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.  








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           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
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            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