BILL ANALYSIS
AB 2173
Page 1
Date of Hearing: April 13, 2010
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 2173 (Beall) - As Amended: April, 5, 2010
SUBJECT : Emergency air medical transportation providers:
penalty levy: reimbursement augmentation.
SUMMARY : Establishes a $3 penalty on every vehicle code
violation to be matched in the Medi-Cal Program and used to make
supplemental payments for emergency air medical transportation
services in the Medi-Cal Program. Specifically, this bill :
1)Creates the Emergency Air Medical Transportation Act (EAMTA).
2)Imposes a penalty of $3 on every conviction of a violation of
the vehicle code or local ordinance adopted pursuant to the
vehicle code, except parking offences.
3)Requires the penalty to be in addition to the state
established penalty and excluded from the base fine or any
other surcharges used to calculate any other penalties.
4)Establishes the EAMTA Fund to be administered by the
Department of Health Care Services (DHCS) and requires each
county to deposit the proceeds of this penalty in a county
emergency air medical transportation act fund and transferred
quarterly to the EAMTA Fund.
5)Requires DHCS to use the proceeds of the EAMTA Fund to obtain
federal matching funds in the Medi-Cal Program for the purpose
of making supplemental payments to emergency air medical
transportation providers in an amount that does not exceed
normal and customary charges.
6) Requires the EAMTA Fund to be available, upon appropriation
by the Legislature, to DHCS to augment emergency air medical
transportation reimbursement, to reimburse DHCS for and each
county for it administrative costs.
7)States legislative intent with regard to air ambulance
service, current reimbursement rates, fines and penalties and
the relationships vehicle code violations.
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EXISTING LAW :
1)Establishes Medi-Cal, administered by DHCS, to provide
comprehensive health care services and long-term care to
pregnant women, children, and people who are aged, blind, and
disabled.
2)Establishes fines imposed by the courts for criminal offences,
including offenses involving a violation of the Vehicle Code.
3)Establishes over 269 penalty assessments in addition to the
base fines. Significant assessments that apply to a Vehicle
Code violation are as follows:
a) A State Penalty Assessment of $10 for every $10 on every
fine, penalty or forfeiture. Of the funds collected, 70%
goes to the state and 30% to the county. The state portion
is distributed to the Fish and Game Preservation Fund, the
Restitution Fund, the Peace Officers Training Fund, the
Driver Training Penalty Assessment Fund, the Corrections
Training Fund, the Local Public Prosecutors and Public
Defenders Fund, the Victim-Witness Assistance Fund, and the
Traumatic Brain Injury Fund.
b) A County Penalty Assessment of $7 for every $10 on every
fine, penalty, or forfeiture imposed and collected. The
proceeds are distributed to funds established by the county
board of supervisors: including a Courthouse Construction
Fund, Criminal Justice Facilities Construction Fund,
Automated Fingerprint Identification Fund, Emergency
Medical Services Fund, and, DNA Fund.
c) State Surcharge of 20% on every base fine collected by
the court, deposited in the General Fund.
d) State Court Facilities Construction Penalty Assessment
of up to $5 for every $10 or fraction thereof, upon every
fine, penalty or forfeiture collected by the courts for
criminal offenses.
e) Court Security Fee of $ 35 on every conviction for a
criminal offense for court security.
f) Proposition 69 levy of $1 penalty assessment on every
$10 in fines and forfeitures resulting from criminal and
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traffic offenses and for state and local governments for
DNA databank implementation purposes.
g) Immediate and Critical Needs Account within the existing
State Court Facilities Construction Fund is an additional
$30 for every felony or misdemeanor criminal conviction and
$35 for every criminal infraction, including traffic
offenses, but not including parking offenses.
h) EMS Assessment of an additional 20% assessment of $2 for
every $10 on every fine, penalty, forfeiture or criminal
offenses and all offenses dealing with the Vehicle Code
except parking offenses for emergency medical services
(EMS), in addition to the EMS Fund.
i) The Maddy EMS Fund which permits each county to levy a
$2 penalty assessment for each $10 of traffic fines to
provide supplemental financing for local emergency medical
services. Ten percent is deducted for administration and
the remainder is distributed to physicians for
uncompensated emergency room care, to trauma centers, and
hospitals and to counties for county emergency medical
services.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, this bill
intended to provide a mechanism for supplemental payments for
air ambulance providers who serve Medi-Cal patients. The
author states that revenue generated by imposing a flat $3 fee
on each motor vehicle violation can be matched with federal
funds through the Medi-Cal Program. The author points out that
Medi-Cal pays air ambulance services far below the cost of
providing emergency air transportation and 40% of the average
Medicare rate. The author asserts that unlike hospitals,
federal law does not permit a provider fee to be assessed.
