BILL NUMBER: SB 635 CHAPTERED
BILL TEXT
CHAPTER 524
FILED WITH SECRETARY OF STATE SEPTEMBER 15, 2004
APPROVED BY GOVERNOR SEPTEMBER 15, 2004
PASSED THE SENATE AUGUST 27, 2004
PASSED THE ASSEMBLY AUGUST 19, 2004
AMENDED IN ASSEMBLY AUGUST 16, 2004
AMENDED IN ASSEMBLY JUNE 30, 2004
AMENDED IN ASSEMBLY MAY 24, 2004
AMENDED IN ASSEMBLY MAY 13, 2004
AMENDED IN ASSEMBLY JANUARY 5, 2004
AMENDED IN ASSEMBLY JULY 14, 2003
AMENDED IN SENATE APRIL 29, 2003
INTRODUCED BY Senator Dunn
(Coauthor: Senator Romero)
(Coauthor: Assembly Member Jackson)
FEBRUARY 21, 2003
An act to add and repeal Section 76104.1 of the Government Code,
to amend, repeal, and add Section 1797.98e of the Health and Safety
Code, and to add and repeal Section 42007.5 of the Vehicle Code,
relating to emergency medical services.
LEGISLATIVE COUNSEL'S DIGEST
SB 635, Dunn. Emergency medical services.
(1) Existing law authorizes each county to establish an emergency
medical services fund, funded by specified revenue penalties, and
makes money in the fund available for the reimbursement of physicians
and surgeons and hospitals for losses incurred in the provision of
emergency medical services when payment is not otherwise made for
those services.
This bill would, until January 1, 2007, authorize Santa Barbara
County to collect additional penalties, fines, or forfeitures, and to
modify the percentage distribution of the fund to the various
medical care providers, provided that the Santa Barbara County Board
of Supervisors adopts a resolution stating that implementation of
these provisions is necessary to the county for purposes of providing
payment for emergency medical services.
(2) Existing law provides that payments for emergency medical
services from the county emergency medical services fund shall be
made only for emergency medical services provided on the calendar day
on which emergency medical services are first provided and on the
immediately following 2 calendar days, and specifies that payments
may not be made for services provided beyond a 48-hour period of
continuous service to the patient.
Existing law also provides that if it is necessary to transfer the
patient to a 2nd facility providing a higher level of care for the
treatment of the emergency condition, reimbursement shall be
available for services provided at the facility to which the patient
was transferred on the calendar day of transfer and on the
immediately following 2 calendar days, and specifies that payments
may not be made for services provided beyond a 48-hour period of
continuous service to the patient.
This bill would, until January 1, 2007, eliminate the limitation
against making those payments for services provided beyond a 48-hour
period of continuous services to the patient.
(3) Existing law requires the clerk of the court to collect a fee
from every person who is ordered or permitted to attend a traffic
violator school or who attends any other court-supervised program of
traffic safety instruction, and provides for the allocation of the
fee. Existing law provides that any county that has established a
Maddy Emergency Medical Services Fund shall deposit $2 for every $7
of additional penalties imposed by the courts for criminal offenses.
This bill would, until January 1, 2007, provide that the
allocation of fees authorized by this bill for Santa Barbara County
shall be deposited in that fund.
This bill would require the Board of Supervisors of Santa Barbara
County to report to the Legislature whether, and to the extent that,
actions are taken by the county to implement alternative local
sources of funding, thereby imposing a state-mandated local program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement, including the creation of a State Mandates Claims Fund
to pay the costs of mandates that do not exceed $1,000,000 statewide
and other procedures for claims whose statewide costs exceed
$1,000,000.
