BILL NUMBER: AB 2173	ENROLLED
	BILL TEXT

	PASSED THE SENATE  AUGUST 24, 2010
	PASSED THE ASSEMBLY  AUGUST 25, 2010
	AMENDED IN SENATE  AUGUST 20, 2010
	AMENDED IN SENATE  AUGUST 17, 2010
	AMENDED IN SENATE  JULY 15, 2010
	AMENDED IN ASSEMBLY  MAY 28, 2010
	AMENDED IN ASSEMBLY  APRIL 5, 2010

INTRODUCED BY   Assembly Member Beall
   (Coauthors: Assembly Members Arambula, Chesbro, Coto, Davis,
Galgiani, and Ma)

                        FEBRUARY 18, 2010

   An act to add and repeal Section 76000.10 of the Government Code,
relating to emergency services.


	LEGISLATIVE COUNSEL'S DIGEST


   AB 2173, Beall. Emergency medical air transportation providers:
penalty levy: reimbursement augmentation.
   Existing law requires an additional county penalty of $7 for every
$10, or part of $10, to be levied upon every fine, penalty, or
forfeiture imposed and collected by the courts for all criminal
offenses, for deposit into specified county funds relating to the
construction of courthouses, criminal justice facilities, and
forensic laboratories, and the support of emergency medical services.

   Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services, under
which health care services, including medical transportation
services, are provided to qualified low-income persons. The Medi-Cal
program is partially governed and funded under federal Medicaid
provisions.
   Existing law, the Emergency Medical Services System and the
Prehospital Emergency Medical Care Personnel Act, authorizes each
county to designate an emergency medical services agency, for the
establishment and administration of an emergency medical services
program in the county. Existing law also establishes the Emergency
Medical Services Authority, which, among other things, adopts
regulations governing the provision of emergency medical services.
   This bill, which would be known as the Emergency Medical Air
Transportation Act, would impose an additional penalty of $4 upon
every conviction for an offense involving a vehicle violation, except
certain parking offenses. This bill would require each county board
of supervisors to establish in the county treasury an emergency
medical air transportation act fund into which the penalty collected
pursuant to this bill would be deposited. This bill would require,
within 30 days following the last day of each calendar quarter of the
year, the county treasurer to transfer moneys in the county's
emergency medical air transportation act fund to the Controller for
deposit into the Emergency Medical Air Transportation Act Fund, which
would be established by the bill. The bill would authorize the
county treasurer, prior to transferring the moneys in the county fund
to the Controller, to withhold a sufficient amount from being
transferred to reimburse the county and the courts for their actual,
reasonable, and necessary costs associated with administering the
bill. Moneys in the Emergency Medical Air Transportation Act Fund
would be available, upon appropriation by the Legislature, to the
department for the purposes of offsetting the state portion of the
Medi-Cal reimbursement rate for emergency medical air transportation
services and augmenting emergency medical air transportation
reimbursement payments made through the Medi-Cal program, as
specified.
   This bill would terminate assessment of the penalties commencing
July 1, 2016, and would repeal these provisions on January 1, 2018,
as provided. The bill would require that any moneys in the Emergency
Medical Air Transportation Act Fund that remain unexpended and
unencumbered on June 30, 2017, shall be transferred to the General
Fund to be available, upon appropriation by the Legislature, for the
purposes of augmenting Medi-Cal reimbursement of emergency medical
air transportation and related costs, generally.
   By requiring counties to create emergency medical air
transportation act funds and then deposit the levy imposed by this
bill into those funds, this bill would create a state-mandated local
program.
   The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
   This bill would provide that no reimbursement is required by this
act for a specified reason.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

