BILL ANALYSIS Ó AB 1868 Page 1 Date of Hearing: March 25, 2014 ASSEMBLY COMMITTEE ON HEALTH Richard Pan, Chair AB 1868 (Gomez) - As Introduced: February 19, 2014 SUBJECT : Medi-Cal: optional benefits: podiatric medicine. SUMMARY : Allows specified podiatric services to be eligible for reimbursement in Medi-Cal, if the services provided by a podiatrist are services that would be considered physician services if provided by a physician, as specified in law. EXISTING LAW : 1)Establishes the Medicaid program (Medi-Cal in California) as a joint federal-state program to provide health care services to low-income families with children, seniors, and persons with disabilities. 2)Establishes specified Medi-Cal benefits, some required by federal law and other benefits which are optional under state law. 3)Excludes podiatry as an optional benefit in Medi-Cal. FISCAL EFFECT : This bill has not been analyzed by a fiscal committee. COMMENTS : 1)PURPOSE OF THIS BILL . According to the author, podiatrists perform physician services and have full medical staff, admitting and surgical privileges in hospitals and surgery centers. Eliminating coverage of services provided by podiatrists is a false savings, saving very little money in the short run but resulting in much more expensive complications downstream. The author notes essential foot and ankle services for Medi-Cal patients are now being provided at a costlier rate, often by emergency room providers or being delayed as patients attempt to find a provider eligible for reimbursement under current Medi-Cal requirements. The author argues recent studies show access to podiatrists can prevent complications for patients and actually provide savings for delivery systems. AB 1868 Page 2 2)BACKGROUND . Medi-Cal is California's version of the federal Medicaid program. States have the option of participating in Medicaid and all states have chosen to participate. States establish and administer their own Medicaid programs and determine the type, amount, duration, and scope of services within broad federal guidelines. States are required to cover mandatory benefits, and can choose to provide optional benefits through their Medicaid program. There are many optional benefits, including adult dental, podiatry, and prescription drugs. Faced with a budget crisis in 2009, the Legislature and Governor enacted a budget that limited some optional benefits that had been covered under Medi-Cal, including adult dental, podiatry, optometry, and chiropractic services. Dentists were still allowed to provide services if the services could be provided by a physician as physician services. Subsequent federal approval of the reductions was required and obtained. Litigation brought by rural health clinics resulted in podiatry and other services being reinstated at rural clinics and federally qualified health centers. Additionally, the Legislature and Governor reinstated some adult dental services in AB 82 (Committee on Budget), Chapter 23, Statutes of 2013, the 2013-14 budget health trailer bill. 3)SUPPORT . The California Podiatric Medical Association (CPMA), the sponsor of AB 1868, argues eliminating coverage of services provided by podiatrists has resulted in much more expensive complications down the road. This elimination of podiatry removed Medicaid coverage by podiatrists, but not the services themselves. They argue the same services provided by a physician or surgeon are covered in Medi-Cal, but podiatrists are prevented from providing these services in California resulting in services being delivered at a costlier rate. CPMA cites a study that found podiatric care of diabetic patients results in significant savings and the patients were less likely to experience a lower extremity amputation. The study focused on diabetic ulcerations which lead to lower extremity amputations for diabetics. CPMA notes overall patients with diabetes were less likely to experience a lower extremity amputation if a podiatrist was a member of the patient care team. Other supporters, the California Labor Federation and AB 1868 Page 3 Teamsters, argue the state eliminated the optional benefit to achieve savings, but there were no actual savings that resulted from the action. They note podiatrists often provide critical preventive care which forestalls the need for more expensive services, including costly and disfiguring amputations. 4)PREVIOUS LEGISLATION . a) AB 5 X3 (Evans), Chapter 20, Statutes of 2009-10 Third Extraordinary Session, eliminated specified optional benefits, including dental and podiatry. Exempt from the elimination medical and surgical services that may be provided by a physician, regardless of whether the service is actually provided by either a physician or dentist. b) AB 82 among its other provisions, partially restored adult dental services which allow preventive/diagnostic services, restoration services (amalgams, composite and stainless steel crowns), and full mouth dentures to be eligible for reimbursement in Medi-Cal. REGISTERED SUPPORT / OPPOSITION : Support California Podiatric Medical Association (sponsor) California Labor Federation California Teamsters Public Affairs Council Opposition None on file. Analysis Prepared by : Roger Dunstan / HEALTH / (916) 319-2097