Plain English Breakdown
The official text contains conflicting dates (July 1, 2026 and July 1, 2027), indicating uncertainty about which year applies.
Medi-Cal Nonemergency Ambulance Payment Rules
This law changes how much Medi-Cal pays for nonemergency ambulance trips, allows more types of doctors to approve these trips, and lets providers use GPS or digital mapping software alongside odometer readings to track mileage.
What This Bill Does
- Sets payment rates at 80% of the federal Medicare rate starting July 1, 2026 or 2027, if funding is approved.
- Requires a new managed care program that pays nonemergency ambulance services at least as much as the fee-for-service rate.
- Allows physicians or authorized nonphysicians to certify when nonemergency ambulance transport is medically necessary.
- Permits transportation providers to use GPS tracking or digital mapping software alongside odometer readings for mileage records.
- Requires the state department to update provider manuals and regulations to match these new rules.
Who It Names or Affects
- Medi-Cal recipients who need nonemergency medical transportation
- Ambulance companies and other medical transportation providers
- Physicians and authorized nonphysician practitioners
- The State Department of Health Care Services
Terms To Know
- Fee-for-service reimbursement
- Payment made directly to a provider for each specific service given.
- Managed care directed payment program
- A system where the state pays providers extra money on top of what health plans pay them.
- Geographic Practice Cost Index
- A number used to adjust payments based on how much it costs to do business in a specific area.
Limits and Unknowns
- The new payment rates only start if the state legislature approves funding.
- If federal money is not available, the bill requires using state funds instead.
- The exact effective date of July 1, 2026 or 2027 depends on which version of the text applies.