PP-GEMT Program
Reference Guide
Background
In accordance with Assembly Bill (AB) 1705 (Chapter 544, Statu tes 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 collec ted will be used to provide an add -on increase to the fee -for-services (FFS) fee schedule rates 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. Additional resources can be found on the AB 1705 website: https://www.dhcs.ca.gov/provgovpart/Pages/PPGEMTIGT.aspx Program Eligibility
Non-contracted public providers are eligible to participate in the PP-GEMT IGT program if they continually meet all of the following requirements for the entirety of the rate period:
1. Provide GEMT services to Medi-Cal beneficiaries,
2. Are enrolled as a Medi-Cal provider for the period being claimed, and
3. 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.
How to participate
1. Send an email to [email protected] with the following information:
a. Legal name of participating funding entity
b. All applicable email contacts (including titles)
c. Any National Provider Identifiers (NPI) associated with your Funding Entity
2. DHCS will use the information provided to calculate an estimated non-federal share.
Benefits of PP-GEMT IGT Program
1. Per transport, the total reimbursement under the PP-GEMT IGT Program is expected to be higher than what was received historically under existing GEMT programs.
2. The program applies to both FFS and managed care providers.
3. The following chart includes the Add-on Amount
For more information, contact DHCS at [email protected] Procedure Code
Procedure Code Description
Current Fee Schedule
Rate*
Medi-Cal PP-GEMT
IGT Add-on
Resulting Payment
Amount
A0225 NEONATAL EMERGENCY
TRANSPORT
$179.92 $946.92 $1126.84
A0427 ALS1-EMERGENCY $118.20 $946.92 $1065.12
A0429 BLS-EMERGENCY $118.20 $946.92 $1065.12
A0433 ALS 2 $118.20 $946.92 $1065.12
A0434 SPECIALTY CARE TRANSPORT
$118.20 $946.92 $1065.12
These are the base rate associated with these codes, but are subject to further adjustments pursuant to the State Plan.