Michelle Baass | Director
Director’s Office
P.O. Box No. 997413 | MS 0000
Sacramento, CA 95899-7413
Phone (916) 440-7400 | www.dhcs.ca.gov
State of California
Gavin Newsom, Governor
California Health and Human Services Agency
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
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
Attachment C
Ms. Miller
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 ap proval:
• CMS 179 – Transmittal and Notice of Approval of State Plan Material • Supplement 29 to Attachment 4.19-B, 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 [email protected].
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
[email protected]
Rafael Davtian
Deputy Director
Health Care Financing
Department of Health Care Services
[email protected]
Alek Klimek
Assistant Deputy Director
Health Care Financing
Department of Health Care Services
[email protected]
Saralyn M. Ang-Olson, JD, MPP
Chief Compliance Officer
Office of Compliance
Department of Health Care Services
[email protected]
Aditya Voleti, Chief
Fee-For-Service Rates Development
Division
Department of Health Care Services
[email protected]
DEPARTMENT OF HEALTH AND HUMAN SERVICES FORM APPROVED
CENTERS FOR MEDICARE & MEDICAID SERVICES OMB No. 0938-0193
TRANSMITTAL AND NOTICE OF APPROVAL OF
STATE PLAN MATERIAL
FOR: CENTERS FOR MEDICARE & MEDICAID SERVICES
1. TRANSMITTAL NUMBER 2. STATE
3. PROGRAM IDENTIFICATION: TITLE OF THE SOCIAL
SECURITY ACT
TO: CENTER DIRECTOR
CENTERS FOR MEDICAID & CHIP SERVICES
DEPARTMENT OF HEALTH AND HUMAN SERVICES
4. PROPOSED EFFECTIVE DATE
5. FEDERAL STATUTE/REGULATION CITATION 6. FEDERAL BUDGET IMPACT (Amounts in WHOLE dollars) a. FFY $
b. FFY $
7. PAGE NUMBER OF THE PLAN SECTION OR ATTACHMENT 8. PAGE NUMBER OF THE SUPERSEDED PLAN SECTION OR ATTACHMENT (If Applicable)
9. SUBJECT OF AMENDMENT
10. GOVERNOR’S REVIEW (Check One)
GOVERNOR’S OFFICE REPORTED NO COMMENT OTHER, AS SPECIFIED:
COMMENTS OF GOVERNOR’S OFFICE ENCLOSED
NO REPLY RECEIVED WITHIN 45 DAYS OF SUBMITTAL
11. SIGNATURE OF STATE AGENCY OFFICIAL 15. RETURN TO
12. TYPED NAME
13. TITLE
14. DATE SUBMITTED
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
XIX XXI
Please note: The Governor’s Office does not wish to review the State Plan Amendment.
1. TRANSMITTAL NUMBER 25-0030 2. STATE
3. PROGRAM IDENTIFICATION: TITLE OF THE SOCIAL
SECURITY ACT XIX
4. PROPOSED EFFECTIVE DATE January 1, 2026
5. FEDERAL STATUTE/REGULATION CITATION Title 42 C.F.R.
440.170 and 1905(a)(32) of the Act
6. FEDERAL BUDGET IMPACT (Amounts in WHOLE dollars) a.
FFY 2026 $24,159,000 b. FFY 2027 $8,917,000
7. PAGE NUMBER OF THE PLAN SECTION OR ATTACHMENT Supplement 29, Attachment 4.19-B pages 3-4
8. PAGE NUMBER OF THE SUPERSEDED PLAN SECTION OR ATTACHMENT (If Applicable) Supplement 29, Attachment 4.19-B pages 3-4
9. SUBJECT OF AMENDMENT One-year Public Provider Ground Emergency Medical Transport Intergovernmental Transfer Program for dates of service January 1, 2026 through December 31, 2026.
10. GOVERNORS REVIEW (Check One) OTHER, AS SPECIFIED: Please note: The Governor's Office does not wish to review the State Plan Amendment.
11. SIGNATURE OF STATE AGENCY OFFICIAL Redacted Signature
12. TYPED NAME Tyler
Sadwith
13. TITLE State Medicaid Director and Chief Deputy Director
14. DATE SUBMITTED September
30, 2025
15. RETURN TO
Department of Health Care
Services
Attn: Director's Office
P.O.
Box 997413, MS 0000
Sacramento,
CA 95899-7413
Supplement 29 To Attachment 4.19-B
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT
STATE: California
TN No. 25-0030
Supersedes
TN No. 25-0002 Approval Date: _______ Effective Date: January 1, 2026
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.
Supplement 29 To Attachment 4.19-B
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT
STATE: California
TN No. 25-0030
Supersedes
TN No. 25-0002 Approval Date: _______ Effective Date: January 1, 2026 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
Code Description
Current Fee
Schedule
Rate*
Add On
Amount
Resulting
Payment
Amount
A0429 Basic Life Support, Emergency $118.20 $1,518.61 $1,636.81 A0427 Advanced Life Support, Level 1,
Emergency $118.20 $1,518.61 $1,636.81
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.