BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 326
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|AUTHOR: |Beall |
|---------------+-----------------------------------------------|
|VERSION: |February 23, 2015 |
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|HEARING DATE: |April 8, 2015 | | |
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|CONSULTANT: |Scott Bain |
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SUBJECT : Courts: penalties: emergency services funding
SUMMARY : Makes permanent a $4 penalty assessment for Vehicle Code
violations other than parking offenses, with the resulting
revenue deposited in the Emergency Medical Air Transportation
Act Fund (Fund.) Money in that Fund is primarily used to fund
Medi-Cal reimbursement for emergency medical air transportation
services.
Existing law:
1.Levies, under the Emergency Medical Air Transportation Act
(the Act), a penalty of $4 upon every conviction for a
violation of the Vehicle Code, or a local ordinance adopted
pursuant to the Vehicle Code, other than a parking offense.
2.Sunsets the assessment of the $4 penalty under the Act
commencing January 1, 2016, and transfers any moneys
unexpended and unencumbered in the Fund on June 30, 2017 to
the General Fund.
3.Requires the county or the court that imposed the fine to
transfer the moneys collected to the Emergency Medical Air
Transportation Act Fund.
4.Requires moneys in the Fund to be made available, upon
appropriation by the Legislature, to the Department of Health
Care Services (DHCS), to be for payment of DHCS administrative
costs, with the remainder being used as follows:
a. Twenty percent to offset the state portion of
the Medi-Cal reimbursement rate for emergency medical
air transportation services; and,
b. Eighty percent to augment emergency medical
SB 326 (Beall) Page 2 of ?
air transportation reimbursement payments made through
the Medi-Cal program.
5.Requires DHCS to seek to obtain federal matching funds by
using the moneys in the Fund for the purpose of augmenting
Medi-Cal reimbursement paid to emergency medical air
transportation providers.
6.Repeals the section of law establishing the Act, the Fund and
the Medi-Cal emergency medical air transportation
reimbursement provisions on January 1, 2018.
This bill:
1.Deletes the January 1, 2016 sunset date of the $4 penalty
assessment established under the Act, thereby extending its
operation permanently.
2.Deletes the January 1, 2018 sunset date of the Act, thereby
extending its provisions permanently, and makes related
changes.
FISCAL
EFFECT : This bill has not been analyzed by a fiscal committee.
COMMENTS :
1.Author's statement. According to the author, many emergency
patients transported by air ambulances have no insurance, are
not eligible for Medi-Cal, and have no ability to pay for the
service, yet these patients are given the same high level of
care as those with medical insurance. The Medi-Cal fee
schedule pays air ambulance services far below the cost of
providing emergency air transportation, and pays nothing if
the patient is indigent. Emergency air ambulance services
provide coverage to multiple counties within a 100-mile radius
of their bases, and as a result often their transports
originate in a county other than where they are based. This
makes it difficult for them to be funded by local tax support
except in the largest of counties. Emergency physicians and
air ambulances do not receive additional funding through the
Disproportionate Share Hospital (DSH) program, or the county
Maddy Emergency Medical Services Fund when they provide
treatment to indigent patients. Prior to enactment of the Act,
Medi-Cal funding for air ambulances had not increased for
nearly 20 years. This bill will continue to provide critical
funding to these services and will prevent funding for air
SB 326 (Beall) Page 3 of ?
ambulances from reverting back to 1993 levels by continuing
the $4 penalty to fund air ambulance services.
2.Background. AB 2173 (Beall), Chapter 547, Statutes of 2010,
levied a $4 additional penalty on Vehicle Code violations
(excluding parking tickets), with the resulting revenue being
used as the state match to draw down additional federal
Medicaid matching funds to fund Medi-Cal emergency air medical
transportation services. To be eligible for the supplemental
payments, air medical transportation providers must be
a. Actively enrolled as a Medi-Cal air medical
transportation provider;
b. Operate an aircraft that the meets the
definition of an "air ambulance;" and,
c. Be certified by the Federal Aviation Agency to
use the aircraft for purpose of being an air medical
transportation provider.
As shown in the chart below, between $11.2 and $13.7 million
has been raised annually from the AB 2173 penalty assessment.
Of that amount, $2.2 to $2.7 million is used as the state
match to fund current emergency air ambulance Medi-Cal
provider rates. The remaining $9 to $11 million is used to
match with federal dollars to augment Medi-Cal rates to
emergency air ambulance providers.
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| State Fiscal | Emergency | General Fund | Available for |
| Year | Medical Air | Offset | Rate |
| |Transportation | |Augmentation |
| | Fund | | |
|---------------+---------------+---------------+---------------|
|2012-13 |$13,750,000 |$2,750,000 |$11,000,000 |
|---------------+---------------+---------------+---------------|
|2013-14 |$11,250,000 |$2,250,000 |$9,000,000 |
|---------------+---------------+---------------+---------------|
|2014-15 |$11,250,000 |$2,250,000 |$9,000,000 |
|---------------+---------------+---------------+---------------|
|2015-16* |$11,250,000 |$2,250,000 |$9,000,000 |
| | | | |
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*Projected
SB 326 (Beall) Page 4 of ?
