BILL NUMBER: AB 1223 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY MAY 5, 2015
AMENDED IN ASSEMBLY APRIL 14, 2015
INTRODUCED BY Assembly Member O'Donnell
FEBRUARY 27, 2015
An act to amend Sections 1797.98a, 1797.98e, and 1797.220
of, and to add Section Sections
1797.120 to, and 1797.225 to the
Health and Safety Code, relating to emergency medical services.
LEGISLATIVE COUNSEL'S DIGEST
AB 1223, as amended, O'Donnell. Emergency medical services:
noncritical cases. ambulance transportation.
Existing law establishes the Maddy Emergency Medical Services
(EMS) Fund, and authorizes each county to establish an emergency
medical services fund for reimbursement of costs related to emergency
medical services. Existing law limits payments made from the fund to
claims for care rendered by physicians to patients who are initially
medically screened, evaluated, treated, or stabilized in specified
facilities, including a site that was approved by a county prior to
January 1, 1990, as a paramedic receiving station for the treatment
of emergency patients.
This bill would expand those specified facilities to include any
licensed clinic or mental health facility, and any site approved by a
county as a paramedic receiving station for the treatment of
emergency patients. This bill would make conforming changes.
Existing law establishes the Emergency Medical Services
Authority, and requires it to adopt regulations that further the
purpose of establishing a statewide system for emergency medical
services. Exis ting law, the Emergency Medical
Services System and the Prehospital Emergency Medical Care Personnel
Act, authorizes each county to develop an emergency medical services
program. The act further authorizes a local emergency medical
services (EMS) agency to develop and submit a plan to the Emergency
Medical Services Authority for an emergency medical services system,
and requires the local EMS agency, using state minimum standards, to
establish policies and procedures to assure medical control of the
emergency medical services system that may require basic life support
emergency medical transportation services to meet any medical
control requirements, including dispatch, patient destination
policies, patient care guidelines, and quality assurance
requirements.
This bill would require authorize a
local EMS agency to include in those adopt
policies and procedures specified policies, including
the establishment and enforcement of criteria relating to
ambulance patient offload time, as defined, and for the
transport of a patient to an alternate emergency department or
facility under specified circumstances. defined.
The bill would require the authority to develop a statewide standard
methodology for the calculation and reporting by a local EMS agency
of ambulance patient offload time.
Vote: majority. Appropriation: no. Fiscal committee: no
yes . State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 1797.98a of the Health and
Safety Code is amended to read:
1797.98a. (a) The fund provided for in this chapter shall be
known as the Maddy Emergency Medical Services (EMS) Fund.
(b) (1) Each county may establish an emergency medical services
fund, upon the adoption of a resolution by the board of supervisors.
The moneys in the fund shall be available for the reimbursements
required by this chapter. The fund shall be administered by each
county, except that a county electing to have the state administer
its medically indigent services program may also elect to have its
emergency medical services fund administered by the state.
(2) Costs of administering the fund shall be reimbursed by the
fund in an amount that does not exceed the actual administrative
costs or 10 percent of the amount of the fund, whichever amount is
lower.
(3) All interest earned on moneys in the fund shall be deposited
in the fund for disbursement as specified in this section.
(4) Each administering agency may maintain a reserve of up to 15
percent of the amount in the portions of the fund reimbursable to
physicians and surgeons, pursuant to subparagraph (A) of, and to
hospitals, pursuant to subparagraph (B) of, paragraph (5). Each
administering agency may maintain a reserve of any amount in the
portion of the fund that is distributed for other emergency medical
services purposes as determined by each county, pursuant to
subparagraph (C) of paragraph (5).
(5) The amount in the fund, reduced by the amount for
administration and the reserve, shall be utilized to reimburse
physicians and surgeons and hospitals for patients who do not make
payment for emergency medical services and for other emergency
medical services purposes as determined by each county according to
the following schedule:
(A) Fifty-eight percent of the balance of the fund shall be
distributed to physicians and surgeons for emergency services
provided by all physicians and surgeons, except those physicians and
surgeons employed by county hospitals, in general acute care
hospitals that provide basic, comprehensive, or standby emergency
services pursuant to paragraph (4) or (6) of subdivision (f) of
Section 1797.98e up to the time the patient is stabilized.
(B) Twenty-five percent of the fund shall be distributed only to
hospitals providing disproportionate trauma and emergency medical
care services.
