BILL ANALYSIS Ó
AB 2394
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Date of Hearing: April 20, 2016
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Lorena Gonzalez, Chair
AB
2394 (Eduardo Garcia) - As Amended March 28, 2016
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Urgency: No State Mandated Local Program: NoReimbursable: No
SUMMARY:
This bill requires Medi-Cal to cover nonmedical transportation
(NMT), subject to utilization controls and federally permissible
time and distance standards, for a beneficiary to obtain covered
Medi-Cal services.
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It also states it is the intent of the Legislature to affirm
federal requirements, in which the Department of Health Care
Services (DHCS) is required to provide necessary transportation,
including NMT, for recipients to and from covered services, and
indicates it shall not be interpreted to add a new benefit to
the Medi-Cal program.
FISCAL EFFECT:
1)One-time costs, likely about $100,000 over one to two years,
to develop utilization control guidelines for this new benefit
(GF/federal).
2)Costs and cost pressure, potentially in the range of $1-2
million (federal/GF) annually combined for Medi-Cal
fee-for-service (FFS) and managed care, associated with
increased utilization of nonmedical transportation benefits.
The majority of costs would be federal dollars, with the
remainder GF. Even where the benefit is already provided,
standardization of time and distance standards or utilization
controls, as well as a definitive statement in statute that
NMT is a covered benefit, could impact utilization of the
benefit.
a) Costs to the managed care system associated with this
bill would be experienced as cost pressure to increased
rates. The majority of managed care plans already provide
this benefit.
b) Any costs to the fee-for-service (FFS) Medi-Cal system
would be experienced as direct state costs. About half of
all counties, accounting for a majority of the Medi-Cal
population, already provide nonmedical transportation
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through the FFS system.
1)Provision of transportation when beneficiaries are otherwise
unable to travel to obtain medical services could have unknown
offsetting savings associated with reduced hospitalizations
and better health outcomes. Some plans reportedly provide
transportation on a cost-neutral basis for this reason.
2)Utilization is highly uncertain and depends on many variables.
Since the coverage of NMT will be required to provided only
for visits that meet a certain time/distance standard, to the
extent provider networks in both managed care plans and FFS
Medi-Cal grow more robust, the demand for transportation
services would decrease. The inverse is also true; if
networks grew more sparse, demand for transportation would
increase based on a higher likelihood that visits meet the
defined standard. Utilization of transportation services,
and corresponding costs, could also vary dramatically based on
whether beneficiaries and providers know it is a covered
benefit, and how easy it is to access.
COMMENTS:
1)Purpose. The author states this bill ensures low-income
beneficiaries in rural areas have access to transportation for
their specialty care needs. It is sponsored by the Western
Center on Law and Poverty, who works closely with health law
programs throughout the state that report severe accessibility
challenges for medical visits, particularly among rural
Medi-Cal enrollees, and particularly given the recent
expansion of managed care to rural counties.
2)Background. DHCS distinguishes between: 1) Non-Emergency
Medical Transportation (NEMT), which is medical transportation
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but on a non-emergency basis; and 2) and Non-Medical
Transportation (NMT), which is ordinary transport to medical
services by passenger car, taxicabs, or other forms of public
or private conveyances. NEMT is a covered benefit for all
enrollees as it is provided 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. However, NMT (i.e., "ordinary"
transportation of enrollee to medical services) is only
provided to children and individuals enrolled in the
Coordinated Care Initiative, a demonstration project in
certain counties for those dually eligible for Medicare and
Medi-Cal. This bill would make NMT a covered benefit for all
enrollees, but only for visits that meet certain time/distance
standards.
Federal regulations require the state to provide "necessary"
transportation services to and from medical appointments.
Supporters note the Medi-Cal state plan "assures"
transportation to and from health care services, and consider
this bill further clarification of what the state plan already
requires, but is not being implemented.
3)Prior Legislation. AB 1231 (Wood) of 2015 was substantially
similar to this bill. Along with five other bills, AB 1231
was vetoed by the Governor, citing fiscal uncertainty in the
Medi-Cal program. The author believes action earlier this
year to reform the tax on Medi-Cal managed care plans has
addressed a key source of fiscal uncertainty.
4)Support and Opposition. The Western Center on Law and Poverty,
the sponsor of this bill, and numerous other supporters,
consider access to transportation a critical need and report
California's implementation of the transportation benefit
varies widely across the state. The California Ambulance
Association states in opposition that Medi-Cal severely
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underpays ambulance providers and that Medi-Cal should not be
expanded to include new services until Medi-Cal properly funds
emergency ambulance services.
Analysis Prepared by:Lisa Murawski / APPR. / (916)
319-2081