BILL ANALYSIS
AB 217
Page 1
GOVERNOR'S VETO
AB 217 (Beall)
As Amended June 1, 2009
2/3 vote
HEALTH 19-0 APPROPRIATIONS 17-0
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| |Jones, Fletcher, Adams, |Ayes:|De Leon, Nielsen, |
| |Ammiano, Block, Carter, | |Ammiano, |
| |Conway, De La Torre, De | |Charles Calderon, Davis, |
| |Leon, Emmerson, Gaines, | |Duvall, Fuentes, Hall, |
|Ayes:|Hall, Hayashi, Hernandez, | |Harkey, Miller, |
| | | |John A. Perez, Price, |
| |Bonnie Lowenthal, Nava, | |Skinner, Solorio, Audra |
| |V. Manuel Perez, Salas, | |Strickland, Torlakson, |
| |Audra Strickland | |Krekorian |
| | | | |
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|ASSEMBLY: |78-0 |(June 2, 2009) |SENATE: |28-4 |(September 2, |
| | | | | |2009) |
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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,
to administer the Program for the purpose of increasing the
state's ability to make available alcohol and drug screening and
brief intervention (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
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requirements described in federal regulations, or any successor
thereto, in certifying that the claimed expenditures for alcohol
and drug screening and brief intervention services for Medi-Cal
beneficiaries are eligible for federal financial participation
(FFP).
3)Requires the nonfederal share of expenditures submitted to
federal Centers for Medicare and Medicaid Services (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. Requires a
public entity that participates in the Program, upon receiving
FFP for CPEs made for alcohol and drug screening and brief
intervention services, reimburse the state for any costs of
creating and administering the Program. Implements this bill
only if, and to the extent that, federal funds are available for
this purpose.
4)Requires DHCS to take specified actions in administering this
bill, and 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.
5)Requires participation in the Program to be voluntary for a
Medi-Cal beneficiary, and 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.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, General Fund (GF) cost pressure of under $150,000 (50%
GF) to the DHCS to develop and manage a federal waiver to qualify
local SBI expenditures for matched funding. Annual on-going cost
pressure to manage the waiver and related approval of CPEs of less
than $50,000 (50% GF). On-going actual costs could be less
depending on how many counties take advantage of the federal
funding opportunity created by this bill.
COMMENTS : According to the author, fetal alcohol syndrome is one
of the leading known preventable causes of birth defects and
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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, SBI 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 those
services. The author states an evaluation of 20 counties found a
definitive decline in substance abuse rates during pregnancy and
low birth weights.
GOVERNOR'S VETO MESSAGE :
The author and I share the goal to improve alcohol, drug
screening and brief intervention services in the
Medi-Cal population. In fact, I proposed to include
screening and brief intervention services in my 2008 May
Revision. While this proposal was ultimately rejected, I
appreciate the author's continued efforts to include
this important service in our state's Medicaid program.
Clinical data shows that screening and brief
interventions reduce avoidable health problems
associated with alcohol and drug abuse, including
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emergency room utilization as well as reducing substance
use-related arrests and traffic violations.
Unfortunately, this bill contains several significant
problems that prevent its implementation and put the
state General Fund at risk.
I would urge the author to work with my Administration
to secure a feasible proposal in next year's budget
process.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916) 319-2097
FN: 0003408