BILL ANALYSIS �
AB 540
Page 1
GOVERNOR'S VETO
AB 540 (Beall)
As Amended August 15, 2012
2/3 vote
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|ASSEMBLY: |78-0 |(May 31, 2011) |SENATE: |36-0 |(August 28, |
| | | | | |2012) |
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|ASSEMBLY: |80-0 |(August 29, | | | |
| | |2012) | | | |
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Original Committee Reference: HEALTH
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)Requires the Department of Health Care Services (DHCS), in
consultation with the State Department of Alcohol and Drug
Programs, to provide reimbursement under the Medi-Cal program
for 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 do all of the
following:
a) Create an appropriate mechanism to enable a public
entity to pay the nonfederal share of the cost of providing
services;
b) Submit claims for federal financial participation for
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the expenditures for the services as allowable under
federal law; and,
c) Establish standard billing codes and reimbursement
rates for the services, consistent with federal law.
3)Requires the SBI model to be the most medically appropriate
and within current standard of practice.
4)Requires the nonfederal share of expenditures submitted for
purposes of claiming federal financial participation (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 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 DHCS to seek all necessary federal approvals or
waivers as necessary.
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 and 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.
8)Prohibits General Funds (GF) from being used to implement.
9)Requires, as a condition of receiving FFP for certified public
expenditures, public entities to enter into and abide by an
agreement with DHCS regarding the implementation and
reimbursement of the costs to DHCS of administering this
program.
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 GF expenditures.
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11)Requires this bill to be implemented only to the extent
federal funds are available.
12)Makes legislative findings and declarations with regard to
SBI services for Medi-Cal beneficiaries and the value and
effectiveness of SBI for alcohol and drug abuse prevention,
interruption and treatment.
The Senate amendments are technical and clarifying.
AS PASSED BY THE ASSEMBLY , this bill was essentially similar to
the version as passed by the Senate.
FISCAL EFFECT : 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
dollarsFederal/*
utilization annually likely commencing in
Local
Potential future cost potentially significant, in the
Federal/**
avoidance millions of dollars annually
commencingGF/
after program implementation
Local
Cost pressure to potentially significant, likely in
theGeneral/***
pay private providers millions of dollars annually Federal
for SBI services
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*50% federal funds, 50% public entity funds
**Medi-Cal costs shared 50% federal funds, 50% non-federal funds
(either GF or local funds); Healthy Families Program costs
shared 65% federal funds, 35% GF.
***50% GF, 50% federal funds
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,
Centers for Medicare and Medicaid Services (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.
AB 1599 (Beall) of 2010, AB 217 (Beall) of 2009, and AB 2124
(Beall) of 2008 were substantially similar to this bill. AB
1599 and AB 2124 died on the Assembly and Senate Appropriations
Committees' respective suspense files. Governor Schwarzenegger
vetoed AB 217 stating, "?Clinical data shows that screening and
brief interventions reduce avoidable health problems associated
with alcohol and drug abuse, including emergency room
utilization as well as reducing substance use-related arrests
and traffic violations. Unfortunately, this bill contains
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several significant problems that prevent its implementation and
put the state General Fund at risk."
GOVERNOR'S VETO MESSAGE :
I commend the author for his efforts to mitigate the
risks of alcohol and drug use for pregnant women and
women of childbearing age in the Medi-Cal program.
The federal Patient Protection and Affordable Care Act
requires comprehensive health care coverage to be
provided in the private market and through public
programs. Rather than embarking on this piecemeal
effort, my administration will consider whether a more
comprehensive approach to screening - for all Medi-Cal
beneficiaries, including pregnant women and women of
childbearing age - is possible, as we implement the
changes that are necessary to comply with the
Affordable Care Act.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097
FN: 0005976