BILL ANALYSIS �
AB 1868
Page 1
ASSEMBLY THIRD READING
AB 1868 (Gomez)
As Introduced February 19, 2014
Majority vote
HEALTH 18-0 APPROPRIATIONS 14-0
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|Ayes:|Pan, Maienschein, |Ayes:|Gatto, Bocanegra, |
| |Ammiano, Atkins, Bonilla, | |Bradford, |
| |Gordon, Ch�vez, Chesbro, | |Ian Calderon, Campos, |
| |Gomez, Gonzalez, Roger | |Eggman, Gomez, Holden, |
| |Hern�ndez, Nazarian, | |Linder, Pan, Quirk, |
| |Nestande, Patterson, | |Ridley-Thomas, Wagner, |
| |Ridley-Thomas, Wagner, | |Weber |
| |Wieckowski, Skinner | | |
|-----+--------------------------+-----+--------------------------|
| | | | |
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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.
FISCAL EFFECT : According to the Assembly Appropriations
Committee, potential increased Medi-Cal costs of up to $1.2
million (nearly 50% General Fund, remainder federal funds). Any
reimbursement to podiatrists authorized under this bill are for
services already covered if provided by a physician; therefore,
increased costs would be attributed to higher utilization of
covered services.
COMMENTS : 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
AB 1868
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actually provide savings for delivery systems.
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 (Budget Committee), Chapter
23, Statutes of 2013, the 2013-14 budget health trailer bill.
The California Podiatric Medical Association (CPMA), the sponsor
of this bill, 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 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 Teamsters,
argue the state eliminated the optional benefit to achieve
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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.
There is no known opposition to this bill.
Analysis Prepared by : Roger Dunstan / HEALTH / (916) 319-2097
FN: 0003767