BILL ANALYSIS �
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|SENATE RULES COMMITTEE | AB 540|
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THIRD READING
Bill No: AB 540
Author: Beall (D), et al.
Amended: 8/15/11 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 9-0, 07/06/11
AYES: Hernandez, Strickland, Alquist, Anderson, Blakeslee,
De Le�n, DeSaulnier, Rubio, Wolk
ASSEMBLY FLOOR : 78-0, 05/31/11 - See last page for vote
SUBJECT : Medi-Cal: alcohol and drug screening and brief
intervention
services
SOURCE : County Alcohol and Drug Program Administrators
Association of California
DIGEST : This bill requires the Department of Health Care
Services (DHCS), in consultation with the Department of
Alcohol and Drug Programs (DADP), to provide reimbursement
under the Medi-Cal program for alcohol and drug screening
and brief intervention services for pregnant women or women
of childbearing age.
ANALYSIS : Existing law establishes the Medi-Cal program,
which is administered by DHCS, under which qualified
low-income individuals receive health care services. The
Medi-Cal program is, in part, governed and funded by
federal Medicaid program provisions.
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This bill requires DHCS, in consultation with DADP, to
provide reimbursement to providers of alcohol and drug
screening and brief intervention (SBI) services to Medi-Cal
beneficiaries who are pregnant or women of childbearing
age.
This bill specifies that DHCS, in implementing these
provisions, would be required to create an appropriate
mechanism to enable a public entity, defined as a county or
other local governmental entity designated by the
department that elects to provide or contract for SBI
services, to pay the non-federal share of the cost of
providing services, to seek all necessary federal approvals
in order to implement these provisions, seek federal
financial participation for all allowable expenditures
matched by public entity funding, and establish standards,
billing codes, and reimbursement rates for SBI services.
Federal financial participation would be required to be
remitted by DHCS to the public entity that submitted the
claim.
This bill specifies that General Fund monies would be
prohibited from being used to implement these provisions
and that this bill would be implemented only to the extent
federal financial participation is available. Any public
entity that elects to participate in this program would be
required to reimburse the state for any costs of creating
and administering these provisions. DHCS would likely need
start-up funding of $100,000 in the first year to seek
federal approval and to develop reimbursement rates.
Ongoing costs would likely be about $50,000 annually. All
costs would be shared 50 percent public entity funds and 50
percent federal funds. It is unknown to what extent DADP
would be needed to consult with DHCS on matters related to
this bill. Costs would likely be minor and absorbable.
Background
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 interventions
(15 to 30 minutes), and longer structured interventions
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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. In 2008, Medicare also
created parallel codes to allow for similar services to
persons over 65. Medicare does not cover "screening" so
the Medicare billing codes focus on "assessment."
According to a 2008 report funded by the Department of
Public Health (DPH), Maternal, Child and Adolescent Health
(MCAH) Program entitled, "Perinatal Substance Use Screening
in California: Screening and Assessment with the 4P's Plus
Screen for Substance Use in Pregnancy," published by NTI
Upstream (MCAH Report), 16 California counties have
established a comprehensive system of screening,
assessment, and brief intervention in pregnant women. The
MCAH Report is based on data provided by these counties and
the almost 80,000 screenings on pregnant women they
collected.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2011-12 2012-13
2013-14 Fund
DHCS start-up $50 $75 $50
Federal/*
administrative costs
Local
SBI services
potentially in the millions of dollars
Federal/*
utilization annually likely
commencing in Local
FY 2012-2013
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Potential future cost
potentially significant, in the
Federal/**
avoidance
millions of dollars annually commencing
General/
after program implementation
Local
Cost pressure to
potentially significant, likely in the
General/***
pay private providers millions
of dollars annually
Federal
for SBI services
*50 percent federal funds, 50 percent public entity
funds
**Medi-Cal costs shared 50 percent federal funds, 50
percent non-federal funds (either General Fund or local
funds); Healthy Families Program costs shared 65
percent federal funds, 35 percent General Fund.
***50 percent General Fund, 50 percent federal funds
SUPPORT : (Verified 8/22/12)
County Alcohol and Drug Program Administrators' Association
of
California (source)
American Congress of Obstetricians and Gynecologists -
District IX
California Association of Alcohol and Drug Program
Executives, Inc.
California Commission on the Status of Women
California Communities United Institute
California Council of Community Mental Health Agencies
California Maternal, Child and Adolescent Health Directors
California Medical Association
California Nurses Association
California Psychiatric Association
California Society of Addiction Medicine
California State Associations of Counties
California State Parent-Teacher Association
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City and County of San Francisco
County of Sacramento
County of San Diego
County of Santa Cruz - Health Services Agency
First 5 Association of California
First 5 Los Angeles
First 5 Santa Clara County
Little Hoover Commission
March of Dimes Foundation
Mental Health Association in California
National Association of Social Workers
National Nurses Organizing Committee
Santa Clara County Board of Supervisors
Santa Cruz County Perinatal Council on Substance Abuse and
Families
The Arc California and United Cerebral Policy in California
Urban Counties Caucus
ARGUMENTS IN SUPPORT : The California Psychiatric
Association (CPA) argues that the 2008 study conducted by
Kaiser demonstrates the effectiveness of this model. CPA
further states in support that SBI services would be a
valuable addition to the health care safety net and is the
right thing to do. Santa Clara County states that,
although the state has not tapped federal revenues for
these services, many counties provide them for pregnant
women and adversely affected children and bear the full
cost. According to Santa Clara County, this bill
establishes a voluntary program that allows counties to
provide the nonfederal share of cost and obtain a
one-for-one match.
ASSEMBLY FLOOR : 78-0, 05/31/11
AYES: Achadjian, Alejo, Allen, Ammiano, Atkins, Beall,
Bill Berryhill, Block, Blumenfield, Bonilla, Bradford,
Brownley, Buchanan, Butler, Campos, Carter, Cedillo,
Chesbro, Conway, Cook, Davis, Dickinson, Donnelly, Eng,
Feuer, Fletcher, Fong, Fuentes, Furutani, Beth Gaines,
Galgiani, Garrick, Gatto, Gordon, Grove, Hagman,
Halderman, Hall, Harkey, Hayashi, Roger Hern�ndez, Hill,
Huber, Hueso, Huffman, Jeffries, Jones, Knight, Lara,
Logue, Bonnie Lowenthal, Ma, Mansoor, Mendoza, Miller,
Mitchell, Monning, Morrell, Nestande, Nielsen, Norby,
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Olsen, Pan, Perea, V. Manuel P�rez, Portantino, Silva,
Skinner, Smyth, Solorio, Swanson, Torres, Valadao,
Wagner, Wieckowski, Williams, Yamada, John A. P�rez
NO VOTE RECORDED: Charles Calderon, Gorell
CTW:n 8/23/12 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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