transportation.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, including emergency or nonemergency medical or nonmedical transportation services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.
Under this bill, commencing on July 1,
2026,
2027,
and subject to an appropriation, Medi-Cal fee-for-service reimbursement for nonemergency ambulance transportation services, as defined, would be in an amount equal to 80% of the amount set forth in the federal Medicare ambulance fee
schedule for the corresponding level of service, adjusted by the Geographic Practice Cost Index, as specified. The bill would require the department to establish a Medi-Cal managed care directed payment program for nonemergency ambulance transportation services, with the reimbursement rates set in an amount equal to at least the amount set forth under fee-for-service reimbursement.
The bill would require the department to maximize federal financial participation in implementing the above-described provisions to the extent allowable. To the extent that federal financial participation is unavailable, the bill would require the department to implement the provisions using state funds, as specified.
Under the bill, whenever the medical necessity of nonemergency ambulance transportation services needs to be certified for purposes of Medi-Cal coverage, either a physician or a nonphysician authorized under certain federal
regulations would be permitted to complete that certification, as specified. The bill would require the department to revise and update the Medi-Cal provider manual or any guidance, as applicable, to implement this provision.
Existing Medi-Cal regulations require that records of medical transportation providers include, among other information, odometer readings at each pickup and delivery location.
Under this bill, for purposes of documenting mileage in their records under the Medi-Cal program, medical transportation providers would be authorized to utilize vehicle Global Positioning System (GPS) tracking, digital mapping software or applications, or another reasonable mechanism identified by the department, as specified, in addition to the above-described odometer readings. The bill would require the department to revise and update any corresponding regulations, including the above-described
provision.

Current Bill Text

Download Bill PDF