BILL ANALYSIS �
Senate Appropriations Committee Fiscal Summary
Senator Kevin de Le�n, Chair
SB 973 (Hernandez) - Narcotic treatment programs.
Amended: April 29, 2014 Policy Vote: Health 8-0
Urgency: No Mandate: No
Hearing Date: May 12, 2014 Consultant: Brendan McCarthy
This bill does not meet the criteria for referral to the
Suspense File.
Bill Summary: SB 973 would make several changes to the statutes
governing narcotic treatment programs.
Fiscal Impact:
Potential one-time costs up to $50,000 to revise existing
regulations by the Department of Health Care Services
(General Fund and federal funds).
Unknown impact on county Drug Medi-Cal programs (local
realignment funds). The bill would allow a narcotic
treatment program to admit a Medi-Cal beneficiary at the
medical director's discretion, rather than seven days after
completion of a withdrawal treatment episode. This change to
law may have the effect of increasing demand for services
from narcotic treatment programs. The extent of such a
change in demand is unknown.
Under current law, narcotic treatment programs provide drug
treatment services to Medi-Cal beneficiaries. Drug Medi-Cal
was realigned to the counties in 2011 and the non-federal
share of costs to provide Drug Medi-Cal benefits is
generally paid by the counties from their realignment funds.
Thus any additional costs to the Drug Medi-Cal program would
likely be borne by the counties.
Background: Under state and federal law, the Department of
Health Care Services operates the Medi-Cal program, which
provides health care coverage to pregnant women, children and
their parents with low incomes, as well as blind, disabled, and
certain other populations. Generally, the federal government
provides a 50 percent federal match for state expenditures.
SB 973 (Hernandez)
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Pursuant to the federal Affordable Care Act, California has
opted to expand eligibility for Medi-Cal up to 138 percent of
the federal poverty level and to include childless adults. The
Affordable Care Act provides a significantly enhanced federal
match for the Medi-Cal expansion. Under the law, the federal
government will pay for 100 percent of the cost of the expansion
in 2013-14 declining to a 90 percent federal match in the 2020
federal fiscal year and thereafter.
With the exception of certain populations (for example,
individuals eligible for limited scope Medi-Cal benefits or
individuals dually eligible for Medi-Cal and Medicare in most
counties), managed care is the primary system for providing
Medi-Cal benefits. The Department estimates that in 2014-15, 7.5
million Medi-Cal beneficiaries (73 percent of total enrollment)
will receive care through the managed care system. However, Drug
Medi-Cal, which is the package of benefits related to substance
use disorders has been "carved out" of managed care. Drug
Medi-Cal is a benefit provided by the counties generally using
realignment funds.
Proposed Law: SB 973 would make several changes to the statutes
governing narcotic treatment programs.
Specific provisions of the bill would:
Require narcotic treatment programs to test a patient's
urine or other body fluid for specified narcotic drugs;
Authorize a narcotic treatment program to admit a patient
at the discretion of the medical director, rather than seven
days after completion of a prior withdrawal treatment
episode;
Prohibit narcotic treatment programs from providing
take-home medication doses that require dilution;
Require narcotic treatment programs to assign a unique
identification number to patients;
Make other clarifying and technical changes.
Staff Comments: As noted above, Drug Medi-Cal has been realigned
to the counties. Therefore, counties are responsible for paying
the non-federal share of Medi-Cal costs for services authorized
in Drug Medi-Cal. However, as part of the state's expansion of
Medi-Cal under the federal Affordable Care Act, the state also
expanded the Medi-Cal benefit package to include benefits
provided in the state's essential health benefits benchmark plan
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(the Kaiser Permanente Small Group Plan). In doing so, the state
expanded Drug Medi-Cal to include some new benefits. For new or
expanded Drug Medi-Cal benefits, the state is responsible for
paying for the non-federal share of costs, whereas the counties
will continue to be responsible for paying the non-federal share
of costs for existing benefits. Because this bill makes changes
to a benefit that continues to be a county Drug Medi-Cal
responsibility, the state is not obligated to provide the
non-federal cost share.
Pursuant to Government Code Section 30026.5, legislation enacted
after September 30, 2012, that has an overall effect of
increasing the costs already borne by a local agency for
programs or levels of service under the 2011 Realignment shall
apply to local agencies only to the extent that the state
provides annual funding for the cost increase. Local agencies
shall not be obligated to provide programs or levels of service
required by legislation above the level for which funding has
been provided.