BILL NUMBER: AB 2173 AMENDED
BILL TEXT
AMENDED IN SENATE AUGUST 20, 2010
AMENDED IN SENATE AUGUST 17, 2010
AMENDED IN SENATE JULY 15, 2010
AMENDED IN ASSEMBLY MAY 28, 2010
AMENDED IN ASSEMBLY APRIL 5, 2010
INTRODUCED BY Assembly Member Beall
(Coauthors: Assembly Members Arambula, Chesbro, Coto, Davis,
Galgiani, and Ma)
FEBRUARY 18, 2010
An act to add and repeal Section 76000.10 of the Government Code,
relating to emergency services.
LEGISLATIVE COUNSEL'S DIGEST
AB 2173, as amended, Beall. Emergency medical air transportation
providers: penalty levy: reimbursement augmentation.
Existing law requires an additional county penalty of $7 for every
$10, or part of $10, to be levied upon every fine, penalty, or
forfeiture imposed and collected by the courts for all criminal
offenses, for deposit into specified county funds relating to the
construction of courthouses, criminal justice facilities, and
forensic laboratories, and the support of emergency medical services.
Existing law provides for the Medi-Cal program, which is
administered by the State Department of Health Care Services, under
which health care services, including medical transportation
services, are provided to qualified low-income persons. The Medi-Cal
program is partially governed and funded under federal Medicaid
provisions.
Existing law, the Emergency Medical Services System and the
Prehospital Emergency Medical Care Personnel Act, authorizes each
county to designate an emergency medical services agency, for the
establishment and administration of an emergency medical services
program in the county. Existing law also establishes the Emergency
Medical Services Authority, which, among other things, adopts
regulations governing the provision of emergency medical services.
This bill, which would be known as the Emergency Medical Air
Transportation Act, would impose an additional penalty of $4 upon
every conviction for an offense involving a vehicle violation, except
certain parking offenses. This bill would require each county board
of supervisors to establish in the county treasury an emergency
medical air transportation act fund into which the penalty collected
pursuant to this bill would be deposited. This bill would require,
on within 30 days following the last
day of each calendar quarter of the year, the county treasurer to
transfer moneys in the county's emergency medical air transportation
act fund to the Controller for deposit into the Emergency Medical Air
Transportation Act Fund, which would be established by the bill.
The bill would authorize the co unty treasurer, prior
to transferring the moneys in the county fund to the Controller, to
withhold a sufficient amount from being transferred to reimburse the
county and the courts for their actual, reasonable, and necessary
costs associated with administering the bill. Moneys in the
fund Emergency Medical Air Transportation Act
Fund would be available, upon appropriation by the
Legislature, to the department for the purposes of
augmenting Medi-Cal reimbursement paid to emergency medical air
transportation services providers and to reimburse the department,
the courts, and each county for actual, reasonable, and necessary
expenses of administering the bill offsetting the
state portion of the Medi-Cal reimbursement rate for emergency
medical air transportation services and augmenting emergency medical
air transportation reimbursement payments made through the Medi-Cal
program, as specified .
The bill would, upon appropriation by the Legislature, require the
department to use the moneys in the Emergency Medical Air
Transportation Act Fund and federal matching funds to increase the
Medi-Cal reimbursement or supplemental payments for emergency medical
air transportation services in an amount not to exceed normal and
customary charges charged by an emergency medical air transportation
services provider.
This bill would terminate assessment of the penalties commencing
July 1, 2016, and would repeal these provisions on January 1, 2018,
as provided. The bill would require that any moneys in the Emergency
Medical Air Transportation Act Fund that remain unexpended and
unencumbered on March 2 June 30 , 2017,
shall be transferred to the General Fund to be available, upon
appropriation by the Legislature, for the purposes of augmenting
Medi-Cal reimbursement of emergency medical air transportation and
related costs, generally.
