BILL ANALYSIS                                                                                                                                                                                                    



                                                                  AB 2173
                                                                  Page  1


          ASSEMBLY THIRD READING
          AB 2173 (Beall)
          As Amended May 28, 2010
          Majority vote 

           HEALTH              15-2        APPROPRIATIONS      17-0        
           
           ----------------------------------------------------------------- 
          |Ayes:|Monning, Fletcher,        |Ayes:|Fuentes, Conway, Ammiano, |
          |     |Ammiano, Carter, Conway,  |     |Bradford, Charles         |
          |     |Brownley, De Leon, Eng,   |     |Calderon, Coto, Davis,    |
          |     |Hayashi, Hernandez,       |     |Monning, Ruskin, Harkey,  |
          |     |Bonnie Lowenthal, Nava,   |     |Miller, Nielsen, Norby,   |
          |     |V. Manuel Perez, Smyth,   |     |Skinner, Solorio,         |
          |     |Audra Strickland          |     |Torlakson, Torrico        |
          |     |                          |     |                          |
          |-----+--------------------------+-----+--------------------------|
          |Nays:|Adams, Gaines             |     |                          |
          |     |                          |     |                          |
           ----------------------------------------------------------------- 
           SUMMARY  :  Establishes a $3 penalty on every vehicle code  
          violation to be matched in the Medi-Cal Program and used to make  
          supplemental payments for emergency air medical transportation  
          services in the Medi-Cal Program.  Specifically,  this bill  : 

          1)Imposes a penalty of $3 on every conviction of a violation of  
            the vehicle code or local ordinance adopted pursuant to the  
            vehicle code, except parking offences.

          2)Requires the penalty to be in addition to the state  
            established penalty and excluded from the base fine or any  
            other surcharges used to calculate any other penalties.

          3)Establishes the Emergency Air Medical Transportation Act  
            (EAMTA) Fund to be administered by the Department of Health  
            Care Services (DHCS) and requires each county to deposit the  
            proceeds of this penalty in a county emergency air medical  
            transportation act fund and transferred quarterly to the EAMTA  
            Fund.  

          4)Requires DHCS to use the proceeds of the EAMTA Fund to obtain  
            federal matching funds in the Medi-Cal Program for the purpose  
            of making supplemental payments to emergency air medical  
            transportation providers in an amount that does not exceed  








                                                                  AB 2173
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            normal and customary charges.

          5)Requires the EAMTA Fund to be available, upon appropriation by  
            the Legislature, to DHCS to augment emergency air medical  
            transportation reimbursement, to reimburse DHCS, the courts  
            and each county for it administrative costs. 

          6)States legislative intent with regard to air ambulance  
            service, current reimbursement rates, fines and penalties and  
            the relationships vehicle code violations. 

           FISCAL EFFECT  :  According to the Assembly Appropriations  
          Committee:

          1)Potential increased revenue in the range of $40 million.   
            Extrapolating from the 7,248,217 court abstracts with  
            convictions for typically multiple Vehicle Code violations,  
            which average about two per abstract, between March 2008 and  
            March 2009, a $3 penalty assessment on each traffic fine would  
            result in increased revenue of about $43.5 million, assuming  
            no diminishing returns as a result of changes in judicial  
            behavior, collections, or ability to pay. 
           
           2)Proliferation of assessments and charges has driven fines  
            upward.  For example, a $500 criminal fine with current  
            maximum assessments would be $1,995, shocking defendants who  
            think $500 means $500.

          3)Increasing assessments may result in diminishing returns.   
            Judges do have the discretion to reduce the base fine, which  
            then reduces revenue to state and local governments, as well  
            as to assessments.  As current penalty assessments can almost  
            triple the base fine, increasing fines and assessments may  
            have the unintended consequence of reduced fine collections.   
            Indigent defendants facing ever-increasing fees may simply  
            choose to spend time in jail in lieu of paying the fine,  
            causing taxpayers to pay the jail costs while state and local  
            government receive fewer penalty funds.  Moreover, county jail  
            population caps may provide additional incentives to opt for  
            jail time over fines, as the time served for nonviolent  
            offenders may be minimal.

          As noted by the California Research Bureau in its 2006 review of  
            penalty assessments, "High penalty assessments may result in  








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            higher rates of default by the guilty parties.  Some offenders  
            may spend time in jail, or plea for community service, rather  
            than pay the fine and penalty assessment. The end result may  
            be that a substantial amount of fines, fees and revenue is not  
            collected." 

           COMMENTS  :  According to the author, this bill intended to  
          provide a mechanism for supplemental payments for air ambulance  
          providers who serve Medi-Cal patients.  The author states that  
          revenue generated by imposing a flat $3 fee on each motor  
          vehicle violation can be matched with federal funds through the  
          Medi-Cal Program.  The author points out that Medi-Cal pays air  
          ambulance services far below the cost of providing emergency air  
          transportation and 40% of the average Medicare rate.  The author  
          asserts that unlike hospitals, federal law does not permit a  
          provider fee to be assessed.  Furthermore, air ambulance  
          providers must provide emergency services but are not covered by  
          other supplemental emergency payment funds that are collected  
          for m fines and penalties.  They also do not receive any type of  
          disproportionate share provider supplemental payments.  

          Air ambulance services provide emergency transportation for the  
          most critical patients from automobile scenes directly to trauma  
          centers.  Emergency helicopters also transport patients from  
          rural area or acute care hospitals to tertiary care hospitals  
          such as trauma centers, heart/stroke centers, burn units, and  
          children's specialty hospitals.  They are also used for disaster  
          response.  Air ambulance services providers are a mix of public  
          and private entities.  For instance, the City of Los Angeles  
          provides its own services, whereas the California Shock Trauma  
          Air Rescue (CALSTAR) in a not-for profit community based  
          provider that provides services throughout Central and Northern  
          California.  The services are not self-dispatched, but are  
          called for by on scene first responders, a hospital physician,  
          or other emergency medical services agency.  No one is denied  
          service, regardless of ability to pay.  


           Analysis Prepared by  :    Marjorie Swartz / HEALTH / (916)  
          319-2097 

                                                                FN: 0004672