Furthermore, air ambulance providers must provide emergency
services but are not covered by other supplemental emergency
payment funds that are collected for m fines and penalties.
They also do not receive any type of disproportionate share
provider supplemental payments.
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2)BACKGROUND . Air ambulance services provide emergency
transportation for the most critical patients from automobile
scenes directly to trauma centers. Emergency helicopters also
transport patients from rural area or acute care hospitals to
tertiary care hospitals such as trauma centers, heart/stroke
centers, burn units, and children's specialty hospitals. They
are also used for disaster response. Air ambulance services
providers are a mix of public and private entities. For
instance, the City of Los Angeles provides its own services,
whereas the California Shock Trauma Air Rescue (CALSTAR) in a
not-for profit community based provider that provides services
throughout Central and Northern California. The services are
not self-dispatched, but are called for by on scene first
responders, a hospital physician, or other emergency medical
services agency. No one is denied service, regardless of
ability to pay.
3)REIMBURSEMENT . Private air ambulance services are reimbursed
in the same fashion as other health care services. CALSTAR
and the sponsor have supplied the following data with regard
to reimbursement:
TABLE 1
---------------------------------------------------------------------
|Raw Cost | Cost | Average | Workers |Medicare |Medi-Cal |Medi-Cal |
| |plus bad |insurance| comp | | CALSTAR |average |
| | debt | payment | rate | | | |
|---------+---------+---------+---------+---------+---------+---------|
| $8,974| $15,190| $21,795| $$6,480| $5,400| $2,838|$2,238 |
---------------------------------------------------------------------
Medi-Cal has established a fixed reimbursement rate for
helicopters based on the unit of service plus a per mile
amount and a fixed fee for fixed wing airplanes.
4)PENALTY ASSESSMENTS . The Legislature has increasingly turned
to penalty assessments on criminal and traffic offenses as a
method of raising revenue for various projects. Currently,
the amount of assessments on individuals who commit traffic
violations is almost quadruple the base fine. Table 2
demonstrates some examples:
TABLE 2
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AB 2173
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| | | | | | | | | | | |
| | | | | | | | | | | |
| | | | | | | | | | | |
| | | | | | | | | | | |
|Offense | | | | | | | | | | |
|---------+---------+---------+---------+---------+---------+---------+---------+---------+---------+---------|
|Speeding | $35| $40| $28| $8| $20| $7| $8| $30| $35| $111|
|to 15 | | | | | | | | | | |
|MPH over | | | | | | | | | | |
|65 limit | | | | | | | | | | |
|---------+---------+---------+---------+---------+---------+---------+---------+---------+---------+---------|
|Driving | $200| $200| $140| $40| $100| $40| $40| $30| $35| $825|
|w/out | | | | | | | | | | |
|insurance| | | | | | | | | | |
| | | | | | | | | | | |
|---------+---------+---------+---------+---------+---------+---------+---------+---------+---------+---------|
|Driving | $390| $390| $273| $78| $195| $78| $78| $30| $35| $1547|
|under | | | | | | | | | | |
|the | | | | | | | | | | |
|influence| | | | | | | | | | |
| | | | | | | | | | | |
|---------+---------+---------+---------+---------+---------+---------+---------+---------+---------+---------|
|Transport| $300| $300| $210| $60| $150| $60| $60| $30| $35|$1205 |
| of | | | | | | | | | | |
|hazardous| | | | | | | | | | |
| | | | | | | | | | | |
|materials| | | | | | | | | | |
| | | | | | | | | | | |
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A study conducted by the California Research Bureau (CRB) in
February 2006 disclosed that in counties in which the data was
available, the majority of penalties and assessments collected
were from Vehicle Code violations. Many criminal defendants
who committed more serious offenses under the Penal Code are
unlikely to have the ability to pay any fines assessed in
addition to other punishments such as county jail or state
prison sentences.