By requiring counties to create emergency medical air
transportation act funds and then deposit the levy imposed by this
bill into those funds, this bill would create a state-mandated local
program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that, if the Commission on State Mandates
determines that the bill contains costs mandated by the state,
reimbursement for those costs shall be made pursuant to these
statutory provisions.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all of the
following:
(a) Air ambulance services provide lifesaving emergency
transportation of the most critical patients from automobile accident
scenes directly to trauma centers. The vast majority of helicopter
scene responses are motor vehicle related.
(b) Many of these transports originate in rural areas where ground
transportation is prolonged. In some instances, however, air
transportation may be needed in urban areas where traffic congestion
inhibits rapid transportation.
(c) Air ambulance services providers transport all emergency
patients without knowing if the patient has any form of medical
insurance or ability to pay for the service.
(d) Many emergency patients transported by air ambulances have no
insurance and no ability to pay for the service, but these patients
are given the same high level of care as those with medical
insurance.
(e) Unlike the hospitals where air ambulance services providers
deliver patients, air ambulance services providers are not eligible
to apply for additional federal funding for providing services to
high numbers of indigent patients pursuant to California's
disproportionate share hospital (DSH) program under the Medi-Cal
program.
(f) Unlike the hospitals and emergency physicians who treat the
patients after they are delivered by helicopter, air ambulance
services providers do not receive payment from the county Maddy
Emergency Medical Services Fund when they provide treatment to an
indigent patient.
(g) Emergency air ambulance services providers 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, which makes it virtually impossible for them to
be funded by local tax support except in the largest of counties.
(h) The Medi-Cal program reimburses air ambulance services
providers far below what it costs the providers to provide emergency
air transportation and pays nothing if the patient is indigent and
not eligible for Medi-Cal. The Medi-Cal reimbursement rates for air
ambulances have not increased in over 15 years.
(i) Currently fines and penalties on traffic violations total
between one hundred eight dollars ($108) and nineteen-thousand
dollars ($19,000), inclusive. Some of the fine and penalty money is
already collected by county courts and transferred to the state.
(j) A small additional penalty of four dollars ($4) per traffic
violation would result in a very small percentage increase on each
penalty on traffic violations, but the money collected from the
penalty would go to support air ambulance services, which are the
most critical services that support patients who are injured as a
result of a major collision.
(k) Air ambulance services play a key role in the statewide
emergency medical services system, including disaster response and
homeland security, so it is important for California to support these
vital services.
SEC. 2. Section 76000.10 is added to the Government Code, to read:
76000.10. (a) This section shall be known, and may be cited, as
the Emergency Medical Air Transportation Act.
(b) For purposes of this section:
(1) "Department" means the State Department of Health Care
Services.
(2) "Director" means the Director of the State Department of
Health Care Services.
(3) "Provider" means a provider of emergency medical air
transportation services.
(4) "Rotary wing" means a type of aircraft, commonly referred to
as a helicopter, that generates lift through the use of wings, known
as rotor blades, that revolve around a mast.
(5) "Fixed wing" means a type of aircraft, commonly referred to as
an airplane, that generates lift through the use of the forward
motion of the aircraft and wings that do not revolve around a mast
but are fixed in relation to the fuselage of the aircraft.
(6) "Air mileage rate" means the per-mileage reimbursement rate
paid for services rendered by rotary-wing and fixed-wing providers.
(c) (1) For the purpose of implementing this section, a penalty of
four dollars ($4) shall be imposed upon every conviction for a
violation of the Vehicle Code or a local ordinance adopted pursuant
to the Vehicle Code, except parking offenses subject to Article 3
(commencing with Section 40200) of Chapter 1 of Division 17 of the
Vehicle Code.
(2) The penalty described in this subdivision shall be in addition
to the state penalty assessed pursuant to Section 1464 of the Penal
Code. However, this penalty shall not be included in the base fine
used to calculate the state penalty assessment pursuant to
subdivision (a) of Section 1464 of the Penal Code, the state
surcharge levied pursuant to Section 1465.7 of the Penal Code,
Section 70372 of the Government Code, and to calculate the
other additional penalties levied pursuant to this chapter.
