BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 2173|
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THIRD READING
Bill No: AB 2173
Author: Beall (D), et al
Amended: 8/17/10 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 5-0, 6/23/10
AYES: Alquist, Cedillo, Leno, Pavley, Romero
NO VOTE RECORDED: Strickland, Aanestad, Cox, Negrete
McLeod
SENATE PUBLIC SAFETY COMMITTEE : 7-0, 6/29/10
AYES: Leno, Cogdill, Cedillo, Hancock, Huff, Steinberg,
Wright
SENATE APPROPRIATIONS COMMITTEE : 8-3, 8/12/10
AYES: Kehoe, Alquist, Corbett, Emmerson, Leno, Price,
Wolk, Yee
NOES: Ashburn, Walters, Wyland
ASSEMBLY FLOOR : 65-8, 6/2/10 - See last page for vote
SUBJECT : Emergency air medical transportation providers:
penalty
levy: reimbursement augmentation
SOURCE : California Chapter of the Association of Air
Medical
Services
DIGEST : This bill establishes a $4 flat fee on each
CONTINUED
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Vehicle Code violation in the state, except for parking
tickets, which would be augmented with matching federal
funds, to provide for increased Medi-Cal funding of
emergency air ambulance transportation.
ANALYSIS : Existing federal law establishes the Medicaid
program to provide comprehensive health benefits to
specified groups of low-income persons.
Existing state law:
1. Establishes the Medi-Cal program, the state's Medicaid
program, administered by the Department of Health Care
Services (DHCS), which provides comprehensive health
benefits to low-income children; their parents or
caretaker relatives; pregnant women; elderly, blind or
disabled persons; nursing home residents and refugees.
2. Establishes fines, which are imposed by the courts, for
criminal offenses, 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. State Penalty Assessment of $10 for every $10 on
every fine, penalty or forfeiture. Of the funds
collected, 70 percent goes to the state and 30
percent 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. 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
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Fingerprint Identification Fund, Emergency Medical
Services Fund, and, DNA Fund.
C. State Surcharge of 20 percent 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 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
consisting of 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. 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.
I. Emergency medical services (EMS) assessment of an
additional 20 percent assessment of $2 for every $10
on every fine, penalty, forfeiture or criminal
offense and all offenses dealing with the Vehicle
Code except parking offenses for EMS.
This bill:
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1. Establishes the Emergency Medical Air Transportation Act
(EMATA).
2. Imposes a penalty of $4 on every conviction of a
violation of the Vehicle Code, or a local ordinance
adopted pursuant to the Vehicle Code, except parking
offenses.
3. Requires the penalty to be in addition to the
established penalty, and excluded from the base fine or
any other surcharges used to calculate any other
penalties.
4. Establishes the EMATA Fund, to be administered by DHCS,
and requires each county to deposit the proceeds of this
penalty in a County EMATA fund and to transfer the funds
on a quarterly basis to the EMATA Fund.
5. Requires the EMATA Fund to be available, upon
appropriation by the Legislature, to DHCS as follows:
A. For payment of the administrative costs of DHCS,
and the actual, reasonable and necessary costs of the
courts, and the counties in administering this
program.
B. 20 percent of the remaining funds to offset the
state portion of the Medi-Cal reimbursement rate for
emergency medical air transportation services.
C. 80 percent augment emergency medical air
transportation reimbursement payments made through
the Medi-Cal program.
6. Requires DHCS seek to obtain federal matching funds, as
specified, by using the moneys in the Emergency Medical
Air Transportation Act Fund for the purpose of
augmenting Medi-Cal reimbursement paid to providers
after June 30, 2011.
7. Requires DHCS use the moneys in the EMATA Fund and
federal matching funds to increase the Medi-Cal
reimbursement or supplemental payments for emergency
medical air transportation services in an amount not to
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exceed normal and customary charges charged by the
providers, as specified.
