BILL ANALYSIS Ó AB 430 Page 1 Date of Hearing: May 6, 2015 ASSEMBLY COMMITTEE ON APPROPRIATIONS Jimmy Gomez, Chair AB 430 (Roger Hernández) - As Amended April 20, 2015 ----------------------------------------------------------------- |Policy |Health |Vote:|18 - 1 | |Committee: | | | | | | | | | | | | | | |-------------+-------------------------------+-----+-------------| | | | | | | | | | | | | | | | |-------------+-------------------------------+-----+-------------| | | | | | | | | | | | | | | | ----------------------------------------------------------------- Urgency: No State Mandated Local Program: NoReimbursable: No SUMMARY: This bill: 1)Requires the Emergency Medical Services Authority (EMSA) to AB 430 Page 2 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 AB 430 Page 3 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, AB 430 Page 4 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