BILL ANALYSIS
AB 217
Page 1
Date of Hearing: April 21, 2009
ASSEMBLY COMMITTEE ON HEALTH
Dave Jones, Chair
AB 217 (Beall) - As Amended: April 16, 2009
SUBJECT: Medi-Cal: alcohol and drug screening and brief
intervention (SBI) services.
SUMMARY : Establishes the Medi-Cal Alcohol and Drug Screening
and Brief
Intervention Services Program (Program) for Medi-Cal
beneficiaries who are pregnant or women of childbearing age,
with county or local government entities paying the nonfederal
share of expenditures through certified public expenditures
(CPEs). Specifically, this bill :
1)Requires the Department of Health Care Services (DHCS), in
consultation with the Department of Alcohol and Drug Programs
(DADP), to administer the Program for the purpose of
increasing the state's ability to make available alcohol and
drug SBI services for Medi-Cal beneficiaries who are pregnant
or women of childbearing age.
2)Requires DHCS to administer this bill in accordance with the
CPE requirements described in federal regulations, or any
successor thereto, in certifying that the claimed expenditures
for alcohol and drug SBI services for Medi-Cal beneficiaries
are eligible for federal financial participation (FFP).
3)Requires DHCS to do all of the following in accordance with
administering this bill:
a) Provide evidence supporting the certification, as
specified by DHCS;
b) Submit data, as specified by DHCS, to determine the
appropriate amounts to claim as expenditures qualifying for
FFP; and,
c) Keep, maintain, and have readily retrievable, any
records specified by DHCS to fully disclose reimbursement
amounts to which the eligible public entity is entitled,
and any other records required by the federal Centers for
Medicare and Medicaid Services (CMS);
4)Requires the nonfederal share of expenditures submitted to CMS
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for purposes of claiming FFP to be comprised of only those
funds that are paid by a public entity (county or other local
governmental entity) and certified in accordance with this
bill.
5)Requires DHCS, in administering this bill, to do all of the
following:
a) Promptly seek any necessary federal approvals for the
implementation of this bill;
b) Submit claims for FFP for the expenditures for the
services that are allowable expenditures under federal law;
c) Submit, on an annual basis, any necessary materials to
the federal government to provide assurances that claims
for FFP will include only those expenditures that are
allowable under federal law; and,
d) Create an appropriate mechanism to enable a public
entity to pay the nonfederal share of the cost of providing
services under this bill.
6)Requires DHCS, upon receipt of federal reimbursement for the
claim, including federal matching funds, to provide the
reimbursement to the public entity for which the claim was
submitted.
7)Permits DHCS to implement, interpret, and make specific this
bill by means of all county letters, provider bulletins, and
similar instructions.
8)Requires participation in the SBI Program to be voluntary for
a Medi-Cal beneficiary.
9)Requires participation in the Program, and results of the
screening, to be maintained in the beneficiary's confidential
medical records, and subject to all confidentiality
requirements applicable to medical records.
10) Implements this bill only if, and to the extent that,
federal funds are available for this purpose.
EXISTING LAW :
1) Establishes DADP to develop and implement a statewide plan
to alleviate problems related to inappropriate alcohol use,
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and to license alcoholism and drug abuse recovery or
treatment facilities that provide a broad range of services
in a supportive environment for adults who are addicted to
alcohol or drugs.
2) Establishes the Medi-Cal program, administered by DHCS,
which provides comprehensive health benefits to low-income
children, their parents or caretaker relatives, pregnant
women, elderly, blind or disabled persons, nursing home
residents, and refugees who meet specified eligibility
criteria.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, fetal alcohol
syndrome is one of the leading known preventable causes of
birth defects and developmental disabilities. Prenatal
exposure to alcohol, tobacco, and other drugs have been proven
to severely damage the development, formation, and functioning
of the fetal brain. According to the U.S. Centers for Disease
Control, approximately one in twelve pregnant women admit to
consuming alcohol and one in thirty pregnant women said they
had engaged in binge drinking. Effective prevention,
intervention, and screening can reduce the incidence of
exposed infants while significantly reducing long term health
care costs. However, despite the evidence of the benefits,
SBIs have not yet been widely used in primary care settings,
emergency rooms, state licensed facilities and clinics. SBI
evaluates patients for potential substance abuse by asking a
series of five questions about their potential substance use.
