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HomeMy WebLinkAbout16 - Ground Emergency Medical Transport Intergovernmental Transfer Voluntary Participation for Calendar Year 2026Q �EwPpRT CITY OF s NEWPORT BEACH `q44:09 City Council Staff Report January 13, 2026 Agenda Item No. 16 TO: HONORABLE MAYOR AND MEMBERS OF THE CITY COUNCIL FROM: Jeff Boyles, Fire Chief - 949-644-3101, jboyies@nbfd.net PREPARED BY: Raymund Reyes, Administrative Manager — 949-644-3352, rreyes@nbfd.net TITLE: Ground Emergency Medical Transport Intergovernmental Transfer Voluntary Participation for Calendar Year 2026 ABSTRACT: In 2019, Assembly Bill No. 1705 (AB 1705) authorized the replacement of two existing Medi-Cal reimbursement programs with a single program under a new Public Provider Ground Emergency Medical Transport Intergovernmental Transfer (PP-GEMT-IGT) process. The City of Newport Beach (City) has been a participant since the inaugural Calendar Year (CY) 2023 program. While add -on amount payments are delayed due to medical bill processing times, total reimbursements (including pending amounts) continue to exceed original estimates. This program is voluntary and dependent on the participation of all transporting agencies for it to remain successful. For the City Council's consideration is the continued participation in the PP-GEMT-IGT. RECOMMENDATIONS: a) Determine this action is exempt from the California Environmental Quality Act (CEQA) pursuant to Sections 15060(c)(2) and 15060(c)(3) of the CEQA Guidelines because this action will not result in a physical change to the environment, directly or indirectly; and b) Approve the City of Newport Beach's voluntary participation in the PP-GEMT-IGT program per AB 1705 for Calendar Year 2026 and authorize the city manager to execute the Public Provider Intergovernmental Transfer Program for Ground Emergency Medical Transportation Services Certification Forms and pay all necessary invoices. DISCUSSION: The Medi-Cal program is the State of California's Medicaid program and is administered through the California Department of Health Care Services (DHCS.) Medi-Cal provides qualified California residents with healthcare coverage, which can extend to Emergency Medical Services (EMS), including those provided by the City's Fire Department. Unlike patients with private insurance (or in most cases, Medicare), Medi-Cal patients do not have copayments and medical providers like the City must accept Medi-Cal payments as payment in full. Ground Emergency Medical Transport Intergovernmental Transfer Voluntary Participation for Calendar Year 2026 January 13, 2026 Page 2 Medi-Cal is partially governed and funded by federal Medicaid provisions. Medi-Cal patients typically average 10 - 15 percent of all City medical transports and the City is reimbursed for EMS services directly from the Medi-Cal program. Medi-Cal has historically paid a capitated base rate of $118.20 per transport since 1999, which is significantly lower than the actual costs for the City to provide transport service. The DHCS Quality Assurance Fee (QAF), Ground Emergency Medical Transport (GEMT), and Intergovernmental Transfer (IGT) programs were State attempts to provide additional revenue to help offset the cost of service. The IGT remains viable, and the City continues to participate in this program. AB 1705 was passed in 2019 and implemented in 2023, establishing a new Medi-Cal Public Provider Intergovernmental Transfer Program (PP-GEMT-IGT) for public ground emergency medical transportation providers. This program replaced the QAF and GEMT programs and provides additional payments to public providers who transport Medi-Cal patients. PP-GEMT-IGT is funded by a combination of voluntary funds contributed by participating public ambulance providers (like the City) and matching federal funds. Since the