BILL ANALYSIS Ó
AB 2394
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CONCURRENCE IN SENATE AMENDMENTS
AB
2394 (Eduardo Garcia)
As Amended August 16, 2016
Majority vote
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|ASSEMBLY: |78-0 |(May 31, 2016) |SENATE: |38-0 |August 18, 2016 |
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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
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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
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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.
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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
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