This bill would provide that, if the Commission on State Mandates
determines that the bill contains costs mandated by the state,
reimbursement for those costs shall be made pursuant to these
statutory provisions.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 76104.1 is added to the Government Code, to
read:
76104.1. (a) Except as provided in subdivision (d), and
notwithstanding any other provision of law, for purposes of
supporting emergency medical services pursuant to Chapter 2.5
(commencing with Section 1797.98a) of Division 2.5 of the Health and
Safety Code, in Santa Barbara County, a penalty of five dollars
($5.00) for every ten dollars ($10.00), or fraction thereof, shall be
imposed on every fine, penalty, or forfeiture collected for criminal
offenses, including all offenses involving a violation of the
Vehicle Code or any local ordinance adopted pursuant to the Vehicle
Code, except parking offenses subject to Article 3 (commencing with
Section 40200) of Chapter 1 of Division 17 of the Vehicle Code. This
penalty assessment shall be collected together with and in the same
manner as the amount established by Section 1464 of the Penal Code.
(b) Notwithstanding any other provision of law, for the purposes
of supporting emergency medical services pursuant to Chapter 2.5
(commencing with Section 1797.98a) of Division 2.5 of the Health and
Safety Code, in Santa Barbara County, for every parking offense, as
defined in subdivision (i) of Section 1463 of the Penal Code, where a
parking penalty, fine, or forfeiture is imposed, an added penalty of
two dollars and fifty cents ($2.50) shall be included in the total
penalty, fine, or forfeiture, together with and in the same manner as
the amount established pursuant to subdivision (b) of Section 76000.
(c) The moneys collected pursuant to this section shall be held by
the county treasurer in the same manner, and shall be payable for
the same purposes, described in subdivision (e) of Section 76104.
(d) (1) Notwithstanding any provision of law to the contrary, in
the County of Santa Barbara, the distribution set forth in
subparagraph (B) of paragraph (5) of subdivision (b) of Section
1797.98a shall, instead, be 42 percent of the fund to hospitals
providing disproportionate trauma and emergency medical services to
uninsured patients who do not make any payment for services.
(2) Notwithstanding any provision of law to the contrary, in the
County of Santa Barbara, the 17 percent distribution set forth in
subparagraph (C) of paragraph (5) of subdivision (b) of Section
1797.98a shall not apply.
(e) This section shall be implemented only if the Santa Barbara
County Board of Supervisors adopts a resolution stating that
implementation of this section is necessary to the county for
purposes of providing payment for emergency medical services.
(f) This section shall remain in effect only until January 1,
2007, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2007, deletes or extends
that date.
SEC. 2. Section 1797.98e of the Health and Safety Code is amended
to read:
1797.98e. (a) It is the intent of the Legislature that a
simplified, cost-efficient system of administration of this chapter
be developed so that the maximum amount of funds may be utilized to
reimburse physicians and surgeons and for other emergency medical
services purposes. The administering agency shall select an
administering officer and shall establish procedures and time
schedules for the submission and processing of proposed reimbursement
requests submitted by physicians and surgeons. The schedule shall
provide for disbursements of moneys in the Emergency Medical Services
Fund on at least a quarterly basis to applicants who have submitted
accurate and complete data for payment. When the administering
agency determines that claims for payment for physician and surgeon
services are of sufficient numbers and amounts that, if paid, the
claims would exceed the total amount of funds available for payment,
the administering agency shall fairly prorate, without preference,
payments to each claimant at a level less than the maximum payment
level. Each administering agency may encumber sufficient funds
during one fiscal year to reimburse claimants for losses incurred
during that fiscal year for which claims will not be received until
after the fiscal year. The administering agency may, as necessary,
request records and documentation to support the amounts of
reimbursement requested by physicians and surgeons and the
administering agency may review and audit the records for accuracy.
