BILL ANALYSIS                                                                                                                                                                                                    Ó






                                 SENATE HEALTH
                               COMMITTEE ANALYSIS
                       Senator Ed Hernandez, O.D., Chair


          BILL NO:       AB 215                                      
          A
          AUTHOR:        Beall                                       
          B
          AMENDED:       June 27, 2011                               
          HEARING DATE:  July 6, 2011                                
          2
          CONSULTANT:                                                
          1
          Tadeo                                                      
          5                                                          

          
                                     SUBJECT
                                         
            Emergency services: Emergency Medical Air Transportation 
                                      Act

                                         
                                    SUMMARY  

          Requires a county or court that has imposed a vehicle code 
          fine, as specified, to transfer earmarked penalty 
          assessment moneys to the Treasurer for deposit into the 
          Emergency Medical Air Transportation Act (EMATA) Fund on a 
          monthly basis.   


                             CHANGES TO EXISTING LAW  

          Existing law:
          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.  

          Establishes the EMATA, which imposes a $4 penalty on each 
          conviction of a violation of the Vehicle Code or of a local 
          ordinance adopted pursuant to the Vehicle Code, except 
                                                         Continued---



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          parking offenses.   Requires this penalty to be in addition 
          to the established penalty, and exclude from the base fine 
          any other surcharges used to calculate any other penalties.

          Establishes the EMATA Fund, to be administered by DHCS.  
          Requires each county to deposit the proceeds of the 
          revenues from the above penalty in a county EMATA Fund and 
          to transfer the funds on a quarterly basis to the EMATA 
          Fund.  

          Requires the EMATA Fund to be available, upon appropriation 
          by the Legislature, to DHCS for payment of the 
          administrative costs of DHCS, and for the actual, 
          reasonable and necessary costs of the courts, and the 
          counties in administering this program.  Twenty percent of 
          the remaining funds are to offset the state portion of the 
          Medi-Cal reimbursement rate for emergency medical air 
          transportation services, and eighty percent are to augment 
          emergency medical air transportation reimbursement payments 
          made through the Medi-Cal program.

          Requires DHCS to seek federal matching funds, as specified, 
          by using the moneys in the EMATA Fund for the purpose of 
          augmenting Medi-Cal reimbursement paid to providers after 
          June 30, 2011.

          Sunsets the assessment of penalties on January 1, 2016; 
          however, penalties assessed prior to the fee sunset are 
          required to be collected, administered and distributed 
          until June 30, 2017, or the funds are extinguished.  

          Requires any unused monies in the EMATA Fund on March 3, 
          2017, to be transferred to the General Fund and made 
          available, upon appropriation by the Legislature, for 
          purposes of offsetting the state portion of the Medi-Cal 
          reimbursement rate for emergency medical air transportation 
          services and augmenting emergency medical air 
          transportation reimbursement payments made through the 
          Medi-Cal program, as specified.

          Establishes various other penalty assessments on specified 
          fines, penalties and offenses for distribution to funds 
          established by local governments, including, but not 
          limited to the Courthouse Construction Fund, Criminal 
          Justice Facilities Construction Fund, and the Maddy 




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          Emergency Medical Services Funds.  State portions of these 
          penalty assessments include, but are not limited to, the 
          Fish and Game Preservation Fund, Peace Officers Training 
          Fund, Corrections Training Fund, Traumatic Brain Injury 
          Fund, and the General Fund.   

          This bill: 
          Requires a county or court that imposes a fine on the 
          violation of the Vehicle Code or of a local ordinance 
          adopted pursuant to the Vehicle Code, except parking 
          offenses to transfer earmarked penalty assessment moneys, 
          collected for deposit into the Emergency EMATA Fund, 
          directly to the Treasurer, on a monthly basis.   

          Deletes the requirement that a county establish an EMATA 
          Fund to receive the proceeds of the penalty and transfer 
          the funds on a quarterly basis to the EMATA Fund.  


                                  FISCAL IMPACT  

          The Assembly Appropriations Committee analysis of AB 215 
          stated that this bill would result in minor 
          non-reimbursable costs to counties to provide the state 
          with data related to the number of penalties imposed and 
          total number of funds collected.  However, those 
          requirements have been removed from the current version of 
          the bill. 


                            BACKGROUND AND DISCUSSION  

          According to the author and the California Association of 
          Air Medical Services, the sponsor of AB 215, it is more 
          efficient for counties to submit funds collected from the 
          $4 penalty assessment on Vehicle Code violations directly 
          to the Treasurer along with other fund transfers on a 
          monthly basis.  This is done via the TC30 process, a form 
          and submittal process used to transfer and identify various 
          funds provided to the state.   The current TC30 reporting 
          process within the Controller's office includes a detailed 
          account of the funds transmitted by each county. This is 
          sufficient data to allow DHCS and interested stakeholders 
          to determine any fund trends and dynamics.  The author and 
          sponsor contend that AB 215 will make it more efficient for 




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          counties to transmit these funds, and remove a redundant 
          requirement that the counties provide a detailed account of 
          these funds, as this information can be accessed through 
          the Controller's office.  
          
