HomeMy WebLinkAboutMINUTES - 03202001 - C.62 ,
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CONTRA
TO: BOARD OF SUPERVISORS
b COSTA
FROM: John Sweeten, County Administrator G' ' -C•, '`` '�'
N � COUNTY
DATE: March 20, 2001"
SUBJECT: SB 254 (Dunn)— Support If Amended
SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION
RECOMMENDATION(S):
SUPPORT SB 254 (Dunn) which strengthens the system for emergency medical care, IF
AMENDED to eliminate language restructuring allocation of Maddy EMS funds, or if language is
substituted that is satisfactory to Contra Costa County.
BACKGROUND/REASON(S) FOR RECOMMENDATION(S):
Contra Costa County has long had concerns about the ability of acute care hospitals emergency
systems to respond to crisis and for the County's emergency medical services agency to provide
sufficient oversight and direction to the emergency room system. This bill includes various
measures which would strengthen emergency room systems through oversight, regulation and
funding.
CONTINUED ON ATTACHMENT: _YES SIGNATURE:
_ GRECOMMENDATION OF COUNTY ADMINISTRATOR_RECOMMENDATION OF B ARD COMMITTEE
APPROVE —OTHER
SIGNATURE(S):
ACTION OF BOAR ON :0_ g nn i APPROVED AS RECOMMENDED x OTHER
VOTE OF SUPERVISORS
I HEREBY CERTIFY THAT THIS IS A
XX UNANIMOUS(ABSENT - - - - 1 TRUE AND CORRECT COPY OF AN
AYES: NOES: ACTION TAKEN AND ENTERED
ABSENT: ABSTAIN: ON MINUTES OF THE BOARD OF
SUPERVISORS ON THE DATE SHOWN.
Contact:
ATTESTED March 20, 2001
JOHN SWEETEN,CLERK OF
THE BOARD OF SUPERVISORS
AND COUNTY ADMINISTRATOR
cc: CAO
Dr.William Walker,Health Services
Art Lathrop,Emergency Services Director
BY RAS ,DEPUTY
i
SB 254 Senate Bill- INTRODUCED Page 1 of 9
BILL NUMBER: SB 254 INTRODUCED
BILL TEXT
INTRODUCED BY Senator Dunn
FEBRUARY 15, 2001
An act to amend Sections 1797.98a, 1797.98b, 1797.100, 1797.101,
1797.107, 1797.108, 1797.200, 1797.254, and 1798.161 of, to add
Sections 1275.9, 1367.13, 1797.87, 1797.115, and 1797.251 to, and to
repeal Section 1798.166 of, the Health and Safety Code, to add
Section 10126.7 to the Insurance Code, and to amend Section 14106.6
of, and to add Section 14106.65 to, the Welfare and Institutions
Code, relating to emergency services, and making an appropriation
therefor.
LEGISLATIVE COUNSEL'S DIGEST
SB 254, as introduced, Dunn. Emergency medical services.
Existing law provides for the licensure and regulation of health
facilities, including the provision of emergency medical services and
care by those facilities.
This bill would require the State Department of Health Services,
upon consultation with the Emergency Medical Services Authority and
local EMS agencies, to revise regulations concerning the
categorization and licensure of emergency departments on or before
July 1, 2002.
Existing law regulates health care service plans and certain
insurers that cover hospital, medical, and surgical expenses, and
providers, in the reimbursement of claims of providers. Existing law
sets forth requirements with respect to the reimbursement of claims
for services rendered to a patient who is provided specified
emergency services and care.
This bill would set forth additional requirements with respect to
the reimbursement for initial stabilizing medical services, as
defined, provided in response to medical emergencies.
By changing the definition of a crime relative to health care
service plans, the bill would impose a state-mandated local program.
Under existing law, the Emergency Medical Services System and the
Prehospital Emergency Medical Care Personnel Act, the authority is
responsible for the coordination and integration of state activities
concerning emergency medical services and personnel.
This bill would require the authority to implement a critical
emergency service provider program. The program would require a
local EMS agency to designate within a county a minimum of one
emergency department or designated trauma center as a critical
emergency service facility. The bill would establish the Critical
Emergency Service Facility Fund, the moneys from which, upon
appropriation, would be expended by the authority for purposes of
administering and funding the program in each county.
The bill would require the authority and the department to adopt,
by December 31, 2002, certain regulations related to ensuring minimum
standards for a system of coordinated emergency medical care.
Existing law authorizes each county to designate an emergency
medical services agency (local EMS agency) for the establishment and
administration of an emergency medical services program in the
county, and authorizes the establishment by a county of a Maddy
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SB 254 Senate Bill- INTRODUCED Page 2 of 9
Emergency Medical Services (EMS) Fund for this purpose. The source
of moneys in the fund are penalty assessments each county levies upon
fines, penalties, and forfeitures _imposed and collected by the
courts for criminal offenses. A county establishing a fund under
this provision is required to report certain information related to
the fund to the Legislature through the authority.