Reimbursements requested and reimbursements made that are not
supported by records may be denied to, and recouped from, physicians
and surgeons. Physicians and surgeons found to submit requests for
reimbursement that are inaccurate or unsupported by records may be
excluded from submitting future requests for reimbursement. The
administering officer shall not give preferential treatment to any
facility, physician and surgeon, or category of physician and surgeon
and shall not engage in practices that constitute a conflict of
interest by favoring a facility or physician and surgeon with which
the administering officer has an operational or financial
relationship. A hospital administrator of a hospital owned or
operated by a county of a population of 250,000 or more as of January
1, 1991, or a person under the direct supervision of that person,
shall not be the administering officer. The board of supervisors of
a county or any other county agency may serve as the administering
officer. The administering officer shall solicit input from
physicians and surgeons and hospitals to review payment distribution
methodologies to ensure fair and timely payments. This requirement
may be fulfilled through the establishment of an advisory committee
with representatives comprised of local physicians and surgeons and
hospital administrators. In order to reduce the county's
administrative burden, the administering officer may instead request
an existing board, commission, or local medical society, or
physicians and surgeons and hospital administrators, representative
of the local community, to provide input and make recommendations on
payment distribution methodologies.
(b) Each provider of health services that receives payment under
this chapter shall keep and maintain records of the services
rendered, the person to whom rendered, the date, and any additional
information the administering agency may, by regulation, require, for
a period of three years from the date the service was provided. The
administering agency shall not require any additional information
from a physician and surgeon providing emergency medical services
that is not available in the patient record maintained by the entity
listed in subdivision (f) where the emergency medical services are
provided, nor shall the administering agency require a physician and
surgeon to make eligibility determinations.
(c) During normal working hours, the administering agency may make
any inspection and examination of a hospital's or physician and
surgeon's books and records needed to carry out the provisions of
this chapter. A provider who has knowingly submitted a false request
for reimbursement shall be guilty of civil fraud.
(d) Nothing in this chapter shall prevent a physician and surgeon
from utilizing an agent who furnishes billing and collection services
to the physician and surgeon to submit claims or receive payment for
claims.
(e) All payments from the fund pursuant to Section 1797.98c to
physicians and surgeons shall be limited to physicians and surgeons
who, in person, provide onsite services in a clinical setting,
including, but not limited to, radiology and pathology settings.
(f) All payments from the fund shall be limited to claims for care
rendered by physicians and surgeons to patients who are initially
medically screened, evaluated, treated, or stabilized in any of the
following:
(1) A basic or comprehensive emergency department of a licensed
general acute care hospital.
(2) A site that was approved by a county prior to January 1, 1990,
as a paramedic receiving station for the treatment of emergency
patients.
(3) A standby emergency department that was in existence on
January 1, 1989, in a hospital specified in Section 124840.
(4) For the 1991-92 fiscal year and each fiscal year thereafter, a
facility which contracted prior to January 1, 1990, with the
National Park Service to provide emergency medical services.
(g) Payments shall be made only for emergency medical services
provided on the calendar day on which emergency medical services are
first provided and on the immediately following two calendar days.
(h) Notwithstanding subdivision (g), if it is necessary to
transfer the patient to a second facility providing a higher level of
care for the treatment of the emergency condition, reimbursement
shall be available for services provided at the facility to which the
patient was transferred on the calendar day of transfer and on the
immediately following two calendar days.
(i) Payment shall be made for medical screening examinations
required by law to determine whether an emergency condition exists,
notwithstanding the determination after the examination that a
medical emergency does not exist. Payment shall not be denied solely
because a patient was not admitted to an acute care facility.
Payment shall be made for services to an inpatient only when the
inpatient has been admitted to a hospital from an entity specified in
subdivision (f).
(j) The administering agency shall compile a quarterly and yearend
summary of reimbursements paid to facilities and physicians and
surgeons. The summary shall include, but shall not be limited to,
the total number of claims submitted by physicians and surgeons in
aggregate from each facility and the amount paid to each physician
and surgeon. The administering agency shall provide copies of the
summary and forms and instructions relating to making claims for
reimbursement to the public, and may charge a fee not to exceed the
reasonable costs of duplication.
(k) Each county shall establish an equitable and efficient
mechanism for resolving disputes relating to claims for
reimbursements from the fund. The mechanism shall include a
requirement that disputes be submitted either to binding arbitration
conducted pursuant to arbitration procedures set forth in Chapter 3
(commencing with Section 1282) and Chapter 4 (commencing with Section
1285) of Part 3 of Title 9 of the Code of Civil Procedure, or to a
local medical society for resolution by neutral parties.
