BILL ANALYSIS Ó SB 326 Page 1 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 | | SB 326 Page 2 | | |Garcia, Holden, | | | | |Jones, Quirk, Rendon, | | | | |Wagner, Weber, Wood | | | | | | | | | | | | ------------------------------------------------------------------ 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 SB 326 Page 3 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. SB 326 Page 4 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 SB 326 Page 5 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