BILL ANALYSIS
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|SENATE RULES COMMITTEE | SB 1773|
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UNFINISHED BUSINESS
Bill No: SB 1773
Author: Alarcon (D)
Amended: 8/24/06
Vote: 21
SENATE HEALTH COMMITTEE : 5-2, 4/26/06
AYES: Ortiz, Alquist, Chesbro, Figueroa, Kuehl
NOES: Runner, Cox
NO VOTE RECORDED: Aanestad, Maldonado
SENATE PUBLIC SAFETY COMMITTEE : 4-0, 5/2/06
AYES: Migden, Cedollo, Perata, Romero
NO VOTES RECORDED: Poochigian, Margett
SENATE APPROPRIATIONS COMMITTEE : 7-5, 5/22/06
AYES: Murray, Alarcon, Alquist, Florez, Ortiz, Romero,
Torlakson
NOES: Aanestad, Ashburn, Battin, Dutton, Poochigian
NO VOTE RECORDED: Escutia
SENATE FLOOR : 24-11, 5/25/06
AYES: Alarcon, Alquist, Bowen, Cedillo, Chesbro, Dunn,
Figueroa, Florez, Kehoe, Kuehl, Lowenthal, Machado,
Margett, Migden, Murray, Ortiz, Perata, Romero, Scott,
Simitian, Soto, Speier, Torlakson, Vincent
NOES: Aanestad, Ackerman, Ashburn, Battin, Cox, Denham,
Dutton, Hollingsworth, McClintock, Morrow, Poochigian
NO VOTE RECORDED: Ducheny, Escutia, Maldonado, Runner,
Vacancy
ASSEMLBY FLOOR : Not available
CONTINUED
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SUBJECT : Fines and forfeitures
SOURCE : CA Chapter, American College of Emergency
Physicians
DIGEST : This bill authorizes counties to elect to levy
an additional two dollar for every $10 in base fines for
purposes of supporting emergency medical services, and
requires the additional assessment to be deposited in local
Maddy emergency medical services funds, with 15 percent to
be directed to pediatric trauma services and authorizes up
to 10 percent to be used for administrative expenses and
sunsets the provisions of this bill on January 1, 2009.
Assembly Amendments are technical and clarify the 15
percent Pediatric Funding portion of the bill.
Specifically, the amendments state the funds can be used
for Emergency Care services in hospitals up to the point of
stabilization, be provided to pediatric trauma patients at
trauma centers and other hospitals providing care to
pediatric trauma patients, and allow local emergency
medical services agencies to conduct a needs assessment of
pediatric trauma services in the county to allocate
expeditures.
ANALYSIS :
Existing Law
Government code allows counties to assess additional
charges on fines, penalties and forfeitures collected by
courts for certain criminal and vehicle code violation to
provide Maddy Revenues for the purpose of funding County
EMS Funds.
Health and Safety code:
1.Establishes the Emergency Medical Services Authority
within the California Health and Human Services Agency to
provide statewide coordination of local county EMS
programs.
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2.Authorizes counties to establish Maddy EMS funds to
reimburse health care providers for emergency services
provided to people who cannot afford to pay for emergency
care.
3.Provides that funds collected under the Maddy Emergency
Medical Services Act of 1987 shall be used to reimburse
physicians and surgeons for losses incurred for services
provided to patients.
4.Authorizes a county to use 10 percent of the EMS Fund
for administration costs.
5.Allows for counties to maintain a reserve of up to 15
percent.
6.Provides for reimbursement of physicians and surgeons
from the EMS Fund for up to 50 percent of the amount
claimed and allows additional proportional reimbursement
to physicians and surgeons of all funds remaining at the
end of the fiscal year in excess of certain reserves.
7.Requires a county to adopt a fee schedule to establish a
uniform, reasonable, level of reimbursement from the
physician services account for reimbursable services.
8.Requires the administering agency to establish
procedures and time schedules for submission and
processing of reimbursement claims from the EMS Fund
submitted by physicians in accordance with these
provisions and requires that schedules for payment
provide for periodic disbursement of the funds to
physicians, at least quarterly.