State cannot use its own general funds to provide a match, the voluntary funds are transferred to DHCS. DHCS then uses the funding to obtain matching federal funds. This combined sum of voluntary and federal funds are then used to pay the add -on amount per eligible Medi-Cal transport to all participating agencies. DHCS manages this reimbursement process and can charge each agency a 10 percent administrative fee against the voluntary fund amount. While approval is still pending at the State level, the prospective add -on amount for CY 2026 will be $1,518.61 per eligible transport. This is higher than the original, CY 2023 add -on amount of $946.92, and the revised CY 2025 add -on amount of $1,049.98. Once this amount is approved by the State, the total Medi-Cal payment per eligible transport will be $1,636.81. PP-GEMT-IGT is funded by a combination of ambulance transport agency funds and a federal Centers for Medicare and Medicaid Services (CMS) match, called a Federal Financial Participation (FFP). The State's general fund cannot be utilized for this reimbursement program, so public ambulance providers voluntarily provide the State with the amount needed (now over $110 million) through an Inter -Governmental Transfer. DHCS uses these non-federal funds to draw down available matching federal funds, then uses the combined sum to pay the add -on amount per eligible Medi-Cal transport to all participating agencies. DHCS manages the reimbursement processes and charges an administrative fee of 10 percent of the non-federal share amount. The CY 2026 add -on amount is currently $1,518.61 per pending State Plan Amendment (SPA) 25-0030. This is higher than the CY 2023 $946.92 add -on amount and the amended CY 2025 add -on amount of $1,049.98. Once approved, this will result in a total Medi-Cal payment amount of $1,636.81 (including the normal $118.20 base rate.) Ground Emergency Medical Transport Intergovernmental Transfer Voluntary Participation for Calendar Year 2026 January 13, 2026 Page 3 The City Council previously approved participation for CY 2023, CY 2024 and CY 2025. Based on amounts received to date and pending amounts forthcoming, the program remains successful. FISCAL IMPACT: The City receives PP-GEMT-IGT add -on payments as part of the $118.20 base rate through the normal billing and collection process. This can result in a delay between the month that the transport occurred and the receipt of the State's payment. As a result, pending amounts not yet collected cumulatively roll forward, and revenues received by the City may be add -on amounts from any program year to date. PP-GEMT-IGT ADD ON FEES FOR CY 2023, CY 2024, CY 2025 Calendar Payments to Original Add -On Fees Total Add -on PP-GEMT-IGT Year DHCS Estimated Collected Fees Pending Prospective Program (excluding Revenue through Oct Receipt (Jan. Total Revenue 10% admin 2025 2023 through for CY2023, fee) Oct. 2025) CY2024, CY 2025 2023 $399,377 $1,181,208 $565,514* $3,015,134 $4,933,897 2024 $390,461 $1,155,655 $739,198 2025 $387,136 $1,154,120 $614,051 TOTALS: $1,176,974 $3,490,983 $1,918,763 t ms amount mcmaes approxtmatety ys,ozu.uu in tetrover wAr- retmaursemenrs recetvea rrom uncs aurtng the rr-c tm t-iu t tmptementanon process. Even so, the program continues to surpass original estimates. Add -on fees collected have exceeded the City's total contribution amounts to date. Based on another $3,015,134 in pending amounts due, revenue estimates may be upwards of $1,442,914 higher than originally anticipated for CY 2023, CY 2024 and CY 2025 combined. DHCS PP-GEMT-IGT projected Net Revenue Payments to Prospective Total (including pending amounts) Date Revenue to Date $1,176,974 $4,933,897 $3,756,923 To participate as a funding entity for CY 2026, the City must transfer local funds up to an estimated total contribution amount of $558,180, which includes the 10 percent administrative fee estimate. Based on current DHCS figures, the number of possible transports and the current program reimbursements, the City may expect to receive a total of $1,898,263 from the CY 2026 program at the new add -on rate, resulting in an approximate net revenue of $1,340,083. It is important to note that depending on total agency participation and any reconciliation payments, the actual payments due during the year may be higher or lower. According to DHCS, the increase in the current non-federal share paid by agencies is due to the add- Ground Emergency Medical Transport Intergovernmental Transfer Voluntary Participation for Calendar Year 2026 January 13, 2026 Page 4 on amount increase, as well as various shifts in statewide utilization trends and trip increases in the proportion of GEMT trips by public providers. It is also important to note that DHCS has not yet invoiced agencies any of the 10 percent administrative fee amounts and does not have a timeframe of when administrative fee collection will begin. Collections will likely be on a go -forward basis (i.e. no retro- collection). The adopted budget includes sufficient funding for the first quarterly payment due in January 2026. Payment will be expensed from the PP-GEMT-IGT account in the Fire Department's EMS Division, 01040404-821010. Finance Department staff will review payment estimates for the April 2026 payment and include any necessary budget amendments as part of the Quarter 2 budget report. The two remaining payments in July and October 2026 will be incorporated into the Fiscal Year 2026-27 adopted budget. Anticipated revenues from the CY 2026 program have been incorporated into the current year budget (for amounts previously estimated to be received prior to June 30, 2025) and will also be addressed during the Fiscal Year 2026- 27 budget process. ENVIRONMENTAL REVIEW: Staff recommends the City Council find this action is not subject to the California Environmental Quality Act (CEQA) pursuant to Sections 15060(c)(2) (the activity will not result in a direct or reasonably foreseeable indirect physical change in the environment) and 15060(c)(3) (the activity is not a project as defined in Section 15378) of the CEQA Guidelines, California Code of Regulations, Title 14, Chapter 3, because it has no potential for resulting in physical change to the environment, directly or indirectly. NOTICING: The agenda item has been noticed according to the Brown Act (72 hours in advance of the meeting at which the City Council considers the item). ATTACHMENTS: Attachment A — Certification for CY 2026 PP-GEMT-IGT Program for Invoice No. 1 Attachment B — CY 2026 PP-GEMT-IGT Invoice No. 1 Attachment C — Public Notice re. State Plan Amendment 25-0030 Attachment A Pzj#HCS CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES Michelle Baass I Director PUBLIC PROVIDER GROUND EMERGENCY MEDICAL TRANSPORTATION PROGRAM INTERGOVERNMENTAL TRANSFER CERTIFICATION FORM STATE CALENDAR YEAR 2026 I, the undersigned, hereby declare and certify on behalf of CITY OF NEWPORT BEACH (the "Public Entity") as follows, 1. As a public administrator, a public officer, or other public individual, I am duly authorized to make this certification. 2. The Public Entity elects to make this intergovernmental transfer (IGT) to the Department of Health Care Service (DHCS) as a voluntary contribution to the non-federal share (NFS) of Medi-Cal expenditures for purposes of Assembly Bill 1705 (2019) pursuant to Sections 14105.94, 14105.945, 14129, 14129.3, and 14164 of the Welfare and Institutions (W&I) Code. All funds transferred pursuant to this certification qualify for federal financial participation (FFP) pursuant to Section 1903(w) of the Social Security Act and Title 42 of the Code of Federal Regulations, Section 433 Subpart B, and are not derived from impermissible sources such as recycled Medicaid payments, federal money excluded from use as the NFS, impermissible health care -related taxes, or non -bona fide provider - related donations. 