The $9 to $11 million augmentation amounts from AB 2173 are
provided as supplemental payments to eligible Medi-Cal air
medical transportation providers that provide fee-for-service
emergency air medical transportation services. The payment
augmentation amounts are in addition to the existing fee
schedule rate for emergency air medical transportation and
mileage services. Per DHCS' State Plan Amendment, the payment
augmentation amount and the existing fee schedule rate must
not exceed a provider's usual and customary rates charged to
the general public for an emergency air medical transport.
Approximately 23 air ambulance providers receive the resulting
revenue.
1.Penalty Assessments. According to the Judicial Council, the
calculation for a traffic ticket in California, and
determining where the money goes once collected, is complex.
The cost of a traffic ticket includes a base fine amount plus
penalty assessments and fees to fund specific state and local
activities. The base fine is collected for, and distributed
to, either the local government or local government and
county. The increase in the total cost of a traffic ticket
(above the base fine) in California over the last 20 years is
primarily the result of the addition of mandatory penalty
assessments and fees.
Penalty assessments are typically calculated from the base fine
for the traffic ticket and are part of the punishment that is
imposed for the violation. The penalties collected are
distributed to many different city, county, and state funds
established by the local government and Legislature for
activities such as DNA collection in criminal cases, emergency
medical services, local criminal justice facilities, emergency
medical air transportation, and court facility maintenance and
construction. The chart below lists three examples of the cost
and distribution of a typical traffic ticket, including the
base fine, penalties, and fees. The chart below, created by
the Judicial Council, provides information on a typical ticket
for faulty equipment ($25), a moving violation ($35), and
driving more than 25 MPH over the speed limit ($100).
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| 2013 Traffic Infraction Bail Examples |
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SB 326 (Beall) Page 5 of ?
| |Faulty |Moving | Over |
| |Equipme|Violati| Limit > |
| | nt | on | 25 MPH |
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| | | | | |
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| Base Fine | $25.00| $35.00| $100.00|
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|---------+---------------------+-------+-------+---------|
|Penalty |State PA ($10) | 30.00| 40.00|100.00 |
|Assessmen| | | | |
|t (PA) | | | | |
|for | | | | |
|every | | | | |
|$10 or | | | | |
|part of | | | | |
|$10 of | | | | |
|Base | | | | |
|Fine | | | | |
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| |County PA (up to $7) | 21.00| 28.00| 70.00|
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| |Emergency Medical | 6.00| 8.00| 20.00|
| |Services PA ($2) | | | |
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| |DNA Fund PA ($5) | 15.00| 20.00| 50.00|
|---------+---------------------+-------+-------+---------|
| |Court Facilities PA | 15.00| 20.00| 50.00|
| |($5) | | | |
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|Emergency Medical Air | 4.00| 4.00| 4.00|
|Transportation PA | | | |
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|State Surcharge (20% of Base | 5.00| 7.00| 20.00|
|Fine) | | | |
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| Fine and Penalty Subtotal|$121.00|$162.00| $414.00|
| | | | |
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|Court Operations Fee ($40) | 40.00| 40.00| 40.00|
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|Criminal Conviction Fee ($35) | 35.00| 35.00| 35.00|
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|Night Court Fee | 1.00| 1.00| 1.00|
|-------------------------------+-------+-------+---------|
| Total|$197.00|$238.00|$490.00 |
| | | | |
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2.Prior legislation. AB 1153 (Beall), of 2009, would have
established the Emergency Air Medical Transportation Act,
which would create a $3 penalty assessment on all Vehicle
Code violations (except parking offenses) to provide a
funding source to augment Medi-Cal reimbursement for air
ambulance services. AB 1153 was held on the Assembly
Appropriations suspense file.
3.Support. This bill is sponsored by the California Association
of Air Medical Services (Cal-AAMS), which argues this bill
will maintain the current level of Medi-Cal funding of
emergency air ambulance transportation by removing the sunset
clause on the Act created in 2010. Cal-AAMSS states air
ambulance services provide life-saving emergency
transportation to the most critical patients from automobile
accident scenes directly to trauma centers. In addition,
emergency helicopter air ambulance providers provide a
critical link between rural areas and urban tertiary care
hospitals (trauma centers, heart/stroke centers, burn units)
and are an essential part of the statewide emergency medical
services system. Prior to the Act, Medi-Cal funding for air
ambulances had not increased for nearly 20 years. This bill
will continue to provide critical funding to this essential
life-saving service, and will prevent funding for air
ambulances to revert back to 1993levels. Removing the sunset
for this penalty will ensure the program continues to support
these critical services.
The Rural County Representatives of California (RCRC) write in
support that air ambulance service is critical in rural and
remote areas of California and a healthy air ambulance system
ensures rural communities have access to life-saving care for
both residents and tourists. RCRC states its member counties
have had no issues in their administrative role in
administering the penalty assessment, and they believe the Act
should be continued in order to promote a vital health care
delivery system that is so important in rural and remote
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areas.
SUPPORT AND OPPOSITION :
Support: California Association of Air Medical Services
(sponsor)
Board for Critical Care Transport Paramedic
Certification
California Ambulance Association
California Children's Hospital Association
California Hospital Association
CALSTAR
Care Flight
Children's Hospital Los Angeles
Emergency Nurse Association
Helinet Aviation Services
Loma Linda Children's Hospital
Manteca District Ambulance Service
Mercy Air Services
Mercy Medical Center Redding
PHI Air Medical
REACH Air Medical Services
Rural County Representatives of California
Sonora Regional Medical Center
Stanford Life Flight
Two individuals
Oppose: None received
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