BILL ANALYSIS                                                                                                                                                                                                    

                                                                    AB 1231

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          Date of Hearing:   April 21, 2015

                            ASSEMBLY COMMITTEE ON HEALTH

                                  Rob Bonta, Chair

          AB 1231  
          (Wood) - As Introduced February 27, 2015

          SUBJECT:  Medi-Cal:  nonmedical transportation.

          SUMMARY:  Adds nonmedical transportation, as defined, to the  
          schedule of benefits in the Medi-Cal program administrated by  
          the Department of Health Care Services (DHCS) for beneficiaries  
          who receive services, as specified, and that are located more  
          than 60 minutes or 30 miles from the beneficiary's place of  
          residence.  Authorizes DHCS to seek federal approval and  
          conditions providing the benefit on DHCS obtaining federal  
          matching funds.

          EXISTING LAW:  

          1)Establishes Medi-Cal under the direction of the DHCS, to  
            provide qualifying individuals health care and a uniform  
            schedule of benefits.

          2)Allows emergency and limited nonemergency medical  
            transportation for Medi-Cal beneficiaries.

          FISCAL EFFECT:  This bill has not yet been analyzed by the  


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          fiscal committee.


          1)PURPOSE OF THIS BILL.  According to the author, nonmedical  
            transportation is only a covered Medi-Cal benefit for children  
            and Cal MediConnect beneficiaries.  The author states the  
            geographic and timely access standards for the California  
            Department of Insurance require specialty care services to be  
            provided within 60 minutes or 30 miles of a member's residence  
            or workplace; however, the Department of Managed Health Care,  
            which regulates most of the Medi-Cal managed care plans, has  
            no such standards for specialty care.  The author states the  
            bill ensures low-income beneficiaries in rural areas have  
            access to transportation for their specialty care needs.


             a)   Medicaid Transportation Services.  Existing federal law  
               requires that state Medicaid programs cover medical care  
               and services and fulfill administrative requirements  
               necessary to implement the program effectively, including a  
               mandate that states must ensure necessary transportation  
               for recipients to and from providers.  For states to claim  
               matching federal funding for these services, states may  
               cover transportation services as an administrative expense  
               or as an optional medical service.    

             b)   Medi-Cal Nonmedical Transportation.  DHCS defines  
               "nonmedical transportation" as transportation of  
               beneficiaries to medical services via passenger car,  
               taxicabs, or other forms of public or private conveyances  
               provided by persons who are not registered as Medi-Cal  
               providers.  It does not include medical transportation,  


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               which is defined as the transportation of sick, injured,  
               invalid, convalescent, infirm, or otherwise incapacitated  
               by ambulances, litter vans, or wheelchair vans licensed,  
               operated, and equipped in accordance to state and local  
               statutes, ordinances, and regulations.  

          3)Early Periodic Screening, Diagnostic and Treatment (EPSDT) and  
            Cal MediConnect Nonmedical Transportation Coverage.  The EPSDT  
            benefit provides comprehensive and preventive health care  
            services for Medi-Cal enrolled children under the age of 21.   
            Services include preventive, dental, mental health,  
            developmental, and specialty services.  In June 2014, the  
            Centers for Medicare and Medicaid Services published guidance  
            that mandated states provide transportation services,  
            including appointment scheduling assistance, necessary  
            transportation to and from appointments, and reimbursement for  
            mileage<1>.  Cal MediConnect, also known as California's  
            Coordinated Care Initiative, is three-year pilot project to  
            promote coordinated healthcare delivery to seniors and people  
            with disabilities who are dually eligible for both the state  
            Medi-Cal program and the federal Medicare program.  Cal  
            MediConnect offers nonmedical transportation coverage as a  
            supplemental benefit, allowing beneficiaries access to 30  
            one-way trips per year.  In most cases, prior authorization or  
            referrals are not required.

             a)   Nonmedical transportation services are covered for  
               beneficiaries who qualify for the EPSDT and Cal MediConnect  
               but are not covered for non-EPSDT beneficiaries.  The  
               standard contract for Medi-Cal Managed Care plans does not  
               require nonmedical transportation for non-EPSDT  
               beneficiaries however plans may choose to voluntarily  
               provide these services.  

          <1> Centers for Medicare and Medicaid Services. "EPSDT - A Guide  
          for States: Coverage in the Medicaid Benefit for Children and  
          Adolescents," June 2014.


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          4)Current Coverage.  Existing regulations define "nonmedical  
            transportation" as the movement of participants to and from an  
            adult day health center in vehicles that not specifically  
            equipped for medical transportation services.  The regulations  
            state transportation to and from participants' homes are to be  
            scheduled to insure that participant one-way transit time does  
            not exceed one hour.  Anecdotal evidence strongly suggests  
            there is a need for nonmedical transportation coverage, with  
            transportation costs being denied by plans for scheduled  
            specialty care on numerous occasions.

          5)SUPPORT.  The Western Center on Law and Poverty, the sponsor  
            of this bill, asserts access to transportation services is  
            critical for residents in rural areas where public transport  
            is scarce and low-income beneficiaries cannot afford the  
            limited transportation options available.  Although  
            transportation to and from health care services is assured  
            through the Medicaid State Plan, variation in implementation  
            of this benefit leaves uncertainty to availability and  
            criteria for receiving such benefits.  

            Supporters of the bill note specialty care often requires  
            multiple trips to a specialist, which can be difficult for  
            Medi-Cal beneficiaries in rural areas.  This problem is  
            exacerbated by the mandatory transition to managed care for  
            Medi-Cal consumers in 28, mostly rural, counties who are  
            reporting farther travel distances to access medically needed  
            specialty services within the plan's network.

          6)CHAPTERING OUT.  This bill and AB 741 (Williams) both amend  
            the same code sections.  Each should be amended to avoid  
            chaptering out the other, should both bills be enacted.



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          Western Center on Law and Poverty (sponsor)

          Asian Law Alliance

          California Academy of Family Physicians

          California Pan-Ethnic Health Network

          California Primary Care Association

          Central California Alliance for Health

          Children Now

          Health Access California

          Legal Services of Northern California

          National Association of Social Workers, California Chapter


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          None on file.

          Analysis Prepared by:An-Chi Tsou / HEALTH / (916) 319-2097