8. Sunsets the assessment of penalties on January 1, 2016,
however, penalties assessed prior to the fee sunset
shall continue to be collected, administered and
distributed until the funds are extinguished or March 2,
2017. Any unused monies in the EMATA Fund on March 3,
2017, are to be transferred to the General Fund and be
available, upon appropriation by the Legislature, for
purposes of augmenting Medi-Cal reimbursement for
emergency medical air transportation and related costs.
9. Sunsets the bill on January 1, 2018.
10.States legislative intent and makes declarations
regarding air ambulance service, current reimbursement
rates, fines and penalties and the relationships to
Vehicle Code violations.
Background
Air ambulance services provide emergency transportation for
the most critical patients from accident scenes directly to
trauma centers. According to a Foundation for Air-Medical
Research and Education (FARE) 2006 report, the most serious
car accidents are located in rural areas, where 60 percent
of fatal car accidents occur, a rate double that of similar
accidents in suburban or urban areas. The FARE report also
states that the closure of rural hospitals in recent years
has created large geographical gaps in the availability of
specialized surgical resources.
Helicopter ambulances provide medical care at an advanced
life support level, and conduct specialty care transports.
Helicopters are used for the transport of patients from the
scene of an injury to a hospital, for flights between
hospitals, and from rural areas and urban acute care
hospitals to trauma centers, heart/stroke centers, burn
units, and children's specialty hospitals. Medical care is
provided in fixed wing ambulances (airplanes) on longer
inter-hospital flights when the closest appropriate medical
facility is either inaccessible, difficult to reach, or
distantly located. The FARE report approximates that a
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half-million air ambulance transports are conducted each
year.
These patient transports are overseen by referring
physicians and receiving specialist physicians using
guidelines developed by the National Association of EMS
Physicians, the Air Medical Physician Association, and the
Association of Air Medical Services.
Air ambulance services are also used for disaster response.
In times of either man made or natural disaster, air
ambulance services provide highly experienced resources
that can be rapidly deployed. Air ambulance service
providers are comprised of a mix of public and private
entities. For example, the City of Los Angeles provides
its own services, whereas the California Shock Trauma Air
Rescue (CALSTAR) is a non- profit community-based provider
that provides services throughout Central and Northern
California.
Private air ambulance services are reimbursed by
third-party payers in the same fashion as other health care
services. According to information provided by CALSTAR
based on May 31, 2007 audited financial statements, the
average private insurance payment for air ambulance
services between June 1, 2006 and May 31, 2007 was $20,795;
the average Medicare payment was $5,400, and the average
Medi-Cal payment was $2,838.
Medi-Cal rates for air ambulance transportation were set in
1993, and have not received an increase. According to a
March 28, 2008 Med-Cal rate history table for 1985-2001,
provided by the bill's sponsor, the history of Medi-Cal
rate increases for related emergency medical care services
have been as follows:
For fiscal year 1998/99, ground ambulance medical
transportation received a 47.8 percent emergency base
rate increase (responding to car accidents, other
emergencies) and a 55.5 percent non-emergency base rate
increase (scheduled patient transport to a hospital, for
example), resulting in a total increase of 37.9 percent.
Mileage rates were not adjusted.
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For fiscal year 1999/2000, ground ambulance medical
transportation received an ambulance base rate/mileage
rate adjustment of 11.7 percent.
Emergency room physicians also received an increase of 25
percent in 1997/98, and an increase of 16.7 percent in
2000/01.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
According to the Senate Appropriations Committee:
Fiscal Impact (in thousands)
Major Provisions 2010-11 2011-12 2012-13 Fund
Estimated fee revenue ($13,000)
($26,000) ($26,000) Special*
Estimated corresponding $13,000 $26,000
$26,000Special/**
increase in Medi-Cal rates
Federal
DHCS staff $50 $100 $100
Special/**
Federal
* EMATA Fund
**Costs would be shared 50 percent EMATA Fund, 50 percent
federal funds
SUPPORT : (Unable to verify at time of writing)
California Chapter of the Association of Air Medical
Services (source)
Barton Health
Board for Critical Care Transport Paramedic Certification
CDF Firefighters Local 2881
California Children's Hospital Association
California Hospital Association
Cal-Ore Life Flight
Congressman Dennis A. Cardoza
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Diamond Springs - El Dorado Fire Protection District
Hall Critical Care Transport
John C. Fremont Healthcare District
Mercy Air
Mercy Flights, Inc.