  SECTION 1.  The Legislature finds and declares all of the
following:
   (a) Air ambulance services provide lifesaving emergency
transportation of the most critical patients from automobile accident
scenes directly to trauma centers. The vast majority of helicopter
scene responses are motor vehicle related.
   (b) Many of these transports originate in rural areas where ground
transportation is prolonged. In some instances, however, air
transportation may be needed in urban areas where traffic congestion
inhibits rapid transportation.
   (c) Air ambulance services providers transport all emergency
patients without knowing if the patient has any form of medical
insurance or ability to pay for the service.
   (d) Many emergency patients transported by air ambulances have no
insurance and no ability to pay for the service, but these patients
are given the same high level of care as those with medical
insurance.
   (e) Unlike the hospitals where air ambulance services providers
deliver patients, air ambulance services providers are not eligible
to apply for additional federal funding for providing services to
high numbers of indigent patients pursuant to California's
disproportionate share hospital (DSH) program under the Medi-Cal
program.
   (f) Unlike the hospitals and emergency physicians who treat the
patients after they are delivered by helicopter, air ambulance
services providers do not receive payment from the county Maddy
Emergency Medical Services Fund when they provide treatment to an
indigent patient.
   (g) Emergency air ambulance services providers provide coverage to
multiple counties within a 100-mile radius of their bases, and, as a
result, often their transports originate in a county other than
where they are based, which makes it virtually impossible for them to
be funded by local tax support except in the largest of counties.
   (h) The Medi-Cal program reimburses air ambulance services
providers far below what it costs the providers to provide emergency
air transportation and pays nothing if the patient is indigent and
not eligible for Medi-Cal. The Medi-Cal reimbursement rates for air
ambulances have not increased in over 15 years.
   (i) Currently fines and penalties on traffic violations total
between one hundred eight dollars ($108) and nineteen-thousand
dollars ($19,000), inclusive. Some of the fine and penalty money is
already collected by county courts and transferred to the state.
   (j) A small additional penalty of four dollars ($4) per traffic
violation would result in a very small percentage increase on each
penalty on traffic violations, but the money collected from the
penalty would go to support air ambulance services, which are the
most critical services that support patients who are injured as a
result of a major collision.
   (k) Air ambulance services play a key role in the statewide
emergency medical services system, including disaster response and
homeland security, so it is important for California to support these
vital services.
  SEC. 2.  Section 76000.10 is added to the Government Code, to read:

