BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                     AB 430


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          Date of Hearing:  May 6, 2015


                        ASSEMBLY COMMITTEE ON APPROPRIATIONS


                                 Jimmy Gomez, Chair


          AB  
          430 (Roger Hernández) - As Amended April 20, 2015


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          Urgency:  No  State Mandated Local Program:  NoReimbursable:  No


          SUMMARY:


          This bill:


          1)Requires the Emergency Medical Services Authority (EMSA) to  








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            develop a statewide trauma plan that addresses specified  
            threats by March 2016. 


          2)Requires local emergency medical services agency implementing  
            a trauma care system to commission an independent regional  
            assessment of equitability and access to its trauma system.


          FISCAL EFFECT:


          1)Costs to EMSA to contract for a consultant to modify their  
            recently completed statewide trauma plan to address threats  
            specified in the bill, estimated at $250,000 (GF). 


          2)Potential state-reimbursable mandate costs of more than $2  
            million GF every five years associated with a new requirement  
            on local EMS agencies for comprehensive regional assessments.   
            Additional staff costs in the same range may be incurred by  
            local EMS agencies to support such assessments, but it is  
            unclear whether these costs will be reimbursable.


          COMMENTS:


          1)Purpose. According to the author, this bill would create a new  
            state standard for EMSA certification by requiring local EMSAs  
            to commission a comprehensive assessment of their regional  
            trauma system.  The author states that this bill is a  
            necessary response to the recent State Auditor report  
            suggesting the need for better oversight in the spending and  
            allocation of Los Angeles (L.A.) County's Measure B funds, and  
            also suggests independent assessment would benefit EMS systems  
            statewide.

          2)Responsibilities for Trauma Care Systems.  EMSA provides  








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            statewide coordination and leadership for the planning,  
            development, and implementation of local trauma care systems.   
            EMSA's responsibilities include the development of statewide  
            standards for trauma care systems and trauma centers, the  
            provision of technical assistance to local agencies  
            developing, implementing or evaluating components of a trauma  
            care system, and the review and approval of local trauma care  
            system plans to ensure compliance with minimum standards set  
            by EMSA. 

            California has 33 local EMS agencies: seven regional  
            multi-county systems and 25 single-county agencies.  Local EMS  
            agencies are responsible for planning, implementing, and  
            managing local trauma care systems, including assessing needs,  
            developing the system design, designating trauma care centers,  
            collecting trauma care data, and providing quality assurance.
           
           3)RTCCs.  In 2008, EMSA defined five regions and created  
            corresponding RTCCs composed of trauma system providers, local  
            EMS agency staff, and trauma system stakeholders from within  
            each region.  The RTCCs serve in an advisory capacity to  
            promote regional cooperation, enhance and develop best  
            practices, assist with the analysis of regional data, and work  
            collaboratively with the state and local EMS agencies to  
            develop regional policies and protocols in support of the  
            state trauma system.
           
           4)L.A. County's Measure B.  In order to maintain, expand, and  
            improve the trauma system countywide, L.A. County approved  
            Measure B in 2002.  In recent years, concerns have been raised  
            about the expenditure of Measure B funds and whether they are  
            being equitably allocated throughout the county.  A February  
            2014 State Auditor report recommended the L.A. County Board of  
            Supervisors reinstate a defunct oversight committee, and that  
            Measure B funds be used to engage the American College of  
            Surgeons (ACS) to perform a comprehensive assessment of the  
            trauma system.  

          5)Opposition.  Local EMS agencies and counties oppose this bill,  








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            they indicate the current framework governing trauma care is  
            transparent, accountable, and has served to support robust  
            local EMS systems for decades.  They believe this bill would  
            upend this system by requiring local EMS agencies to  
            incorporate RTCC recommendations into their trauma care plans  
            while imposing additional mandates and costs.  They argue that  
            while they collaborate through RTCCs, local EMS agencies  
            should not be forced to cede authority over system planning  
            and design to these committees.  They further explain that  
            RTCCs are informal, voluntary committees that serve as a forum  
            to share best practices for trauma care, but lack a standard  
            structure or any function established in regulations.

          6) Related Legislation. AB 70 (Waldron), pending in Assembly  
            Health, changes the reporting requirement that EMSA report  
            annually to the Legislature on the effectiveness of the  
            statewide trauma system to once every five years.  

          7)Prior Legislation. AB 1975 (Hernández) of 2014 was similar to  
            this bill, but also contained an appropriation for EMSA to  
            create a data system, and was held on the Suspense File of  
            this committee.
          


          Analysis Prepared by:Lisa Murawski / APPR. / (916)  
          319-2081