BILL ANALYSIS Ó
AB 2394
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Date of Hearing: April 12, 2016
ASSEMBLY COMMITTEE ON HEALTH
Jim Wood, Chair
AB 2394
(Eduardo Garcia) - As Amended March 28, 2016
SUBJECT: Medi-Cal: nonmedical transportation.
SUMMARY: Requires Medi-Cal to cover nonmedical transportation
(NMT) for a beneficiary to obtain covered Medi-Cal services.
Specifically, this bill:
1)Requires Medi-Cal to cover NMT, subject to utilization
controls and permissible time and distance standards, for a
beneficiary to obtain covered Medi-Cal services.
2)States that NMT includes, at a minimum, round trip
transportation for a beneficiary to obtain covered Medi-Cal
services by passenger car, taxicab, or any other form of
public or private conveyance, and mileage reimbursement when
conveyance is in a private vehicle arranged by the beneficiary
and not through a transportation broker, bus passes, taxi
vouchers, or train tickets.
3)Excludes from NMT the transportation of the sick, injured,
invalid, convalescent, infirm, or otherwise incapacitated
beneficiaries by ambulances, litter vans, or wheelchair vans
licensed, operated or equipped in accordance with state and
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local statutes, ordinances or regulations.
4)Requires NMT to be provided for a beneficiary who can attest
in a manner to be specified by the Department of Health Care
Services (DHCS), that other currently available resources have
been reasonably exhausted. Provides that for beneficiaries
enrolled in a managed care plan (MCP), NMT must be provided by
the MCP. Requires, for Medi-Cal fee-for-service
beneficiaries, DHCS to provide NMT when those services are not
available to the beneficiary.
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 applicable state and
federal disability rights laws.
6)States it is the intent of the Legislature to affirm federal
requirements, in which DHCS is required to provide necessary
transportation, including NMT, for recipients to and from
covered services.
7)Requires DHCS to seek any federal approvals that may be
required to implement this bill, as specified.
8)Authorizes DHCS to implement this bill by means of an
all-county letters or plan or provider bulletins, as
specified.
EXISTING LAW:
1)Establishes the federal Medicaid Program (Medi-Cal in
California), administered by DHCS, to provide comprehensive
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health care services and long-term care to pregnant women,
children, and people who are aged, blind, and disabled.
2)Defines under regulations a nonemergency medical transport
(NEMT) as ambulance, litter van, and wheelchair van services,
which are to be provided when the beneficiary's medical and
physical condition is such that transport by ordinary means of
public or private conveyance is medically contraindicated, and
transportation is required for the purpose of obtaining needed
medical care.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal
committee.
COMMENTS:
1)PURPOSE OF THIS BILL. According to the author, this bill
clarifies that NMT is a covered Medi-Cal benefit, aligning it
with federal law and California's State Medicaid Plan and
ensuring beneficiaries have needed access to health care
services. Many Medi-Cal beneficiaries report difficulty
accessing health care providers due to a lack of adequate
transportation, especially within rural communities. This
transportation issue can mean delayed or skipped appointments,
which inevitably exasperates many medical conditions and even
results in higher costs to the state system. The author
states that this bill ensures low-income beneficiaries,
especially in rural areas, have access to medical care by
clarifying that accessible NMT is a Medi-Cal benefit.
2)BACKGROUND. Medi-Cal covers both emergency and nonemergency
medical transportation. Emergency medical transportation is
provided when necessary to obtain program covered benefits
when the beneficiary's medical/physical condition is acute and
severe, necessitating immediate medical diagnosis and
treatment in order to prevent death or disability. Such
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transportation does not require prior authorization and is
always by ambulance.
NEMT is provided when necessary to obtain program covered
medical services and when the beneficiary's medical and
physical condition is such that transport by ordinary means of
private or public conveyance is medically contraindicated.
This type of medical transportation is subject to prior
authorization. Each authorization request for such
transportation must be accompanied by either a prescription or
order signed by a physician, dentist, or podiatrist, which
describes the medical reasons necessitating the use of NEMT.
Authorization is granted only for the lowest cost type of
medical transport that is adequate for the patient's medical
needs and is available to transport the patient at the time
transportation is required.
