BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Deborah V. Ortiz, Chair
BILL NO: SB 1773
S
AUTHOR: Alarcon
B
AMENDED: As introduced
HEARING DATE: April 26, 2006
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FISCAL: Public Safety / NonFiscal
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CONSULTANT:
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Machi / ak
SUBJECT
Fines and forfeitures
SUMMARY
This bill authorizes counties to collect an additional $2
penalty assessment for every $10 in base fines for purposes
of providing payment for emergency medical services.
Requires revenue generated from the assessment to be
deposited into the Maddy Emergency Medical Services Fund
(Maddy EMS Fund), with 15 percent designated for pediatric
trauma centers, and allows for up to10 percent to be used
for administrative costs. Sunsets the provisions of this
bill January 1, 2009. This measure is a reintroduction of
the final version of SB 57 (Alarcon, 2005) which was vetoed
by Governor Schwarzenegger.
ABSTRACT
Existing law:
Government code:
1.Allows counties to assess additional charges on fines,
penalties and forfeitures collected by courts for certain
criminal and vehicle code violation to provide Maddy
Revenues for the purpose of funding County EMS Funds.
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Health and Safety code:
1.Establishes the Emergency Medical Services Authority
within the California Health and Human Services Agency to
provide statewide coordination of local county EMS
programs.
2.Authorizes counties to establish Maddy EMS funds to
reimburse health care providers for emergency services
provided to people who cannot afford to pay for emergency
care.
3.Provides that funds collected under the Maddy Emergency
Medical Services Act of 1987 shall be used to reimburse
physicians and surgeons for losses incurred for services
provided to patients.
4.Authorizes a county to use 10 percent of the EMS Fund for
administration costs.
5.Allows for counties to maintain a reserve of up to 15
percent.
6.Provides for reimbursement of physicians and surgeons
from the EMS Fund for up to 50 percent of the amount
claimed and allows additional proportional reimbursement
to physicians and surgeons of all funds remaining at the
end of the fiscal year in excess of certain reserves.
7.Requires a county to adopt a fee schedule to establish a
uniform, reasonable, level of reimbursement from the
physician services account for reimbursable services.
8.Requires the administering agency to establish procedures
and time schedules for submission and processing of
reimbursement claims from the EMS Fund submitted by
physicians in accordance with these provisions and
requires that schedules for payment provide for periodic
disbursement of the funds to physicians, at least
quarterly.
9.Authorizes payments from the EMS Fund for un-reimbursed
emergency medical services performed on the calendar day
on which the services are first performed and the
immediately following two calendar days.
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This bill:
This bill amends the Maddy EMS Fund to provide that of the
money deposited into the EMS Fund pursuant to this bill, 15
percent shall be utilized to provide funding for pediatric
trauma centers. Specifically, this bill:
1.Requires that funds collected under the provisions of
this bill be deposited into the Maddy EMS Fund, as
specified.
2.Provides that expenditure of money deposited in a Maddy
EMS Fund pursuant to this bill shall be limited to
reimbursement to physicians and surgeons, and hospitals
for patients who do not make payment for services, or for
expanding the services provided at pediatric trauma
centers, including the purchase of equipment.
3.Specifies that of the money deposited into the fund
pursuant to Section 76000.5 of the Government Code, 15
percent shall be utilized to provide funding for all
pediatric trauma centers throughout the county, both
publicly and privately owned and operated. Expenditure
of money shall be limited to reimbursement to physicians
and surgeons, and hospitals for patients who do not make
payment for services, or to hospitals for expanding the
services provided at pediatric trauma centers, including
the purchase of equipment. Counties that do not maintain
a pediatric trauma center shall utilize the money
deposited into the fund to improve access to pediatric
trauma and emergency services in the county, with
preference for funding given to hospitals that specialize
in services to children, and physicians and surgeons who
provide care for children. Funds spent for the purposes
of this section, shall be known as the Pediatric Care
Allocation.
4.Requires that funds shall be collected under the
provisions of this bill only if the county board of
supervisors provides that the increased penalties do not
offset or reduce the funding of other programs from other
sources, but that these additional revenues result in
increased funding to those programs.
5.Provides that the costs of administering money deposited
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in a Maddy EMS Fund under this bill should not exceed 10
percent.
This measure is a reintroduction of the final version of SB
57 (Alarcon, 2005) which was vetoed by Governor
Schwarzenegger.
FISCAL IMPACT
No fiscal impact on the state. However, this bill may
potentially generate up to $60 million for county EMS
funds.
BACKGROUND AND DISCUSSION
Need for the legislation
According to the author, this bill would create a specific
mechanism for the Maddy EMS Fund to allow counties to
collect an additional $2 penalty assessment of every $10
penalty for all criminal offenses, as specified. This
would be a $20 increase on an average $340 ticket payment.
As a result of this bill, increased funding for Emergency
and Trauma Care is estimated to be $60 million per year.
This bill would also establish a Pediatric Care Allocation
for equipment and facilities. According to the author,
these additional funds would also be instrumental in
maintaining the financial stability of the emergency and
trauma centers, decreasing the diversion time and patient
wait time and improving services overall.
