BILL ANALYSIS
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
217 (Beall)
Hearing Date: 8/27/2009 Amended: 6/1/2009
Consultant: Katie Johnson Policy Vote: Health 10-1
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BILL SUMMARY: AB 217 would establish the Medi-Cal Alcohol and
Drug Screening and Brief Intervention Services Program to make
alcohol and drug screening and brief intervention services
available to Medi-Cal beneficiaries who are pregnant women or
women of child-bearing age.
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Fiscal Impact (in thousands)
Major Provisions 2009-10 2010-11 2011-12 Fund
DHCS administration unknown, but likely hundreds of
General/
of SBI program thousands annually Federal/
Local
SBI services as a unknown, but likely in the
Federal/
Medi-Cal benefit millions Local
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STAFF COMMENTS: SUSPENSE FILE.
This bill would require the Department of Health Care Services
(DHCS), in consultation with the State Department of Alcohol and
Drug Programs (DADP), to establish the Medi-Cal Alcohol and Drug
Screening and Brief Intervention Services Program (SBI). The SBI
program would provide for alcohol and drug screening and brief
intervention services to Medi-Cal beneficiaries who are pregnant
women and women of child-bearing age through various local
public entities. Public entity means a county or other local
governmental entity designated by the department that elects to
provide or contract for SBI services.
This bill would require DHCS to administer the SBI program in
accordance with the federal certified public expenditure (CPE)
requirements, as specified, and would require that the
nonfederal share of expenditures submitted to the federal
Centers for Medicare and Medicaid Services (CMS) be only those
funds that are paid by a public entity and certified as public
expenditures. This bill would state that it is the intent of the
Legislature to provide SBI services and administer this program
without the expenditure of General Fund moneys.
This bill would require DHCS to seek any necessary federal
approvals for the implementation of this program. It is possible
that the department would need to update the Medi-Cal state plan
by submitting a state plan amendment (SPA) to CMS.
This bill would also require DHCS to: 1) submit claims for
federal financial participation for the public entities' CPEs;
2) submit, on an annual basis, any necessary materials to CMS to
provide assurances that claims for federal financial
participation would only
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AB 217 (Beall)
include allowable expenditures; and 3) create an appropriate
mechanism to enable a public entity to pay the nonfederal share
of the cost of providing SBI services; and 4) provide
reimbursement to the public entity for which a claim was
submitted, upon receipt of federal reimbursement for that claim.
This bill would require a participating public entity to: 1)
reimburse the state for any costs of creating and administering
the program upon receipt of federal financial participation; and
2) enter into an agreement with DHCS regarding the reimbursement
to the department for its administration costs. This bill would
provide that this program would be implemented on the condition
that federal financial participation is available.
Although DHCS's start-up and ongoing administrative costs, to be
reimbursed by participating local entities, are unknown, it is
likely that they would be in the hundreds of thousands of
dollars with expenses to be shared equally between the state
General Fund and federal funds.
Additionally, there would be significant General Fund pressure
in probably the millions of dollars to allow private entities to
offer the services and to extend SBI services to all Medi-Cal
enrollees. Since using CPEs as a nonfederal match is an option
for only public entities, state funds, likely General Funds,
would constitute the nonfederal share for any expansions of this
program.
DADP is currently conducting a pilot project in San Diego and
Los Angeles counties, the California Screening, Brief
Intervention, Referral, and Treatment (CASBIRT) Program, under a
federal grant from the federal Substance Abuse and Mental Health
Services Administration (SAMSHA), Center for Substance Abuse
Treatment. The grant provides $3.4 million annually over 5 years
through September 2009 to reduce substance use of nondependent
adult users through screening, brief intervention, and brief
treatment.
Screening costs range from $2.50 to $38.00 per screen for
screening and laboratory testing. Brief intervention costs range
from $10.00 to $112.50 per intervention, which include a 10 - 30
minute intervention by a health educator as well as a follow-up
call or visit. These cost estimates are not specific to Medi-Cal
patients. However, to estimate potential costs, if 1000 people
were screened and received brief interventions, program costs
would range from $2,500 to $112,500. If 1000 patients received
SBI services per county, costs would range from $145,000 to $6.5
million statewide plus DHCS administrative costs. The cost of
the program and the pressure on the General Fund would increase
accordingly if it were expanded to private entities or all
Medi-Cal enrollees. There could be potential future state
savings to the extent that the provision of SBI services
decreases the number of Medi-Cal enrollees with substance abuse
and children with substance abuse-related birth defects.
This bill is similar to AB 2124 (Beall) of 2008, which would
have established a SBI program within Medi-Cal for the purpose
of allowing local funds to be used to secure federal matching
funds for these services. AB 2124 was held on the Senate
Appropriations Committee suspense file.