BILL ANALYSIS                                                                                                                                                                                                    



          SENATE COMMITTEE ON APPROPRIATIONS
                             Senator Ricardo Lara, Chair
                            2015 - 2016  Regular  Session

          AB 1231 (Wood) - Medi-Cal:  nonmedical transportation
          
           ----------------------------------------------------------------- 
          |                                                                 |
          |                                                                 |
          |                                                                 |
           ----------------------------------------------------------------- 
          |--------------------------------+--------------------------------|
          |                                |                                |
          |Version: June 19, 2015          |Policy Vote: HEALTH 9 - 0       |
          |                                |                                |
          |--------------------------------+--------------------------------|
          |                                |                                |
          |Urgency: No                     |Mandate: No                     |
          |                                |                                |
          |--------------------------------+--------------------------------|
          |                                |                                |
          |Hearing Date: August 17, 2015   |Consultant: Brendan McCarthy    |
          |                                |                                |
           ----------------------------------------------------------------- 
          
          This bill meets the criteria for referral to the Suspense File.


          Bill  
          Summary:  AB 1231 would require the Department of Health Care  
          Services to provide nonmedical transportation as a covered  
          benefit in the Medi-Cal program.


          Fiscal  
          Impact:  
           One-time costs, likely about $150,000 to $300,000 for one to  
            two years to develop program requirements, amend the state's  
            Medicaid plan, and adopt regulations to implement the bill  
            (General Fund and federal funds).

           Ongoing costs of $1.5 million to $6.5 million to provide  
            nonmedical transportation to Medi-Cal beneficiaries enrolled  
            in Medi-Cal managed care plans that do not already provide  
            nonmedical transportation as a covered benefit (General Fund  
            and federal funds). According to the Department of Health Care  
            Services, 17 out of 21 Medi-Cal managed care plans already  
            provide coverage for nonmedical transportation, covering  
            between 50% and 70% of all existing Medi-Cal managed care plan  







          AB 1231 (Wood)                                         Page 1 of  
          ?
          
          
            enrollees. The Department estimates the annual cost per member  
            to provide nonmedical transportation is between $0.50 and  
            $2.00 per year.

           Ongoing costs of $1.5 million to $3.0 million per year to  
            provide coverage for nonmedical transportation to Medi-Cal  
            beneficiaries not enrolled in Medi-Cal managed care. The  
            Department currently does not provide coverage for nonmedical  
            transportation in the fee for service system (except for  
            children).

           Unknown impact on overall utilization of specialty health care  
            services in the Medi-Cal program (General Fund and federal  
            funds). By ensuring that Medi-Cal beneficiaries have access to  
            nonmedical transportation to specialty care, the bill is  
            likely to allow for increased access to specialty care by  
            Medi-Cal beneficiaries, particularly those in rural areas of  
            the state. This is likely to increase utilization of those  
            services. On the other hand, timely access to specialty  
            services may allow beneficiaries and their providers to better  
            manage serious medical conditions, potentially reducing future  
            needs for additional specialty services or hospitalization.  
            The net impact of these factors is unknown.


          Background:  Under state and federal law, the Department of Health Care  
          Services operates the Medi-Cal program, which provides health  
          care coverage to low income individuals, families, and children.  
          Medi-Cal provides coverage to childless adults and parents with  
          household incomes up to 138% of the federal poverty level and to  
          children with household incomes up to 266% of the federal  
          poverty level. The federal government provides matching funds  
          that vary from 50% to 90% of expenditures depending on the  
          category of beneficiary.
          Federal regulations require state Medicaid programs to provide  
          coverage for "necessary transportation for recipients to and  
          from providers". Under the state's Medicaid State Plan, Medi-Cal  
          provides coverage for emergency medical transportation (e.g.  
          ambulance transportation to an emergency department),  
          nonemergency medical transportation (e.g. ambulance  
          transportation from a hospital to a skilled nursing facility),  
          and nonmedical transportation (e.g. reimbursement of travel in a  
          private car or taxi to a specialist's office) for children and  
          dual eligibles enrolled in the Coordinated Care Initiative.  








          AB 1231 (Wood)                                         Page 2 of  
          ?
          
          
          Current state policy does not require nonmedical transportation  
          to be provided to other Medi-Cal beneficiaries. However, many  
          Medi-Cal managed care plans do provide nonmedical transportation  
          as a covered benefit, but with differing requirements and  
          authorization procedures.


          In recent years, the state has dramatically expanded enrollment  
          in Medi-Cal managed care (due both to the expansion of Medi-Cal  
          eligibility under the Affordable Care Act and state policy to  
          shift Medi-Cal beneficiaries from fee-for-service into managed  
          care). A significant change in the Medi-Cal program in recent  
          years has been the expansion of Medi-Cal managed care to rural  
          counties. Given the low population density in some of those  
          counties, there are a limited number of medical specialists who  
          participate in the Medi-Cal program. In some counties, the  
          design of Medi-Cal managed care specialty networks has resulted  
          in Medi-Cal beneficiaries needing to travel significant  
          distances to obtain specialty care.




          Proposed Law:  
            AB 1231 would require the Department of Health Care Services  
          to provide nonmedical transportation as a covered benefit in the  
          Medi-Cal program.
          Specific provisions of the bill would:
           Require nonmedical transportation to be covered, subject to  
            utilization controls, to allow a beneficiary obtain covered  
            specialty care if those services are more than 60 minutes or  
            30 miles from the beneficiary's residence;
           Define nonmedical transportation;
           State legislative intent that the intent of the bill is to  
            affirm existing federal requirements, rather than to create a  
            new benefit in the Medi-Cal program;
           Require implementation of the bill only to the extent that  
            federal financial participation is available and federal  
            approvals have been obtained;
           Authorize the Department of Health Care Services to implement  
            the bill through all county letters or other means, until  
            implementing regulations are adopted.










          AB 1231 (Wood)                                         Page 3 of  
          ?
          
          
                                      -- END --