BILL ANALYSIS Ó
AB 2394
Page 1
ASSEMBLY THIRD READING
AB
2394 (Eduardo Garcia)
As Amended March 28, 2016
Majority vote
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|Committee |Votes|Ayes |Noes |
| | | | |
| | | | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Health |19-0 |Wood, Maienschein, | |
| | |Bonilla, Burke, | |
| | |Campos, Chiu, | |
| | |Dababneh, Gomez, | |
| | | | |
| | | | |
| | |Roger Hernández, | |
| | |Lackey, Nazarian, | |
| | |Olsen, Patterson, | |
| | |Ridley-Thomas, | |
| | |Rodriguez, Santiago, | |
| | |Steinorth, Thurmond, | |
| | |Waldron | |
| | | | |
|----------------+-----+----------------------+--------------------|
|Appropriations |20-0 |Gonzalez, Bigelow, | |
| | |Bloom, Bonilla, | |
| | |Bonta, Calderon, | |
| | |Chang, Daly, Eggman, | |
| | |Gallagher, Eduardo | |
AB 2394
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| | |Garcia, Roger | |
| | |Hernández, Holden, | |
| | |Jones, Obernolte, | |
| | |Quirk, Santiago, | |
| | |Wagner, Weber, Wood | |
| | | | |
| | | | |
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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
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
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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
FISCAL EFFECT: According to the Assembly Appropriations
Committee:
1)One-time costs, likely about $100,000 over one to two years,
to develop utilization control guidelines for this new benefit
(General Fund (GF)/federal funds).
2)Costs and cost pressure, potentially in the range of $1-2
million (federal funds/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
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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 increase
rates. The majority of managed care plans already provide
this benefit.
b) Any costs to the 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
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,
including the network robustness, whether beneficiaries and
providers know it is a covered benefit, and how easy it is to
access.
COMMENTS: 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
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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.
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 transportation does not
require prior authorization and is always by ambulance.
Nonemergency medical transportation (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
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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 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.
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.
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Local Health Plans of California states they are in support if
amended and 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.
The California Ambulance Association states in opposition 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.
Analysis Prepared by:
Rosielyn Pulmano/ HEALTH / (916) 319-2097 FN:
0003290