BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: AB 2248
A
AUTHOR: Hernandez
B
AMENDED: June 10, 2010
HEARING DATE: June 30, 2010
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CONSULTANT:
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Tadeo/jl
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SUBJECT
Emergency medical care
SUMMARY
Requires a county, that establishes a Maddy Emergency
Medical Services Fund (Maddy Fund) for reimbursement of
emergency medical services (EMS) related costs, to provide
additional information regarding the moneys collected and
disbursed in a report required to be submitted to the
Legislature on an annual basis.
CHANGES TO EXISTING LAW
Existing law:
Authorizes counties to establish a Maddy Fund for
reimbursement EMS related costs. Counties are authorized
to levy $7 for every $10, or fraction thereof, upon fines,
penalties and forfeitures collected for criminal offenses
for deposit into the Maddy Fund.
Requires costs of administering the Maddy Fund to be
reimbursed based on actual administrative costs, not to
exceed 10 percent of the amount of the Maddy Fund.
Authorizes, until January 1, 2014, counties to levy an
Continued---
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additional penalty in the amount of $2 for every $10, or
fraction thereof, upon fines, penalties, and forfeitures
collected for criminal offenses for deposit into the Maddy
Fund.
Requires costs of administering the additional $2 penalties
in the Maddy Fund to be reimbursed based on administrative
costs, not to exceed 10 percent of the amount of the Maddy
Fund.
Requires a county that has established a Maddy Fund to
submit an annual report to the Legislature on the
implementation and status of the Fund, including the Fund
balance, and amount of money disbursed to physicians and
surgeons, hospitals, and for other emergency medical
purposes.
This bill:
Requires a county that establishes a Maddy Fund to include
the following in the county's annual Maddy Fund report
submitted to the Legislature:
A breakdown of the total amounts of penalty
assessments by statute section that provides the
authority for the penalty assessment;
A description of the process used for obtaining
input from physicians, surgeons and hospitals to
create the payment methodology;
An identification of the fee schedule used by the
county; and,
A description of the methodology used to disburse
money(s) to hospitals.
Additionally, if no money was deposited in the Fund, the
reason(s) why would also be required to be stated.
FISCAL IMPACT
According to the Assembly Appropriations analysis of AB
2248, no direct fiscal impact to counties or state agencies
would result due to the expansion of reporting established
by this bill.
BACKGROUND AND DISCUSSION
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The author states that, while Maddy Funds only reimburse a
small portion of the cost of emergency services, they are
nevertheless a critical source of funding to help preserve
the safety net. The author adds that, physicians report
that the annual administrative reports do not contain
sufficient information to determine if the Maddy Fund is
being properly administered. The author further adds that,
in one county, an error was discovered by a local ER
physician which led to the recovery of $2.4 million that
should have been deposited into the Maddy Fund.
Maddy Fund
In 1987, the Legislature concluded that EMS providers bore
higher costs for their services than did providers of other
medical services, but often received only partial or no
payment from patients. The state enacted a series of bills
to compensate physicians and medical facilities for EMS
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 EMS
funds, also known as Maddy Funds. Revenue sources for
Maddy Funds are penalty assessments on certain criminal and
traffic violations, and a portion of the fees come from
people attending traffic violator schools.
Funds from penalty assessments must be used to reimburse
physicians and hospitals for patients who do not make
payments for EMS and have no third-party or government
source of payment. Fifty-eight percent of these funds,
after administrative costs, must be distributed to
physicians for emergency services, twenty-five percent to
hospitals providing disproportionate levels of trauma and
EMS, and seventeen percent to other EMS, including, but not
limited to, regional poison centers, as determined by each
county. Physicians can be reimbursed for up to 50 percent
of the losses submitted. Approximately 50 counties have
established Maddy Funds.
Related bills
AB 1503 (Lieu) 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. This bill is in the Senate
Appropriations Committee.
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SB 1368 (Senate Committee on Health) requires each county
establishing a Maddy Fund to send an annual report on the
implementation and status of the fund to State Emergency
Medical Services Authority (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. This bill is set to be heard in Assembly
Health Committee on June 29, 2010.
Prior legislation
AB 1475 (Solorio), Chapter 537, Statutes of 2009, limits
the administrative costs for money deposited into county
Maddy EMS Funds to actual administrative costs, or 10
percent of the money collected, whichever amount is lower.
Limits administrative costs of money deposited into the
Maddy EMS Fund from an additional penalty assessment
authorized until January, 2014 to the actual administrative
costs, or 10 percent of the money collected, whichever
amount is lower.
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.
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.