          Air ambulance services 
          Air ambulance services provide emergency transportation for 
          the most critical patients from accident scenes directly to 
          trauma centers and other advanced care 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 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 estimates that a 
          half-million air ambulance transports are conducted each 
          year.  

          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 disasters, 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.  




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          Reimbursement for air ambulance services 
          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 been increased since.  

          Penalty assessments
          The Legislature has increasingly turned to penalty 
          assessments on criminal and traffic offenses as a method of 
          raising revenue for various projects.  Currently, the 
          amount of assessments on individuals who commit traffic 
          violations is almost quadruple the base fine.  For example:
                 The fine for speeding up to 15 MPH over the 65 MPH 
               limit has a base penalty of $35, but amounts to $111 
               after additional penalties and assessments are 
               applied;
                 The fine for driving without insurance has a base 
               penalty of $200, but amounts to $825 after additional 
               penalties and assessments are applied;
                 The fine for driving under the influence has a base 
               penalty of $390, but amounts to $1,547 after 
               additional penalties and assessments are applied; and,
                 The fine for improper transport of hazardous 
               materials has a base penalty of $300, but amounts to 
               $1,205 after additional penalties and assessments are 
               applied.

          According to a February 2006 California Research Bureau 
          (CRB) study, in counties in which the data was available, 
          the majority of penalties and assessments collected were 
          from Vehicle Code violations.  The study noted that, many 
          criminal defendants who commit serious offenses under the 
          Penal Code are unlikely to have the ability to pay any 
          fines assessed in addition to other punishments, such as 
          county jail or state prison sentences.
          
          Prior legislation




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          AB 2173 (Beall), Chapter 547, Statutes of 2010,  
          establishes the EMATA which imposes a $4 penalty on 
          convictions of a violation of the Vehicle Code, except 
          parking offenses, as specified, to augment emergency air 
          medical transportation reimbursement payments made through 
          the Medi-Cal program, and to reimburse DHCS, the courts, 
          and each county for its administrative costs.  Allows 
          unused monies in the EMATA Fund to be transferred to the 
          General Fund and be available, upon appropriation by the 
          Legislature, as specified.
          
          AB 1900 (Nava), Chapter 323, Statutes of 2008, extends the 
          sunset date from January 1, 2009, to January 1, 2011, 
          authorizing Santa Barbara county to collect additional 
          penalty assessments of $5 for every $10 in base fines, to 
          be imposed on every fine, penalty, or forfeiture collected 
          for criminal offenses, and restricted Vehicle Code 
          violations to specified DUI violations for purposes of 
          providing payment for EMS.
          
          SB 1236 (Padilla), Chapter 60, Statutes of 2008, extends 
          the sunset date from January 1, 2009, to January 1, 2014, 
          authorizing a county board of supervisors to elect to levy 
          an additional penalty in the amount of $2 for every $10, 
          upon fines, penalties, and forfeitures collected for 
          criminal offenses, and requires 15 percent of the funds 
          collected pursuant to that additional penalty to be 
          expended for pediatric trauma centers. 

          SB 1773 (Alarcon), Chapter 841, Statutes of 2006, 
          authorizes counties, until January 1, 2009, to collect an 
          additional $2 penalty assessment for every $10 in base 
          fines for purposes of providing payment for EMS, and 
          requires revenue generated from the assessment to be 
          deposited into the Maddy EMS Fund, with 15 percent 
          designated for pediatric trauma centers.
          
          SB 57 (Alarcon) of 2005 would have authorized counties to 
          collect an additional $2 penalty assessment for every $10 
          in base fines for purposes of providing payment for  
          EMS.  Would have required revenue generated from the 
          assessment to be deposited into the Maddy EMS Fund, with 15 
          percent designated for pediatric trauma centers. This bill 
          was vetoed by the Governor. 





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          SB 807 (Dunn) of 2002 would have provided for an additional 
          $200 assessment on specified moving violations to be 
          deposited into the county Maddy EMS Fund and allocated in a 
          specified manner. This bill was vetoed by the Governor.

          SB 12 (Maddy), Chapter 1240, Statutes of 1987, allows 
          counties to establish a Maddy EMS Fund through a $1 penalty 
          assessment on fines, forfeitures, and penalties associated 
          with certain criminal and traffic violations, and a portion 
          of the fees from people attending traffic violator schools 
          for purposes of supporting EMS.

          Arguments in support
          The California Association of Air Medical Services (CAAMS), 
          the sponsor of AB 215, argues that AB 215 will make the 
          submission of penalty assessment funds on a monthly basis 
          more efficient for counties and will remove an unnecessary 
          requirement that the counties provide detailed information 
          on these funds.   CAAMS adds that the current TC30 process 
          within the Controller's office includes a detailed account 
          of funds transmitted by each county, providing sufficient 
          data to allow DHCS and stakeholders to determine any fund 
          trends and dynamics for their current process of 
          establishing a rate methodology.


                                  PRIOR ACTIONS

           Assembly Health:    13- 6  
          Assembly Appropriations:12- 4
          Assembly Floor:     51- 25


                                    POSITIONS  
                                        
          Support:  California Association of Air Medical Services 
          (sponsor) 

          Oppose:None received


                                   -- END --
          






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