3. Voluntary contributions attributable to the period of January 1, 2024, through December 31, 2026, will be made via recurring transfers as indicated on the invoices provided to the Public Entity by DHCS. The voluntary contributions made by the Public Entity may also include adjustments related to the calendar year (CY) 2024 and CY 2025 rating period's NFS reconciliation as described in paragraph 7 below. Please note, the total IGT amount at the bottom of this IGT certification will continue to be itemized on your invoice which is sent to you along with this IGT certification form 45-days in advance of the IGT contribution due date. The Public Entity acknowledges that any transfers made pursuant to this certification during this time period are considered an elective IGT made pursuant to W&I Code sections 14105.945 and 14164, to be used by DHCS, subject to paragraph four herein, exclusively as the source for the NFS of ground emergency medical transport public provider supplemental payments in both California Department of Health Care Services Capitated Rates Development Division 1501 Capitol Avenue, P.O. Box 997413 Sacramento, CA 195899-7413 MS 4413 1 www.dhcs.ca.gov State of California 4- ` Gavin Newsom, Governor IWI California Health and Human Services Agency PUBLIC PROVIDER GROUND EMERGENCY MEDICAL TRANSPORTATION PROGRAM INTERGOVERNMENTAL TRANSFER CERTIFICATION FORM STATE CALENDAR YEAR 2026 Medi-Cal fee for service (FFS) payments and the portion of the risk -based capitation rate to Medi-Cal managed care health plans associated with reimbursement made in accordance with Section 14105.945, subdivision (h)(1) (hereafter, the AB 1705 Public Provider (PP) Ground Emergency Medical Transportation (GEMT) Program, or the (PP-GEMT Program), and DHCS costs associated with administering the PP-GEMT Program. 4. DHCS may accept this voluntary contribution to the extent it is able to obtain FFP for the PP-GEMT Program as permitted by federal law. In the event DHCS is unable to obtain FFP for the PP-GEMT Program, or the full payments cannot otherwise be made to and retained by eligible public providers, and, therefore, all or a portion of the transferred amount cannot be used as the NFS of payments, DHCS will notify the Public Entity via e-mail and return the applicable portion of the unused IGT amount. 5. The Public Entity acknowledges that state law in W&I Code section 14105.945, subdivision (h)(2) authorizes DHCS, upon obtaining any necessary approvals, to assess a ten percent (10%) fee on each transfer of public funds to the state to pay for health care coverage and to reimburse DHCS its costs associated with administering the PP-GEMT Program. The Public Entity acknowledges that while DHCS is not assessing this fee currently pending federal approval, DHCS has not waived its right to assess the administrative fee under state law upon obtaining any necessary federal approvals. 6. The Public Entity acknowledges that the IGT is to be used by DHCS for the filing of a claim with the federal government for federal funds and understands that any misrepresentation regarding the IGT may violate federal and state law. 7. The amount voluntarily transferred to DHCS is based on the estimated Medi-Cal FFS and Medi-Cal managed care NFS of ground emergency medical transport payments, as referenced in paragraph three herein. Since the amount to be voluntarily transferred to DHCS will be based on an estimate, the Public Entity acknowledges that a reconciliation of the voluntary NFS contributions to the actual NFS expenditures will occur. To the degree necessary to fund the NFS for the PP-GEMT