This bill would require every county to designate a local EMS
agency and establish a fund under these provisions.
Existing law provides for specified percentage distributions of
the money in a Maddy EMS fund to certain physicians and surgeons, to
hospitals providing disproportionate trauma and emergency medical
services, and for other emergency :medical services purposes as
determined by each county.
This bill would delete the distributions to the hospitals and
revise the distribution formula upon the implementation and funding
of the critical emergency services program provided under this bill.
Existing law sets forth requirements of local EMS agencies,
including the submission of an annual emergency medical services
plan.
The bill would require the local EMS agency to evaluate and
periodically inspect hospitals within its jurisdiction pursuant to
regulations established by the authority. The bill would add to the
requirements of a local EMS agency with regard to the submission of
the annual emergency medical services plan.
By increasing the duties of counties and local EMS agencies, this
bill would impose a state-mandated local program.
Existing law provides for the Medi-Cal program, which is
administered by the department, pursuant to which medical benefits
are provided to public assistance recipients and certain other
low-income persons.
This bill would specify that initial stabilizing medical services
in response to medical emergencies are a covered benefit under the
Medi-Cal program.
Existing law requires the director to establish and update
annually a rate schedule of reimbursement under the Medi-Cal program
for paramedic services based on reasonable cost standards of the
department.
This bill would instead require the director to establish and
update annually separate specified schedules of reimbursement for (1)
advanced life support and basic life support ambulance
transportation services and (2) advanced life support and basic life
support initial stabilizing medical services.
The bill would appropriate $200,000,000 from the General Fund to
the authority for purposes of the critical emergency services program
required under the bill. The bill would appropriate $100,000,000
from the General Fund to the authority to distribute to counties as
provided under the bill.
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 with regard to certain mandates no
reimbursement is required by this act for a specified reason.
With regard to any other mandates, this bill would provide that,
if the Commission on State Mandates determines that the bill contains
costs so mandated by the state, reimbursement for those costs shall
be made pursuant to the statutory provisions noted above.
Vote: 2/3. Appropriation: yes. Fiscal committee: yes.
State-mandated local program: yes.
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SB 254 Senate Bill- INTRODUCED Page 3 of 9
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. (a) This act shall be known and may be cited as the
Essential Trauma and Emergency Care Act.
(b) The Legislature finds and declares all of the following:
(1) Access to trauma and emergency care is hindered by a decrease
in the availability of trauma and emergency care services statewide,
hospital diversions, a lack of on-call medical specialists, and an
inability to provide advanced life support services by first
responder agencies which could result in lower institutional costs.
(2) Eighty percent of licensed emergency departments reported
losing money during the 1998-99 fiscal year. Losses for those
hospitals exceeded $315 million statewide.
(3) Losses to physicians providing emergency and on-call specialty
services exceeded $100 million during the 1998-99 fiscal year.
(4) Trauma and emergency care is an essential public service.
SEC. 2. Section 1275.9 is added to the Health and Safety Code, to
read:
1275.9. The department, upon consultation with the Emergency
Medical Services Authority and local EMS agencies, shall revise
regulations concerning the categorization and licensure of emergency
departments on or before July 1, 2002. These regulations shall
ensure a minimum level of service for critical emergency services,
including on-call physician services, provided by an critical
emergency service facility, as defined in Section 1797.87.
SEC. 3. Section 1367.13 is added to the Health and Safety Code, to
read:
1367.13. (a) Every health care service plan issued, amended, or
renewed on or after January 1, 2002, shall contain a provision
requiring that reimbursement be provided for initial. stabilizing
medical services provided to subscribers and enrollees in response to
medical emergencies.
(b) For purposes of this section, "initial stabilizing medical
services" means that component of emergency medical services that is
provided by the EMT-Is, EMT-IIs, and EMT-Ps who first arrive on the
scene of the medical emergency and provide any emergency medical
services needed to stabilize the medical emergency, other than
transport services.
(c) The reimbursement for initial stabilizing medical services
pursuant to this section shall be provided to the EMS provider of the
services. This reimbursement shall be in addition to any
reimbursement that might be provided to the providers of
transportation services.
SEC. 4. Section 1797.87 is added to the Health and Safety Code, to
read:
1797.87. "Critical emergency service facility" means an emergency
department that may include a designated trauma center, designated
by a local EMS agency as provided in subdivision (a) of Section
1797.251, that is necessary to meet the needs of the community by
maintaining the availability of trauma and emergency services.
SEC. 5. Section 1797.98a of the Health and Safety Code is amended
to read:
1797.98a. (a) The fund provided for in this chapter shall be
known as the Maddy Emergency Medical Services (EMS) Fund.