(C) Seventeen percent of the fund shall be distributed for other
emergency medical services purposes as determined by each county,
including, but not limited to, the funding of regional poison control
centers. Funding may be used for purchasing equipment and for
capital projects only to the extent that these expenditures support
the provision of emergency services and are consistent with the
intent of this chapter.
(c) The source of the moneys in the fund shall be the penalty
assessment made for this purpose, as provided in Section 76000 of the
Government Code.
(d) Any physician and surgeon may be reimbursed for up to 50
percent of the amount claimed pursuant to subdivision (a) of Section
1797.98c for the initial cycle of reimbursements made by the
administering agency in a given year, pursuant to Section 1797.98e.
All funds remaining at the end of the fiscal year in excess of any
reserve held and rolled over to the next year pursuant to paragraph
(4) of subdivision (b) shall be distributed proportionally, based on
the dollar amount of claims submitted and paid to all physicians and
surgeons who submitted qualifying claims during that year.
(e) Of the money deposited into the fund pursuant to Section
76000.5 of the Government Code, 15 percent shall be utilized to
provide funding for all pediatric trauma centers throughout the
county, both publicly and privately owned and operated. The
expenditure of money shall be limited to reimbursement to physicians
and surgeons, and to hospitals for patients who do not make payment
for emergency care services in hospitals up to the point of
stabilization, or to hospitals for expanding the services provided to
pediatric trauma patients at trauma centers and other hospitals
providing care to pediatric trauma patients, or at pediatric trauma
centers, including the purchase of equipment. Local emergency medical
services (EMS) agencies may conduct a needs assessment of pediatric
trauma services in the county to allocate these expenditures.
Counties that do not maintain a pediatric trauma center shall utilize
the money deposited into the fund pursuant to Section 76000.5 of the
Government Code to improve access to, and coordination of, pediatric
trauma and emergency services in the county, with preference for
funding given to hospitals that specialize in services to children,
and physicians and surgeons who provide emergency care for children.
Funds spent for the purposes of this section, shall be known as
Richie's Fund. This subdivision shall remain in effect until January
1, 2017, and shall have no force or effect on or after that date,
unless a later enacted statute, that is chaptered before January 1,
2017, deletes or extends that date.
(f) Costs of administering money deposited into the fund pursuant
to Section 76000.5 of the Government Code shall be reimbursed from
the money collected in an amount that does not exceed the actual
administrative costs or 10 percent of the money collected, whichever
amount is lower. This subdivision shall remain in effect until
January 1, 2017, and shall have no force or effect on or after that
date, unless a later enacted statute, that is chaptered before
January 1, 2017, deletes or extends that date.
SEC. 2. Section 1797.98e of the Health and
Safety Code is amended to read:
1797.98e. (a) It is the intent of the Legislature that a
simplified, cost-efficient system of administration of this chapter
be developed so that the maximum amount of funds may be utilized to
reimburse physicians and surgeons and for other emergency medical
services purposes. The administering agency shall select an
administering officer and shall establish procedures and time
schedules for the submission and processing of proposed reimbursement
requests submitted by physicians and surgeons. The schedule shall
provide for disbursements of moneys in the Emergency Medical Services
Fund on at least a quarterly basis to applicants who have submitted
accurate and complete data for payment. When the administering agency
determines that claims for payment for physician and surgeon
services are of sufficient numbers and amounts that, if paid, the
claims would exceed the total amount of funds available for payment,
the administering agency shall fairly prorate, without preference,
payments to each claimant at a level less than the maximum payment
level. Each administering agency may encumber sufficient funds during
one fiscal year to reimburse claimants for losses incurred during
that fiscal year for which claims will not be received until after
the fiscal year. The administering agency may, as necessary, request
records and documentation to support the amounts of reimbursement
requested by physicians and surgeons and the administering agency may
review and audit the records for accuracy. Reimbursements requested
and reimbursements made that are not supported by records may be
denied to, and recouped from, physicians and surgeons. Physicians and
surgeons found to submit requests for reimbursement that are
inaccurate or unsupported by records may be excluded from submitting
future requests for reimbursement. The administering officer shall
not give preferential treatment to any facility, physician and
surgeon, or category of physician and surgeon and shall not engage in
practices that constitute a conflict of interest by favoring a
facility or physician and surgeon with which the administering
officer has an operational or financial relationship. A hospital
administrator of a hospital owned or operated by a county of a
population of 250,000 or more as of January 1, 1991, or a person
under the direct supervision of that person, shall not be the
administering officer. The board of supervisors of a county or any
other county agency may serve as the administering officer. The
administering officer shall solicit input from physicians and
surgeons and hospitals to review payment distribution methodologies
to ensure fair and timely payments. This requirement may be fulfilled
through the establishment of an advisory committee with
representatives comprised of local physicians and surgeons and
hospital administrators. In order to reduce the county's
administrative burden, the administering officer may instead request
an existing board, commission, or local medical society, or
physicians and surgeons and hospital administrators, representative
of the local community, to provide input and make recommendations on
payment distribution methodologies.
