BILL ANALYSIS
SENATE COMMITTEE ON PUBLIC SAFETY
Senator Carole Migden, Chair S
2005-2006 Regular Session B
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SB 896 (Runner)
As Amended June 21, 2006
Hearing date: August 10, 2006
Penal Code (URGENCY)
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LOCAL PERSONS "IN CUSTODY" AND JAIL INMATES
REIMBURSEMENT TO PROVIDERS OF LOCAL EMERGENCY SERVICES
HISTORY
Source: Author
Prior Legislation: SB 159 (Runner) - Ch.481, Stats. 2005
SB 1102 (Committee on Budget and Fiscal Review) -
Ch. 227,
Stats. 2004 (Urgency)
AB 2475 (Wolk) - 2004, held Senate Appropriations
Committee
Support: University of California; California Hospital
Association
Opposition:None known
Assembly Floor Vote: Ayes 75 - Noes 0
( THIS BILL IS BEFORE THE COMMITTEE PURSUANT TO SENATE RULE
29.10. THE COMMITTEE, BY A MAJORITY VOTE OF THE MEMBERSHIP, MAY
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EITHER: (1) HOLD THE BILL; OR (2) RETURN THE BILL TO THE SENATE
FLOOR FOR CONSIDERATION OF THE ASSEMBLY AMENDMENTS.)
KEY ISSUES
SHOULD LOCAL PUBLIC OFFICIALS OTHER THAN SHERIFFS AND POLICE CHIEFS
BE AUTHORIZED TO ENTER INTO CONTRACTS FOR EMERGENCY HEALTH SERVICES
FOR CARE TO "LOCAL LAW ENFORCEMENT PATIENTS?"
SHOULD THE "INMATE HEALTH CARE AND MEDICAL PROVIDER FAIR PRICING
WORKING GROUP" ADDRESS THE ISSUE OF WHETHER A DISPROPORTIONATE SHARE
OF LOCAL LAW ENFORCEMENT PATIENTS IS BEING TREATED AT ANY ONE
HOSPITAL OR SYSTEM OF HOSPITALS?
PURPOSE
The purpose of this bill is to (1) amend current law which
permits sheriffs and police chiefs to contract for emergency
health services to extend this authority to "other public
officials" and (2) provide that existing Inmate Health Care and
Medical Provider Fair Pricing Working Groups address the issue
of whether a disproportionate share of local law enforcement
patients is being treated at any one hospital or system of
hospitals.
Existing law provides that it is the intent of the Legislature
to provide county sheriffs, chiefs of police, and directors or
administrators of local detention facilities with an incentive
to not engage in practices designed to avoid payment of
legitimate emergency health care costs for the treatment or
examination of persons lawfully in their custody, and to
promptly pay those costs as requested by the provider of
services. Further, it is the intent of the Legislature to
encourage county sheriffs, chiefs of police, and directors or
administrators of local detention facilities to bargain in good
faith when negotiating a service contract with hospitals
providing emergency health care services. The Legislature has
set a date of January 1, 2009, for this section to be repealed,
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and does not intend to delete or extend that date if county
sheriffs, chiefs of police, and directors or administrators have
not complied with the intent of the Legislature, as expressed in
this subdivision. (Penal Code 4011.10 (a).)
Existing law provides that, notwithstanding any other provision
of law, a county sheriff or police chief may contract with
providers of emergency health care services. Hospitals that do
not contract with the sheriff or police chief for emergency
health care services shall provide these services to their
departments at a rate equal to 110 percent of the hospital's
actual costs according to the most recent Hospital Annual
Financial Data report issued by the Office of Statewide Health
Planning and Development, as calculated using a cost-to-charge
ratio. (Penal Code 4011.10 (b).)
Existing law provides that a county sheriff or police chief
shall not request the release of an inmate from custody for the
purpose of allowing the inmate to seek medical care at a
hospital, and then immediately rearrest the same individual
upon discharge from the hospital, unless the hospital
determines this action would enable it to bill and collect from
a third-party payment source. (Penal Code 4011.10 (c).)
Existing law provides that the California Hospital Association,
the University of California, the California State Sheriffs'
Association and the California Police Chiefs' Association shall,
immediately upon enactment of this section, convene the Inmate
Health Care and Medical Provider Fair Pricing Working Group.
