BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 1231 (Wood) - Medi-Cal: nonmedical transportation
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|Version: June 19, 2015 |Policy Vote: HEALTH 9 - 0 |
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|Urgency: No |Mandate: No |
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|Hearing Date: August 17, 2015 |Consultant: Brendan McCarthy |
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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
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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.
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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.
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