BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | AB 1231| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- 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. AB 1231 Page 2 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. AB 1231 Page 3 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 AB 1231 Page 4 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 AB 1231 Page 5 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: (Verified9/4/15) Western Center on Law and Poverty (source) American Federation of State, County and Municipal Employees Asian Law Alliance California Academy of Family Physicians AB 1231 Page 6 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 United Ways of California 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 AB 1231 Page 7 rural Medi-Cal beneficiaries seeing a specialist is not a 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 / 9/4/15 18:50:09 **** END ****