BILL ANALYSIS
AB 2248
Page 1
Date of Hearing: April 13, 2010
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 2248 (Hernandez) - As Introduced: February 18, 2010
SUBJECT : Emergency medical care.
SUMMARY : Requires each county establishing a Maddy Emergency
Medical Services Fund (Maddy Fund) to include in its annual
report to the Legislature a description of each disbursement for
"other emergency medical services (EMS)," if funds were
disbursed for this purpose.
EXISTING LAW :
1)Authorizes each county to establish a Maddy Fund for
reimbursement of EMS-related costs.
2)Authorizes, until January 1, 2014, counties to levy an
additional penalty in the amount of $2 for every $10 upon
fines, penalties, and forfeitures collected for criminal
offenses for deposit into the Maddy Fund.
3)Requires the costs of administering money deposited into the
Maddy Fund pursuant to 2) above to be reimbursed from the
money collected, to be the lower of the actual administrative
costs or 10% of the money collected.
4)Requires the amount in the Maddy Fund, reduced by the amount
for administration, and the reserve to be utilized to
reimburse physicians and surgeons and hospitals for patients
who do not make payment for EMS and for other EMS purposes as
determined by each county according to the following schedule:
a) Fifty-eight percent of the balance to be distributed to
physicians and surgeons for emergency services provided by
all physicians and surgeons, except those employed by
county hospitals, in general acute care hospitals that
provide basic or comprehensive emergency services up to the
time the patient is stabilized;
b) Twenty-five percent of the fund to be distributed only
to hospitals providing disproportionate trauma and
emergency medical care services; and,
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c) Seventeen percent of the fund to be distributed for
other EMS purposes as determined by each county, including,
but not limited to, the funding of regional poison control
centers. Permits funding to be used for purchasing
equipment and for capital projects only to the extent that
these expenditures support the provision of emergency
services.
5)Requires each county establishing a Maddy Fund to report
annually to the Legislature on the implementation and status
of the fund by April 15 of every year. Specifies the report
to include, but not be limited to:
a) The total amount of fines and forfeitures collected and
the amount of penalty assessments deposited into the Maddy
Fund;
b) The fund balance and the amount of moneys disbursed
under the program to physicians and surgeons, for
hospitals, and for other EMS purposes;
c) The number of claims paid to physicians and surgeons,
and the percentage of claims paid, based on the uniform fee
schedule adopted by each county;
d) The amount of moneys available to be disbursed to
physicians and surgeons, descriptions of the physician and
surgeon and hospital claims payment methodologies, the
dollar amount of the total allowable claims submitted, and
the percentage at which those claims were reimbursed;
e) A statement of the policies, procedures, and regulatory
action taken to implement and run the Maddy Fund; and,
f) The name of the physician and surgeon and hospital
administrator organization, or names of specific physicians
and surgeons and hospital administrators, contracted to
review claims payment methodologies.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
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1)PURPOSE OF THIS BILL . According to the author, the annual
reports on Maddy Funds submitted to the Legislature by
counties include money dispersed to physicians and hospitals.
However, the report does not give details regarding how other
EMS funds are appropriated. The author claims that there have
been complaints from some physicians in some counties that the
Maddy Fund reports do not contain sufficient information to
determine if the Maddy Fund is being properly administered.
The author states that this bill will add additional
transparency to the administration of the Maddy Fund by
specifying disbursements that otherwise are grouped under
"other EMS."
2)BACKGROUND . In 1987, the Legislature concluded that emergency
medical service providers bore higher costs for their services
than did providers of other medical services but often
received only partial or no payment from patients. To address
this, the state enacted a series of bills and revenue sources
to compensate physicians and medical facilities for emergency
services provided to patients who do not have health insurance
and cannot pay for their medical care. SB 12 (Maddy), Chapter
1240, Statutes of 1987, allows counties to establish Maddy
Funds. Approximately 50 counties have established Maddy
Funds. Counties have several sources of revenue for Maddy
Funds: a portion of county penalty assessments on certain
criminal offenses and motor vehicle violations; traffic
violator school fees; revenues from taxes on tobacco products
deposited in the Proposition 99 tobacco tax fund; and,
redirected money from the Proposition 99 fund through an
annual EMS appropriation.
3)PROPOSITION 99 FUNDS . In 1988, the voters passed Proposition
99, which imposes taxes on the distribution of cigarettes and
other tobacco products. The state deposits these taxes in the
state Cigarette and Tobacco Products Surtax Fund to fund a
variety of programs which fund counties for indigent care.