The questions can easily be integrated into the initial
prenatal visit and used for follow-up screening throughout the
pregnancy. If the patient screens positive indicating they
are at risk for alcohol or other substance abuse, the provider
will recommend a brief intervention involving one or more
short counseling sessions. Individuals who are considered
high risk for abuse or addiction are given a brief
intervention counseling session and are also scheduled for a
brief treatment appointment. The author reports San
Bernardino County recorded an 18% reduction in low birth
weights over three years among women whose physicians provided
SBIs compared with women whose physicians did not provide
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those services. The author states an evaluation of 20 counties
found a definitive decline in substance abuse rates during
pregnancy and low birth weights.
2)BACKGROUND . Effective January 2007, new billing codes
approved by CMS allow Medicaid reimbursement for SBI services.
According to the White House Office of National Drug Control
Policy, the impetus behind the Medicaid decision to reimburse
for SBI services was the recognition of the number of people
who go unidentified and who are in need of treatment.
According to the author, a typical SBI evaluates patients by
asking a series of questions about their potential substance
use. If the patient screens positive, indicating they are at
risk for alcohol or other substance abuse, the provider will
recommend a brief intervention that usually involves one or
more short counseling sessions. Individuals who are
considered high risk for abuse or addiction are given a brief
intervention counseling session and are also scheduled for a
brief treatment appointment. According to the author, due to
the absence of state action, twenty counties have chosen to
begin their own county-funded prenatal SBI programs. The
author reports that an evaluation of those counties found a
sharp decline both in rates of substance abuse during
pregnancy and in low birth weight newborns.
3)PREVALENCE OF ALCOHOL AND DRUG ABUSE IN CALIFORNIA . According
to DADP's Web site, alcohol and other drug abuse is a major
factor in chronic disease, the spread of infectious diseases,
hospital emergency room visits, newborn health problems,
violence, and auto fatalities. According to a 2004 DADP
survey of alcohol and drug use in the month prior to the
survey found that an estimated 18.5 million persons had used
alcohol, 7.5 million had engaged in binge drinking (drinking
four or more drinks in a row), and 3.5 million had used
illicit drugs. DADP also reports that fetal alcohol syndrome,
caused by drinking during pregnancy, is the number one cause
of preventable developmental disabilities and birth defects in
the U.S. DADP estimated that the 2005 cost to society of
alcohol and drug abuse in California was over $44 billion,
including loss of productivity, health care costs, prevention
and treatment costs, criminal justice costs, and losses due to
crimes. DADP reported that in 2004, 308,683 Californians were
arrested on alcohol-related charges and 431,769 on
drug-related charges.
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4)SUPPORT . Counties and the California Probation Parole and
Correctional Association write in support of increasing the
state's ability to make alcohol and drug SBI services
available to Medi-Cal beneficiaries as contributing to the
prevention and treatment of individuals suffering from alcohol
and drug addiction.
5)PREVIOUS LEGISLATION .
a) AB 2124 (Beall) of 2008 would have allowed counties to
set up a voluntary program to fund the states share of SBI
in draw down federal funds. AB 2124 was held on the Senate
Appropriations suspense file.
b) AB 2129 (Beall) also of 2008 would have required the
Department of Public Health to collaborate with DADP in
developing a model program for the screening and treatment
of pregnant women who are suffering from drug and alcohol
abuse. AB 2129 was held on the Assembly Appropriations
suspense file.
REGISTERED SUPPORT / OPPOSITION :
Support
American College of Obstetricians and Gynecologists, District IX
American Federation of State, County and Municipal Employees,
AFL-CIO
California Commission on the Status of Women
California Probation Parole and Correctional Association
California Society for Clinical Social Work
California State Association of Counties
Drug Policy Alliance
Santa Clara County Board of Supervisors
Opposition
None on file.
Analysis Prepared by : Scott Bain / HEALTH / (916) 319-2097