BILL ANALYSIS
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|SENATE RULES COMMITTEE | AB 2248|
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THIRD READING
Bill No: AB 2248
Author: Hernandez (D)
Amended: 8/18/10 in Senate
Vote: 21
SENATE HEALTH COMMITTEE : 8-0, 6/30/10
AYES: Alquist, Strickland, Aanestad, Cedillo, Leno,
Negrete McLeod, Pavley, Romero
NO VOTE RECORDED: Cox
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
ASSEMBLY FLOOR : 74-0, 4/29/10 (Consent) - See last page
for vote
SUBJECT : Emergency medical care
SOURCE : CA Chapter of the American College of
Emergency Physicians
California Medical Association
DIGEST : This bill requires a county, which establishes a
Maddy Emergency Medical Services Fund for reimbursement of
emergency medical services 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.
Senate Floor Amendments 8/18/10 (1) require the name and
contact number of the entities responsible for the
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collection of fines, forfeitures, and penalties, (2) the
distribution of penalty assessments into the fund, and (3)
the distribution of monies to physicians and surgeons.
ANALYSIS :
Existing law
1. Authorizes counties to establish a Maddy Emergency
Services Fund (Maddy Fund) for reimbursement emergency
medical services (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.
2. 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.
3. Authorizes, until January 1, 2014, counties to levy an
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.
4. 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.
5. 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:
1. A breakdown of the total amounts of penalty assessments
by statute section that provides the authority for the
penalty assessment.
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2. A description of the process used for obtaining input
from physicians and surgeons and hospitals to create the
payment methodology.
3. An identification of the fee schedule used by the
county.
4. A description of the methodology used to disburse
money(s) to hospitals.
5. The amount of monies available to be disbursed to
hospitals.
6. If monies are disbursed to hospitals on a claim basis,
the dollar amount of the total allowable claims
submitted and the percentage at which those claims were
reimbursed to hospitals.
Additionally, if no money was deposited in the Fund, the
reason(s) why would also be required to be stated.
Background
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
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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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: Yes
SUPPORT : (Verified 8/3/10)
CA Chapter of the American College of Emergency Physicians
(co-source)
California Medical Association (co-source)
California Hospital Association
ARGUMENTS IN SUPPORT : The California Chapter of the
American College of Emergency Physicians (CAL/ACEP),
co-sponsor of this bill argues that this bill is important
because it provides accountability and transparency to the
administration of Maddy EMS Funds collected and distributed
at the county level. CAL/ACEP adds that this bill requires
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
this bill, 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 this
bill increases transparency and accountability for Maddy
Fund expenditures and reimbursements by counties that
administer this fund. CHA adds that Maddy Fund
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reimbursement is a critical program to reimburse providers
for uncompensated emergency care.
ASSEMBLY FLOOR :
AYES: Adams, Ammiano, Anderson, Arambula, Beall, Bill
Berryhill, Tom Berryhill, Blakeslee, Block, Blumenfield,
Bradford, Brownley, Buchanan, Charles Calderon, Carter,
Chesbro, Conway, Cook, Coto, Davis, De La Torre, De Leon,
DeVore, Emmerson, Eng, Evans, Feuer, Fletcher, Fong,
Fuentes, Fuller, Furutani, Gaines, Galgiani, Garrick,
Gilmore, Hagman, Hall, Harkey, Hayashi, Hernandez, Hill,
Huber, Huffman, Jeffries, Knight, Lieu, Logue, Ma,
Mendoza, Miller, Monning, Nava, Nestande, Niello,
Nielsen, Norby, V. Manuel Perez, Portantino, Ruskin,
Salas, Saldana, Silva, Skinner, Smyth, Solorio, Audra
Strickland, Swanson, Torlakson, Torres, Tran, Villines,
Yamada, John A. Perez
NO VOTE RECORDED: Bass, Caballero, Jones, Bonnie Lowenthal,
Torrico, Vacancy
CTW:do 8/18/10 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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