Judges do have the discretion to reduce the base fine, which
then reduces revenue to state and local governments, as well
as to assessments. As current penalty assessments can almost
quadruple the base fine, increasing fines and assessments may
have the unintended consequence of reduced fine collections.
Indigent defendants facing ever-increasing fees may simply
choose to spend time in jail in lieu of paying the fine,
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causing taxpayers to pay the jail costs while state and local
government receive fewer penalty funds. Moreover, county jail
population caps may provide additional incentives to opt for
jail time over fines, as the time served for nonviolent
offenders may be minimal. As noted by the CRB in its 2006
review of penalty assessments, "High penalty assessments may
result in higher rates of default by the guilty parties. Some
offenders may spend time in jail, or plea for community
service, rather than pay the fine and penalty assessment. The
end result may be that a substantial amount of fines, fees,
and revenue is not collected."
Nonetheless, the Legislature has continued to raise these
penalties and assessments. In 2008, SB 1407 (Perata), Chapter
311 Statutes of 2008, raised the court construction assessment
by $15 and added the $35 conviction assessment. The Budget
Act of 2009-10 increased the court security assessment from
$20 to $30. Furthermore, the dips in receipts, as shown by
the 2006 CRB Report also coincide with decreases in crime.
5)PREVIOUS LEGISLATION .
a) SB 13 X4, (Ducheny), Chapter 22, Statutes of 2009,
increases the fee used to fund court security from $20 to
$30. This increase sunsets on July 1, 2011.
b) AB 1153 (Torrico) of 2009, would have established a $3
penalty assessment on all Vehicle Code violations (except
parking offenses) to provide a funding source to augment
Medi-Cal reimbursement for air ambulance services. AB 1153
died in the Assembly Appropriations Committee.
c) AB 1407 (Perata), Statutes of 2008, Chapter 311, allows
the issuance of up to $5 billion in lease-revenue bonds to
finance the construction of critical needs courthouse
construction projects, and supports the debt service for
the bonds by raising specified criminal and civil fees and
fines.
6)SUPPORT . The California Chapter of the Association of Air
Ambulance Medical Services (CAL-AAMS), in support, states that
air ambulances provide an essential service to our community
and provide life-saving emergency transports to many trauma
and cardiac patients without any form of health insurance.
Cal-AAMS goes on to argue that properly funding air ambulance
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services is essential to maintaining the integrity of our EMS
system. CALSTAR writes in support that this bill would
provide for increases funding of emergency air ambulance
transportation without any impact on the general fund. The
Regional Council of Rural Counties, also in support, states
that given the vast distances between hospital or trauma
facilities and the range of geographic barriers for land-based
transportation, access to air ambulance services is commonly a
matter of life or death in rural areas.
7)OPPOSITION . The Automobile Club of Southern California and
the AAA of Northern California writes in opposition and points
out that 70% to 80% of penalty assessment revenue is generated
from Vehicle Code moving violations. According to this
opposition, the original purpose of penalty assessments was to
fund driver's training. The AAA goes on to argue in
opposition that while air medical transportation is a
necessary and laudable program, funding through assessments on
Vehicle Code tickets place a disproportionate burden upon the
motoring public. The California Teamsters Public Affairs
Council also writes in opposition that the cost of citations
has risen dramatically in recent years as an alternative means
of funding services rather than by increasing taxes.
According to this opposition, the citations are now
unaffordable for working Californians and fall
disproportionately on the shoulders of commercial drivers.
REGISTERED SUPPORT / OPPOSITION :
Support
Board for Critical Care Transport Paramedic Certification
California Chapter of the Association of Air Ambulance Medical
Services
California Children's Hospital Association
California Shock Trauma Air Rescue
Cal-Ore Life Flight
PHI Air Medical
Placer Hills Fire Protection District
Regional Council of Rural Counties
Opposition
Automobile Club of Southern California
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California State Automobile Association
California Teamsters Public Affairs Council
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097