BILL ANALYSIS AB 2173 Page 1 CONCURRENCE IN SENATE AMENDMENTS AB 2173 (Beall) As Amended August 20, 2010 Majority vote ----------------------------------------------------------------- |ASSEMBLY: |65-8 |(June 2, 2010) |SENATE: |23-7 |(August 24, | | | | | | |2010) | ----------------------------------------------------------------- Original Committee Reference: HEALTH SUMMARY : Establishes a $4 fee on every vehicle code violation to be collected by the county and transferred to the Department of Health Care Services (DHCS) for deposit in the Emergency Medical Air Transportation Act (EMATA) Fund to be used in the Medi-Cal Program to obtain federal funds and to fund supplemental payments for emergency medical air transportation services. The Senate amendments : 1)Increase the vehicle code violation penalty fee from $3 to $4. 2)Authorize, prior to the transfer of EMATA funds to DHCS, the county to withhold a sufficient amount to reimburse the county and court for actual, reasonable and necessary administrative costs. 3)Specify that the EMATA funds are to be used as follows: a) Payment of administrative costs; b) Twenty percent of the remaining funds for the non-federal share of the Medi-Cal reimbursement rate for emergency medical air transportation; and, c) Eighty percent to augment Medi-Cal emergency medical air transportation reimbursement rates. 4)Require, by March 1, 2011, the Director of DHCS to meet with medical air transportation providers to determine a methodology to distribute the funds and implement the most appropriate methodology in a timely manner. AB 2173 Page 2 5)Authorizes the distribution of funds in the absence of federal approval. 6)Ensure that there is no General Fund impact from an increase in Medi-Cal reimbursement for emergency medical air transportation services. 7)Authorize DHCS to implement by means of all county letters, plan letters, plan or provider bulletins, or similar instructions without taking regulatory action. 8)Terminate the penalty assessment on January 1, 2016, allows payments to continue until March 2, 2017 and sunsets all provisions on January 1, 2018. AS PASSED BY THE ASSEMBLY , this bill established a $3 penalty on every vehicle code violation to be matched with federal funds through the Medi-Cal Program, pursuant to a federal waiver, and to make supplemental payments for emergency air medical transportation services in the Medi-Cal Program. FISCAL EFFECT : 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 $26,000 Special/** increase in Medi-Cal rates $13,000 $26,000 $26,000Federal DHCS staff $50 $100 $100 Special/** Federal *Emergency Air Medical Transportation Act Fund **Costs would be shared 50% EMATA Fund, 50% federal funds COMMENTS : According to the author, this bill is 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 $4 fee on each motor AB 2173 Page 3 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 from fines and penalties. They also do not receive any type of disproportionate share provider supplemental payments. 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 areas 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 is 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. Analysis Prepared by : Marjorie Swartz / HEALTH / (916) 319-2097 FN: 0006679