BILL ANALYSIS Ó AB 1231 Page 1 CONCURRENCE IN SENATE AMENDMENTS AB 1231 (Wood) As Amended September 4, 2015 Majority vote -------------------------------------------------------------------- |ASSEMBLY: |76-0 |(June 2, 2015) |SENATE: | 40-0 |(September 9, | | | | | | |2015) | | | | | | | | | | | | | | | -------------------------------------------------------------------- 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 AB 1231 Page 2 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 AB 1231 Page 3 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 AB 1231 Page 4 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