BILL ANALYSIS Ó AB 2394 Page 1 CONCURRENCE IN SENATE AMENDMENTS AB 2394 (Eduardo Garcia) As Amended August 16, 2016 Majority vote -------------------------------------------------------------------- |ASSEMBLY: |78-0 |(May 31, 2016) |SENATE: |38-0 |August 18, 2016 | | | | | | | | | | | | | | | -------------------------------------------------------------------- Original Committee Reference: HEALTH SUMMARY: Requires Medi-Cal to cover nonmedical transportation (NMT) for a beneficiary to obtain covered Medi-Cal services commencing on July 1, 2017 or the effective date of any necessary federal approvals, whichever is later. 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 AB 2394 Page 2 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 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 The Senate amendments delay the implementation date of this bill AB 2394 Page 3 to July 1, 2017. FISCAL EFFECT: According to 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 nonmedical transportation to Medi-Cal beneficiaries enrolled in Medi-Cal MCPs 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 DHCS, 17 out of 21 Medi-Cal MCPs already provide coverage for nonmedical transportation, covering between 50% and 70% of all existing Medi-Cal MCP enrollees. DHCS currently does not provide coverage for nonmedical transportation 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 nonmedical transportation 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 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. AB 2394 Page 4 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 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. 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. Analysis Prepared by: Rosielyn Pulmano / HEALTH / (916) 319-2097 FN: 0004751 AB 2394 Page 5