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HomeMy WebLinkAboutMINUTES - 07071987 - 1.39 TO: BOARD OF SUPERVISORS Phil Batchelor, FROM: County Administrator Contra July 1, 1987 Costa DATE: County SUBJECT: LEGISLATION - SB 12 (MADDY) SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION , RECOMMENDATION• Adopt a position in opposition SB 12 by Senator Ken Maddy which, while it makes a number of commendable changes in the law requiring hospital to treat emergency room patients and provides a method of funding those services, also requires counties to utilize a portion of their Medically Indigent (MIA) funds to pay for emergency health care services rendered to county indigents in non-county facilities. BACKGROUND: SB 12 imposes an additional assessment of $1 on each $10 or fraction thereof of various fines, penalties and forfeitures imposed and collected by the courts. This money would be forwarded to the State for deposit in the Emergency Medical Services Fund. The money in the Emergency Medical Services Fund would be made available upon appropriation by the Legislature and reimburse physicians and hospitals for a percentage of the losses they incur in providing emergency medical services on and after July 1, 1988. One-third of the money would go to disproportionate share hospitals with the other two-thirds of the fund going to physicians employed by general acute care hospitals, except for county or district hospitals. SB 12 also requires counties to maintain a portion of existing MIA funds for emergency care of patients in non-county facilities. SB 12 also regulates the treatment of patients brought to hospital emergency departments and the transfer of those patients to other medical facilities. Many of the features regulating patient care in emergency rooms are designed to prevent the medically inappropriate transfer of patients to county facilities when the reason for doing so is the patient' s inability to pay the cost of care. These are, generally, laudable objectives which are needed both medically and fiscally to protect counties and low-income patients. The provision to pay for this by a surcharge on fines and forfeitures is a little far-removed and may impair the county' s ability to increase such surcharges for legitimate court-related purposes. However, the most troublesome provision is the final paragraph of the bill which reads: "It is the intent of the Legislature that all counties receiving state funds for county indigent health care programs utilize a portion of this funding to pay for CONTINUED ON ATTACHMENT: X YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE APPROVE OTHER SIGNATURE(S): f' ACTION OF BOARD ON July / • 1987 APPROVED AS RECOMMENDED OTHER VOTE OF SUPERVISORS 1 HEREBY CERTIFY THAT THIS IS A TRUE X UNANIMOUS (ABSENT AND CORRECT COPY OF AN ACTION TAKEN AYES: NOES: AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. County Administrator JUL 7 1987 cc: Health Services Director ATTESTED Jackson/Barish & Associates PHIL BATCHELOR, CLERK OF THE BOARD OF CSAC SUPERVISORS AND COUNTY ADMINISTRATOR Senator ruddy BY— M382/7-83 DEPUTY emergency health care services rendered to county indigents in non-county facilities. The Legislature also intends that counties that do not have a policy to pay for these emergency services be encouraged to voluntarily establish this policy immediately." While there have been some counties that have absolutely refused to pay non-county facilities for emergency medical care, this paragraph does not appear to be the solution to the problem. Who the medically indigent are is poorly enough defined that in the absence of contractual agreements, hospitals could use this provision to bill counties for any of their unreimbursed losses or "bad debts" . The rest of the bill sets forth a more acceptable method of reimbursing non-county facilities for emergency services. This paragraph mandates that some undefined proportion of the county' s MIA funds be, used to provide for emergency care in non-county facilities without placing any limits on the extent to which such funds may be required to be spent for this purpose, without establishing any agreed on contractual standards for who is covered for such care, for how long nor for how the non-county hospital will be reimbursed for such services. If such a requirement is needed, then all of these areas must be much more carefully defined, transfer protocols negotiated among facilities, MIA' s distinguished from "bad debt" and rates of payment negotiated among facilities. In the absence of such provisions, counties are left completely exposed by this language. While this language has been tempered from earlier versions, the language continues to leave counties with an open-ended and undefined liability which is unacceptable. It is, therefore, recommended that the Board of Supervisors oppose SB 12 as long as the language remains in the bill without any more closely defined limits on the county' s exposure.