BILL ANALYSIS Ó AB 210 Page 1 Date of Hearing: May 11, 2011 ASSEMBLY COMMITTEE ON APPROPRIATIONS Felipe Fuentes, Chair AB 210 (Solorio) - As Amended: April 4, 2011 Policy Committee: HealthVote:14-5 Urgency: No State Mandated Local Program: Yes Reimbursable: Yes SUMMARY This bill revises existing statute relating to the role of city, county or fire districts with regard to prehospital emergency medical services (EMS). Specifically, this bill: 1)Requires that a local emergency medical services agency (LEMSA) grant to a city, county or fire district that has been continuously providing prehospital EMS since June 1, 1980 and has not entered into an agreement with the LEMSA, authorization to provide the same services or an exclusive operating area. It also repeals the existing similar provision and requires the EMS provider to enter into an agreement by December 31, 2013. 2)Defines "prehospital EMS provider," requires a LEMSA to include all prehospital EMS providers in its local EMS plans, and requires all prehospital EMS providers to comply with LEMSA policies and procedures regarding administration of the local EMS system. 3)Grants a prehospital EMS provider the same right as a LEMSA to appeal a determination by the Emergency Medical Services Authority (EMSA) that a LEMSA developed plan does not meet the required standard. FISCAL EFFECT Annual GF costs to EMSA, potentially in the range of hundreds of thousands of dollars, related to legal workload to evaluate and respond to appeals of EMSA's determinations regarding local EMS plans. Costs could subside in future years, depending on the number of appeals and the resolution of litigation. AB 210 Page 2 COMMENTS 1)Rationale . The author states that the practice of prehospital medicine has witnessed significant changes and growth in the last decades, increasing the importance of a coordinated EMS system. He further states that it has become more common for EMS transportation providers to function without entering into a written agreement with their respective LEMSA. The author argues that this has created confusion in determining which EMS providers are required to maintain services in certain areas. By defining key terms, requiring that all prehospital providers are part of a local EMS plan, and clarifying under what circumstances certain providers are granted exclusive operating areas, the author intends to resolve litigation and improve coordination of local EMS systems. 2)History . Prehospital EMS services have been a source of friction between cities, counties, fire districts, and other prehospital providers for three decades, at times resulting in litigation. The sources of this tension involve jurisdictional and operational issues, historical service relationships, and the differences in profitability of various levels of EMS service and the provision of services in rural versus urban areas. In 1980, LEMSAs were given control over local EMS systems, and EMSA was created to oversee the development of a coordinated statewide EMS system. Because rural areas are geographically sparse and less profitable than urban areas, LEMSAs were given the right to offer exclusive operating areas through competitive contracts. These arrangements allow them to ensure consistent EMS service is provided to all communities. A LEMSA electing to create one or more exclusive operating areas must develop and submit to EMSA for approval, as part of the local plan, its competitive process for selecting providers. However, some cities, counties and fire districts have maintained operating areas through a "grandfathering" clause based on their level of service and area served in 1980. The original intent of the 1980 law was that prehospital EMS providers would gradually integrate into the local EMS system, organized by the LEMSA. However, many of the existing providers opted not to formally integrate, and were able to AB 210 Page 3 maintain their operating areas by avoiding written agreements with a LEMSA. As the sponsors of this bill note, the lack of written agreements undermines attempts to coordinate local EMS systems. 3)Stakeholder process ongoing . To help resolve the longstanding disputes regarding these issues, EMSA hosted a one-day stakeholder workshop in May 2010. The Commission on EMS also established a subcommittee to evaluate these issues. In December 2010, the subcommittee submitted a report and recommendations which were intended to serve as a road map for further action for EMSA and the EMS community at large. In response, EMSA convened a task force consisting of EMS constituents with knowledge of these issues. The task force has been meeting on a bi-weekly basis since late January 2011, and is developing a draft set of regulations and possible statutory changes to address the same issues this bill is seeking to address. According to the December 2010 subcommittee report, the regulatory package and recommended statutory framework are to be considered at the June 2011 Commission meeting. The language in this bill largely reflects the stakeholder agreement so far. 4)Ability to appeal EMS plans . This bill significantly expands the number of entities that can appeal EMSA's decisions to approve or deny local EMS plans. It appears likely that given the legal right to appeal, a range of providers would appeal determinations that negatively affect their operations. Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081