BILL ANALYSIS �
AB 540
Page 1
ASSEMBLY THIRD READING
AB 540 (Beall)
As Amended April 7, 2011
Majority vote
HEALTH 17-0 APPROPRIATIONS 17-0
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|Ayes:|Monning, Logue, Ammiano, |Ayes:|Fuentes, Harkey, |
| |Atkins, Bonilla, Eng, | |Blumenfield, Bradford, |
| |Garrick, Hayashi, Roger | |Charles Calderon, Campos, |
| |Hern�ndez, Bonnie | |Davis, Donnelly, Gatto, |
| |Lowenthal, Mansoor, | |Hall, Hill, Lara, |
| |Mitchell, Nestande, Pan, | |Mitchell, Nielsen, Norby, |
| |Silva, Knight, Williams | |Solorio, Wagner |
| | | | |
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SUMMARY : Establishes the Medi-Cal Alcohol and Drug Screening
and Brief Intervention (SBI) Services 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.
Specifically, this bill :
1)Authorizes the Department of Health Care Services (DHCS), in
consultation with the State Department of Alcohol and Drug
Programs, to establish alcohol and drug SBI services for
Medi-Cal beneficiaries who are pregnant women or women of
child bearing age in the Medi-Cal Program.
2)Requires DHCS, in implementing SBI, to create an appropriate
mechanism to enable a public entity to pay the nonfederal
share of the cost of providing services, to submit claims for
federal financial participation (FFP) for the expenditures for
the services as allowable under federal law, and to establish
standard billing codes, and reimbursement rates for the
services.
3)Requires the SBI model to be based on the most medically
appropriate and within current standards of practice.
4)Requires the nonfederal share of expenditures submitted to
Centers for Medicare and Medicaid Services (CMS) for purposes
of claiming FFP to be comprised of only those funds that are
AB 540
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paid by a public entity (county or other local governmental
entity) and certified in accordance with this bill.
5)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.
6)Permits DHCS to implement this bill by means of all county
letters, provider bulletins, and similar instructions.
7)Requires participation in the SBI Program to be voluntary for
a Medi-Cal beneficiary.
8)Requires participation in the SBI 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.
9)Requires all participating public entities to enter into and
abide by an agreement with DHCS regarding the implementation
and reimbursement of the costs to DHCS.
10)States legislative intent of this bill to provide alcohol and
drug SBI services to Medi-Cal beneficiaries who are pregnant
or who are women of childbearing age without General Fund (GF)
expenditures.
11)Requires this bill to be implemented only to the extent
federal funds are available.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)One-time state costs of $200,000 to $300,000 to DHCS to
develop and manage a federal waiver to qualify local SBI
expenditures for matched funding. On-going state costs in the
range of $50,000.
2)This bill indicates that participating counties would
reimburse the state for costs associated with the program, but
it is unclear the workload to garner federal support and
document local expenditures can be accomplished without an
initial GF investment.
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3)Potentially significant savings to the extent SBI reduces or
prevents substance abuse or results in improved birth
outcomes.
COMMENTS : 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. The
author states, citing the U.S. Centers for Disease Control and
Prevention, that approximately one in 12 pregnant women admit to
consuming alcohol and one in 30 pregnant women said they had
engaged in binge drinking. The author argues that effective
prevention, intervention, and screening such as the SBI services
provided can reduce the incidence of exposed infants while
significantly reducing long term health care costs. Despite
evidence of the benefits, the author continues, SBIs have not
yet been widely used in primary care settings, emergency rooms,
state licensed facilities and clinics. Effective January 2007,
CMS approved new billing codes to allow Medicaid reimbursement
for SBI services. Specifically, states may add as an optional
Medi-Cal benefit, alcohol and/or substance abuse, brief
intervention (15 to 30 minutes), and a longer structured
intervention distinct from other clinic and emergency department
visit services performed during the same encounter. According
to the author, due to the absence of state action, 20 counties
have chosen to begin their own county-funded prenatal SBI
programs. This bill would allow counties to obtain federal
matching funds for these services.
Analysis Prepared by: Marjorie Swartz / HEALTH / (916)
319-2097
FN: 0000991