BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 2394 (Eduardo Garcia) - Medi-Cal: nonmedical transportation
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|Version: June 14, 2016 |Policy Vote: HEALTH 8 - 0 |
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|Urgency: No |Mandate: No |
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|Hearing Date: August 1, 2016 |Consultant: Brendan McCarthy |
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This bill meets the criteria for referral to the Suspense File.
Bill
Summary: AB 2394 would require the Department of Health Care
Services to provide nonmedical transportation as a covered
benefit in the Medi-Cal program.
Fiscal
Impact:
One-time costs of $120,000 and ongoing costs of $110,000 per
year to develop program requirements, amend the state's
Medicaid plan, adopt regulations to implement the bill, and
provide ongoing monitoring of benefit coverage (General Fund
and federal funds).
Ongoing costs of $3 million to $6 million per year 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 and
fee-for-service beneficiaries who do not already qualify for
nonmedical transportation (General Fund and federal funds).
According to the Department of Health Care Services, 17 out of
21 Medi-Cal managed care plans already provide coverage for
AB 2394 (Eduardo Garcia) Page 1 of
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nonmedical transportation, covering between 50% and 70% of all
existing Medi-Cal managed care plan enrollees. The Department
currently does not provide coverage for nonmedical
transportation in the fee-for-service system, except for
children and participants in the Coordinated Care Initiative.
The Department estimates the annual cost per member to provide
nonmedical transportation is between $0.50 and $2.00 per year.
Unknown impact on overall utilization of health care services
in the Medi-Cal program (General Fund and federal funds). By
ensuring that Medi-Cal beneficiaries have access to nonmedical
transportation to covered services, the bill is likely to
allow for increased access to care by Medi-Cal beneficiaries,
particularly specialty care for beneficiaries 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.
Background: Under state and federal law, the Department of Health Care
Services operates the Medi-Cal program, which provides health
care coverage to low income individuals, families, and children.
Medi-Cal provides coverage to childless adults and parents with
household incomes up to 138% of the federal poverty level and to
children with household incomes up to 266% of the federal
poverty level. The federal government provides matching funds
that vary from 50% to 90% of expenditures depending on the
category of beneficiary.
Federal regulations require state Medicaid programs to provide
coverage for "necessary transportation for recipients to and
from providers". Under the state's Medicaid State Plan, Medi-Cal
provides coverage for emergency medical transportation (e.g.
ambulance transportation to an emergency department),
nonemergency medical transportation (e.g. ambulance
transportation from a hospital to a skilled nursing facility),
and nonmedical transportation (e.g. reimbursement of travel in a
private car or taxi to a specialist's office). Coverage of
nonmedical transportation is limited to children and dual
eligibles enrolled in the Coordinated Care Initiative. Current
state policy does not require nonmedical transportation to be
provided to other Medi-Cal beneficiaries. However, many Medi-Cal
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managed care plans do provide nonmedical transportation as a
covered benefit, but with differing requirements and
authorization procedures.
In recent years, the state has dramatically expanded enrollment
in Medi-Cal managed care (due both to the expansion of Medi-Cal
eligibility under the Affordable Care Act and state policy to
shift Medi-Cal beneficiaries from fee-for-service into managed
care). A significant change in the Medi-Cal program in recent
years has been the expansion of Medi-Cal managed care to rural
counties. Given the low population density in some of those
counties, there are a limited number of medical specialists who
participate in the Medi-Cal program. In some counties, the
design of Medi-Cal managed care specialty networks has resulted
in Medi-Cal beneficiaries needing to travel significant
distances to obtain specialty care.
Proposed Law:
AB 2394 would require the Department of Health Care Services
to provide nonmedical transportation as a covered benefit in the
Medi-Cal program.
Specific provisions of the bill would:
Require nonmedical transportation to be covered, subject to
utilization controls and permissible time and distance
standards (generally if those services are more than 60
minutes or 30 miles from the beneficiary's residence), to
allow a beneficiary obtain covered services;
Define nonmedical transportation;
Require nonmedical transportation to be provided to a
beneficiary who can attest that other currently available
resources have been reasonably exhausted;
State legislative intent that the intent of the bill is to
affirm existing federal requirements, rather than to create a
new benefit in the Medi-Cal program;
Require implementation of the bill only to the extent that
federal financial participation is available and federal
approvals have been obtained;
State that prior to the effective date of any necessary
federal approvals, nonmedical transportation was not a
Medi-Cal managed care benefit;
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Authorize the Department of Health Care Services to implement
the bill through all county letters or other means, until
implementing regulations are adopted;
Require implementing regulations to be adopted by July 1,
2018.
Related
Legislation: AB 1231 (Wood, 2015) was substantially similar to
this bill. That bill was vetoed by Governor Brown, as were
several other bills impacting the Medi-Cal program.
Staff
Comments: The requirement for Medi-Cal managed care plans to
provide nonmedical transportation would begin in the middle of
the 2016-17 fiscal year. The capitation rates that the state
pays to Medi-Cal managed care plans would already be in effect
for that fiscal year. According to the Department of Health Care
Services, when a new benefit goes into effect during a fiscal
year, the Department assesses whether the new benefit would
materially impact managed care plans' costs. If the Department
determines that there would be a material impact to managed care
plans' costs, a retroactive rate adjustment would be made in the
following fiscal year to offset the costs incurred until
capitation rates have been adjusted.
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