BILL ANALYSIS Ó
AB 1231
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ASSEMBLY THIRD READING
AB
1231 (Wood)
As Introduced May 28, 2015
Majority vote
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|Committee |Votes |Ayes |Noes |
| | | | |
| | | | |
|----------------+------+--------------------+----------------------|
|Health |18-0 |Bonta, Maienschein, | |
| | |Bonilla, Burke, | |
| | |Chiu, Gomez, | |
| | |Gonzalez, Roger | |
| | |Hernández, Lackey, | |
| | |Nazarian, | |
| | |Patterson, | |
| | |Ridley-Thomas, | |
| | |Rodriguez, | |
| | |Santiago, | |
| | |Steinorth, | |
| | |Thurmond, Waldron, | |
| | |Wood | |
| | | | |
|----------------+------+--------------------+----------------------|
|Appropriations |17-0 |Gomez, Bigelow, | |
| | |Bonta, Calderon, | |
| | |Chang, Daly, | |
| | |Eggman, Gallagher, | |
| | | | |
| | | | |
AB 1231
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| | |Eduardo Garcia, | |
| | |Gordon, Holden, | |
| | |Jones, Quirk, | |
| | |Rendon, Wagner, | |
| | |Weber, Wood | |
| | | | |
| | | | |
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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.
FISCAL EFFECT: According to the Assembly Appropriations
Committee, unknown cost pressure, potentially in the range of $1
million in Medi-Cal managed care, and low hundreds of thousands in
direct costs in fee-for-service (FFS) Medi-Cal annually (General
Fund/majority federal). Due to data limitations this estimate is
fairly rough, it assumes a small percentage of rural Medi-Cal
enrollees receives transportation services each year for a single
specialty visit; is based on 20,000 additional transports in
managed care, and 5,000 in FFS annually at a cost of $50 per
transport. The cost of mandating "nonmedical transportation"
(NMT) as a covered benefit in Medi-Cal depends on several factors,
which are in turn subject to significant uncertainty and change.
Some additional cost dynamics and cost offsets are described
below:
1)To the extent better access to transportation increases
utilization of specialty care services, additional unknown costs
in FFS and cost pressure on managed care rates for more
specialty care visits. These increased costs for specialty care
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would be offset to some extent by cost savings from better
management of chronic conditions, fewer complications, and
reduced emergency room use.
2)Managed care plans, as well as the DHCS, are likely to
experience some administrative costs to institute policies and
procedures to ensure coverage complies with the defined
standards.
3)The actual impact on managed care rates from the potential
increased cost pressure identified here is unknown and may
depend in part on how it compares to what plans currently
provide.
4)Since the coverage of NMT is only available for visits that meet
a certain time/distance standard, to the extent provider
networks in both managed care plans and FFS Medi-Cal grow more
robust, the demand for transportation services would decrease.
The inverse is also true; if networks grew more sparse, demand
for transportation would increase based on a higher likelihood
that visits meet the defined standard.
5)Utilization of transportation services for specialty visits, and
corresponding costs, could also vary dramatically based on
whether beneficiaries and providers know it is a covered
benefit, and how easy it is to access.
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
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availability and criteria for receiving such benefits. Supporters
of this 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.
OPPOSITION: There is no opposition to this bill.
Analysis Prepared by:
An-Chi Tsou / HEALTH / (916) 319-2097 FN: 0000863