BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 2394
---------------------------------------------------------------
|AUTHOR: |Eduardo Garcia |
|---------------+-----------------------------------------------|
|VERSION: |June 14, 2016 |
---------------------------------------------------------------
---------------------------------------------------------------
|HEARING DATE: |June 22, 2016 | | |
---------------------------------------------------------------
---------------------------------------------------------------
|CONSULTANT: |Scott Bain |
---------------------------------------------------------------
SUBJECT : Medi-Cal: nonmedical transportation
SUMMARY : Requires Medi-Cal to provide coverage of nonmedical
transportation for a beneficiary to obtain covered Medi-Cal
services, subject to utilization controls and permissible time
and distance standards.
Existing law:
1)Establishes the Medi-Cal program, administered by the
Department of Health Care Services (DHCS), under which
qualified low-income individuals receive health care services.
2)Establishes a schedule of benefits under the Medi-Cal program,
which includes medical transportation services, subject to
utilization controls, and in-home medical care services when
medically appropriate and subject to utilization controls, for
beneficiaries who would otherwise require care for an extended
period of time in an acute care hospital at a cost higher than
in-home medical care services. Included within the definition
of in-home medical care services are emergency and
non-emergency medical transportation (NMT).
3)Requires, under federal Medicaid regulations, states' Medicaid
plans to:
a) Specify that the Medicaid agency will ensure
necessary transportation for recipients to and from
providers; and,
b) Describe the methods that the Medicaid agency will
use to meet this requirement.
This bill:
AB 2394 (Eduardo Garcia) Page 2 of ?
1)Requires Medi-Cal to provide coverage for NMT for a
beneficiary to obtain covered Medi-Cal services, subject to
utilization controls and permissible time and distance
standards.
2)Defines "NMT" to include, 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 the definition of NMT the transportation of
sick, injured, invalid, convalescent, infirm, or otherwise
incapacitated beneficiaries by ambulances, litter vans, or
wheelchair vans licensed, operated, and 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 DHCS that other currently
available resources have been reasonably exhausted.
5)Requires, for beneficiaries enrolled in a Medi-Cal managed
care plan, NMT to be provided by the beneficiary's Medi-Cal
managed care plan.
6)Requires DHCS, for Medi-Cal fee-for-service beneficiaries, to
provide NMT when those services are not available to the
beneficiary under specified provisions of existing law
providing federal Medicaid funding for targeted case
management and Medi-Cal administrative activities.
7)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.
8)Prohibits this bill from being interpreted to add a new
benefit to the Medi-Cal program.
9)Requires DHCS to seek any federal approvals that may be
required to implement this bill, including, but not limited
to, approval of revisions to the existing Medicaid State Plan
that DHCS determines are necessary to implement this bill.
AB 2394 (Eduardo Garcia) Page 3 of ?
10)Implements this bill only to the extent that federal
financial participation is available and not otherwise
jeopardized and any necessary federal approvals have been
obtained.
11)States that, prior to the effective date of any necessary
federal approvals, NMT was not a Medi-Cal managed care benefit
with the exception of when provided as an Early and Periodic
Screening, Diagnosis, and Treatment (EPSDT) service.
12)Requires DHCS to implement, interpret or make specific this
bill by means of all-county letters, plan letters, plan or
provider bulletins, or similar instructions until regulations
are adopted. Requires DHCS, by July 1, 2018, to adopt
regulations in accordance with the Administrative Procedure
Act. Requires DHCS, commencing July 1, 2017, to provide a
status report to the Legislature on a semiannual basis until
regulations have been adopted.
13)States legislative intent in enacting this bill to affirm the
requirement under federal Medicaid regulation, in which DHCS
is required to provide necessary transportation, including
nonmedical transportation, for recipients to and from covered
services.
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 NMT 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
AB 2394 (Eduardo Garcia) Page 4 of ?
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.
PRIOR
VOTES :
-----------------------------------------------------------------
|Assembly Floor: |78 - 0 |
|------------------------------------+----------------------------|
|Assembly Appropriations Committee: |20 - 0 |
|------------------------------------+----------------------------|
|Assembly Health Committee: |19 - 0 |
| | |
-----------------------------------------------------------------
COMMENTS :
1)Author's statement. According to the author, under federal
Medicaid law and California's State Medicaid Plan,
transportation of eligible recipients to and from health care
services is assured through a variety of methods. However,
NMT, defined by DHCS as 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, is only provided directly as a Medi-Cal
AB 2394 (Eduardo Garcia) Page 5 of ?
benefit for children and CalMediConnect beneficiaries
(CalMediConnect beneficiaries are people who are dually
eligible for Medi-Cal and Medicare). Unfortunately, for all
other adults, questions remain regarding the basic
availability of NMT as a covered benefit. Based on
information provided by DHCS in 2015, 17 of the 21 Medi-Cal
managed care plans purport that they provide NMT, but wide
variances in policies and procedures make it difficult for
beneficiaries to obtain NMT and there is no clear statewide
process for all other beneficiaries. This bill ensures that
low-income Medi-Cal beneficiaries throughout the state, but
particularly in rural areas, have access to transportation to
get to needed doctor appointments.
