BILL ANALYSIS �
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 215
A
AUTHOR: Beall
B
AMENDED: June 27, 2011
HEARING DATE: July 6, 2011
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CONSULTANT:
1
Tadeo
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SUBJECT
Emergency services: Emergency Medical Air Transportation
Act
SUMMARY
Requires a county or court that has imposed a vehicle code
fine, as specified, to transfer earmarked penalty
assessment moneys to the Treasurer for deposit into the
Emergency Medical Air Transportation Act (EMATA) Fund on a
monthly basis.
CHANGES TO EXISTING LAW
Existing law:
Establishes the Medi-Cal program, the state's Medicaid
program, administered by the Department of Health Care
Services (DHCS), which provides comprehensive health
benefits to low-income children; their parents or caretaker
relatives; pregnant women; elderly, blind or disabled
persons; nursing home residents and refugees.
Establishes the EMATA, which imposes a $4 penalty on each
conviction of a violation of the Vehicle Code or of a local
ordinance adopted pursuant to the Vehicle Code, except
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parking offenses. Requires this penalty to be in addition
to the established penalty, and exclude from the base fine
any other surcharges used to calculate any other penalties.
Establishes the EMATA Fund, to be administered by DHCS.
Requires each county to deposit the proceeds of the
revenues from the above penalty in a county EMATA Fund and
to transfer the funds on a quarterly basis to the EMATA
Fund.
Requires the EMATA Fund to be available, upon appropriation
by the Legislature, to DHCS for payment of the
administrative costs of DHCS, and for the actual,
reasonable and necessary costs of the courts, and the
counties in administering this program. Twenty percent of
the remaining funds are to offset the state portion of the
Medi-Cal reimbursement rate for emergency medical air
transportation services, and eighty percent are to augment
emergency medical air transportation reimbursement payments
made through the Medi-Cal program.
Requires DHCS to seek federal matching funds, as specified,
by using the moneys in the EMATA Fund for the purpose of
augmenting Medi-Cal reimbursement paid to providers after
June 30, 2011.
Sunsets the assessment of penalties on January 1, 2016;
however, penalties assessed prior to the fee sunset are
required to be collected, administered and distributed
until June 30, 2017, or the funds are extinguished.
Requires any unused monies in the EMATA Fund on March 3,
2017, to be transferred to the General Fund and made
available, upon appropriation by the Legislature, for
purposes of offsetting the state portion of the Medi-Cal
reimbursement rate for emergency medical air transportation
services and augmenting emergency medical air
transportation reimbursement payments made through the
Medi-Cal program, as specified.
Establishes various other penalty assessments on specified
fines, penalties and offenses for distribution to funds
established by local governments, including, but not
limited to the Courthouse Construction Fund, Criminal
Justice Facilities Construction Fund, and the Maddy
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Emergency Medical Services Funds. State portions of these
penalty assessments include, but are not limited to, the
Fish and Game Preservation Fund, Peace Officers Training
Fund, Corrections Training Fund, Traumatic Brain Injury
Fund, and the General Fund.
This bill:
Requires a county or court that imposes a fine on the
violation of the Vehicle Code or of a local ordinance
adopted pursuant to the Vehicle Code, except parking
offenses to transfer earmarked penalty assessment moneys,
collected for deposit into the Emergency EMATA Fund,
directly to the Treasurer, on a monthly basis.
Deletes the requirement that a county establish an EMATA
Fund to receive the proceeds of the penalty and transfer
the funds on a quarterly basis to the EMATA Fund.
FISCAL IMPACT
The Assembly Appropriations Committee analysis of AB 215
stated that this bill would result in minor
non-reimbursable costs to counties to provide the state
with data related to the number of penalties imposed and
total number of funds collected. However, those
requirements have been removed from the current version of
the bill.
BACKGROUND AND DISCUSSION
According to the author and the California Association of
Air Medical Services, the sponsor of AB 215, it is more
efficient for counties to submit funds collected from the
$4 penalty assessment on Vehicle Code violations directly
to the Treasurer along with other fund transfers on a
monthly basis. This is done via the TC30 process, a form
and submittal process used to transfer and identify various
funds provided to the state. The current TC30 reporting
process within the Controller's office includes a detailed
account of the funds transmitted by each county. This is
sufficient data to allow DHCS and interested stakeholders
to determine any fund trends and dynamics. The author and
sponsor contend that AB 215 will make it more efficient for
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counties to transmit these funds, and remove a redundant
requirement that the counties provide a detailed account of
these funds, as this information can be accessed through
the Controller's office.
Air ambulance services
Air ambulance services provide emergency transportation for
the most critical patients from accident scenes directly to
trauma centers and other advanced care centers. According
to a Foundation for Air-Medical Research and Education
(FARE) 2006 report, the most serious car accidents are
located in rural areas, where 60 percent of fatal car
accidents occur, a rate double that of similar accidents in
suburban or urban areas. The FARE report also states that
the closure of rural hospitals in recent years has created
large geographical gaps in the availability of specialized
surgical resources.
Helicopter ambulances provide medical care at an advanced
life support level, and conduct specialty care transports.
Helicopters are used for the transport of patients to
trauma centers, heart/stroke centers, burn units, and
children's specialty hospitals. Medical care is provided
in fixed wing ambulances (airplanes) on longer
inter-hospital flights when the closest appropriate medical
facility is either inaccessible, difficult to reach, or
distantly located. The FARE report estimates that a
half-million air ambulance transports are conducted each
year.
