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Emergency Medical Services Appropriation Contract Back Program

The Emergency Medical Services Appropriation (EMSA) Contract Back Program is a Proposition 99 Contract Back Program administered by the County Health Services Branch to reimburse Medi-Cal physicians for uncompensated emergency services provided to medically indigent persons in qualifying counties.  Claims may be initially reimbursed for up to 50% of the claimed amount and at the end of the year, may be reimbursed up to 100% of the claimed amount.  The actual percent reimbursed is subject to the availability of Fiscal Year funding.

EMSA Progam Announcement

  • EMSA Program Announcement 9/09/2009 (PDF)  Opens a new browser window.
  • EMSA Contract Back Program Eligible Counties

    Medi-Cal providers located in counties that decline their Rural Health Services EMSA allocations and instruct the State to administer those funds may participate in the EMSA Contract Back Program for uncompensated medical services.

    The 23 EMSA Contract Back Program eligible counties include:

    Alpine, Butte, Calaveras, Colusa, Del Norte, El Dorado, Glenn, Humboldt, Imperial, Inyo, Kings, Lake, Lassen, Madera, Mariposa, Modoc, Plumas, San Benito, Shasta, Sierra, Sutter, Tehama, and Yuba.

    A map of the eligible EMSA Contract Back Program eligible counties can be found as a link under EMSA Contract Back Program Documents.

    EMSA Contract Back Program Documents

    EMSA Contract Back Program Policies and Procedures Manual (Word) Opens a new browser window.

    Annual Physician Enrollment and Claim Certification Form (PDF) Opens a new browser window.

    Medical Services Claim Form (PDF) Opens a new browser window.

    Electronic Billing Certification Claim Form (PDF) Opens a new browser window.

    EMSA Data File Format (Excel) Opens a new browser window.

    Payee Data Record Form (PDF) Opens a new browser window.

    EMSA Contract Back Program Single Fee Schedule Revised Payment Periods (Word) Opens a new browser window.

    EMSA Contract Back Program HIPAA Compliance Letter (PDF) Opens a new browser window.   

    EMSA Contract Back Program Notice of Privacy Practices (PDF, English) Opens a new browser window.... Spanish

    EMSA Contract Back Program Map of Eligible Counties (PDF) Opens a new browser window.

     
     
    Last modified on: 1/13/2011 1:25 PM