Program, amounts due to or owed by Public Entity as a result of the reconciliation may be offset against, or added to, future transfers as applicable California Department of Health Care Services Capitated Rates Development Division 1501 Capitol Avenue, P.O. Box 997413 Sacramento, CA 195899-7413 MS 4413 1 www.dhcs.ca.gov State of California Gavin Newsom, Governor California Health and Human Services Agency PUBLIC PROVIDER GROUND EMERGENCY MEDICAL TRANSPORTATION PROGRAM INTERGOVERNMENTAL TRANSFER CERTIFICATION FORM STATE CALENDAR YEAR 2026 and as determined by DHCS. DHCS may accept a voluntary contribution to the extent it is able to obtain FFP for PP-GEMT payments as permitted by federal law. 8. The Public Entity acknowledges that all records of funds transferred are subject to review and audit upon DHCS` request. The Public Entity will maintain documentation supporting the allowable funding source of the IGTs. 9. Upon notice from the federal government of a disallowance or deferral related to this IGT, the Public Entity responsible for this IGT shall be the entity responsible for the federal portion of that expenditure. I hereby declare under penalty of perjury under the law of the United States that the foregoing is true and correct to the best of my knowledge. I further understand that the known filing of a false or fraudulent claim, or making false statements in support of a claim, may violate the Federal False Claims Act or other applicable statute and federal law and may be punishable thereunder. Executed on this day of , 20_ at California. Signature of Authorized Person: Name of Authorized Person: SeImOne JUrjIS Title of Authorized Person: Name of Public Entity: NPI of Public Entity: City Manager CITY OF NEWPORT BEACH 1679579296 Amount of IGT: $126,8S8.98 . -PROVED AS TO FORM: CITY ATTORNEYj3 OFFICE Date: 12124 Z n C. Harp, Attorney ti14 �t'1pF California Department of Health Care Services Capitated Rates Development Division 1501 Capitol Avenue, P.O. Box 997413 Sacramento, CA 1 95899-7413 MS 4413 1 www.dhcs.ca.gov State of California Gavin Newsom, Governor California Health and Human Services Agency kwo H C S CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES M,0h 11r 9dav, I Di-, Eur PUBLIC PROVIDER GROUND EMERGENCY MEDICAL TRANSPORTATION (PP-GEMT) PROGRAM MANAGED CARE AND FEE FOR SERVICE — INVOICE Entity information:r 1/16/2026 Entity Name: City Of Newport Beach Payment Details: Year 2026 Contribution M 1 NPI: 1679579296 Total Amount Due: $126,858.98 Program/Payee Information: Banking Information: Vendor Name: Bank Name: California Department of Health Care Services US Bank Please await Wire Request Memo for payment instructions PP-GEMT Program Email: Payment Methods AB1705(a)dhcs.ca.gov JACH or Wire Transfer Payment Instructions: Attention: Please review, sign, and submit the Intergovernmental Transfer (IGT) Certification form by January 2, 2026, to AB1705@dhcs.ca.gov. IGT Certification forms are required to be submitted prior to each collection due date. Once the IGT Certification form is received, DHCS will send a Wire Request Memo providing payment details and instructions. Please do not send your IGT payment until you have received the Wire Request Memo as payment details are subject to change. IGT Non -Federal Share (NFS) Breakdown By DHCS Delivery System Care (MC) MC NFS #1 $ 113,403.72 Fee For Service IFFS} FFS NFS #1 $ 13,455.26 Total* IGT Transfer Amount: $ 126,858.98 *Any differences are due to rounding. CY 2026 Invoicing Schedule CY 2026 Invoice #1 Invoice Packets Sent 12/2/202S IGT Certifications Due Payment Due 1/2/2026 1/16/2026 CY 2026 Invoice 92 Invoice Packets Sent 3/3/2026 IGT Certifications Due 4/3/202 Payment Due 4/17/2026 CY 2024 FFS Recon #1 Date of Service Jan - Jun 202 CY 2025 MC Recon #1 Date of Service TBD CY 2026 Invoice #3 Invoice Packets Sent 6/2/2026 