MADDY EMS Reimbursements

About the Emergency Medical Services Fund

Tuolumne County administers its Emergency Medical Services Fund 6208 (EMSF) pursuant to Chapter 1240, 1987 Statutes (“SB612-Maddy”), Health and Safety Code, Division 2.5, Part 1, Section 1797.98. This fund is derived from traffic violation collections and is designed to provide reimbursement to physicians for the emergency medical management of patients who do not qualify for private or public insurance, and from whom efforts to collect fees have been unsuccessful.

This fund is collected and administered by the auditor / controller with the assistance of the emergency medical services agency. Payments are distributed to local physicians who are not directly employed by the county for emergency services rendered to patients with no source for payment. Physicians must demonstrate unsuccessful efforts to collect charges in order to qualify for reimbursement from the EMSF.

The attached policies and procedures represent a refinement of the protocols to be followed by local physicians in order to receive compensation under this program. These procedures establish a fee schedule by which payments to physicians will be standardized, and are consistent with the guidelines established by Health and Safety Code. They are designed to allow reimbursement up to, but not exceeding, the fees billed by qualifying physicians for these emergency services.

Existing Law

Existing law provides that payments for emergency medical services from the county emergency medical services fund shall be made only for uncompensated emergency medical services provided on the calendar day on which emergency services are first provided and on the immediately following two calendar days, and specifies that payments may not be made for services provided beyond a 48-hour period of continuous service to the patient.

Existing law also provides that if it is necessary to transfer the patient to a second facility providing a higher level of care for the treatment of the emergency condition, payment will be made for services provided on the day of transfer and the immediately following two calendar days, and specifies that payments may not be made for services provided beyond a 48-hour period of continuous service to the patient.

Claims will be paid at 100% of Medi-Cal reimbursement rates, on a first come, first served basis in the first three quarters of the year. Claims received after the allocation for each quarter has been expended will receive priority for the subsequent quarter. Fourth quarter claims, and any unpaid claims from the previous quarters will be paid on a pro-rated basis, as long as the total payment for a single claim does not exceed 50% of the invoiced amount, per the Health and Safety Code Section 1797.98.

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