BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 2394|
|Office of Senate Floor Analyses | |
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THIRD READING
Bill No: AB 2394
Author: Eduardo Garcia (D), et al.
Amended: 8/16/16 in Senate
Vote: 21
SENATE HEALTH COMMITTEE: 8-0, 6/22/16
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth
NO VOTE RECORDED: Wolk
SENATE APPROPRIATIONS COMMITTEE: 7-0, 8/11/16
AYES: Lara, Bates, Beall, Hill, McGuire, Mendoza, Nielsen
ASSEMBLY FLOOR: 78-0, 5/31/16 - See last page for vote
SUBJECT: Medi-Cal: nonmedical transportation
SOURCE: Western Center on Law and Poverty
DIGEST: This bill 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.
ANALYSIS:
Existing law:
1) Establishes the Medi-Cal program, administered by the
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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 (NEMT).
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:
1) Requires Medi-Cal to provide coverage for nonmedical
transportation (NMT) for a beneficiary to obtain covered
Medi-Cal services, subject to utilization controls and
permissible time and distance standards. Requires this bill
to take effect July 1, 2017 or the effective date of any
necessary federal approvals, whichever is later.
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
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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.
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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 July 1, 2017 or 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 NMT, for recipients to and from covered services.
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
benefit for children and CalMediConnect beneficiaries
(CalMediConnect beneficiaries are people who are dually
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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)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 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
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counties). CalMediConnect beneficiaries receive up to 30
one-way trips per year with no co-payment. For Medi-Cal
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.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Senate Appropriations Committee:
1)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).
2)Ongoing costs of $3 million to $6 million per year to provide
NMT to Medi-Cal beneficiaries enrolled in Medi-Cal managed
care plans that do not already provide NMT as a covered
benefit and fee-for-service beneficiaries who do not already
qualify for NMT (General Fund and federal funds). According to
DHCS, 17 out of 21 Medi-Cal managed care plans already provide
coverage for NMT, covering between 50% and 70% of all existing
Medi-Cal managed care plan enrollees. DHCS currently does not
provide coverage for NMT in the fee-for-service system, except
for children and participants in the Coordinated Care
Initiative. DHCS estimates the annual cost per member to
provide NMT is between $0.50 and $2.00 per year.
3)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 NMT to
covered services, this 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.
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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.
SUPPORT: (Verified8/15/16)
Western Center on Law and Poverty (source)
American Cancer Society Cancer Action Network
Anthem Blue Cross
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
LeadingAge California
Legal Services of Northern California
Local Health Plans of California
Maternal and Child Health Access
NAMI California
National Association of Social Workers, California Chapter
National Health Law Program
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Planned Parenthood Action Fund of Santa Barbara, Ventura and San
Luis Obispo Counties
Planned Parenthood Action Fund of the Pacific Southwest
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
OPPOSITION: (Verified8/15/16)
California Ambulance Association
ARGUMENTS IN SUPPORT: This bill is sponsored by the Western
Center on Law and Poverty (WCLP), which writes that this bill
ensures 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 distances to access medically needed specialty
services.
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ARGUMENTS IN 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.
ASSEMBLY FLOOR: 78-0, 5/31/16
AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker,
Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke,
Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley,
Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Beth
Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto,
Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper,
Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim,
Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis,
Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, O'Donnell,
Olsen, Quirk, Ridley-Thomas, Rodriguez, Salas, Santiago,
Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber,
Wilk, Williams, Wood, Rendon
NO VOTE RECORDED: Obernolte, Patterson
Prepared by:Scott Bain / HEALTH / (916) 651-4111
8/16/16 18:21:26
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