IGT Certifications Due 7/3/2026 Payment Due 7/17/2026 CY 2026 Invoice 04 Invoice Packets Sent 9/1/202 IGT Certifications Due 10/2/2026 Payment Due 10/16/202 CY 2024 FFS Recon #2 Date of Service Jul - Dec 2024 CY 2025 MC Recon #2 Date of Service TBD Attachment B Pzjo H C CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES Michelle Baass I Director PUBLIC PROVIDER GROUND EMERGENCY MEDICAL TRANSPORTATION (PP-GEMT) PROGRAM MANAGED CARE AND FEE FOR SERVICE — INVOICE Entity Name: City Of Newport Beach NPI: 1679579296 Vendor Name: California Department of Health Care Services PP-GEMT Program Email: Due D• 1/16/2026 Year: 2026 Contribution #: 1 Total Amount Due: $126,858.98 Bank Name: US Bank Please await Wire Request Memo for payment instructions ACH or Wire Transfer Attention: Please review, sign, and submit the Intergovernmental Transfer (IGT) Certification form by January 2, 2026, to AB1705@dhcs.ca.gov. IGT Certification forms are required to be submitted prior to each collection due date. Once the IGT Certification form is received, DHCS will send a Wire Request Memo providing payment details and instructions. Please do not send your IGT payment until you have received the Wire Reauest Memo as Davment details are subject to chanae. Manaeed Care (MC MC NFS #1 $ 113,403.72 Fee For Service (FFS) FFS NFS #1 $ 13,455.26 Total* IGT Transfer Amount: $ 126,858.98 *Any differences are due to rounding. CY 2026 Invoice #1 Invoice Packets Sent 12/2/2025 IGT Certifications Due 1/2/2026 Payment Due 1/16/2026 CY 2026 Invoice #2 Invoice Packets Sent 3/3/2026 IGT Certifications Due 4/3/2026 Payment Due 4/17/2026 CY 2024 FFS Recon #1 Date of Service Jan - Jun 2024 CY 2025 MC Recon #1 Date of Service I TBD CY 2026 Invoice #3 Invoice Packets Sent 6/2/2026 IGT Certifications Due 7/3/2026 Payment Due 7/17/2026 CY 2026 Invoice #4 Invoice Packets Sent 9/1/2026 IGT Certifications Due 10/2/2026 Payment Due 10/16/2026 CY 2024 FFS Recon #2 Date of Service Jul - Dec 2024 CY 2025 MC Recon #2 Date of Service I TBD hao H C S CALIFORNIA DEPARTMENT OF HEALTH CARE SERVICES Michelle Baass I Director September 30, 2025 THIS LETTER SENT VIA EMAIL Ms. Courtney Miller, Director Division of Program Operations Medicaid and CHIP Operations Group Centers for Medicare & Medicaid Services 601 East 12th Street, Suite 0300 Kansas City, MO 64106-2898 Attachment C STATE PLAN AMENDMENT 25-0030: PUBLIC PROVIDER GROUND EMERGENCY MEDICAL TRANSPORT INTERGOVERNMENTAL TRANSFER PROGRAM Dear Ms. Miller: The Department of Health Care Services (DHCS) is submitting State Plan Amendment (SPA) 25-0030 for your review and approval. This SPA proposes to continue the Public Provider Ground Emergency Medical Transport Intergovernmental Transfer (PP-GEMT IGT) Program in calendar year (CY) 2026 to continue providing an add -on increase for eligible Ground Emergency Medical Transport (GEMT) services for dates of service January 1, 2026, to December 31, 2026. SPA 22-0015 established the PP-GEMT IGT program to provide an add -on increase for eligible GEMT services when provided by qualified public providers in accordance with Assembly Bill (AB) 1705 (Chapter 544, Statutes of 2019). Eligible public providers of GEMT services will be qualified to receive an add -on increase to the Medi-Cal Fee -For -Service fee schedule base rates for each eligible transport provided to Medi-Cal beneficiaries. The following service codes are eligible for the add -on increase: • A0429 - Basic Life Support • A0427 - Advanced Life Support, Level 1 • A0433 - Advanced Life Support, Level 2 • A0434 - Specialty Care Transport • A0225 - Neonatal Emergency Transport Director's Office P.O. Box No. 9974131 MS 0000 Sacramento, CA 95899-7413 Phone (916) 440-7400 1 www.dhcs.ca.gov State of California Gavin Newsom, Governor California Health and Human Services Agency Ms. Miller Page 2 September 