   76000.10.  (a) This section shall be known, and may be cited, as
the Emergency Medical Air Transportation Act.
   (b) For purposes of this section:
   (1) "Department" means the State Department of Health Care
Services.
   (2) "Director" means the Director of the State Department of
Health Care Services.
   (3) "Provider" means a provider of emergency medical air
transportation services.
   (4) "Rotary wing" means a type of aircraft, commonly referred to
as a helicopter, that generates lift through the use of wings, known
as rotor blades, that revolve around a mast.
   (5) "Fixed wing" means a type of aircraft, commonly referred to as
an airplane, that generates lift through the use of the forward
motion of the aircraft and wings that do not revolve around a mast
but are fixed in relation to the fuselage of the aircraft.
   (6) "Air mileage rate" means the per-mileage reimbursement rate
paid for services rendered by rotary-wing and fixed-wing providers.
   (c) (1) For the purpose of implementing this section, a penalty of
four dollars ($4) shall be imposed upon every conviction for a
violation of the Vehicle Code or a local ordinance adopted pursuant
to the Vehicle Code, except parking offenses subject to Article 3
(commencing with Section 40200) of Chapter 1 of Division 17 of the
Vehicle Code.
   (2) The penalty described in this subdivision shall be in addition
to the state penalty assessed pursuant to Section 1464 of the Penal
Code. However, this penalty shall not be included in the base fine
used to calculate the state penalty assessment pursuant to
subdivision (a) of Section 1464 of the Penal Code, the state
surcharge levied pursuant to Section 1465.7 of the Penal Code,
Section 70372 of the Government Code, and to calculate the other
additional penalties levied pursuant to this chapter.
   (d) The county board of supervisors shall establish in the county
treasury an emergency medical air transportation act fund into which
shall be deposited the moneys collected pursuant to this section.
Moneys in each county's fund, including interest and dividends earned
thereon, shall be held by the county treasurer separate from funds
subject to transfer or division pursuant to Section 1463 of the Penal
Code.
   (e) (1) Within 30 days following the last day of each calendar
quarter of the year, the county treasurer shall transfer moneys in
the county's emergency medical air transportation act fund to the
Controller for deposit into the Emergency Medical Air Transportation
Act Fund, which is hereby established in the State Treasury.
Notwithstanding Section 16305.7, the Emergency Medical Air
Transportation Act Fund shall include interest and dividends earned
on money in the fund. Prior to the transfer of funds from the county'
s emergency medical air transportation act fund to the state, the
county treasurer may withhold a sufficient amount from the fund to
reimburse the county and the courts for their actual, reasonable, and
necessary costs associated with administering this section. To the
extent moneys are withheld by the county treasurer, an accounting
report detailing these costs shall be sent to the department at least
once per calendar year.
   (2) The Emergency Medical Air Transportation Act Fund shall be
administered by the State Department of Health Care Services. Moneys
in the Emergency Medical Air Transportation Act Fund shall be made
available, upon appropriation by the Legislature, to the department
to be used as follows:
   (A) For payment of the administrative costs of the department in
administering this section.
   (B) Twenty percent of the fund remaining after payment of
administrative costs pursuant to subparagraph (A) shall be used to
offset the state portion of the Medi-Cal reimbursement rate for
emergency medical air transportation services.
   (C) Eighty percent of the fund remaining after payment of
administrative costs pursuant to subparagraph (A) shall be used, to
augment emergency medical air transportation reimbursement payments
made through the Medi-Cal program, as set forth in paragraphs (3) and
(4).
   (3) (A) The department shall seek to obtain federal matching funds
by using the moneys in the Emergency Medical Air Transportation Act
Fund for the purpose of augmenting Medi-Cal reimbursement paid to
emergency medical air transportation providers.
   (B) The director shall do all of the following:
   (i) By March 1, 2011, meet with medical air transportation
providers to determine the most appropriate methodology to distribute
the funds for medical air services.
   (ii) Implement the methodology determined most appropriate in a
timely manner.
   (iii) Develop the methodology in collaboration with the medical
air providers.
   (iv) Submit any state plan amendments or waiver requests that may
be necessary to implement this section.
   (v) Submit any state plan amendment or waiver request that may be
necessary to implement this section.
   (vi) Seek federal approvals or waivers as may be necessary to
implement this section and to obtain federal financial participation
to the maximum extent possible for the payments under this section.
If federal approvals are not received, moneys in the fund may be
distributed pursuant to this section until federal approvals are
received.
   (C) The director may give great weight to the needs of the
emergency medical air services providers, as discussed through the
development of the methodology.
   (4) (A) Upon appropriation by the Legislature, the department
shall use moneys in the Emergency Medical Air Transportation Act Fund
and any federal matching funds to increase the Medi-Cal
reimbursement for emergency medical air transportation services in an
amount not to exceed normal and customary charges charged by the
providers.
   (B) Notwithstanding any other provision of law, and pursuant to
this section, the department shall increase the Medi-Cal
reimbursement for emergency medical air transportation services
provided that both of the following conditions are met:
   (i) Moneys in the Emergency Medical Air Transportation Act Fund
will cover the cost of increased payments pursuant to subparagraph
(A).
   (ii) The state does not incur any General Fund expense to pay for
the Medi-Cal emergency medical air transportation services increase.
   (e) The assessment of penalties pursuant to this section shall
terminate commencing January 1, 2016. Penalties assessed prior to
January 1, 2016, shall continue to be collected, administered, and
distributed pursuant to this section until exhausted or until June
30, 2017, whichever occurs first. On June 30, 2017, moneys remaining
unexpended and unencumbered in the Emergency Medical Air
Transportation Act Fund shall be transferred to the General Fund, to
be available, upon appropriation by the Legislature, for the purposes
of augmenting Medi-Cal reimbursement for emergency medical air
transportation and related costs, generally.
   (f) Notwithstanding the rulemaking provisions of Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 2 of the
Government Code, the department may implement, interpret, or make
specific this section and any applicable federal waivers and state
plan amendments by means of all county letters, plan letters, plan or
provider bulletins, or similar instructions without taking
regulatory action.
   (g) This section shall remain in effect only until January 1,
2018, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2018, deletes or extends
that date.
  SEC. 3.  No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because a
local agency or school district has the authority to levy service
charges, fees, or assessments sufficient to pay for the program or
level of service mandated by this act, within the meaning of Section
17556 of the Government Code.