BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                     SB 326


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          SENATE THIRD READING


          SB  
          326 (Beall)


          As Amended  August 31, 2015


          Majority vote


          SENATE VOTE:  31-5


           ------------------------------------------------------------------ 
          |Committee       |Votes|Ayes                  |Noes                |
          |                |     |                      |                    |
          |                |     |                      |                    |
          |                |     |                      |                    |
          |----------------+-----+----------------------+--------------------|
          |Health          |18-0 |Bonta, Maienschein,   |                    |
          |                |     |Bonilla, Burke, Chiu, |                    |
          |                |     |Gomez, Gonzalez,      |                    |
          |                |     |Roger Hernández,      |                    |
          |                |     |Lackey, McCarty,      |                    |
          |                |     |Nazarian, Patterson,  |                    |
          |                |     |Ridley-Thomas,        |                    |
          |                |     |Rodriguez, Steinorth, |                    |
          |                |     |Thurmond, Waldron,    |                    |
          |                |     |Wood                  |                    |
          |                |     |                      |                    |
          |----------------+-----+----------------------+--------------------|
          |Appropriations  |17-0 |Gomez, Bigelow,       |                    |
          |                |     |Bloom, Bonta,         |                    |
          |                |     |Calderon, Chang,      |                    |
          |                |     |Nazarian, Eggman,     |                    |
          |                |     |Gallagher, Eduardo    |                    |








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          |                |     |Garcia, Holden,       |                    |
          |                |     |Jones, Quirk, Rendon, |                    |
          |                |     |Wagner, Weber, Wood   |                    |
          |                |     |                      |                    |
          |                |     |                      |                    |
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          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.  States  
          it is the intent of the Legislature to cease collection of  
          penalty assessments on January 1, 2018, pursuant to EMATA and  
          that the Legislature identify alternative funding sources for  
          emergency medical air transportation and cease reliance on  
          penalty assessment revenue.  Requires the Department of Health  
          Care Services, in coordination with the Department of Finance,  
          to develop a funding plan that ensures adequate reimbursement to  
          emergency medical air transportation providers following the  
          termination of the Vehicle Code penalty assessments.
          FISCAL EFFECT:  According to the Assembly Appropriations  
          Committee:


          1)Penalty revenues of around $10 million per year for an  
            additional two years, until 2018 (EMATA Fund).  Annual  
            revenues will fluctuate depending on the number of vehicle  
            code violations that result in convictions, as well as other  
            factors.  The numbers below are based on an assumption of $10  
            million in annual revenue.


          2)Administrative costs, likely in the low hundreds of thousands  
            (EMATA Fund).


          3)Reduced General Fund (GF) expenditures of around $2 million  








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            per year for Medi-Cal payments, by using penalty revenues to  
            offset GF expenditures for emergency air ambulance services  
            for Medi-Cal beneficiaries.


          4)Annual expenditures of around $16 million per year for  
            supplemental payments to private emergency air medical service  
            providers (EMATA Fund and federal funds).


          5)Based on language stating intent to cease collection of  
            assessments for its current purpose and requiring a plan for  
            an alternate funding source for emergency medical air  
            transportation services, potential GF cost pressure to augment  
            GF spending on these services.


          COMMENTS:  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.









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          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.   
          Between $11.2 million and $13.7 million has been raised annually  
          from the AB 2173 penalty assessment.  Of that amount, $2.2  
          million to $2.7 million is used as the state match to fund  
          current emergency air ambulance Medi-Cal provider rates.  The  
          remaining $9 million to $11 million is used to match with  
          federal dollars to augment Medi-Cal rates to emergency air  
          ambulance providers.


          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. 


          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 accident scenes directly to  
          trauma centers. 


          The Rural County Representatives of California (RCRC) states in  
          support that air ambulance service is critical in rural and  








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          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, also in support, 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.


          There is no known opposition to this bill.




          Analysis Prepared by:                                             
                          Patty Rodgers / HEALTH / (916) 319-2097  FN:  
          0001744