BILL ANALYSIS                                                                                                                                                                                                    



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          Date of Hearing:   April 28, 2010

                        ASSEMBLY COMMITTEE ON APPROPRIATIONS
                                Felipe Fuentes, Chair

                    AB 2173 (Beall) - As Amended:  April 5, 2010 

          Policy Committee:                              HealthVote:15-2

          Urgency:     No                   State Mandated Local Program:  
          Yes    Reimbursable:              Yes

           SUMMARY  


          This bill establishes the Emergency Air Medical Transportation  
          Act, which would create 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. Specifically, this bill: 


          1)Adds $3 to every fine, penalty, or forfeiture imposed and  
            collected by the courts for all offenses involving a violation  
            of the Vehicle Code or a local ordinance adopted pursuant to  
            the Vehicle Code, except specified parking offenses. The  
            county board of supervisors shall establish in the county  
            treasury a special fund into which the $3 assessment will be  
            deposited prior to monthly transfer to the State Controller  
            for credit to the Emergency Air Medical Transportation Act  
            Fund, created by this bill, under the State Department of  
            Health Care Services (DHCS) to augment Medi-Cal emergency air  
            medical transportation reimbursements. 


          2)Requires DHCS to seek federal matching funds by the Emergency  
            Air Medical Transportation Act Fund to augment Medi-Cal  
            reimbursements for air ambulance service. 


           FISCAL EFFECT


          1)Potential increased revenue in the range of $40 million  .  
            Extrapolating from the 7,248,217 court abstracts with  








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            convictions for typically multiple Vehicle Code violations,  
            which average about two per abstract, between March 2008 and  
            March 2009, a $3 penalty assessment on each traffic fine would  
            result in increased revenue of about $43.5 million, assuming  
            no diminishing returns as a result of changes in judicial  
            behavior, collections, or ability to pay.  


          2)Proliferation of assessments and charges has driven fines  
            upward  . For example, a $500 criminal fine with current maximum  
            assessments would be $1,995, shocking defendants who think  
            $500 means $500.


           3)Increasing assessments may result in diminishing returns  .  
            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  
            triple 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,  
            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 California Research Bureau (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." 


           COMMENTS


          1)Rationale  . The author states that air ambulance services are a  
            crucial, cost-effective component of the emergency medical  
            system that is significantly undercompensated by Medi-Cal. The  
            purpose of this bill is to create a funding source to increase  








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            Medi-Cal reimbursents for air ambulances. 


            According to the author, "Air ambulance services provide  
            life-saving emergency transportation for the most critical  
            patients from accident scenes directly to trauma centers.  
            Emergency helicopter air ambulance providers maintain a  
            critical link between rural areas and urban tertiary care  
            hospitals (trauma centers, heart/stroke centers, burn units,  
            etc.). 


            "They are an essential part of the Statewide EMS system and  
            play a key role in disaster response and homeland security.  
            The Medi-Cal program pays air ambulance services far below the  
            cost of providing emergency air transportation, and pays  
            nothing if the patient is indigent and not eligible for  
            Medi-Cal. Current Medi-Cal base rates for helicopter services  
            are only 40% of the average Medicare rates in California,  
            which are similarly inadequate to cover costs. In rural areas  
            this can fall below 35% of the cost of the transport."  


           2)Existing Penalty Assessments  . Existing law provides for a  
            series of intertwined and complex penalty assessments. As  
            noted by the CRB, "California now has dedicated funding  
            streams for over 269 separate court fines, fees, forfeitures,  
            surcharges and penalty assessments that may be levied on  
            offenders and violators." The major assessments include: 


             a)   A state penalty assessment  of $10 for every $10 on every  
               fine, penalty or forfeiture imposed and collected by the  
               courts for all criminal offenses, including vehicle  
               offenses except parking fines. Of the funds collected, 70%  
               goes to the state and 30% to the county. The state portion  
               is distributed as follows: 

               i)     Fish and Game Preservation Fund: .33% 
               ii)      Restitution Fund: 32.02%
               iii)                               Peace Officers Training  
                 Fund: 23.99%                       
               iv)      Driver Training Penalty Assessment Fund: 25.70% 
               v)     Corrections Training Fund: 7.88% 
               vi)      Local Public Prosecutors and Public Defenders  








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                 Fund: .78%, not to exceed $850,000
               vii)   Victim-Witness Assistance Fund: 8.64%
               viii)  Traumatic Brain Injury Fund: .66%. 

              b)   A county penalty assessment  of $7 for every $10 on every  
               fine, penalty, or forfeiture imposed and collected by the  
               courts for criminal offenses, including vehicle offenses,  
               except parking fines. Proceeds are distributed to funds  
               established by county boards of supervisors: Courthouse  
               Construction, Criminal Justice Facilities Construction,  
               Automated Fingerprint Identification, Emergency Medical  
               Services, DNA.  


             c)   A state surcharge of 20%  on every base fine collected by  
               the court, deposited in the GF.  


             d)   A State Court Facilities Construction penalty assessment   
               of up to $5 for every $10 upon every fine, penalty or  
               forfeiture collected by the courts for criminal offenses. 


             e)   A court security fee  of $30 on every conviction for a  
               criminal offense for court security.  


             f)   Proposition 69  levied a $1 penalty assessment on every  
               $10 in fines and forfeitures resulting from criminal and  
               traffic offenses and dedicates these revenues to state and  
               local governments for DNA databank implementation purposes.  
                


             g)   The EMS Fund  provides supplemental financing for local  
               emergency services via a $2 penalty assessment for each $10  
               of traffic fines.  


             h)   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, in addition to the  
               EMS Fund.  









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             i)   An additional $30 for every felony or misdemeanor  
               criminal conviction and $35  for every criminal infraction,  
               including traffic offenses, but not including parking  
               offenses, for the Immediate and Critical Needs Account  
               (ICNA) within the existing State Court Facilities  
               Construction Fund (SCFCF).  


             j)   The CRB found that 86% of penalty assessments are paid  
               by Vehicle Code violators  . Criminal defendants who  
               committed more serious offenses are less likely to have the  
               ability to pay any fines assessed in addition to other  
               punishments such as county jail or state prison sentences

           3)Support  . The California Chapter of the Association of Air  
            Ambulance Medical Services (CAL-AAMS) states that air  
            ambulances provide an essential service and provide emergency  
            transports to many trauma and cardiac patients without any  
            form of health insurance. 

            The Regional Council of Rural Counties 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 often a matter of life or  
            death in rural areas.  

          4)Opposition  . The Automobile Club of Southern California and the  
            AAA of Northern California states that 70% to 80% of penalty  
            assessment revenue is generated from Vehicle Code moving  
            violations. The AAA contends that while air medical  
            transportation is a laudable program, increasing program  
            funding via Vehicle Code assessments places a disproportionate  
            burden upon the motoring public. 

            The California Teamsters Public Affairs Council notes the cost  
            of citations has increased dramatically in recent years as an  
            alternative means of funding services. As a result, citations  
            are now unaffordable for many Californians and often fall on  
            commercial drivers. 

           5)Previous Legislation  . This bill is essentially the same as the  
            author's AB 1153, which was held on this committee's Suspense  
            File last year.
           Analysis Prepared by  :    Geoff Long / APPR. / (916) 319-2081 








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