(d) The county board of supervisors shall establish in the county
treasury an emergency medical air transportation act fund into which
shall be deposited the moneys collected pursuant to this section.
Moneys in each county's fund, including interest and dividends earned
thereon, shall be held by the county treasurer separate from funds
subject to transfer or division pursuant to Section 1463 of the Penal
Code.
(e) (1) Within 10 30 days following
the last day of each calendar quarter of the year, the county
treasurer shall transfer moneys in the county's emergency medical air
transportation act fund to the Controller for deposit into the
Emergency Medical Air Transportation Act Fund, which is hereby
established in the State Treasury. Notwithstanding Section 16305.7,
the Emergency Medical Air Transportation Act Fund shall include
interest and dividends earned on money in the fund. Prior to the
transfer of funds from the county's emergency medical air
transportation act fund to the state, the county treasurer may
withhold a sufficient amount from the fund to rei mburse
the county and the courts for their actual, reasonable, and necessary
costs associated with administering this section. To the extent
moneys are withheld by the county treasurer, an accounting report
detailing these costs shall be sent to the department at least once
per calendar year.
(2) The Emergency Medical Air Transportation Act Fund shall be
administered by the State Department of Health Care Services. Moneys
in the Emergency Medical Air Transportation Act Fund shall be made
available, upon appropriation by the Legislature, to the department
to be used as follows:
(A) For payment of the administrative costs of the department
, and the actual, reasonable, and necessary costs of the
courts, and the counties in administering this section.
in administering this section.
(B) Twenty percent of the fund remaining after payment of
administrative costs pursuant to subparagraph (A) shall be used to
offset the state portion of the Medi-Cal reimbursement rate for
emergency medical air transportation services.
(C) Eighty percent of the fund remaining after payment of
administrative costs pursuant to subparagraph (A) shall be used, to
augment emergency medical air transportation reimbursement payments
made through the Medi-Cal program, as set forth in paragraphs (3) and
(4).
(D) The counties and courts may apply to the department for
reimbursement by the department for their actual, reasonable, and
necessary costs associated with administering this section. The
department shall, upon appropriation by the Legislature, reimburse
counties and courts for their actual, reasonable, and necessary costs
and may, as a condition of reimbursement, require a fiscal audit to
ensure that the claimed reimbursement does not exceed the actual,
reasonable, and necessary costs.
(3) (A) The department shall seek to obtain federal matching funds
by using the moneys in the Emergency Medical Air Transportation Act
Fund for the purpose of augmenting Medi-Cal reimbursement paid to
providers through supplemental payments administered after
June 30, 2011. emergency medical air transportation
providers.
(B) The director shall do all of the following:
(i) By March 1, 2011, meet with medical air transportation
providers to determine the most appropriate methodology to distribute
the funds for medical air services.
(ii) Implement the methodology determined most appropriate in a
timely manner.
(iii) Develop the methodology in collaboration with the medical
air providers.
(iv) Submit any state plan amendments or waiver requests that may
be necessary to implement this section.
(i)
(v) Submit any state plan amendment or waiver request
that may be necessary to implement this section.
(ii)
(vi) Seek federal approvals or waivers as may be
necessary to implement this section and to obtain federal financial
participation to the maximum extent possible for the payments under
this section. If federal approvals are not received, moneys in
the fund may be distributed pursuant to this section until federal
approvals are received.
(C) The director may give great weight to the needs of the
emergency medical air services providers, as discussed through the
development of the methodology.
(4) (A) Upon appropriation by the
Legislature, the department shall use moneys in the Emergency Medical
Air Transportation Act Fund and any federal
matching funds to increase the Medi-Cal reimbursement by way
of supplemental payments for emergency medical air
transportation services in an amount not to exceed normal and
customary charges charged by the providers , as follows:
.
