BILL ANALYSIS Ó
SB 326
Page 1
Date of Hearing: June 30, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
SB
326 (Beall) - As Amended June 2, 2015
SENATE VOTE: 31-5
SUBJECT: Courts: penalties: emergency services funding.
SUMMARY: Extends the sunset date of the $4 penalty assessment
for Vehicle Code violations, other than parking offenses, from
January 1, 2016 to January 1, 2018, and extends the resulting
revenue be deposited in the Emergency Medical Air Transportation
Act (EMATA) Fund from June 30, 2017 to June 30, 2019. Extends
the January 1, 2018 sunset date of the Act to January 1, 2020,
and makes related changes. Money in the EMATA Fund is to be
primarily used to augment Medi-Cal reimbursement for emergency
medical air transportation services.
EXISTING LAW:
1)Levies, under EMATA, a penalty of $4 on every conviction for a
violation of the Vehicle Code, or a local ordinance adopted
pursuant to the Vehicle Code, with the exception of a parking
offense.
2)Sunsets assessment of the $4 penalty under EMATA on January 1,
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2016, and transfers any monies unexpended and unencumbered in
the EMATA Fund on June 30, 2017 to the General Fund.
3)Requires the county or the court that imposed the fine to
transfer the monies collected to the EMATA Fund.
4)Requires monies in the EMATA Fund to be made available, upon
appropriation by the Legislature, to the Department of Health
Care Services (DHCS) for administrative costs, with the
remainder to be 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 air
transportation reimbursement payments made through the
Medi-Cal program.
5)Requires DHCS to seek to obtain federal matching funds by
using the monies in the EMATA Fund for the purpose of
augmenting Medi-Cal reimbursement paid to emergency medical
air transportation providers.
6)Repeals the section of law establishing EMATA, the Fund, and
the Medi-Cal emergency medical air transportation
reimbursement provisions on January 1, 2018.
FISCAL EFFECT: According to the Senate Appropriations
Committee:
1)Penalty revenues of $11 million to $13 million per year (EMATA
Fund).
2)Minor administrative costs to process payments (EMATA Fund).
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3)Reduced General Fund expenditures of $2 million to $3 million
per year for Medi-Cal payments, by using penalty revenues to
offset General Fund expenditures for emergency air ambulance
services for Medi-Cal beneficiaries.
4)Annual expenditures of $18 million to $22 million per year for
supplemental payments to private emergency air medical service
providers (EMATA Fund and federal funds).
COMMENTS:
1)PURPOSE OF THIS BILL. 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 program or the county Maddy
Emergency Medical Services (EMS) Fund when they provide
treatment to indigent patients. Prior to enactment of EMATA,
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
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
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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 purposes 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.
---------------------------------------------------------
| State | EMATA Fund | General Fund | Available |
| Fiscal | | Offset | for Rate |
| Year | | |Augmentation |
|-----------+----------------+--------------+-------------|
| 2012-13 | $13,750,000 | $2,750,000 |$11,000,00 |
| | | | 0 |
|-----------+----------------+--------------+-------------|
| 2013-14 | $11,250,000 | $2,250,000 |$9,000,000 |
| | | | |
|-----------+----------------+--------------+-------------|
| 2014-15 | $11,250,000 | $2,250,000 |$9,000,000 |
| | | | |
|-----------+----------------+--------------+-------------|
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| 2015-16* | $11,250,000 | $2,250,000 |$9,000,000 |
| | | | |
---------------------------------------------------------
*Projected
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. DHCS' State Plan Amendment states, 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.
3)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, EMS,
local criminal justice facilities, emergency medical air
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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). The
penalty assessment (PA) accrues for every $10 or portion of
$10 ($.01 to $9.99) of the base fine. For example, if the
violation for faulty equipment is $25; the State PA is $30 (3
x $10); the County PA is $21 (3 x $7); the EMS PA is $6 (3 x
$2); the DNA Fund PA $15 (3 x $5); and, the Court Facilities
PA is $15 (3 x $5).
