In 2019, Assembly Bill 1705 (AB1705) was passed and certain sections of the California Welfare and Institutions Code, related to Medi-Cal, were amended and added. In accordance with the passage of the bill, 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 this 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. The new legislation requires the non-federal share of any supplemental reimbursement provided under this program to be derived from voluntary intergovernmental transfers of local funds. Known to us as the “PP-GEMT IGT” program, this program will replace the current Quality Assurance Fee (QAF) and Ground Emergency Medical Transport (GEMT) Medi-Cal supplemental reimbursement programs.
The bill requires eligible providers, including the Fire District, to receive an add-on increase to the associated Medi-Cal fee-for-service and managed care payments. The District has agreed to provide funding, along with all other public providers, to support the financial sustainability of the program for the non-federal share of the program. We anticipate the District will need to provide intergovernmental transfers to the state of approximately $10 million annually, which is currently scheduled to be paid in three installments of approximately $2.8 million per payment for calendar year 2023. The District anticipates total revenue from the program and the revised Medi-Cal reimbursements to be approximately $25 million annually, according to estimates provided by the District’s contracted medical billing firm. After accounting for the intergovernmental transfers and the dissolution of the QAF and GEMT supplemental reimbursement programs, it is anticipated the District will realize a net increase in total revenue in the range of $5 million to $7 million annually from the PP-GEMT IGT program.
The District received the attached invoice from DHCS on May 1, 2023. The invoice is for the period January through April of 2023 in the amount of $2,741,497.88. This request is for calendar year 2023 transports and the payment for this invoice is due on June 15, 2023. The IGT Certification form must be executed and submitted to the DHCS no later than June 1, 2023.
If this payment is not made the State may withhold supplemental provider payments for ambulance services provided to Medi-Cal recipients.