The author states that many hospitals throughout California
suffer from funding shortages. As a result, hospitals are
not prepared to adequately serve the patients in their area
and are often forced to close their doors. Many of these
hospitals offer trauma care services that are essential to
saving the lives of many patients who without them would
have no choice but to go elsewhere for services. The
author asserts that currently, trauma care centers face a
$635 million loss. The author states that this bill seeks
to generate funding to help alleviate this problem.
Maddy EMS Funds
In 1987, the Legislature concluded that the emergency
medical service providers bore higher costs for their
services than did providers of other medical services but
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often received only partial or no payment from patients.
To address this, the state enacted a series of laws
providing revenues 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.
The first of these laws, Chapter 1240, Statutes of 1987,
authored by Senator Ken Maddy allows counties to establish
Emergency Medical Services Funds (EMS Funds).
As of November 2003, 49 counties had established EMS funds.
Counties finance these funds through several revenue
sources: (1) penalty assessments on certain criminal and
traffic violations, known as Maddy revenues; (2) a portion
of the fees from people attending traffic violator schools;
(3) revenues from taxes on tobacco products deposited in
the State's Cigarette and Tobacco Products Surtax Fund; and
(4) redirected money from the State's Cigarette and Tobacco
Products Surtax Fund through an annual Emergency Medical
Services Appropriation.
Counties must use Maddy revenues as follows: 10 percent
may be used for administration; 58 percent is allocated to
an account for physicians who provide emergency medical
services and are not employed in county hospitals, 25
percent to an account for hospitals that provide for a
larger share of a county's trauma and emergency care
services, and 17 percent to an account for discretionary
emergency medical services as determined by the county.
Physicians can receive reimbursement for up to 50 percent
of their claims, whereas hospital and discretionary costs
can be reimbursed up to 100 percent.
Previous legislation
SB 57 (Alarcon, 2005) would have authorized counties to
collect an additional $2 penalty assessment for every $10
in base fines for purposes of providing payment for
emergency medical services. Required revenue generated
from the assessment to be deposited into the Maddy EMS
Fund, with 15 percent designated for pediatric trauma
centers, and allows for up to10 percent to be used for
administrative costs. This measure was vetoed by the
Governor.
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Governor's veto message
"The levels of court-ordered fines and fees have
increased dramatically in recent years as many individual
programs seek ways to increase their funding. However,
the total amount of dollars collected or available for
collection has not increased accordingly. The effect is
that the addition of new fines and fees tends to reduce
the imposition and collection of existing penalties,
which are passed out on a prorated basis to the various
funds. The Victim Compensation Program receives a
significant portion of its funding from restitution
fines.
While programs seeking new or additional funding in this
manner might in fact be deserving or worthwhile, it is
simply not possible to continue adding new recipients to
the existing program distribution without reducing
funding to current deserving recipients. Local EMS funds
currently receive funds from penalty assessments. In
recognition of the need for funding, my 2005-2006 budget
contains another $10 million in General Fund for trauma
centers.
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However, I cannot approve further attachment of this
source of funding at the expense of victims and others
who are likely to lose precious funding from this source
if SB 57 were to become law."
General Fund augmentation
The 2005-06 Budget contained a $10 million one-time General
Fund Augmentation. The Governor's 2006-07 Budget does not
continue this augmentation.
Arguments in support
According to the sponsor, this bill could potentially raise
$50 million to be used to reimburse physicians and surgeons
for care given to uninsured patients. The sponsor states
that the Maddy EMS Fund is one of the primary mechanisms to
reimburse physicians and surgeons for treating uninsured
patients. The sponsor asserts that counties throughout
California have only been able to reimburse physicians a
fraction of the dollar amount of the claims submitted by
physicians for treating uninsured patients. The sponsor
states that as the number of uninsured grows to over 6
million people statewide the losses sustained in emergency
departments continue to grow. According to the sponsor, in
2004 the California Medical Association reported that over
the past decade more that 65 emergency rooms have closed
that the losses sustained by hospitals and physicians for
the year 2001-2002 was over $635 million. The author
argues that as the losses continue to grow, the Maddy EMS
Fund becomes even more vital. According to the sponsor,
although the passage of SB 1773 will not fix the entire
emergency care crisis, it does help prevent the already
fragile emergency care system from sustaining further
deterioration.
Arguments in opposition
According to the opposition, there is no question that
emergency rooms are facing a myriad problems and are
suffering the effects of an underfunded healthcare system.
They argue that this is a public crisis deserving of a
broad solution. The California Teamsters Public Affairs
Council and the California Labor Federation argue that,
unfortunately, SB 1773 represents a tiny band aid that will
have little impact on the overall problem but have a
significant negative impact on the group the bill targets
for what can only be characterized as a tax on our members
and every other working driver in this state.
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The opposition continues by stating that they have become
increasingly concerned over the high level of fines for
infractions. They argue that the fines have been on a
steady rise in recent years and their view is that they
have reached their saturation point. According to the
opposition, just a few years ago, the Legislature increased
fines across the board 20 percent. The opposition asserts
that this coupled with high insurance rates and the fact
that their members are no longer permitted to attend
traffic school under a recently enacted measure, make
further increase in fines and penalties difficult to take.
POSITIONS
Support: California Chapter, American College of Emergency
Physicians (sponsor)
California Hospital Association
California Medical Association
County of Los Angeles
Peace Officers Research Association of California
Oppose:California Labor Federation AFL-CIO
California Teamsters Public Affairs Council
Commission on Peace Officer Standards and
Training