30, 2025 A Notice of Public Interest for SPA 25-0030 was published on August 25, 2025, on the DHCS webpage. The Tribal Notice for this SPA was sent on August 22, 2025, and the Tribal Webinar was held on August 27, 2025. No comments have been received. The following SPA documents are enclosed for your review and approval: • CMS 179 — Transmittal and Notice of Approval of State Plan Material • Supplement 29 to Attachment 4.19-13, Pages 3-4 — clean and redline versions • CMS Standard Funding Questions • Public Notice • Tribal Notice If you have any questions or need additional information, please contact Aditya Voleti, Chief, Fee -For -Service Rates Development Division, at (916) 345-8717 or by email at Aditya.Voleti(a dhcs.ca.gov. Sincerely, Tyler Sadwith State Medicaid Director Chief Deputy Director, Health Care Programs California Department of Health Care Services Enclosures CC' Lindy Harrington Assistant State Medicaid Director Director's Office Department of Health Care Services Lindy. Harrington(@-dhcs.ca.gov Rafael Davtian Deputy Director Health Care Financing Department of Health Care Services Rafael. Davtian(a_d hcs.ca.gov Alek Klimek Assistant Deputy Director Health Care Financing Department of Health Care Services Alek. Klimek(D_dhcs.ca.gov Saralyn M. Ang-Olson, JD, MPP Chief Compliance Officer Office of Compliance Department of Health Care Services Sara lyn.Ang-Olson (a)-dhcs.ca.gov Aditya Voleti, Chief Fee -For -Service Rates Development Division Department of Health Care Services Aditya.Voleti(c_dhcs.ca.gov DEPARTMENT OF HEALTH ANDHUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES FORM APPROVED OMB No. 0938-0193 1. TRANSMITTAL NUMBER 2. STATE TRANSMITTAL AND NOTICE OF APPROVAL OF 2 5 0 0 3 0 CA STATE PLAN MATERIAL — — — — — 3. PROGRAM IDENTIFICATION: TITLE OF THE SOCIAL FOR: CENTERS FOR MEDICARE & MEDICAID SERVICES SECURITY ACT Q XiX XXi TO: CENTER DIRECTOR 4. PROPOSED EFFECTIVE DATE CENTERS FOR MEDICAID & CHIP SERVICES January 1, 2026 DEPARTMENT OF HEALTH AND HUMAN SERVICES 5. FEDERAL STATUTE/REGULATION CITATION 6. FEDERAL BUDGET IMPACT (Amounts in WHOLE dollars) Title 42 C.F.R. 440.170 and 1905(a)(32) of the Act a FFY 2026 $ 24,159,000 b. FFY 2027 $ 8,917,000 7. PAGE NUMBER OF THE PLAN SECTION OR ATTACHMENT 8. PAGE NUMBER OF THE SUPERSEDED PLAN SECTION Supplement 29, Attachment 4.19-13 pages 3-4 OR ATTACHMENT (If Applicable) Supplement 29, Attachment 4.19-13 pages 3-4 9. SUBJECT OF AMENDMENT One-year Public Provider Ground Emergency Medical Tranport Intergovernmental Transfer Program for dates of service January 1, 2026 through December 31, 2026. 10. GOVERNOR'S REVIEW (Check One) © GOVERNOR'S OFFICE REPORTED NO COMMENT Q OTHER, AS SPECIFIED: © COMMENTS OF GOVERNOR'S OFFICE ENCLOSED Please note: The Governor's Office does not wish to review ® NO REPLY RECEIVED WITHIN 45 DAYS OF SUBMITTAL the State Plan Amendment. 11. SIGNATURE OF STATE AGENCY OFFICIAL 15. RETURN TO Department of Health Care Services Attn: Director's Office 12. TYPED NAME P.O. Box 997413, MS 0000 Tyler Sadwith Sacramento, CA 95899-7413 13. TITLE State Medicaid Director and Chief Deputy Director 14. DATE SUBMITTED September 30, 2025 FOR CMS USE ONLY 16. DATE RECEIVED 17. DATE APPROVED PLAN APPROVED - ONE COPY ATTACHED 18. EFFECTIVE DATE OF APPROVED MATERIAL 19. SIGNATURE OF APPROVING OFFICIAL 20. TYPED NAME OF APPROVING OFFICIAL 21. TITLE OF APPROVING OFFICIAL 22. REMARKS FORM CMS-179 (09/24) Instructions on Back Supplement 29 To Attachment 4.19-13 Page 3 STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT STATE: California ONE-YEAR PUBLIC PROVIDER GROUND EMERGENCY MEDICAL TRANSPORT INTERGOVERNMENTAL TRANSFER PROGRAM Introduction The Public Provider Ground Emergency Medical Transport Intergovernmental Transfer (PP-GEMT IGT) program provides increased reimbursement to eligible public providers of