The working group shall consist of at least six members from the
California Hospital Association and the University of
California, and six members from the California State Sheriffs'
Association and the California Police Chiefs' Association. Each
organization should give great weight and consideration to
appointing members of the working group with diverse geographic
and demographic interests. The working group shall meet at
least three times annually to identify and resolve industry
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issues that create fiscal barriers to timely and affordable
emergency inmate health care. In addition, the working group
shall address issues including, but not limited to, inmates
being admitted for care and later rearrested and any other
fiscal barriers to hospitals being able to enter into fair
market contracts with public agencies. No reimbursement is
required under this provision. (Penal Code 4011.10 (d).)
Existing law provides that an entity that provides ambulance or
any other emergency or nonemergency response service to a
sheriff or police chief, and that does not contract with their
departments for that service, shall be reimbursed for the
service at the rate established by Medicare. Neither the
sheriff nor the police chief shall reimburse a provider of any
of these services that their department has not contracted with
at a rate that exceeds the provider's reasonable and allowable
costs, as specified, regardless of whether the provider is
located within or outside of California. (Penal Code 4011.10
(f).)
Existing law provides that, for purposes of this section, in
those counties in which the sheriff does not administer a jail
facility, a director or administrator of a local department of
corrections established pursuant to Section 23013 of the
Government Code is the person who may contract for services
provided to jail inmates in the facilities he or she administers
in those counties. (Penal Code 4011.10 (h).)
Existing law provides that notwithstanding any other provision
of law, except in counties in which the sheriff, as of July 1,
1993, is not in charge of and the sole and exclusive authority
to keep the county jail and the prisoners in it, the sheriff
shall take charge of and be the sole and exclusive authority to
keep the county jail and the prisoners in it, except for work
furlough facilities where by county ordinance the work furlough
administrator is a person other than the sheriff. (Government
Code 24000 and 26600 et seq.)
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Existing law provides that the board of supervisors of any
county may, by resolution, establish a department of
corrections, to be headed by an officer appointed by the board,
which shall have jurisdiction over all county functions,
personnel, and facilities, or so many as the board names in its
resolution, relating to institutional punishment, care,
treatment, and rehabilitation of prisoners including, but not
limited to, the county jail and industrial farms and road camps,
their functions and personnel. (Government Code 23013.)
Existing law provides that the police department of a city which
creates one is under the control of the chief of police.
(Government Code 38630.)
Existing law states legislative intent that the California
Department of Corrections and Rehabilitation (CDCR) operate in
the most cost-effective and efficient manner possible when
purchasing health care services for inmates; to achieve this
goal, it is desirable that the CDCR have the benefit and
experience of the California Medical Assistance Commission
(CMAC) in planning and negotiating for the purchase of health
care services. (Penal Code 5023(a).)
Existing law provides that the CDCR shall consult with the CMAC
to assist the CDCR in planning and negotiating contracts for the
purchase of health care services, the CMAC shall advise the
CDCR, and the CMAC may negotiate directly with providers on
behalf of the CDCR as mutually agreed upon by CMAC and the CDCR.
(Penal Code 5024(b).)
Existing law provides that in no event shall the provision of
emergency services and care be based upon, or affected by, the
person's race, ethnicity, religion, national origin,
citizenship, age, sex, preexisting medical condition, physical
or mental handicap, insurance status, economic status, or
ability to pay for medical services, except to the extent that a
circumstance such as age, sex, preexisting medical condition, or
physical or mental handicap is medically significant to the
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provision of appropriate medical care to the patient. (Health
and Safety Code 1317(a) and (b).)
Existing law provides that notwithstanding any other provision
of law, the CDCR and the Division of Juvenile Justice (DJJ) may
contract with providers of emergency health care services.
Hospitals that do not contract with the CDCR or the DJJ for
emergency health care services shall provide these services to
these departments on the same basis as they are required to
provide these services pursuant to Section 489.24 of Title 42 of
the Code of Federal Regulations. Neither the CDCR nor the DJJ
shall reimburse a hospital that provides these services, and
that the departments have not contracted with, at a rate that
exceeds the hospital's reasonable and allowable costs,
regardless of whether the hospital is located within or outside
of California. (Penal Code 5023.5(a).)