(b) Each provider of health services that receives payment under
this chapter shall keep and maintain records of the services
rendered, the person to whom rendered, the date, and any additional
information the administering agency may, by regulation, require, for
a period of three years from the date the service was provided. The
administering agency shall not require any additional information
from a physician and surgeon providing emergency medical services
that is not available in the patient record maintained by the entity
listed in subdivision (f) where the emergency medical services are
provided, nor shall the administering agency require a physician and
surgeon to make eligibility determinations.
(c) During normal working hours, the administering agency may make
any inspection and examination of a hospital's or physician and
surgeon's books and records needed to carry out this chapter. A
provider who has knowingly submitted a false request for
reimbursement shall be guilty of civil fraud.
(d) Nothing in this chapter shall prevent a physician and surgeon
from utilizing an agent who furnishes billing and collection services
to the physician and surgeon to submit claims or receive payment for
claims.
(e) All payments from the fund pursuant to Section 1797.98c to
physicians and surgeons shall be limited to physicians and surgeons
who, in person, provide onsite services in a clinical setting,
including, but not limited to, radiology and pathology settings.
(f) All payments from the fund shall be limited to claims for care
rendered by physicians and surgeons to patients who are initially
medically screened, evaluated, treated, or stabilized in any of the
following:
(1) A basic or comprehensive emergency department of a licensed
general acute care hospital.
(2) A licensed clinic or mental health facility.
(3) A site that is approved by a county as a paramedic receiving
station for the treatment of emergency patients.
(4) A standby emergency department that was in existence on
January 1, 1989, in a hospital specified in Section 124840.
(5) For the 1991-92 fiscal year and each fiscal year thereafter, a
facility which contracted prior to January 1, 1990, with the
National Park Service to provide emergency medical services.
(6) A standby emergency room in existence on January 1, 2007, in a
hospital located in Los Angeles County that meets all of the
following requirements:
(A) The requirements of subdivision (m) of Section 70413 and
Sections 70415 and 70417 of Title 22 of the California Code of
Regulations.
(B) Reported at least 18,000 emergency department patient
encounters to the Office of Statewide Health Planning and Development
in 2007 and continues to report at least 18,000 emergency department
patient encounters to the Office of Statewide Health Planning and
Development in each year thereafter.
(C) A hospital with a standby emergency department meeting the
requirements of this paragraph shall do both of the following:
(i) Annually provide the State Department of Public Health and the
local emergency medical services agency with certification that it
meets the requirements of subparagraph (A). The department shall
confirm the hospital's compliance with subparagraph (A).
(ii) Annually provide to the State Department of Public Health and
the local emergency medical services agency the emergency department
patient encounters it reports to the Office of Statewide Health
Planning and Development to establish that it meets the requirement
of subparagraph (B).
(g) Payments shall be made only for emergency medical services
provided on the calendar day on which emergency medical services are
first provided and on the immediately following two calendar days.
(h) Notwithstanding subdivision (g), if it is necessary to
transfer the patient to a second facility providing a higher level of
care for the treatment of the emergency condition, reimbursement
shall be available for services provided at the facility to which the
patient was transferred on the calendar day of transfer and on the
immediately following two calendar days.
(i) Payment shall be made for medical screening examinations
required by law to determine whether an emergency condition exists,
notwithstanding the determination after the examination that a
medical emergency does not exist. Payment shall not be denied solely
because a patient was not admitted to an acute care facility. Payment
shall be made for services to an inpatient only when the inpatient
has been admitted to a hospital from an entity specified in
subdivision (f).