SB 57 (Alarcon) of 2005 would have amended the Maddy
Emergency Medical Services Fund to earmark funds for
pediatric trauma centers, as specified. This bill was
vetoed by the Governor.
SB 941 (Alquist), Chapter 671, Statutes of 2005,
establishes the Emergency Medical Services (EMS) Funding
Act, which revises existing law governing administration of
the Maddy EMS Fund and the California Tobacco Tax and
Health Promotion Act of 1988 (Proposition 98) Physician
Services Account to make the statutes more consistent.
SB 476 (Florez), Chapter 707, Statutes of 2003, authorizes
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each administering agency of an emergency medical services
fund to maintain a reserve in specified portions of its
Maddy Emergency Medical Services Fund. Requires
administering agencies to distribute all funds remaining at
the end of the fiscal year in excess of any reserve held
and rolled over to the next year.
AB 883 (Florez) of 2001 would have raised the level of
possible reimbursement for physicians and surgeons from the
Maddy Fund from 50 to 75 percent. Would have established a
state Emergency Medical Services Equalization Fund for
redistribution of excess funds and required the county
administering officer of emergency medical services to
establish an advisory committee to review methodologies and
payment processes. This bill died on the Assembly Floor
pending concurrence.
SB 254 (Dunn) of 2001 would have appropriated $300 million
from the General Fund to EMSA, with $200 million for
critical emergency service facilities and $100 million for
payment of uncompensated emergency services provided by
physicians and hospitals. Would have created the Critical
Emergency Facility Fund for payments to these critical
facilities and limits the portion of this Fund that can be
used for administrative purposes to no more than 10
percent. Would have required the money for uncompensated
emergency care to be paid through county Maddy Funds, which
each county would have been required to create. This bill
was returned to the Secretary of the Senate pursuant to
Joint Rule 56.
SB 623 (Speier), Chapter 679, Statutes of 1999, requires,
in a county that has established an EMS Fund, an amount
equal to $2 for every $7 that would have been collected in
traffic penalty assessments to be deposited into the Fund.
Requires counties with EMS Funds to add to an existing
report to the Legislature the total amount of traffic fines
and forfeitures collected, the total amount of penalty
assessments collected, and the total amount of penalty
assessments deposited into the EMS Fund. Requires each
county to make this report available to the public upon
request.
Arguments in support
The California Chapter of the American College of Emergency
Physicians (CAL/ACEP), co-sponsor of AB 2248, argues that
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this bill is important because it would provide
accountability and transparency to the administration of
Maddy EMS Funds collected and distributed at the county
level. CAL/ACEP adds that AB 2248 would require counties
to report on the collection and distribution of the Maddy
EMS Funds to ensure that every dollar is spent to support
the emergency care safety net as required by current law.
The California Medical Association (CMA), co-sponsor of AB
2248, states that the current economic downturn has led to
a substantial increase in the number of uninsured, placing
additional pressure on counties' Maddy EMS Funds to provide
care for this population. CMA argues that this bill is
needed because, due to the budget crisis California has
endured in recent years, the Proposition 99 tobacco tax
funds that county Maddy EMS Funds used to receive have been
redirected, and as a result, thorough accounting and
efficient use of these funds has become critical.
The California Hospital Association (CHA) states that AB
2248 would increase transparency and accountability for
Maddy Fund expenditures and reimbursements by counties that
administer this fund. CHA adds that Maddy Fund
reimbursement is a critical program to reimburse providers
for uncompensated emergency care.
COMMENTS
1. Author's amendment. The author will propose additional
amendments in committee
to ensure that the hospital portion of the Maddy Fund
operates in a transparent
manner:
Proposed language:
Page 3, lines 3 - 5:
(8) (9) (a) A description of the methodology used to
disburse moneys to hospitals per
subparagraph (B) of paragraph (5) of subdivision (b) of
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Section 1797.98a.
(b) The amount of moneys available to be disbursed
to hospitals,
(c) If moneys are disbursed to hospitals on a claims
basis, the dollar amount of the
total allowable claims submitted and the percentage at
which those claims were
reimbursed to hospitals.
2. Technical amendments.
Page 2, lines 36 - 38:
(7) A description of the process
used for obtaining input from
physicians and surgeons and hospitals to create the
payment methadology. (8) An
Identification
(7) A description of the process used for
obtaining input from physicians and
surgeons and hospitals to create the payment
methodology.
(8) An identification
PRIOR ACTIONS
Assembly Health: 19-0
Assembly Appropriations: 17-0
Assembly Floor: 74-0
POSITIONS
Support: California Chapter of the American College of
Emergency Physicians
(co-sponsor)
California Medical Association
(co-sponsor)
California Hospital Association
Oppose: None received
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