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--- STAFF ANALYSIS OF ASSEMBLY BILL 215 (Beall) Page 2 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 STAFF ANALYSIS OF ASSEMBLY BILL 215 (Beall) Page 3 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 STAFF ANALYSIS OF ASSEMBLY BILL 215 (Beall) Page 4 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. STAFF ANALYSIS OF ASSEMBLY BILL 215 (Beall) Page 5 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 STAFF ANALYSIS OF ASSEMBLY BILL 215 (Beall) Page 6 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. STAFF ANALYSIS OF ASSEMBLY BILL 215 (Beall) Page 7 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 -- STAFF ANALYSIS OF ASSEMBLY BILL 215 (Beall) Page 8