(l) This section shall remain in effect only until January 1,
2007, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2007, deletes or extends
that date.
SEC. 3. Section 1797.98e is added to the Health and Safety Code,
to read:
1797.98e. (a) It is the intent of the Legislature that a
simplified, cost-efficient system of administration of this chapter
be developed so that the maximum amount of funds may be utilized to
reimburse physicians and surgeons and for other emergency medical
services purposes. The administering agency shall select an
administering officer and shall establish procedures and time
schedules for the submission and processing of proposed reimbursement
requests submitted by physicians and surgeons. The schedule shall
provide for disbursements of moneys in the Emergency Medical Services
Fund on at least a quarterly basis to applicants who have submitted
accurate and complete data for payment. When the administering
agency determines that claims for payment for physician and surgeon
services are of sufficient numbers and amounts that, if paid, the
claims would exceed the total amount of funds available for payment,
the administering agency shall fairly prorate, without preference,
payments to each claimant at a level less than the maximum payment
level. Each administering agency may encumber sufficient funds
during one fiscal year to reimburse claimants for losses incurred
during that fiscal year for which claims will not be received until
after the fiscal year. The administering agency may, as necessary,
request records and documentation to support the amounts of
reimbursement requested by physicians and surgeons and the
administering agency may review and audit the records for accuracy.
Reimbursements requested and reimbursements made that are not
supported by records may be denied to, and recouped from, physicians
and surgeons. Physicians and surgeons found to submit requests for
reimbursement that are inaccurate or unsupported by records may be
excluded from submitting future requests for reimbursement. The
administering officer shall not give preferential treatment to any
facility, physician and surgeon, or category of physician and surgeon
and shall not engage in practices that constitute a conflict of
interest by favoring a facility or physician and surgeon with which
the administering officer has an operational or financial
relationship. A hospital administrator of a hospital owned or
operated by a county of a population of 250,000 or more as of January
1, 1991, or a person under the direct supervision of that person,
shall not be the administering officer. The board of supervisors of
a county or any other county agency may serve as the administering
officer. The administering officer shall solicit input from
physicians and surgeons and hospitals to review payment distribution
methodologies to ensure fair and timely payments. This requirement
may be fulfilled through the establishment of an advisory committee
with representatives comprised of local physicians and surgeons and
hospital administrators. In order to reduce the county's
administrative burden, the administering officer may instead request
an existing board, commission, or local medical society, or
physicians and surgeons and hospital administrators, representative
of the local community, to provide input and make recommendations on
payment distribution methodologies.
(b) Each provider of health services that receives payment under
this chapter shall keep and maintain records of the services
rendered, the person to whom rendered, the date, and any additional
information the administering agency may, by regulation, require, for
a period of three years from the date the service was provided. The
administering agency shall not require any additional information
from a physician and surgeon providing emergency medical services
that is not available in the patient record maintained by the entity
listed in subdivision (f) where the medical services are provided,
nor shall the administering agency require a physician and surgeon to
make eligibility determinations.
(c) During normal working hours, the administering agency may make
any inspection and examination of a hospital's or physician and
surgeon's books and records needed to carry out the provisions of
this chapter. A provider who has knowingly submitted a false request
for reimbursement shall be guilty of civil fraud.
(d) Nothing in this chapter shall prevent a physician and surgeon
from utilizing an agent who furnishes billing and collection services
to the physician and surgeon to submit claims or receive payment for
claims.
(e) All payments from the fund pursuant to Section 1797.98c to
physicians and surgeons shall be limited to physicians and surgeons
who, in person, provide onsite services in a clinical setting,
including, but not limited to, radiology and pathology settings.
(f) All payments from the fund shall be limited to claims for care
rendered by physicians and surgeons to patients who are initially
medically screened, evaluated, treated, or stabilized in any of the
following:
(1) A basic or comprehensive emergency department of a licensed
general acute care hospital.