NMT is the 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 which represents a continuation of an original
emergency transportation event is covered without prior
authorization, such as transportation from an emergency room
of one hospital on to a second hospital for admission or for
emergency services when the initial emergency room cannot
provide the appropriate emergency medical treatment.
According to DHCS, children and adolescents eligible for the
Early Periodic Screening, Diagnostic, and Treatment Program
are eligible for NEMT and NMT. Additionally, under Cal
MediConnect, also known as California's Coordinated Care
Initiative, which is a three-year pilot project to promote
coordinated healthcare delivery to seniors and people with
disabilities who are dually eligible for both Medicare and
Medi-Cal, NMT coverage is a supplemental benefit, allowing
beneficiaries access to 30 one-way trips per year. In most
cases, prior authorization or referrals are not required. For
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beneficiaries enrolled in a MCP, a managed care plan may
voluntarily choose to provide NMT and MCPs must inform all
members in writing the procedures for obtaining nonmedical
transportation and conditions under which NMT is available.
3)PREVIOUS LEGISLATION. AB 1231 (Wood) of 2015 was
substantially similar to this bill and would have added NMT as
a Medi-Cal benefit. Along with five other bills, AB 1231 was
vetoed by the Governor, who stated that, "These bills
unnecessarily codify certain existing health care benefits or
require the expansion or development of new benefits and
procedures in the Medi-Cal program. Taken together, these
bills would require new spending at a time when there is
considerable uncertainty in the funding of this program.
Until the fiscal outlook for Medi-Cal is stabilized, I cannot
support these measures."
4)SUPPORT. The Western Center on Law and Poverty, the sponsor
of this bill, and other supporters such as Justice in Aging,
Planned Parenthood Action Fund of the Pacific Southwest, and
the Coalition of California Welfare Rights Organizations,
Inc., state that access to transportation services is critical
for rural residents where distances to health providers are
significant, public transport is scarce, and low-income
beneficiaries cannot afford the limited transportation options
available. California's implementation of the transportation
benefit varies widely across the state. As a result, Medi-Cal
beneficiaries are either unaware that they may get assistance
to go to their appointments or must fight through nearly
impossible administrative hurdles to access the benefit. The
County Health Executives Association of California further
states that with the recent expansion of MCP into rural areas
throughout California, access to NMT services has become a
vital issue, particularly when it comes to specialty care
services.
5)SUPPORT IF AMENDED. The Local Health Plans of California
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states that this bill does not provide needed clarity that
health plan rates reflect the inclusion of transportation when
provided under this bill. Without this clarity, under the
current managed care rate-setting process, health plans would
be required to cover the service without receiving payment.
6)OPPOSITION. The California Ambulance Association states that
the Medi-Cal Program severely underpays ambulance providers
and that Medi-Cal should not be expanded to include new
services until the Medi-Cal program properly funds emergency
ambulance services.
7)POLICY COMMENT. The Governor previously vetoed a
substantially similar bill. The Committee may wish to ask the
author how he will address the Governor's veto message.
REGISTERED SUPPORT / OPPOSITION:
Support
Western Center on Law and Poverty (sponsor)
Asian Law Alliance
Association of Regional Center Agencies
California Advocates for Nursing Home Reform
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California Immigrant Policy Center
California Pan-Ethnic Health Network
California Primary Care Association
Central California Legal Services, Inc.
Children Now
Children's Defense Fund - California
Coalition of California Welfare Rights Organizations, Inc.
Community Action Fund of Planned Parenthood of Orange and San
Bernardino Counties
Community Health Councils, Inc.
County Health Executives Association of California
Disability Rights Education and Defense Fund
Health Access California
Justice in Aging
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LeadingAge California
Legal Services of Northern California
Maternal and Child Health Access
NAMI California
National Health Law Program
Planned Parenthood Action Fund of Santa Barbara, Ventura and San
Luis Obispo Counties
Planned Parenthood Action Fund of the Pacific Southwest
Planned Parenthood Northern California Action Fund
Project Inform
SEIU California
Opposition
California Ambulance Association
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Analysis Prepared by:Rosielyn Pulmano / HEALTH / (916) 319-2097