9.Authorizes payments from the EMS Fund for un-reimbursed
emergency medical services performed on the calendar day
on which the services are first performed and the
immediately following two calendar days.
This bill:
1.Authorizes, for purposes of supporting EMS, as
specified, a county board of supervisors to elect to levy
an additional penalty of two dollar for every $10 or
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fraction thereof, which is to be collected together with
and in the same manner as existing assessments, as
specified, upon every fine, penalty, or forfeiture
imposed and collected by the courts for certain criminal
and vehicle code violations.
2.Requires funds to be collected pursuant to #1) above
only if the county board of supervisors provides that the
increased penalties do not offset or reduce the funding
of other programs from other sources, but that these
additional revenues result in increased funding to those
programs, and be deposited into the Maddy EMS Fund, as
specified.
3.Requires 15 percent of the money deposited in the Maddy
EMS Fund pursuant to #1) above to be used to provide
funding for publicly and privately owned and operated
pediatric trauma centers through out the county. Limits
expenditure of this money to reimbursement to physicians
and surgeons, hospitals for patients who do not make
payment for emergency care services in hospitals up to
the point of stabilization, or for expanding the services
provided to pediatric trauma patients at trauma centers
and other hospitals providing care to pediatric trauma
patients at trauma centers and other hospitals providing
care to pediatric trauma patients, or pediatric trauma
centers, including the purchase of equipment.
4.Authorizes local emergency medical services agencies to
conduct a needs assessment of pediatric trauma services
in the county to allocate these expenditures.
5.Requires counties that do not maintain pediatric trauma
centers to use the pediatric trauma money deposited into
the Maddy EMS Fund to improve access to and coordination
of pediatric trauma and emergency services in the county,
with preference for funding given to hospitals that
specialize in services to children, and physicians and
surgeons who provide emergency care for children. Refers
to funds spent for these purposes to be known as
"Richie's Fund."
6.Requires costs of administering money deposited into the
Maddy EMS Fund pursuant to #3) above to be reimbursed
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from the money collected, not to exceed 10 percent.
Background
Maddy EMS Funds . In 1987, the Legislature concluded that
the emergency medical service providers bore higher costs
for their services than did providers of other medical
services but often received only partial or no payment from
patients. To address this, the state enacted a series of
laws providing revenues to compensate physicians and
medical facilities for emergency services provided to
patients who do not have health insurance and cannot pay
for their medical care.
The first of these laws, Chapter 1240, Statutes of 1987,
authored by Senator Ken Maddy allows counties to establish
Emergency Medical Services Funds (EMS Funds).
As of November 2003, 49 counties had established EMS funds.
Counties finance these funds through several revenue
sources: (1) penalty assessments on certain criminal and
traffic violations, known as Maddy revenues; (2) a portion
of the fees from people attending traffic violator schools;
(3) revenues from taxes on tobacco products deposited in
the State's Cigarette and Tobacco Products Surtax Fund; and
(4) redirected money from the State's Cigarette and Tobacco
Products Surtax Fund through an annual Emergency Medical
Services Appropriation.
Counties must use Maddy revenues as follows: 10 percent
may be used for administration; 58 percent is allocated to
an account for physicians who provide emergency medical
services and are not employed in county hospitals, 25
percent to an account for hospitals that provide for a
larger share of a county's trauma and emergency care
services, and 17 percent to an account for discretionary
emergency medical services as determined by the county.
Physicians can receive reimbursement for up to 50 percent
of their claims, whereas hospital and discretionary costs
can be reimbursed up to 100 percent.
Previous legislation:
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SB 57 (Alarcon), of 2005 , would have authorized counties to
collect an additional two dollar penalty assessment for
every $10 in base fines for purposes of providing payment
for emergency medical services. Required revenue generated
from the assessment to be deposited into the Maddy EMS
Fund, with 15 percent designated for pediatric trauma
centers, and allows for up to10 percent to be used for
administrative costs. This bill was vetoed by the
Governor.
FISCAL EFFECT : Appropriation: No Fiscal Com.: No
Local: No
According to the Assembly Appropriations Committee:
1.Increased revenue for emergency medical services for the
duration of this bill, depending upon county decisions
and the amounts collected, potentially in the tens of
millions of dollars annually, to the extent that judges
do not reduce base fines and offenders do not opt for
jail time in lieu of the increased fines. Based on state
revenue amounts received from existing penalty
assessments, if all counties levied a two dollar
increase, their total additional revenue would be
approximately $45 million.
