BILL ANALYSIS                                                                                                                                                                                                    



                                                                  AB 2173
                                                                  Page  1

          CONCURRENCE IN SENATE AMENDMENTS
          AB 2173 (Beall)
          As Amended August 20, 2010
          Majority vote
           
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          |ASSEMBLY:  |65-8 |(June 2, 2010)  |SENATE: |23-7 |(August 24,    |
          |           |     |                |        |     |2010)          |
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          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