BILL ANALYSIS
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THIRD READING
Bill No: AB 217
Author: Beall (D)
Amended: 6/1/09 in Assembly
Vote: 21
SENATE HEALTH COMMITTEE : 10-1, 7/8/09
AYES: Alquist, Strickland, Cedillo, Cox, DeSaulnier, Leno,
Maldonado, Negrete McLeod, Pavley, Wolk
NOES: Aanestad
SENATE APPROPRIATIONS COMMITTEE : 11-2, 8/27/09
AYES: Kehoe, Cox, Corbett, Denham, Hancock, Leno, Oropeza,
Price, Wolk, Wyland, Yee
NOES: Runner, Walters
ASSEMBLY FLOOR : 78-0, 6/2/09 - See last page for vote
SUBJECT : Medi-Cal: alcohol and drug screening and brief
intervention
services
SOURCE : Author
DIGEST : This bill establishes a screening and brief
intervention services program within the Medi-Cal program,
to be administered by the Department of Health Care
Services, in collaboration with the Department of Alcohol
and Drug Programs, for the purpose of allowing local funds
to be used to secure federal matching funds for these
services.
CONTINUED
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ANALYSIS :
Existing federal law:
1. Establishes the Medicaid program, which provides basic
health care coverage for low-income individuals and
their families; pregnant women; elderly, blind, or
disabled persons; nursing home residents; and refugees
who meet specified eligibility criteria.
2. Requires states that participate in the Medicaid program
to offer certain benefits and allows states the option
of providing other specified benefits, including
substance abuse programs.
3. Provides that states can obtain Medicaid reimbursement
if they choose to offer screening and brief intervention
(SBI) in their Medicaid program.
Existing state law:
1. Establishes the Medi-Cal program, the state's version of
Medicaid, and provides that the program will be
administered by the Department of Health Care Services
(DHCS).
2. Names the Department of Alcohol and Drug Programs (DADP)
as the lead state agency for alcohol and drug programs
and establishes the Drug Medi-Cal program which is
administered by DADP.
3. Requires Drug Medi-Cal to provide defined modes of
treatment for Medi-Cal eligible persons with drug or
alcohol abuse problems.
This bill:
1. Establishes an alcohol and drug SBI program in Medi-Cal,
to be administered by DHCS, in consultation with DADP
for the purpose of making available alcohol and drug
screening and brief intervention services for Medi-Cal
beneficiaries who are pregnant women or women of
childbearing age.
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2. Makes specific findings concerning the benefits of the
SBI program and maximizing the use of federal funds.
3. Provides that participation in the screening and
intervention program shall be voluntary for a Medi-Cal
beneficiary and that the results shall be maintained in
the beneficiary's confidential medical records and
subject to all confidentiality requirements applicable
to medical records.
4. Defines "public entity" to mean a county, or other local
governmental entity designated by DHCS, that elects to
provide or contract for SBI services for Medi-Cal
beneficiaries pursuant to this bill.
5. Requires a public entity that participates in the
program to do all of the following:
A. Certify that the claimed expenditures for SBI
services for Medi-Cal beneficiaries are eligible for
federal financial participation (FFP).
B. Provide evidence supporting the certification, as
specified by DHCS.
C. Submit data, as specified by DHCS, to determine
the appropriate amounts to claim as expenditures
qualifying for FFP, and maintain records as specified
by DHCS and the federal Centers for Medicare and
Medicaid Services (CMS).
6. Requires DHCS to administer this bill in accordance with
the certified public expenditure requirements described
in applicable federal regulations.
7. Requires DHCS to seek any federal approvals necessary to
implement this bill.
8. Requires DHCS to submit claims for FFP, and submit, on
an annual basis, necessary materials to the federal
government, to provide assurances that claims for FFP
will include only those expenditures that are allowable
under federal law.
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9. Directs DHCS to develop an appropriate mechanism to
enable a public entity to pay the nonfederal share of
the cost of providing services under this bill.
10.Requires DHCS to pass the federal reimbursement on to
the claiming public entity.
11.Requires that the states share of the reimbursement
submitted to CMS for purposes of claiming FFP, must be
comprised of only those funds that are certified
expenditures by a public entity.
12.Directs a public entity that participates in the SBI
program to reimburse the state for any costs of creating
and administering the program.
13.Mandates that this bill would be implemented only if
federal funds are available.
14.Allows DHCS to implement this bill by means of all
county letters, provider bulletins, and similar
instructions.
