BILL ANALYSIS �
AB 1868
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Date of Hearing: March 25, 2014
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 1868 (Gomez) - As Introduced: February 19, 2014
SUBJECT : Medi-Cal: optional benefits: podiatric medicine.
SUMMARY : Allows specified podiatric services to be eligible for
reimbursement in Medi-Cal, if the services provided by a
podiatrist are services that would be considered physician
services if provided by a physician, as specified in law.
EXISTING LAW :
1)Establishes the Medicaid program (Medi-Cal in California) as a
joint federal-state program to provide health care services to
low-income families with children, seniors, and persons with
disabilities.
2)Establishes specified Medi-Cal benefits, some required by
federal law and other benefits which are optional under state
law.
3)Excludes podiatry as an optional benefit in Medi-Cal.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, podiatrists
perform physician services and have full medical staff,
admitting and surgical privileges in hospitals and surgery
centers. Eliminating coverage of services provided by
podiatrists is a false savings, saving very little money in
the short run but resulting in much more expensive
complications downstream. The author notes essential foot and
ankle services for Medi-Cal patients are now being provided at
a costlier rate, often by emergency room providers or being
delayed as patients attempt to find a provider eligible for
reimbursement under current Medi-Cal requirements. The author
argues recent studies show access to podiatrists can prevent
complications for patients and actually provide savings for
delivery systems.
AB 1868
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2)BACKGROUND . Medi-Cal is California's version of the federal
Medicaid program. States have the option of participating in
Medicaid and all states have chosen to participate. States
establish and administer their own Medicaid programs and
determine the type, amount, duration, and scope of services
within broad federal guidelines. States are required to cover
mandatory benefits, and can choose to provide optional
benefits through their Medicaid program. There are many
optional benefits, including adult dental, podiatry, and
prescription drugs.
Faced with a budget crisis in 2009, the Legislature and
Governor enacted a budget that limited some optional benefits
that had been covered under Medi-Cal, including adult dental,
podiatry, optometry, and chiropractic services. Dentists were
still allowed to provide services if the services could be
provided by a physician as physician services. Subsequent
federal approval of the reductions was required and obtained.
Litigation brought by rural health clinics resulted in
podiatry and other services being reinstated at rural clinics
and federally qualified health centers. Additionally, the
Legislature and Governor reinstated some adult dental services
in AB 82 (Committee on Budget), Chapter 23, Statutes of 2013,
the 2013-14 budget health trailer bill.
3)SUPPORT . The California Podiatric Medical Association (CPMA),
the sponsor of AB 1868, argues eliminating coverage of
services provided by podiatrists has resulted in much more
expensive complications down the road. This elimination of
podiatry removed Medicaid coverage by podiatrists, but not the
services themselves. They argue the same services provided by
a physician or surgeon are covered in Medi-Cal, but
podiatrists are prevented from providing these services in
California resulting in services being delivered at a costlier
rate. CPMA cites a study that found podiatric care of
diabetic patients results in significant savings and the
patients were less likely to experience a lower extremity
amputation. The study focused on diabetic ulcerations which
lead to lower extremity amputations for diabetics. CPMA notes
overall patients with diabetes were less likely to experience
a lower extremity amputation if a podiatrist was a member of
the patient care team.
Other supporters, the California Labor Federation and
AB 1868
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Teamsters, argue the state eliminated the optional benefit to
achieve savings, but there were no actual savings that
resulted from the action. They note podiatrists often provide
critical preventive care which forestalls the need for more
expensive services, including costly and disfiguring
amputations.
4)PREVIOUS LEGISLATION .
a) AB 5 X3 (Evans), Chapter 20, Statutes of 2009-10 Third
Extraordinary Session, eliminated specified optional
benefits, including dental and podiatry. Exempt from the
elimination medical and surgical services that may be
provided by a physician, regardless of whether the service
is actually provided by either a physician or dentist.
b) AB 82 among its other provisions, partially restored
adult dental services which allow preventive/diagnostic
services, restoration services (amalgams, composite and
stainless steel crowns), and full mouth dentures to be
eligible for reimbursement in Medi-Cal.
REGISTERED SUPPORT / OPPOSITION :
Support
California Podiatric Medical Association (sponsor)
California Labor Federation
California Teamsters Public Affairs Council
Opposition
None on file.
Analysis Prepared by : Roger Dunstan / HEALTH / (916) 319-2097