BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 1231|
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THIRD READING
Bill No: AB 1231
Author: Wood (D)
Amended: 9/1/15 in Senate
Vote: 21
SENATE HEALTH COMMITTEE: 9-0, 6/17/15
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth, Wolk
SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/27/15
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
ASSEMBLY FLOOR: 76-0, 6/2/15 - See last page for vote
SUBJECT: Medi-Cal: nonmedical transportation
SOURCE: Western Center on Law and Poverty
DIGEST: This bill adds nonmedical transportation as a Medi-Cal
benefit, subject to utilization controls, for a beneficiary to
obtain covered specialty care Medi-Cal services, if those
services are more than 60 minutes or 30 miles from the
beneficiary's place of residence.
ANALYSIS:
Existing law:
1) Establishes the Medi-Cal program, administered by the
Department of Health Care Services (DHCS), under which
qualified low-income individuals receive health care
services.
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2) Establishes a schedule of benefits under the Medi-Cal
program, which includes medical transportation services,
subject to utilization controls, and in-home medical care
services when medically appropriate and subject to
utilization controls, for beneficiaries who would otherwise
require care for an extended period of time in an acute care
hospital at a cost higher than in-home medical care services.
Included within the definition of in-home medical care
services are emergency and nonemergency medical
transportation
This bill:
1) Adds nonmedical transportation (NMT) as a Medi-Cal benefit,
subject to utilization controls, for a Medi-Cal beneficiary
to obtain covered specialty care Medi-Cal services, if those
services are more than 60 minutes or 30 miles from the
beneficiary's place of residence.
2) Defines NMT to include, but not be limited to, roundtrip
transportation for a beneficiary to obtain covered specialty
care Medi-Cal services by passenger car, taxicab, or any
other form of public or private conveyance, mileage
reimbursement for conveyance by private vehicle, bus passes,
taxi vouchers, or train tickets.
3) Requires the cost of NMT to be paid for a Medi-Cal
beneficiary who can attest in a manner to be specified by
DHCS that other available resources have been reasonably
exhausted.
4) Excludes from the definition of NMT the transportation of
sick, injured, invalid, convalescent, infirm, or otherwise
incapacitated beneficiaries by ambulances, litter vans, or
wheelchair vans licensed, operated and equipped in accordance
with state and local statutes, ordinances or regulations.
5) Requires NMT to be provided in a form and manner that is
accessible, in terms of physical and geographic
accessibility, for the beneficiary, and consistent with
policies and procedures established for a beneficiary with a
disability.
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6) States legislative intent in enacting this bill to affirm
the requirement under a specified provision of federal
regulation in which DHCS is required to ensure necessary
transportation for recipients to and from providers.
7) Prohibits this bill from being interpreted to add a new
benefit to the Medi-Cal program.
8) Requires DHCS to seek any federal approvals necessary to
implement this bill that DHCS determines are necessary.
Prohibits this bill from being implemented until all
necessary federal approvals are obtained.
9) Requires this bill to be implemented only to the extent that
federal financial participation is available and not
otherwise jeopardized and any necessary federal approvals
have been obtained.
10)Permits DHCS without taking regulatory action, to implement,
interpret, or make specific this bill by means of all-county
letters, plan letters, plan or provider bulletins, or similar
instructions until the time regulations are adopted. Requires
DHCS to adopt regulations by July 1, 2017, and requires DHCS
to provide a status report to the Legislature on a semiannual
basis until regulations have been adopted.
Comments
Author's statement. According to the author, NMT, defined as
transportation of members to medical services by passenger car,
taxicabs, or other forms of public or private conveyances
provided by persons not registered as Medi-Cal providers, is
only a covered Medi-Cal benefit for children and Cal MediConnect
beneficiaries. Unfortunately, for all other beneficiaries, NMT
is an optional benefit that plans may provide. Although plans
provide for this service, beneficiaries report difficulty
accessing this service due to wide variances in policies and
procedures. The Department of Managed Health Care (DMHC), which
licenses and oversees most health plans and requires licensed
health plans to comply with network adequacy requirements,
includes geographic access to care requirements. DMHC has no
geographic or timely access standards for specialty care. AB
1231 ensures that low-income beneficiaries in rural areas have
access to transportation for their specialty care needs. The
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bill requires that NMT will be provided to specialty care
beneficiaries if those services are more than 60 minutes or 30
miles from the beneficiary's place of residence.
Background on Medi-Cal coverage of transportation. Medi-Cal
coverage of transportation services is governed by state and
federal law. Federal regulations require a state's Medicaid
State Plan to specify that the Medicaid agency will ensure
necessary transportation for recipients to and from providers,
and to describe the methods that the agency will use to meet
this requirement. California's Medicaid State Plan indicates
California provides both emergency and non-emergency medical
transportation. DHCS distinguishes between non-emergency medical
transportation (NEMT) and NMT.