Background
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. 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 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.
Fetal alcohol syndrome, caused by drinking during
pregnancy, is a major cause of developmental disabilities
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and birth defects in the United States and is completely
preventable. While the exact incidence is unknown, such
defects and disabilities are more common than Down's
syndrome or spina bifida and are the leading cause of
mental retardation, a specific developmental disability, as
defined by the American Psychiatric Association. While
prenatal alcohol exposure does not automatically result in
fetal alcohol syndrome, the United States Surgeon General
advises pregnant women to abstain from alcohol use due to
the risk of the syndrome.
Alcohol and other drug dependency is a treatable condition
and treatment is widely considered to save money by
combating the problems associated with substance abuse.
The benefit cost analysis done in conjunction with the
evaluation of the Substance Abuse and Crime Prevention Act
of 2000, which was Proposition 36 on the ballot, found
that, for every $1 invested in substance abuse treatment,
state and local governments have saved $2.50 from reduced
health costs, crime and other impacts. Other studies have
found that the per capita cost of treatment is
significantly less than the cost of incarceration.
According to the Institute of Medicine, the cost of
incarceration is approximately $40,000 per year, compared
to $12,500 and $3,100 for residential and outpatient
treatments, respectively. Despite the cost effectiveness
of substance abuse treatment programs, a substantial gap
exists between the number of people who need treatment and
the number who receive treatment.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
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
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SBI services as a unknown, but likely in the
millionsFederal/
Medi-Cal benefit Local
SUPPORT : (Verified 8/28/09)
American College of Obstetricians and Gynecologists,
District IX
California Medical Association
California State Association of Counties
Commission on the Status of Women
National Association of Social Workers
Santa Clara County Board of Supervisors
OPPOSITION : (Verified 8/28/09)
Department of Finance
ARGUMENTS IN SUPPORT : Supporters argue that effective
screening and intervention services are a vital tool that
can lower the risk of substance abuse during pregnancy and
prevent birth defects in infants and this measure would
allow counties to provide these services to Medi-Cal
beneficiaries by drawing down federal dollars to match
scarce county funds. They note that under existing law,
counties must provide the full cost of services and,
because of the cost factor, not all counties provide these
vital services to expectant mothers. Supporters argue that
accessing federal funds would provide more money to
counties to provide these programs and help mothers give
birth to healthy babies.
ARGUMENTS IN OPPOSITION : The Department of Finance
states:
"The Administration supports the concept of authorizing
the use of local funds to match federal funds for the
provision of alcohol and drug screening to individuals
that need such services. However, in order to implement
a cost effective program, it should be structured in a
way that targets the services only to those individuals
who reasonably have indications of substance abuse
problems. As drafted this bill would conflict with that
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approach.
"DHCS has raised an operational policy concern regarding
implementation of the program as envisioned. The
Medi-Cal payment system cannot be set up to ensure that
local funds support the program costs rather than state
General Fund. To the extent that the local funds were
set up as a General Fund revenue intended to offset
General Fund expenditures for Medi-Cal benefits, once the
services are authorized there is no practical way to
ensure that revenues fully support the costs of services
provided. Without such administrative safeguards, a
significant and unintended General Fund cost could
result."
ASSEMBLY FLOOR :
AYES: Adams, Ammiano, Anderson, Arambula, Beall, Tom
Berryhill, Blakeslee, Blumenfield, Brownley, Buchanan,
Caballero, Charles Calderon, Carter, Chesbro, Conway,
Cook, Coto, Davis, De La Torre, De Leon, DeVore, Duvall,
Emmerson, Eng, Evans, Feuer, Fletcher, Fong, Fuentes,
Fuller, Furutani, Gaines, Galgiani, Garrick, Gilmore,
Hagman, Hall, Harkey, Hayashi, Hernandez, Hill, Huber,
Huffman, Jeffries, Jones, Knight, Krekorian, Lieu, Logue,
Bonnie Lowenthal, Ma, Mendoza, Miller, Monning, Nava,
Nestande, Niello, Nielsen, John A. Perez, V. Manuel
Perez, Portantino, Price, Ruskin, Salas, Saldana, Silva,
Skinner, Smyth, Solorio, Audra Strickland, Swanson,
Torlakson, Torres, Torrico, Tran, Villines, Yamada, Bass
NO VOTE RECORDED: Bill Berryhill, Block
CTW/JJA:mw 8/28/09 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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