BILL ANALYSIS �
AB 210
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Date of Hearing: May 11, 2011
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Felipe Fuentes, Chair
AB 210 (Solorio) - As Amended: April 4, 2011
Policy Committee: HealthVote:14-5
Urgency: No State Mandated Local Program:
Yes Reimbursable: Yes
SUMMARY
This bill revises existing statute relating to the role of city,
county or fire districts with regard to prehospital emergency
medical services (EMS). Specifically, this bill:
1)Requires that a local emergency medical services agency
(LEMSA) grant to a city, county or fire district that has been
continuously providing prehospital EMS since June 1, 1980 and
has not entered into an agreement with the LEMSA,
authorization to provide the same services or an exclusive
operating area. It also repeals the existing similar
provision and requires the EMS provider to enter into an
agreement by December 31, 2013.
2)Defines "prehospital EMS provider," requires a LEMSA to
include all prehospital EMS providers in its local EMS plans,
and requires all prehospital EMS providers to comply with
LEMSA policies and procedures regarding administration of the
local EMS system.
3)Grants a prehospital EMS provider the same right as a LEMSA to
appeal a determination by the Emergency Medical Services
Authority (EMSA) that a LEMSA developed plan does not meet the
required standard.
FISCAL EFFECT
Annual GF costs to EMSA, potentially in the range of hundreds of
thousands of dollars, related to legal workload to evaluate and
respond to appeals of EMSA's determinations regarding local EMS
plans. Costs could subside in future years, depending on the
number of appeals and the resolution of litigation.
AB 210
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COMMENTS
1)Rationale . The author states that the practice of prehospital
medicine has witnessed significant changes and growth in the
last decades, increasing the importance of a coordinated EMS
system. He further states that it has become more common for
EMS transportation providers to function without entering into
a written agreement with their respective LEMSA. The author
argues that this has created confusion in determining which
EMS providers are required to maintain services in certain
areas. By defining key terms, requiring that all prehospital
providers are part of a local EMS plan, and clarifying under
what circumstances certain providers are granted exclusive
operating areas, the author intends to resolve litigation and
improve coordination of local EMS systems.
2)History . Prehospital EMS services have been a source of
friction between cities, counties, fire districts, and other
prehospital providers for three decades, at times resulting in
litigation. The sources of this tension involve
jurisdictional and operational issues, historical service
relationships, and the differences in profitability of various
levels of EMS service and the provision of services in rural
versus urban areas.
In 1980, LEMSAs were given control over local EMS systems, and
EMSA was created to oversee the development of a coordinated
statewide EMS system. Because rural areas are geographically
sparse and less profitable than urban areas, LEMSAs were given
the right to offer exclusive operating areas through
competitive contracts. These arrangements allow them to
ensure consistent EMS service is provided to all communities.
A LEMSA electing to create one or more exclusive operating
areas must develop and submit to EMSA for approval, as part of
the local plan, its competitive process for selecting
providers.
However, some cities, counties and fire districts have
maintained operating areas through a "grandfathering" clause
based on their level of service and area served in 1980. The
original intent of the 1980 law was that prehospital EMS
providers would gradually integrate into the local EMS system,
organized by the LEMSA. However, many of the existing
providers opted not to formally integrate, and were able to
AB 210
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maintain their operating areas by avoiding written agreements
with a LEMSA. As the sponsors of this bill note, the lack of
written agreements undermines attempts to coordinate local EMS
systems.
3)Stakeholder process ongoing . To help resolve the longstanding
disputes regarding these issues, EMSA hosted a one-day
stakeholder workshop in May 2010. The Commission on EMS also
established a subcommittee to evaluate these issues. In
December 2010, the subcommittee submitted a report and
recommendations which were intended to serve as a road map for
further action for EMSA and the EMS community at large.
In response, EMSA convened a task force consisting of EMS
constituents with knowledge of these issues. The task force
has been meeting on a bi-weekly basis since late January 2011,
and is developing a draft set of regulations and possible
statutory changes to address the same issues this bill is
seeking to address. According to the December 2010
subcommittee report, the regulatory package and recommended
statutory framework are to be considered at the June 2011
Commission meeting. The language in this bill largely reflects
the stakeholder agreement so far.
4)Ability to appeal EMS plans . This bill significantly expands
the number of entities that can appeal EMSA's decisions to
approve or deny local EMS plans. It appears likely that given
the legal right to appeal, a range of providers would appeal
determinations that negatively affect their operations.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081