BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 326|
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UNFINISHED BUSINESS
Bill No: SB 326
Author: Beall (D), et al.
Amended: 8/31/15
Vote: 21
SENATE HEALTH COMMITTEE: 8-0, 4/8/15
AYES: Hernandez, Hall, Mitchell, Monning, Nielsen, Pan, Roth,
Wolk
NO VOTE RECORDED: Nguyen
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/28/15
AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza, Nielsen
SENATE FLOOR: 31-5, 6/3/15
AYES: Allen, Bates, Beall, Berryhill, Block, Cannella, De
León, Galgiani, Glazer, Hall, Hernandez, Hertzberg, Hill,
Hueso, Huff, Jackson, Lara, Leno, Leyva, Liu, McGuire,
Mendoza, Mitchell, Monning, Nielsen, Pan, Pavley, Roth, Vidak,
Wieckowski, Wolk
NOES: Anderson, Moorlach, Morrell, Nguyen, Stone
NO VOTE RECORDED: Fuller, Gaines, Hancock, Runner
ASSEMBLY FLOOR: 74-0, 9/10/15 - See last page for vote
SUBJECT: Courts: penalties: emergency services funding
SOURCE: California Association of Air Medical Services
DIGEST: This bill extends the sunset date of the $4 penalty
assessment for Vehicle Code violations other than parking
offenses, until January 1, 2018, 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.
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Requires the Department of Health Care Services to develop a
funding plan that ensures adequate reimbursement to emergency
medical air transportation providers following the termination
of penalty assessments under this bill on January 1, 2018.
Assembly Amendments require DHCS, by March 1, 2017, 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 penalty assessments under this bill on January 1, 2018, and
make legislative findings and declarations as to the harmful
effects of relying on penalty assessments to fund core state
programs and the necessity to identify alternative funding
sources for emergency medical air transportation services.
ANALYSIS:
Existing law:
1)Levies, under the Emergency Medical Air Transportation Act
(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 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 air
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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)Extends the sunset date of the $4 penalty assessment
established under the Act, from January 1, 2016 to January 1,
2018.
2)Extends the January 1, 2018 sunset date of the Act to January
1, 2020, and makes related changes.
3)Requires DHCS, by March 1, 2017, 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 penalty assessments
under this bill on January 1, 2018.
4)Make legislative findings and declarations as to the harmful
effects of relying on penalty assessments to fund core state
programs and the necessity to identify alternative funding
sources for emergency medical air transportation services.
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.
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
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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. 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. 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).
-----------------------------------------------------------
| 2013 Traffic Infraction Bail Examples |
-----------------------------------------------------------
------------------------------------------------------------
| | Faulty | Moving | Over |
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| |Equipment|Violatio| Limit |
| | | n | 25 MPH |
------------------------------------------------------------
------------------------------------------------------------
| | | | | |
------------------------------------------------------------
------------------------------------------------------------
| Base Fine | $25.00| $35.00| $100.00|
------------------------------------------------------------
|--------------------+--------------------+--------------------+--------------------+--------------------|
|Penalty Assessment |State PA ($10) | 30.00| 40.00| 100.00|
|(PA) for every $10 | | | | |
|or part of $10 of | | | | |
|Base Fine | | | | |
--------------------------------------------------------------------------------------------------------
| |County PA (up to | 21.00| 28.00| 70.00|
| |$7) | | | |
--------------------------------------------------------------------------------------------------------
| |Emergency Medical | 6.00| 8.00| 20.00|
| |Services PA ($2) | | | |
--------------------------------------------------------------------------------------------------------
| |DNA Fund PA ($5) | 15.00| 20.00| 50.00|
|--------------------+--------------------+--------------------+--------------------+--------------------|
| |Court Facilities PA | 15.00| 20.00| 50.00|
| |($5) | | | |
--------------------------------------------------------------------------------------------------------
------------------------------------------------------------
|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| $121.00| $162.00| $414.00|
------------------------------------------------------------
|Court Operations Fee ($40) | 40.00| 40.00| 40.00|
------------------------------------------------------------
|Criminal Conviction Fee ($35) | 35.00| 35.00| 35.00|
------------------------------------------------------------
|Night Court Fee | 1.00| 1.00| 1.00|
|------------------------------+---------+--------+----------|
| Total| $197.00| $238.00|$490.00 |
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| | | | |
------------------------------------------------------------
Comments
Author's statement. According to the author, "[M]any 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 ambulances from reverting back to 1993 levels by
continuing the $4 penalty to fund air ambulance services."
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Assembly Appropriations Committee:
1)Penalty revenues of around $10 million per year for an
additional two years, until 2018 (Emergency Medical Air
Transportation Act 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
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(Emergency Medical Air Transportation Act Fund).
3)Reduced GF expenditures of around $2 million 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 (Emergency Medical Air Transportation Act Fund and
federal funds).
SUPPORT: (Verified9/8/15)
California Association of Air Medical Services (source)
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
Hall Ambulance Service, Inc.
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
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OPPOSITION: (Verified9/8/15)
None received
ARGUMENTS IN 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 1993 levels. 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 areas.
ASSEMBLY FLOOR: 74-0, 9/10/15
AYES: Achadjian, Alejo, Baker, Bigelow, Bloom, Bonilla, Bonta,
Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chávez,
Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd,
Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia,
Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray,
Grove, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer,
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Kim, Lackey, Levine, Lopez, Low, Maienschein, Mathis, Mayes,
McCarty, Medina, Melendez, Mullin, Nazarian, O'Donnell, Olsen,
Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez,
Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting,
Waldron, Weber, Wilk, Williams, Wood, Atkins
NO VOTE RECORDED: Travis Allen, Hadley, Harper, Linder,
Obernolte, Wagner
Prepared by:Scott Bain / HEALTH /
9/10/15 23:27:59
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