----------------------------------------------------------
| 2013 Traffic Infraction Bail Examples |
----------------------------------------------------------
|-------------------------------+-------+-------+---------|
| |Faulty |Moving | Over |
| |Equipme|Violati| Limit > |
| | nt | on | 25 MPH |
|-------------------------------+-------+-------+---------|
| Base Fine |$25.0 |$35.00 |$100.00 |
| | 0 | | |
---------------------------------------------------------
|---------+---------------------+-------+-------+---------|
|PA for |State PA ($10.00) |30.00 | 40.00 | 100.00 |
|every | | | | |
|$10 or | | | | |
|part of | | | | |
|$10 of | | | | |
|Base | | | | |
|Fine | | | | |
|---------+---------------------+-------+-------+---------|
| |County PA (up to |21.00 | 28.00 | 70.00 |
| |$7.00) | | | |
---------------------------------------------------------
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| |EMS PA ($2.00) | 6.00 | 8.00 | 20.00 |
---------------------------------------------------------
| |DNA Fund PA ($5.00) |15.00 | 20.00 | 50.00 |
| | | | | |
|---------+---------------------+-------+-------+---------|
| |Court Facilities PA |15.00 | 20.00 | 50.00 |
| |($5.00) | | | |
---------------------------------------------------------
---------------------------------------------------------
|Emergency Medical Air | 4.00 | 4.00 | 4.00 |
|Transportation PA | | | |
---------------------------------------------------------
|State Surcharge (20% of Base | 5.00 | 7.00 | 20.00 |
|Fine) | | | |
---------------------------------------------------------
| Fine and Penalty Subtotal|$121. |$162.0 |$414.00 |
| | 00 | 0 | |
---------------------------------------------------------
|Court Operations Fee ($40.00) |40.00 | 40.00 | 40.00 |
| | | | |
---------------------------------------------------------
|Criminal Conviction Fee |35.00 | 35.00 | 35.00 |
|($35.00) | | | |
---------------------------------------------------------
|Night Court Fee | 1.00 | 1.00 | 1.00 |
|-------------------------------+-------+-------+---------|
| Total|$197. |$238.0 |$490.00 |
| | 00 | 0 | |
| | | | |
| | | | |
| | | | |
---------------------------------------------------------
4)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 extending the sunset
clause on the EMATA created in 2010. Cal-AAMSS states air
ambulance services provide life-saving emergency
transportation to the most critical patients from automobile
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accident scenes directly to trauma centers. In addition,
emergency helicopter air ambulances 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 EMS system. Prior to the
EMATA, 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 1993
levels.
The Rural County Representatives of California (RCRC) states
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 EMATA should be
continued in order to promote a vital health care delivery
system that is so important in rural and remote areas.
The California Ambulance Association (CAA) notes that ambulance
service, including air ambulance, is critical to the health
care safety net, providing desperately needed care immediately
to all people without exception. Emergency ambulance service
providers are legally and morally bound to provide emergency
services regardless of a patient's ability to pay. The funds
collected under EMATA are needed for better state funding of
air ambulance activities. CAA explains that Medi-Cal rates
cover only one quarter of the cost of service, are not updated
annually for inflation and have actually been reduced over the
last decade. California provides the fourth lowest
reimbursement rates for ambulance services provided to
Medicaid recipients of all states.
5)PREVIOUS LEGISLATION.
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a) 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.
b) AB 2173 establishes a $4 fee on every vehicle code
violation to be collected by the county and transferred to
DHCS for deposit in the EMATA Fund to be used in the
Medi-Cal Program to obtain federal funds and to fund
supplemental payments for emergency medical air
transportation services.
REGISTERED SUPPORT / 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
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CALSTAR
Care Flight Critical Care Transport
Children's Hospital Los Angeles
Emergency Nurses Association
Emergency Nurses Association of California
Hall Ambulance Service Incorporated
Helinet Aviation Services
Loma Linda Children's Hospital
Manteca District Ambulance Service
Mercy Medical Center Redding
PHI Air Medical
REACH Air Medical Services
Rural County Representatives of California
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Sonora Regional Medical Center
Stanford Life Flight
Opposition
None on file.
Analysis Prepared by:Patty Rodgers / HEALTH / (916)
319-2097