Each county is required to establish a physician services
account within its Maddy Fund for revenues appropriated by the
Legislature from Proposition 99 tobacco tax revenues. These
funds can be used to reimburse physicians for emergency,
obstetric, and pediatric care.
4)STATE CONTROLLER AUDIT . In a 2009 audit report by California
State Controller John Chiang, the Controller found that there
was an error by the San Bernardino County Courts of over $7.3
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million collected in court revenues that were never remitted
to the State Treasurer. Over $2.3 million of that amount was
collected in penalties from traffic violator school cases that
should have been remitted to the State Treasurer for deposit
into the San Bernardino Maddy Fund to be used to reimburse
physicians and hospitals for emergency care provided to
uninsured patients.
5)SUPPORT . The California Chapter of the American College of
Emergency Physicians (Cal/ACEP), cosponsor of this bill,
writes in support that this bill requires counties to report
on the collection and distribution of the Maddy Fund to ensure
that every dollar that is supposed to be collected and spent
on unreimbursed emergency medical care is actually being used
for that purpose. According to Cal/ACEP even though the Maddy
Fund only reimburses a small portion of the cost of providing
EMS to those unable to pay, it is essential that every Maddy
Fund dollar is spent to preserve access to emergency services.
The California Medical Association, the other cosponsor of
this bill, writes in support that due to factors like the
current economic downturn and Proposition 99 funds being
redirected to other services, this bill is critical to ensure
that there is thorough accounting and efficient use of these
funds.
6)RELATED LEGISLATION .
a) AB 1503 (Lieu), currently in the Senate Health
Committee, requires emergency room physicians to provide a
discount payment policy for uninsured and specified low
income patients and revises the conditions under which
physicians may seek uncompensated care payments through a
Maddy Fund.
b) AB 2456 (Torrico), set for hearing in Assembly Health
Committee for April 13, 2010, requires the State Emergency
Medical Services Authority (EMSA) to include model
policies, procedures, treatment protocols, and licensure
and certification requirements in guidelines for local EMS
systems and requires local emergency services authorities
to adhere to these guidelines.
c) SB 1368 (Committee on Health), set for hearing in the
Senate Health Committee on April 21, 2010, among other
things, requires each county establishing a Maddy Fund to
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send an annual report on the implementation and status of
the fund to EMSA instead of to the Legislature. Requires
EMSA to compile and forward a summary of each Maddy Fund
and forward that summary to the appropriate policy and
fiscal committees of the Legislature.
7)PREVIOUS LEGISLATION .
a) AB 1475 (Solorio), Chapter 537, Statutes of 2009, limits
the administrative costs for money deposited into county
Maddy Funds to actual administrative costs, or 10% of the
money collected, whichever amount is lower. Limits
administrative costs of money deposited into the Maddy Fund
from an additional penalty assessment authorized until
January 2014 to the actual administrative costs, or 10% of
the money collected, whichever amount is lower.
b) SB 1236 (Padilla), Chapter 60, Statutes of 2008, extends
the sunset date from January 1, 2009 to January 1, 2014,
county boards of supervisors to levy additional penalties
on criminal offenses for EMS.
c) AB 2702 (Nunez), Chapter 288, Statutes of 2008, allows
physicians providing services in a standby emergency
department that was in existence January 1, 2007 in a
hospital in Los Angeles County to receive reimbursement
from Proposition 99) and Maddy Funds if the emergency
department treats at least 18,000 patients per year and
meets general, staffing, and equipment requirements of a
basic emergency department.
d) SB 1773 (Alarcon), Chapter 841, Statutes of 2006,
authorizes, until January 1, 2009, county boards of
supervisors to levy additional penalties on criminal
offenses for EMS.
e) SB 941 (Alquist), Chapter 671, Statutes of 2005,
establishes the Emergency Medical Services Funding Act,
which revises existing law governing administration of the
Maddy Fund and Proposition 99 Physician Services Account to
make the statutes more consistent.
f) SB 12 (Maddy) creates the Maddy Fund to provide
supplemental financing for local emergency services.
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REGISTERED SUPPORT / OPPOSITION :
Support
American College of Emergency Physicians, California Chapter
(cosponsor)
California Medical Association (cosponsor)
California Emergency Nurses Association
California Hospital Association
Opposition
None on file.
Analysis Prepared by : Patty Rodgers / HEALTH / (916) 319-2097