The Centers for Medicare and Medicaid Services (CMS) approved State Plan Amendment (SPA) 18-004 authorizing the Ground Emergency Medical Transportation (GEMT) / Quality Assurance Fee (QAF) program in March 2019. QAF is an add-on fee used to increase Medi-Cal funding. Essentially, emergency medical transportation providers in California must pay this fee on all transports, and in return, providers receive an uplift that increases the Medi-Cal reimbursement base rate for Medi-Cal fee-for-service and managed care recipients. The GEMT/QAF program increases the historic base rate of Medi-Cal reimbursement by $220.80 per transport. The GEMT/QAF program, therefore, increases the per transport reimbursement from the historic base rate of $118.20 to $339.00.
To fund this program, the State of California Department of Health Care Services (DHCS) began assessing all transport providers within the State of California a fee of $25.23 per transport effective July 1, 2018. The fee was increased to $26.07 for FY 2019-20, to $32.30 for FY 2020-21, and to $33.42 for FY 2021-22. The current rate of $33.42 in effect for FY 2021-22 is assessed on ground emergency medical transports with dates of service beginning January 1, 2021 through December 31, 2021.
The District received the attached invoices from DHCS on September 28, 2021. The invoices are for the period January, February, March 2021 (Quarter 1), for $609,112.92, and April, May, June 2021 (Quarter 2), for $623,249.58.
This request is for calendar year 2021 quarters 1 and 2 fees (for January-June 2021 transports). The payment for Q1 is due on or before October 15, 2021. State program representatives indicated there would be no exceptions and late fees may be assessed by the State for payments not received by the due date. Payments for Q2 are due November 1, 2021.
The QAF payment is mandatory for all providers (public and private) within the State. If not paid, the State can assess late payment penalties and withhold provider payments for ambulance services provided to Medi-Cal recipients.