(2) A site that was approved by a county prior to January 1, 1990,
as a paramedic receiving station for the treatment of emergency
patients.
(3) A standby emergency department that was in existence on
January 1, 1989, in a hospital specified in Section 124840.
(4) For the 1991-92 fiscal year and each fiscal year thereafter, a
facility which contracted prior to January 1, 1990, with the
National Park Service to provide emergency medical services.
(g) Payments shall be made only for emergency services provided on
the calendar day on which emergency medical services are first
provided and on the immediately following two calendar days, however,
payments may not be made for services provided beyond a 48-hour
period of continuous service to the patient.
(h) Notwithstanding subdivision (g), if it is necessary to
transfer the patient to a second facility providing a higher level of
care for the treatment of the emergency condition, reimbursement
shall be available for services provided at the facility to which the
patient was transferred on the calendar day of transfer and on the
immediately following two calendar days, however, payments may not be
made for services provided beyond a 48-hour period of continuous
service to the patient.
(i) Payment shall be made for medical screening examinations
required by law to determine whether an emergency condition exists,
notwithstanding the determination after the examination that a
medical emergency does not exist. Payment shall not be denied solely
because a patient was not admitted to an acute care facility.
Payment shall be made for services to an inpatient only when the
inpatient has been admitted to a hospital from an entity specified in
subdivision (f).
(j) The administering agency shall compile a quarterly and yearend
summary of reimbursements paid to facilities and physicians and
surgeons. The summary shall include, but shall not be limited to,
the total number of claims submitted by physicians and surgeons in
aggregate from each facility and the amount paid to each physician
and surgeon. The administering agency shall provide copies of the
summary and forms and instructions relating to making claims for
reimbursement to the public, and may charge a fee not to exceed the
reasonable costs of duplication.
(k) Each county shall establish an equitable and efficient
mechanism for resolving disputes relating to claims for
reimbursements from the fund. The mechanism shall include a
requirement that disputes be submitted either to binding arbitration
conducted pursuant to arbitration procedures set forth in Chapter 3
(commencing with Section 1282) and Chapter 4 (commencing with Section
1285) of Part 3 of Title 9 of the Code of Civil Procedure, or to a
local medical society for resolution by neutral parties.
(l) This section shall become operative January 1, 2007.
SEC. 4. Section 42007.5 is added to the Vehicle Code, to read:
42007.5. (a) Notwithstanding paragraph (2) of subdivision (b) of
Section 42007, in Santa Barbara County, upon the establishment of a
Maddy Emergency Medical Services Fund pursuant to Section 1797.98a of
the Health and Safety Code, the amount that would have been
collected pursuant to Section 76104.1 of the Government Code shall be
deposited in the Maddy Emergency Medical Services Fund established
by the county pursuant to Section 1797.98a of the Health and Safety
Code.
(b) The Board of Supervisors of the County of Santa Barbara shall
report to the Legislature whether, and to the extent that, any
actions are taken by the County of Santa Barbara to implement
alternative local sources of funding.
(c) This section shall remain in effect only until January 1,
2007, and as of that date is repealed, unless a later enacted
statute, that is enacted before January 1, 2007, deletes or extends
that date.
SEC. 5. The Legislature finds and declares that due to unique
circumstances regarding emergency medical services in Santa Barbara
County, a general statute cannot be made applicable within the
meaning of Section 16 of Article IV of the California Constitution.
Therefore, the special legislation contained in Section 1 of this act
is necessarily applicable only to Santa Barbara County.
SEC. 6. Notwithstanding Section 17610 of the Government Code, if
the Commission on State Mandates determines that this act contains
costs mandated by the state, reimbursement to local agencies and
school districts for those costs shall be made pursuant to Part 7
(commencing with Section 17500) of Division 4 of Title 2 of the
Government Code. If the statewide cost of the claim for
reimbursement does not exceed one million dollars ($1,000,000),
reimbursement shall be made from the State Mandates Claims Fund.