NEMT is transport by ambulance, litter van, and wheelchair van
medical transportation when transport by ordinary means of
public or private conveyance is medically contraindicated, and
transportation is required for the purpose of obtaining needed
medical care. By contrast, NMT is transportation of members to
medical services by passenger car, taxicabs, or other forms of
public or private conveyances provided by persons not registered
as Medi-Cal providers. NMT does not include the transportation
of sick, injured, invalid, convalescent, infirm, or otherwise
incapacitated members by ambulances, litter vans, or wheelchair
vans licensed, operated and equipped in accordance with state
and local statutes, ordinances or regulations.
DHCS indicates NMT is covered for children under age 21 through
the Early and Periodic Diagnosis and Treatment Program, and for
dually eligible beneficiaries enrolled in CalMediConnect plans
(plans that combine Medicare and Medi-Cal benefits in one health
plan, which operate in seven counties). CalMediConnect
beneficiaries receive up to 30 one-way trips per year with no
co-payment.
For Medi-Cal beneficiaries enrolled in Medi-Cal managed care
plans, 17 out of 21 plans DHCS surveyed reported having a
contracted network for NEMT, and the four health plans that did
not have a network were in the process of contracting with a
vendor or were utilizing only qualified Medi-Cal providers.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
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According to the Senate Appropriations Committee:
1)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 this bill
(General Fund and federal funds).
2)Ongoing costs of $1.5 million to $6.5 million to provide NMT
to Medi-Cal beneficiaries enrolled in Medi-Cal managed care
plans that do not already provide NMT as a covered benefit
(General Fund and federal funds). According to DHCS, 17 out of
21 Medi-Cal managed care plans already provide coverage for
NMT, covering between 50% and 70% of all existing Medi-Cal
managed care plan enrollees. DHCS estimates the annual cost
per member to provide NMT is between $0.50 and $2.00 per year.
3)Ongoing costs of $1.5 million to $3.0 million per year to
provide coverage for NMT to Medi-Cal beneficiaries not
enrolled in Medi-Cal managed care. DHCS currently does not
provide coverage for NMT in the fee for service system (except
for children).
4)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
NMT to specialty care, this 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.
SUPPORT: (Verified8/31/15)
Western Center on Law and Poverty (source)
American Federation of State, County and Municipal Employees
Asian Law Alliance
California Academy of Family Physicians
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California Chapter of the National Association of Social Workers
California Coverage and Health Initiatives
California Pan-Ethnic Health Network
California Primary Care Association
Children Now
Children's Defense Fund of California
Disability Rights California
Disability Rights Education & Defense Fund
First 5 Mendocino
Health Access California
Justice in Aging
Legal Aid Society of San Diego, Inc.
Legal Services of Northern California
National Alliance on Mental Illness California
National Health Law Program
Project Inform
OPPOSITION: (Verified8/31/15)
Department of Finance
ARGUMENTS IN SUPPORT: This bill is sponsored by the Western
Center on Law and Poverty (WCLP), which writes that this bill
clarifies that accessible NMT is a covered Medi-Cal benefit,
including roundtrip transportation for beneficiaries who must
travel more than 60 minutes or 30 miles from his/her residence
to access specialty care. The time and distance standard is
based on the Department of Insurance's specialty care service
standards and is double the standards DMHC has for primary care
providers of 30 minutes or 15 miles.
WCLP argues access to transportation services is critical for
rural residents where distances to specialty care are
significant, 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 California's Medicaid State Plan,
variation in implementation of this benefit leaves many
remaining questions regarding the basic availability and
criteria for getting such benefits. WCLP states that, for many
rural Medi-Cal beneficiaries seeing a specialist is not a
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one-time trip, but multiple trips where time off work must be
requested, childcare needs to be arranged, rides from relatives
and friends must be scrounged, and financial tradeoffs must be
made. WCLP concludes that this issue is exacerbated by the
mandatory transition into managed care for Medi-Cal consumers in
28 mostly rural counties who are reporting farther travel
distances to access medically needed specialty services.
ARGUMENTS IN OPPOSITION:The Department of Finance (DOF) writes
in opposition to the previous version of this bill as it expands
benefits in the Medi-Cal program and adds significant additional
General Fund costs that are not part of the 2015 Budget Act. DOF
states this bill may also be unnecessary as many Medi-Cal
managed care plans already offer NMT to their enrolled
beneficiaries.
ASSEMBLY FLOOR: 76-0, 6/2/15
AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,
Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang,
Chau, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd,
Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia,
Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray,
Hadley, Harper, Roger Hernández, Holden, Irwin, Jones, Kim,
Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis,
Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte,
O'Donnell, Olsen, Patterson, Perea, Quirk, Rendon, Rodriguez,
Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting,
Wagner, Waldron, Weber, Wilk, Williams, Wood, Atkins
NO VOTE RECORDED: Chávez, Grove, Jones-Sawyer, Ridley-Thomas
Prepared by:Scott Bain / HEALTH /
9/1/15 21:30:28
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