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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