Patient transports are overseen by referring physicians and
receiving specialist physicians using guidelines developed
by the National Association of EMS Physicians, the Air
Medical Physician Association, and the Association of Air
Medical Services.
Air ambulance services are also used for disaster response.
In times of either man-made or natural disasters, air
ambulance services provide highly experienced resources
that can be rapidly deployed. Air ambulance service
providers are comprised of a mix of public and private
entities. For example, the city of Los Angeles provides
its own services, whereas the California Shock Trauma Air
Rescue (CALSTAR) is a non-profit, community-based provider
that provides services throughout central and northern
California.
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Reimbursement for air ambulance services
Private air ambulance services are reimbursed by
third-party payers in the same fashion as other health care
services. According to information provided by CALSTAR
based on May 31, 2007, audited financial statements, the
average private insurance payment for air ambulance
services between June 1, 2006, and May 31, 2007, was
$20,795; the average Medicare payment was $5,400, and the
average Medi-Cal payment was $2,838.
Medi-Cal rates for air ambulance transportation were set in
1993, and have not been increased since.
Penalty assessments
The Legislature has increasingly turned to penalty
assessments on criminal and traffic offenses as a method of
raising revenue for various projects. Currently, the
amount of assessments on individuals who commit traffic
violations is almost quadruple the base fine. For example:
The fine for speeding up to 15 MPH over the 65 MPH
limit has a base penalty of $35, but amounts to $111
after additional penalties and assessments are
applied;
The fine for driving without insurance has a base
penalty of $200, but amounts to $825 after additional
penalties and assessments are applied;
The fine for driving under the influence has a base
penalty of $390, but amounts to $1,547 after
additional penalties and assessments are applied; and,
The fine for improper transport of hazardous
materials has a base penalty of $300, but amounts to
$1,205 after additional penalties and assessments are
applied.
According to a February 2006 California Research Bureau
(CRB) study, in counties in which the data was available,
the majority of penalties and assessments collected were
from Vehicle Code violations. The study noted that, many
criminal defendants who commit serious offenses under the
Penal Code are unlikely to have the ability to pay any
fines assessed in addition to other punishments, such as
county jail or state prison sentences.
Prior legislation
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AB 2173 (Beall), Chapter 547, Statutes of 2010,
establishes the EMATA which imposes a $4 penalty on
convictions of a violation of the Vehicle Code, except
parking offenses, as specified, to augment emergency air
medical transportation reimbursement payments made through
the Medi-Cal program, and to reimburse DHCS, the courts,
and each county for its administrative costs. Allows
unused monies in the EMATA Fund to be transferred to the
General Fund and be available, upon appropriation by the
Legislature, as specified.
AB 1900 (Nava), Chapter 323, Statutes of 2008, extends the
sunset date from January 1, 2009, to January 1, 2011,
authorizing Santa Barbara county to collect additional
penalty assessments of $5 for every $10 in base fines, to
be imposed on every fine, penalty, or forfeiture collected
for criminal offenses, and restricted Vehicle Code
violations to specified DUI violations for purposes of
providing payment for EMS.
SB 1236 (Padilla), Chapter 60, Statutes of 2008, extends
the sunset date from January 1, 2009, to January 1, 2014,
authorizing a county board of supervisors to elect to levy
an additional penalty in the amount of $2 for every $10,
upon fines, penalties, and forfeitures collected for
criminal offenses, and requires 15 percent of the funds
collected pursuant to that additional penalty to be
expended for pediatric trauma centers.
SB 1773 (Alarcon), Chapter 841, Statutes of 2006,
authorizes counties, until January 1, 2009, to collect an
additional $2 penalty assessment for every $10 in base
fines for purposes of providing payment for EMS, and
requires revenue generated from the assessment to be
deposited into the Maddy EMS Fund, with 15 percent
designated for pediatric trauma centers.
SB 57 (Alarcon) of 2005 would have authorized counties to
collect an additional $2 penalty assessment for every $10
in base fines for purposes of providing payment for
EMS. Would have required revenue generated from the
assessment to be deposited into the Maddy EMS Fund, with 15
percent designated for pediatric trauma centers. This bill
was vetoed by the Governor.
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SB 807 (Dunn) of 2002 would have provided for an additional
$200 assessment on specified moving violations to be
deposited into the county Maddy EMS Fund and allocated in a
specified manner. This bill was vetoed by the Governor.
SB 12 (Maddy), Chapter 1240, Statutes of 1987, allows
counties to establish a Maddy EMS Fund through a $1 penalty
assessment on fines, forfeitures, and penalties associated
with certain criminal and traffic violations, and a portion
of the fees from people attending traffic violator schools
for purposes of supporting EMS.
Arguments in support
The California Association of Air Medical Services (CAAMS),
the sponsor of AB 215, argues that AB 215 will make the
submission of penalty assessment funds on a monthly basis
more efficient for counties and will remove an unnecessary
requirement that the counties provide detailed information
on these funds. CAAMS adds that the current TC30 process
within the Controller's office includes a detailed account
of funds transmitted by each county, providing sufficient
data to allow DHCS and stakeholders to determine any fund
trends and dynamics for their current process of
establishing a rate methodology.
PRIOR ACTIONS
Assembly Health: 13- 6
Assembly Appropriations:12- 4
Assembly Floor: 51- 25
POSITIONS
Support: California Association of Air Medical Services
(sponsor)
Oppose:None received
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