(A) Supplemental payments to providers shall not be made until
there is a positive fund balance in the Emergency Medical Air
Transportation Act Fund. The supplemental payments shall be made only
in a manner that ensures that there is no additional burden upon the
state General Fund other than the payment of revenue from penalties
authorized by this section.
(B) The department shall make supplemental payments for emergency
medical air transportation services for Medi-Cal patients pursuant to
this section twice annually, by August 31, and by March 1, as
follows:
(i) The department shall use the total fund balance 20 days after
the end of the second quarter, ending June 30, and the fourth quarter
ending December 31, to calculate the supplemental payment.
(ii) To calculate the supplemental payment the department shall
use the amount specified in clause (i) and divide it by the total
number of Medi-Cal base rate trips paid for rotary-wing and
fixed-wing emergency medical air transportation for dates of service
corresponding to the period beginning 18 months prior to the end of
the quarter being calculated and ending 12 months prior to the end of
the same quarter. The department shall not make a supplemental
payment for the base rates for rotary-wing or fixed-wing emergency
medical air transportation that exceeds the average Medicare rates
for those services when combined with the Medi-Cal base rate for
these same services.
(iii) If any funds remain after the calculation of the funds
pursuant to clause (ii), the remaining funds shall be used to make a
supplemental payment of the air mileage rates for rotary-wing and
fixed-wing emergency medical air transportation for the Medi-Cal
services in a manner similar to clause (ii), but not to exceed the
average Medicare rates paid for the same services during this period
when added to the Medi-Cal rates paid for these service.
(iv) If any funds remain after the calculation of the funds
pursuant to clause (iii), the remaining funds shall not be matched
with federal funds and shall be provided as a second supplemental
payment to the base rates for rotary-wing and fixed-wing emergency
medical air transportation services for Medi-Cal services following
the methodology described in clause (ii).
(B) Notwithstanding any other provision of law, and pursuant to
this section, the department shall increase the Medi-Cal
reimbursement for emergency medical air transportation services
provided that both of the following conditions are met:
(i) Moneys in the Emergency Medical Air Transportation Act Fund
will cover the cost of increased payments pursuant to subparagraph
(A).
(ii) The state does not incur any General Fund expense to pay for
the Medi-Cal emergency medical air transportation services increase.
(e) The assessment of penalties pursuant to this section shall
terminate commencing January 1, 2016. Penalties assessed prior to
January 1, 2016, shall continue to be collected, administered, and
distributed pursuant to this section until exhausted or until
March 2 June 30 , 2017, whichever
occurs first. On March 2 June 30 ,
2017, moneys remaining unexpended and unencumbered in the Emergency
Medical Air Transportation Act Fund shall be transferred
to the General Fund, to be available, upon appropriation by the
Legislature, for the purposes of augmenting Medi-Cal reimbursement
for emergency medical air transportation and related costs,
generally.
(f) Notwithstanding the rulemaking provisions of Chapter 3.5
(commencing with Section 11340) of Part 1 of Division 2 of the
Government Code, the department may implement, interpret, or make
specific this section and any applicable federal waivers and state
plan amendments by means of all county letters, plan letters, plan or
provider bulletins, or similar instructions without taking
regulatory action.
(f)
(g) This section shall remain in effect only until
January 1, 2018, and as of that date is repealed, unless a later
enacted statute, that is enacted before January 1, 2018, deletes or
extends that date.
SEC. 3. If the Commission on State Mandates
determines that this act contains costs mandated by the state,
reimbursement to local agencies and school districts for those costs
shall be made pursuant to Part 7 (commencing with Section 17500) of
Division 4 of Title 2 of the Government Code.
SEC. 3. No reimbursement is required by this act
pursuant to Section 6 of Article XIII B of the California
Constitution because a local agency or school district has the
authority to levy service charges, fees, or assessments sufficient to
pay for the program or level of service mandated by this act, within
the meaning of Section 17556 of the Government Code.
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Text--Pages 5 and 6.
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