(j) The administering agency shall compile a quarterly and yearend
summary of reimbursements paid to facilities and physicians and
surgeons. The summary shall include, but shall not be limited to, the
total number of claims submitted by physicians and surgeons in
aggregate from each facility and the amount paid to each physician
and surgeon. The administering agency shall provide copies of the
summary and forms and instructions relating to making claims for
reimbursement to the public, and may charge a fee not to exceed the
reasonable costs of duplication.
(k) Each county shall establish an equitable and efficient
mechanism for resolving disputes relating to claims for
reimbursements from the fund. The mechanism shall include a
requirement that disputes be submitted either to binding arbitration
conducted pursuant to arbitration procedures set forth in Chapter 3
(commencing with Section 1282) and Chapter 4 (commencing with Section
1285) of Part 3 of Title 9 of the Code of Civil Procedure, or to a
local medical society for resolution by neutral parties.
( l ) Physicians and surgeons shall be
eligible to receive payment for patient care services provided by, or
in conjunction with, a properly credentialed nurse practitioner or
physician's assistant for care rendered under the direct supervision
of a physician and surgeon who is present in the facility where the
patient is being treated and who is available for immediate
consultation. Payment shall be limited to those claims that are
substantiated by a medical record and that have been reviewed and
countersigned by the supervising physician and surgeon in accordance
with regulations established for the supervision of nurse
practitioners and physician assistants in California.
SEC. 3. SECTION 1. Section 1797.120
is added to the Health and Safety Code, to read:
1797.120. (a) The authority shall
develop develop, using input from stakeholders,
including, but not limited to, hospitals, local EMS agencies, and
public and private EMS service providers, a statewide standard
methodology for the calculation and reporting by a local EMS agency
of ambulance patient offload time.
(b) For the purposes of this section, "ambulance patient offload
time" is defined as the interval between the arrival of an ambulance
patient transported by a local EMS agency at an emergency department
and the time that the emergency department assumes responsibility for
care of the patient following the transfer of the patient to a
stretcher utilized by the emergency department.
SEC. 4. Section 1797.220 of the Health and
Safety Code is amended to read:
1797.220. (a) The local EMS agency, using state minimum
standards, shall establish policies and procedures approved by the
medical director of the local EMS agency to assure medical control of
the EMS system. The policies and procedures approved by the medical
director may require basic life support emergency medical
transportation services to meet any medical control requirements,
including dispatch, patient destination policies, patient care
guidelines, and quality assurance requirements.
(b) The policies and procedures adopted pursuant to subdivision
(a) shall include the following:
(1) A policy that uses the authority's standard methodology for
calculating ambulance patient offload time to establish and enforce
compliance with criteria for the offloading of a patient transported
by ambulance.
(2) Criteria for the reporting of and quality assurance followup
for a "never event," as defined in subdivision (c).
(3) A policy that allows a patient the right to request transport
to another emergency department if the patient is subject to extended
ambulance patient offload time.
(4) A policy that allows a patient with a minor medical injury or
illness to be transported, as approved by a licensed physician under
direct medical control of the patient, to a county-approved or
state-approved receiving facility, including a clinic, stand-alone
emergency department, mental health facility, or sobering center.
(c) For the purposes of this section, a "never event" occurs when
the ambulance patient offload time for a patient exceeds one hour.
(d) For the purposes of this section, "ambulance patient offload
time" is defined as the interval between the arrival of an ambulance
patient transported by the local EMS agency at an emergency
department and the time that the emergency department assumes
responsibility for care of the patient following the transfer of the
patient to a stretcher utilized by the emergency department.
SEC. 2. Section 1797.225 is added to the
Health and Safety Code , to read:
1797.225. (a) A local EMS agency may adopt policies and
procedures for calculating and reporting ambulance patient offload
time, as defined in subdivision (b) of Section 1797.120.
(b) A local EMS agency that adopts policies and procedures for
calculating and reporting ambulance patient offload time pursuant to
subdivision (a) shall do all of the following:
(1) Use the statewide standard methodology for calculating and
reporting ambulance patient offload time developed by the authority
pursuant to Section 1797.120.
(2) Establish criteria for the reporting of, and quality assurance
followup for, a "never event," as defined in subdivision (c).
(c) For the purposes of this section, a "never event" occurs when
the ambulance patient offload time for a patient exceeds a period of
time designated in the criteria established by the local EMS agency
pursuant to paragraph (2) of subdivision (b).