ground emergency medical transport (GEMT) services by application of an add -on to the Medi-Cal fee -for -service (FFS) fee schedule rates for eligible GEMT services. The add -on will apply to the Healthcare Common Procedure Coding System (HCPCS) Codes described below, effective for services provided during the rate period of January 1, 2026, through December 31, 2026. The base fee schedule rates for GEMT services will remain unchanged through this amendment. Definitions "Emergency medical transport" or "GEMT" means the act of transporting an individual from any point of origin to the nearest medical facility capable of meeting the emergency medical needs of the patient by an ambulance licensed, operated, and equipped in accordance with applicable state or local statutes, ordinances, or regulations, excluding transportation by an air ambulance provider, that are billed with HCPCS Codes A0429 Basic Life Support Emergency; A0427 Advanced Life Support, Level 1, Emergency; A0433 Advanced Life Support, Level 2; A0434 Specialty Care Transport; and A0225 Neonatal Emergency Transport. An "emergency medical transport" does not occur when, following evaluation of a patient, a transport is not provided. "Eligible provider" means a provider who is eligible for reimbursement of Medi-Cal emergency medical transports, and who continually meets all of the following requirements during the entirety of the rate period: (a) provides emergency Medi-Cal transports to beneficiaries, (b) is enrolled as a Medi-Cal provider for the period being claimed, and (c) is defined as a public provider, as described below. "Public provider" means a provider that is owned or operated by the state, a city, county, city and county, fire protection district organized pursuant to Part 2.7 (commencing with Section 13800) of Division 12 of the Health and Safety Code, special district organized pursuant to Chapter 1 (commencing with Section 58000) of Division 1 of Title 6 of the Government Code, community services district organized pursuant to Part 1 (commencing with Section 61000) of Division 3 of Title 6 of the Government Code, health care district organized pursuant to Chapter 1 (commencing with Section 32000) of Division 23 of the Health and Safety Code, or a federally recognized Indian tribe. TN No. 25-0030 Supersedes TN No. 25-0002 Approval Date: Effective Date: January 1, 2026 Supplement 29 To Attachment 4.19-13 Page 4 STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT STATE: California Effective January 1, 2023, public providers of GEMT services are not eligible to participate in the GEMT QAF program and will not receive the reimbursement rate add -on described on pages 1-2 of this Supplement. Methodology For services provided during the rate period of January 1, 2026, through December 31, 2026, the reimbursement rate add -on is a fixed amount. The resulting payment amounts are equal to the sum of the FFS fee schedule base rate and the add -on amount for each eligible ground emergency medical transport as listed by HCPCS Code in the table below. The reimbursement rate add -on will be paid for each eligible ground emergency medical transport on a per -claim basis as a supplemental payment to the base rate. HCPCS Current Fee Add On Resulting Code Description Schedule Amount Payment Rate* Amount A0429 Basic Life Support, Emergency $118.20 $1,518.61 $1,636.81 A0427 Advanced Life Support, Level 1, $118.20 $1,518.61 $1,636.81 Emergency A0433 Advanced Life Support, Level 2 $118.20 $1,518.61 $1,636.81 A0434 Specialty Care Transport $118.20 $1,518.61 $1,636.81 A0225 Neonatal Emergency Transport $179.92 $1,518.61 $1,698.53 *These are the base rates associated with these codes, but are subject to further adjustments pursuant to the State Plan. TN No. 25-0030 Supersedes TN No. 25-0002 Approval Date: Effective Date: January 1, 2026