2)Background on Medi-Cal coverage of transportation. Medi-Cal
coverage of transportation services is governed by state and
federal law. Federal regulations require a state's Medicaid
State Plan to specify that the Medicaid agency will ensure
necessary transportation for recipients to and from providers,
and to describe the methods that the agency will use to meet
this requirement. California's Medicaid State Plan indicates
California provides both emergency and non-emergency medical
transportation.
DHCS distinguishes between non-emergency medical transportation
(NEMT) and NMT. NEMT is transport by ambulance, litter van,
and wheelchair van medical transportation 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. By contrast, NMT is
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
does not include the transportation of sick, injured, invalid,
convalescent, infirm, or otherwise incapacitated members by
ambulances, litter vans, or wheelchair vans licensed, operated
and equipped in accordance with state and local statutes,
ordinances or regulations.
DHCS indicates NMT is covered for children under age 21
through EPSDT, and for dually eligible beneficiaries enrolled
in CalMediConnect plans (plans that combine Medicare and
Medi-Cal benefits in one health plan, which operate in seven
counties). CalMediConnect beneficiaries receive up to 30
one-way trips per year with no co-payment. For Medi-Cal
AB 2394 (Eduardo Garcia) Page 6 of ?
beneficiaries enrolled in Medi-Cal managed care plans, 17 out
of 21 plans DHCS surveyed reported having a contracted network
for NEMT, and the four health plans that did not have a
network were in the process of contracting with a vendor or
were utilizing only qualified Medi-Cal providers.
3)Prior 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. This bill is sponsored by the Western Center on Law
and Poverty (WCLP), which writes that this measure would
ensure Medi-Cal members have access to medical care by
clarifying that NMT is a Medi-Cal benefit and includes
roundtrip transportation for members to obtain covered
Medi-Cal services. WCLP argues 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. According to the state's
Medicaid State Plan, California "assures" transportation to
and from Medi-Cal services, but WCLP argues the 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. WCLP states that, for many rural Medi-Cal
beneficiaries seeing a specialist is not a one-time trip, but
multiple trips where time off work must be requested,
childcare needs to be arranged, rides from relatives and
friends must be scrounged, and financial tradeoffs must be
made. WCLP concludes that this issue is exacerbated by the
mandatory transition into managed care for Medi-Cal consumers
in 28 mostly rural counties who are reporting farther travel
AB 2394 (Eduardo Garcia) Page 7 of ?
distances to access medically needed specialty services.
5)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.
6)Oppose unless amended. The California Association of Health
Plans (CAHP), the Local Health Plans of California and Anthem
Blue Cross write they are opposed to this bill unless it is
amended. CAHP states this bill does not include an
implementation date delay that will allow Medi-Cal managed
care plan reimbursement rates to be developed prior to the
enactment of the new benefit. CAHP argues this bill creates a
new Medi-Cal benefit mandate without at least a six month time
delay, which will result in plans having to absorb the cost of
the new benefit until reimbursement rates are developed.
SUPPORT AND OPPOSITION :
Support: Western Center on Law and Poverty (sponsor)
American Cancer Society Cancer Action Network
Asian Americans Advancing Justice--Los Angeles
Asian Law Alliance
Association of Regional Center Agencies
California Advocates for Nursing Home Reform
California Immigrant Policy Center
California Pan-Ethnic Health Network
California Primary Care Association
California State Council of Services Employees
International Union
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 California
Disability Rights Education and Defense Fund
Health Access California
Justice in Aging
AB 2394 (Eduardo Garcia) Page 8 of ?
LeadingAge California
Legal Services of Northern California
Local Health Plans of California
Maternal and Child Health Access
National Association of Social Workers, California
Chapter
NAMI California
National Health Law Program
Planned Parenthood Action Fund of the Pacific
Southwest
Planned Parenthood Action Fund of Santa Barbara,
Ventura and San Luis Obispo
Counties
Planned Parenthood Advocacy Project Los Angeles County
Planned Parenthood Advocates Pasadena and San Gabriel
Valley
Planned Parenthood Affiliates of California
Planned Parenthood Mar Monte
Planned Parenthood Northern California Action Fund
Project Inform
Oppose: Anthem Blue Cross (unless amended)
California Ambulance Association
California Association of Health Plans (unless
amended)
Local Health Plans of California (unless amended)
-- END --