BILL ANALYSIS Ó
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.
COMMENTS:
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.
2)BACKGROUND.
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.
REGISTERED SUPPORT / OPPOSITION:
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Support
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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Opposition
None on file.
Analysis Prepared by:An-Chi Tsou / HEALTH / (916) 319-2097