Mercy Medical Center Mt. Shasta
Olivehurst Fire Department
Oregon State Ambulance Association
Patterson District Ambulance
Placer Hills Fire Protection District
PHI Air Medical California
Reach Air Medical Services
Regional Council of Rural Counties
Trinity County Life Support
Upland Fire Department
West Side Community Ambulance
OPPOSITION : (Unable to verify at time of writing)
Automobile Club of Southern California
California State Automobile Association
California Teamsters Public Affairs Council
ARGUMENTS IN SUPPORT : According to the California
Chapter of the Association of Air Ambulance Medical
Services (Cal-AAMS), the bill's sponsor, air ambulances
provide an essential service to the community and provide
life-saving emergency transports to trauma and cardiac
patients without any form of health insurance. Cal-AAMS
states that air ambulance medical transportation has not
had a rate change since 1993, at which time the rate was
decreased. Cal-AAMS adds private insurance providers have
recently instituted a national policy to review the rates
paid to air providers as compared to rates paid by public
providers. Cal-AAMS contends that properly funding air
ambulance services is essential to maintaining the
integrity of our EMS system. Proponents of this bill argue
that this bill would provide for increases in funding of
emergency air ambulance transportation, without any impact
on the General Fund.
The Regional Council of Rural Counties adds that, given the
vast distances between hospital or trauma facilities, and
the range of geographic barriers facing land-based
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transportation, access to air ambulance services is
commonly a matter of life or death in rural areas.
The California Hospital Association argues that California
cannot afford for critical air ambulance services to be
reduced and that, without this bill more air ambulance
companies are likely to reduce or eliminate services.
ARGUMENTS IN OPPOSITION : The Automobile Club of Southern
California and the California State Automobile Association,
collectively known as the AAA Clubs, point out that 70 to
80 percent of penalty assessment revenue is generated from
Vehicle Code moving violations. The AAA Clubs note that
the original purpose of penalty assessments was to fund
driver's training. The AAA Clubs argue that while air
medical transportation is a necessary and laudable program,
funding through assessments on Vehicle Code violations
place a disproportionate burden upon the motoring public.
ASSEMBLY FLOOR :
AYES: Adams, Ammiano, Arambula, Bass, Beall, Bill
Berryhill, Blakeslee, Block, Blumenfield, Bradford,
Brownley, Buchanan, Caballero, Charles Calderon, Carter,
Chesbro, Conway, Cook, Coto, Davis, De La Torre, De Leon,
Emmerson, Eng, Evans, Feuer, Fletcher, Fong, Fuentes,
Fuller, Furutani, Galgiani, Gilmore, Hall, Harkey,
Hayashi, Hernandez, Hill, Huber, Huffman, Logue, Bonnie
Lowenthal, Ma, Mendoza, Miller, Monning, Nava, Nestande,
Niello, Nielsen, V. Manuel Perez, Portantino, Ruskin,
Saldana, Skinner, Smyth, Solorio, Swanson, Torlakson,
Torres, Torrico, Tran, Villines, Yamada, John A. Perez
NOES: Anderson, DeVore, Gaines, Garrick, Jeffries, Knight,
Norby, Silva
NO VOTE RECORDED: Tom Berryhill, Hagman, Jones, Lieu,
Salas, Audra Strickland, Vacancy
CTW:mw 8/17/10 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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