Existing law provides that an entity that provides ambulance or
any other emergency or nonemergency response service to the CDCR
and the DJJ, and that does not contract with the departments for
that service, shall be reimbursed for the service at the rate
established by Medicare. Neither the CDCR nor the DJJ shall
reimburse a provider of any of these services that the
departments have not contracted with at a rate that exceeds the
provider's reasonable and allowable costs, regardless of whether
the provider is located within or outside of California. (Penal
Code 5023.5(b).)
Existing law provides that CDCR and the DJJ shall work with the
Department of Health Services (DHS) in obtaining hospital cost
information in order to establish the costs specified in this
section. DHS may provide the CDCR and the DJJ with the
hospital cost information that DHS obtains pursuant to Welfare
and Institutions Code Sections 14170 and 14171. (Penal Code
5023.5(c).)
Existing law provides that "reasonable and allowable costs,"
for purposes of Penal Code Section 5023.5, shall be defined in
accordance with Part 413 of Title 42 of the Code of Federal
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Regulations and federal Centers for Medicare and Medicaid
Services Publication Numbers 15.1 and 15.2. (Penal Code
5023.5(d).)
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This bill provides that "other public agencies," as well as
local sheriffs and police chiefs, are authorized to contract
with hospitals for emergency health care for "local law
enforcement patients."
This bill provides that, to the extent that the rate provisions
of Penal Code Section 4011.10 results in a disproportionate
share of local law enforcement patients being treated at any one
hospital or system of hospitals, the Inmate Health Care and
Medical Provider Fair Pricing Working Group shall address this
issue.
COMMENTS
1. Need for This Bill
According to the author:
This bill is a technical, clean-up measure to SB
159 (Runner), Chapter 481, Statues of 2005, that
dealt with emergency health care for local law
enforcement patients. This bill will clarify that
public agencies, such as county public health
departments, can enter into contracts with
hospitals for emergency health care.
2. Background
Penal Code Section 4011.10 (enacted pursuant to SB 159 (Runner)
- Chap. 481, Stats. 2005) establishes that a county sheriff or
police chief may contract with providers of emergency health
care services. Section 4011.10 also establishes a rate
structure for emergency health care provided to sheriffs or
police departments absent an existing contract between local law
enforcement and health care providers and created a working
group consisting of local law enforcement and health care
providers to consider a variety of issues related to inmate
health care. A letter provided to Committee staff from the
University of California explains the problem that this bill is
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intended to address as follows:
Existing contracts between UC medical centers and
local law enforcement are contained within larger
city or county contracts - these contracts find UC
partnering with local government to meet key public
health goals. Central to these contracts is ensuring
health care access to medically indigent patients.
As amended on May 18th, SB 896 clarifies that the
contracts are for emergency health care services for
local law enforcement patients and can be entered
into with other public agencies that contract for
these types of services. SB 896 also provides
similar clarification to the "grandfather" clause
contained in last year's legislation. The June 21st
amendments added an urgency clause to the bill to
ensure that the above-referenced contracts for
emergency health services for care to local law
enforcement patients are maintained.
3. Vague Definition of the Relevant Patient Population
This bill amends Section 4011.10 to define the relevant patient
population as "local law enforcement patients." This term is
vague and therefore subject to significantly different
interpretations. Is it limited to county jail inmates? Does it
include arrestees or detainees who are at a pre-booking stage
and thus might not be considered inmates? Does it include an
indigent crime victim? Does it include an injured law
enforcement officer?
In defining the relevant patient population, Section 4011.10,
subdivision (a), refers to "persons lawfully in [law
enforcement] custody." Section 4011.10, subdivisions (c), (d)
and (h) refer to "inmates." The proposed term, "local law
enforcement patients," leaves the definition of exactly who the
intended patient population is in the eye of the beholder.
This Committee's analysis of SB 159 states:
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This bill is intended to address payment for
emergency services for persons in need of
emergency care who are in custody of local law
enforcement - but not necessarily arrested, in
jail, or are victims of crime who are at some
point the responsibility of local law enforcement.
This indicates that Section 4011.10 was intended to address a
patient population broader than merely "inmates." The
terminology currently existing in Section 4011.10, subdivision
(a), "persons lawfully in [law enforcement] custody" may most
accurately reflect the intent of both SB 159 and this bill in
identifying the relevant patient population.
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