Public Provider Ground Emergency Medical Transportation Intergovernmental Transfer Program - Assembly Bill 1705
Background
In accordance with Assembly Bill (AB) 1705 (Chapter 544, Statues of 2019), the Department of Health Care Services (DHCS) developed the Public Provider Ground Emergency Medical Transport (PP-GEMT) Intergovernmental Transfer Program (IGT) program to provide increased reimbursements, by application of an add-on increase, to emergency medical transports provided by eligible 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 emergency medical transport billing codes and a rating increment that will be applied to primary capitation rates for contracted Medi-Cal plans.
Program Eligibility
Providers are eligible to participate in the PP-GEMT IGT program if they meet all of the following criteria:
- Provide GEMT services to Medi-Cal beneficiaries,
- Are enrolled as a Medi-Cal provider for the period being claimed, and
- 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.
List of Public CA GEMT Providers (Updated 2/8/2023)
PP-GEMT IGT Add-On Increase Reimbursement
The PP-GEMT IGT Program will provide an add-on increase to the Medi-Cal fee-for-service fee schedule rate of emergency medical transports billed with the following procedure codes:
Procedure Code
| Procedure Code Description |
| A0225 | NEONATAL EMERGENCY TRANSPORT |
| A0427 | ALS1-EMERGENCY |
| A0429 | BLS-EMERGENCY |
| A0433 | ALS 2 |
| A0434 | SPECIALTY CARE TRANSPORT
|
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 fee-for-service 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, which is the 2017-18 audited reports. The add-on increase is subject to federal approval by the Centers for Medicare and Medicaid Services (CMS)
Once the PP-GEMT IGT Program is implemented, public providers will no longer be assessed the Quality Assessment Fee (QAF) prospectively and will not be eligible to receive the add-on pursuant to the GEMT QAF Program, but will be eligible to receive a reimbursement add-on under the PP-GEMT IGT Program. Additionally, public GEMT providers will no longer be eligible to participate in the GEMT Certified Public Expenditures (CPE) program, once the PP-GEMT IGT Program is implemented.
Letter of Intent
All funding entities who wish to participate, must submit a Letter of Intent. A copy of the Letter of Intent is listed in the Forms Section.
Forms
Please note that the forms currently listed in this section are subject to change and may be revised periodically.
PP-GEMT IGT Provider Training
SPA 22-0015
The Centers for Medicare & Medicaid Services approved SPA 22-0015 on December 21, 2022 establishing the PP-GEMT IGT Program effective January 1, 2023.
To review the SPA 22-0015 Public Notice, please visit: SPA 22-0015 Public Notice (ca.gov)
To review the SPA 22-0015 Approval, please visit: SPA 22-0015 Approval (ca.gov)
Contact DHCS
To join the AB1705 ListServe, or to submit questions or comments, please email the DHCS PP-GEMT IGT email box: AB1705@dhcs.ca.gov
Legislation
