BILL ANALYSIS Ó
AB 1231
Page 1
CONCURRENCE IN SENATE AMENDMENTS
AB
1231 (Wood)
As Amended September 4, 2015
Majority vote
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|ASSEMBLY: |76-0 |(June 2, 2015) |SENATE: | 40-0 |(September 9, |
| | | | | |2015) |
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Original Committee Reference: HEALTH
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. Requires DHCS to seek federal approval
and conditions providing the benefit on DHCS obtaining all
necessary federal approvals.
The Senate amendments:
1)Strike the requirement for DHCS to cover nonmedical
transportation for beneficiaries who receive services that are
located more than 60 minutes or 30 miles from the
beneficiary's place of residence and instead insert the
requirement that nonmedical transportation is covered, subject
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to utilization controls and federally permissible time and
distance standards.
2)Strike "specialty care" from the definition of Medi-Cal
services that are covered under nonmedical transportation.
3)Require the cost of nonmedical transportation to be paid for a
Medi-Cal beneficiary who can prove, in a manner to be
specified by DHCS, that other available resources have been
reasonably exhausted.
4)Strike the provisions authorizing DHCS to seek approval of any
necessary state plan amendments to implement coverage for
nonmedical transportation, and instead requires DHCS to seek
any federal approvals necessary to implement this bill,
including, but not limited to, approval of revisions to
existing federal Medicaid authorities that DHCS determines are
necessary to implement this bill. Prohibit this bill from
being implemented until all necessary federal approvals are
obtained.
5)Make technical amendments.
FISCAL EFFECT: According to the Senate Appropriations
Committee, this bill will have the following costs:
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 the bill
(General Fund (GF) and federal funds).
2)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 (GF and federal
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funds). According to DHCS, 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 enrollees. DHCS estimates the annual cost per
member to provide nonmedical transportation is between $0.50
and $2.00 per year.
3)Ongoing costs of $1.5 million to $3 million per year to
provide coverage for nonmedical transportation to Medi-Cal
beneficiaries not enrolled in Medi-Cal managed care. DHCS
currently does not provide coverage for nonmedical
transportation 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 (GF 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.
COMMENTS: 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 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
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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.
There is no known opposition to this bill on file.
Analysis Prepared by:
An-Chi Tsou / HEALTH / (916) 319-2097 FN:
0002305