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AB-2043 Medi-Cal: nonmedical and nonemergency medical transportation.(2023-2024)

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Date Published: 04/01/2024 02:00 PM
AB2043:v98#DOCUMENT

Amended  IN  Assembly  April 01, 2024

CALIFORNIA LEGISLATURE— 2023–2024 REGULAR SESSION

Assembly Bill
No. 2043

Introduced by Assembly Member Boerner

February 01, 2024

An act to add Section 14197.06 to the Welfare and Institutions Code, relating to Medi-Cal.


LEGISLATIVE COUNSEL'S DIGEST


AB 2043, as amended, Boerner. Medi-Cal: nonmedical and nonemergency medical transportation.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services, through managed care or fee-for-service delivery systems. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions. Existing law covers emergency or nonemergency medical transportation, and nonmedical transportation, under the Medi-Cal program, as specified.
This bill would require the department to require Medi-Cal managed care plans that are contracted to provide nonemergency medical transportation or nonmedical transportation to contract with public paratransit service operators who are enrolled Medi-Cal providers, for the purpose of establishing reimbursement rates for those transportation trips provided by a public paratransit service operator. The bill would require that the rates be based on the department’s fee-for-service rates for the transportation service, as specified. ensure that the fiscal burden of nonemergency medical transportation or nonmedical transportation is not unfairly placed on public paratransit service operators and would authorize the department to direct Medi-Cal managed care plans to reimburse public paratransit service operators who are enrolled as Medi-Cal providers at the fee-for-service rates for conducting that transportation, as described. The bill would require the department to engage with public paratransit service operators to understand the challenges as public operators of nonemergency medical transportation or nonmedical transportation services and would require the department to issue new guidance to ensure the fiscal burden is not unfairly placed on public operators on or before June 1, 2026.
The bill would condition implementation of these provisions on receipt of any necessary federal approvals and the availability of federal financial participation.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 The Legislature finds and declares all of the following:
(a) Public transportation is an essential service for the benefit of the total transportation system of the state, including, but not limited to, the elderly, the disabled, and citizens of limited means.
(b) Public transit agencies that provide fixed route services are required under the federal Americans with Disabilities Act of 1990 to provide complementary paratransit services to people with disabilities when these individuals cannot use the fixed route bus or rail service because of their disability. Complementary paratransit services are highly subsidized by public transportation agencies for the public benefit of eligible riders. Public transit agencies are required to accept all eligible riders and are enjoined from turning away customers, making public transit agencies unique when compared to private transportation providers and putting a public transit agency at a unique structural disadvantage as a party to a contract negotiation with managed care plans.
(c) Public transit agencies are often utilized for Medi-Cal transportation services and recognized as one of the least costly options.
(d) Prior to the requirement for Medi-Cal managed care plans to cover transportation for their members, eligible public transit agencies were able to seek partial reimbursement for Medi-Cal covered nonemergency medical transportation and nonmedical transportation trips. Subsequent to this change, transportation funding is now provided directly to a Medi-Cal managed care plan for the purpose of covering transportation costs for its Medi-Cal members.
(e) The fostering, continuance, and development of public transportation systems, including ensuring the fiscal burden of transporting Medicaid beneficiaries is not unfairly placed on public paratransit services, is a matter of state concern.
(f) The federal Centers for Medicare and Medicaid Services publication, the Medicaid Transportation Coverage Guide, issued all of the following guidance through State Medicaid Director letter number 23-006:
(1) State departments of transportation and Medicaid agencies should explore partnerships to better serve the Medicaid population, including considering how public providers and Medicaid agencies can work together to understand transit and Medicaid policies and definitions.
(2) States should ensure that the fiscal burden of transporting Medicaid beneficiaries is not unfairly placed on paratransit services.
(3) Recognizing the higher costs of operating a paratransit system, Medicaid may pay more than the rate charged to individuals with disabilities for a paratransit ride.
(g) The rate charged to individuals with disabilities for a paratransit ride is both of the following:
(1) Not equal to and does not cover the cost of providing the paratransit services.
(2) A subsidized rate designed to make the ride accessible to a public rider paying directly for the service.

SECTION 1.SEC. 2.

 Section 14197.06 is added to the Welfare and Institutions Code, to read:

14197.06.
 (a) The department shall require Medi-Cal managed care plans that are contracted to provide ensure that the fiscal burden of transporting beneficiaries via nonemergency medical transportation or nonmedical transportation pursuant to Section 14132 to contract with public paratransit service operators who are enrolled Medi-Cal providers, for the purpose of establishing reimbursement rates for nonemergency medical transportation and nonmedical transportation trips provided by a public paratransit service operator. is not unfairly placed on public paratransit service operators.

(b)Notwithstanding any other law, rates reimbursed by the managed care plan to the public paratransit service operator shall be based on

(b) (1) The department may ensure compliance with subdivision (a) by directing Medi-Cal managed care plans to reimburse public paratransit service operators who are enrolled as Medi-Cal providers at the department’s fee-for-service rates for conducting nonemergency medical transportation or nonmedical transportation service that does for trips that do not include fixed-route transportation service. The Legislature finds and declares that the reimbursement of the passenger’s fare does not equal the fee-for-service rate.
(2) This subdivision does not address reimbursement for fixed-route transportation service.
(c) The department shall engage with public paratransit service operators to understand the unique challenges as public operators of nonemergency medical transportation or nonmedical transportation services. On or before June 1, 2026, the department shall provide updated guidance that ensures the fiscal burden of transporting beneficiaries is not unfairly placed on public paratransit service operators, as described in subdivision (a).

(c)

(d) This section shall be implemented only to the extent that any necessary federal approvals are obtained and federal financial participation is available and not otherwise jeopardized.