2.Indeterminate state revenue loss, potentially in excess
of $150,000 General Fund (GF), to the extent that
offenders elect jail time or community service in lieu of
paying increased fines, or if judges use their discretion
to reduce base fines as a result of the penalty
assessment increase authorized by this bill. Either of
these scenarios would affect existing state entities
funded through state penalty assessments. Data regarding
the extent to which judges use their discretion to reduce
base fines and the number of offenders who serve jail
time or perform community service in lieu of paying fines
is not collected by the state, so the extent of state
revenue loss resulting from a local penalty assessment
increase is difficult to estimate. However, because the
state received $231 million in state penalty assessment
revenue on a cash basis in
2004-05, a small percentage decrease of .5 percent in
state penalty assessment revenue would result in a state
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revenue loss of $1.2 million. This bill requires that
funds be collected under this bill only if the county
board of supervisors provides that the increased
penalties do not offset or reduce the funding of other
programs from other sources, and that these additional
revenues result in increased funding to those programs.
3.One-time non-reimbursable minor increased General Fund
costs (Trial Court Trust Fund) to counties electing to
implement an additional penalty assessment for accounting
and programming changes, staff training, and revisions to
forms.
SUPPORT : (Verified 8/28/06)
California Chapter, American College of Emergency
Physicians (source)
American College of Physicians - CA Chapters
California Children's Hospital Association (CCHA)
California Emergency Nurses Association - California State
Council
California Hospital Association
California Medical Association
California Nurses Association
Emergency Medical Services Administrators' Association of
California League of California Cities
Los Angeles County Board of Supervisors
Peace Officers Research Association of California
Physician Reimbursement Advisory Committee (PRAC)
University of California
OPPOSITION : (Verified 8/28/06)
California Department of Finance
California Labor Federation, AFL-CIO
California Teamsters Public Affairs Council
Commission on Peace Officer Standards and Training
ARGUMENTS IN SUPPORT : According to the sponsor, this
bill could potentially raise $50 million to be used to
reimburse physicians and surgeons for care given to
uninsured patients. The sponsor states that the Maddy EMS
Fund is one of the primary mechanisms to reimburse
physicians and surgeons for treating uninsured patients.
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The sponsor asserts that counties throughout California
have only been able to reimburse physicians a fraction of
the dollar amount of the claims submitted by physicians for
treating uninsured patients. The sponsor states that as
the number of uninsured grows to over 6 million people
statewide the losses sustained in emergency departments
continue to grow. According to the sponsor, in 2004 the
California Medical Association reported that over the past
decade more that 65 emergency rooms have closed that the
losses sustained by hospitals and physicians for the year
2001-2002 was over $635 million. The author's office,
argues that as the losses continue to grow, the Maddy EMS
Fund becomes even more vital. According to the sponsor,
although the passage of this bill will not fix the entire
emergency care crisis, it does help prevent the already
fragile emergency care system from sustaining further
deterioration.
ARGUMENTS IN OPPOSITION : According to the opposition,
there is no question that emergency rooms are facing a
myriad problems and are suffering the effects of an
underfunded healthcare system. They argue that this is a
public crisis deserving of a broad solution. The
California Teamsters Public Affairs Council and the
California Labor Federation argue that, unfortunately, this
bill represents a tiny band aid that will have little
impact on the overall problem but have a significant
negative impact on the group the bill targets for what can
only be characterized as a tax on our members and every
other working driver in this state.
The opposition continues by stating that they have become
increasingly concerned over the high level of fines for
infractions. They argue that the fines have been on a
steady rise in recent years and their view is that they
have reached their saturation point. According to the
opposition, just a few years ago, the Legislature increased
fines across the board 20 percent. The opposition asserts
that this coupled with high insurance rates and the fact
that their members are no longer permitted to attend
traffic school under a recently enacted measure, make
further increase in fines and penalties difficult to take.
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CTW:do 8/28/06 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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