(b) Each county FRa} shall establish
an emergency medical services fund
l.. 614„ iqq ra 89 84 The money in the
fund shall be available for the reimbursements required by this
chapter. The fund shall be administered by each county, except that
a county electing to have the state administer its medically indigent
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SB 254 Senate Bill-INTRODUCED Page 4 of 9
services program may also elect to have its emergency medical
services fund administered by the state. Costs of administering the
fund shall be reimbursed by the fund, up to 10 percent of the amount
of the fund. All interest earned on moneys in the fund shall be
deposited in the fund for disbursement as specified in this section.
- ii e
(c) The fund shall be utilized to reimburse physicians and
surgeons and hospitals except as provided in
paragraph (2) , for patients who do not make payment for
emergency medical services and for other emergency medical services
purposes as determined by each county T—F4!9tY--e4!ght P.crccnt
of € e i9alaP R e A9 the €44;44Q€€e as
follows:
(1) After costs of administration , 58 percent of the
balance of the money in the fund shall be distributed to
physicians and surgeons for emergency services provided by all
physicians and surgeons, except those physicians and surgeons
employed by county hospitals, in general acute care hospitals that
provide basic or comprehensive emergency services up to the time the
patient is stabilized, 25 percent of the balance of the fund
of€er- 6684is A-9 emeef�lb$r�e3zf6ii-- shall be distributed only to
hospitals providing disproportionate trauma and emergency medical
care services, and 17 percent of the balance of the fund
of€eip 8e8:6eeq-f- shall be distributed for
other emergency medical services purposes as determined by each
county, including, but not limited to, the funding of regional poison
control centers.
,—T8) T-48
(2) Upon the implementation and funding of the critical emergency
services program for purposes of Section 1797.251, the fund shall be
distributed pursuant to this paragraph rather than paragraph (1) .
After costs of administration, 80 percent of the balance of the money
in the fund shall be distributed to physicians and surgeons, as
described in paragraph (1) , and the remaining balance of the fund
shall be distributed for other emergency medical services purposes as
determined by each county, including, but not limited to, the
funding of regional poison control centers.
(d) The continuing source of the money in the fund shall be
the penalty assessment made for this purpose, as provided in Section
76000 of the Government Code.
(e) A General Fund augmentation may supplement any continuing
source of money.
SEC. 6. Section 1797.98b of the Health and Safety Code is amended
to read:
1797.98b. (a) --Saie4a, On January 1, each
county
shall report to the Legislature
on the implementation and status of the Emergency Medical Services
Fund. The report shall include, but not be limited to, all of the
following:
(1) The total amount of fines and forfeitures collected, the total
amount of penalty assessments collected, and the total amount of
penalty assessments deposited into the Emergency Medical Services
Fund.
(2) The fund balance and the amount of moneys disbursed under the
program to physicians and for other emergency medical services
purposes.
(3) The pattern and distribution of claims and the percentage of
claims paid to those submitted.
(4) The amount of moneys available to be disbursed to physicians,
the dollar amount of the total allowable claims submitted, and the
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SB 254 Senate Bill - INTRODUCED Page 5 of 9
percentage at which such claims were reimbursed.
(5) A statement of the policies, procedures, and regulatory action
taken to implement and run the program under this chapter.
(b) (1) Each county, upon request, shall make available to any
member of the public the report required under subdivision (a) .
(2) Each county, upon request, shall make available to any member
of the public a listing of physicians and hospitals that have
received reimbursement from the Emergency Medical Services Fund and
the amount of the reimbursement they have received. This listing
shall be compiled on a semiannual basis.
SEC. 7. Section 1797.100 of the Health and Safety Code is amended
to read:
1797.100. There is in the state government in the California
Health and T'�e— Human Services
Agency, the Emergency Medical Services Authority.
SEC. 8. Section 1797.101 of the Health and Safety Code is amended
to read:
1797.101. The Emergency Medical Services Authority shall be
headed by the Director of the Emergency Medical Services Authority
who shall be appointed by the Governor upon nomination by the
Secretary of the California Health and `�—�e
Human Services Agency. The director shall be a
physician and surgeon licensed in California pursuant to the
provisions of Chapter 5 (commencing with Section 2000) of Division 2
of the Business and Professions Code, and who has substantial
experience in the practice of emergency medicine.
SEC. 9. Section 1797.107 of the Health and Safety Code is amended
to read:
1797.107. (a) The authority shall adopt, amend, or
repeal, after approval by the commission and in accordance with the
provisions of Chapter 3.5 (commencing with Section 11340) of Part 1
of Division 3 of Title 2 of the Government Code, such rules and
regulations as may be reasonable and proper to carry out the purposes
and intent of this division and to enable the authority to exercise
the powers and perform the duties conferred upon it by this division
not inconsistent with any of the provisions of any statute of this
state.
(b) The authority and the department shall, jointly, adopt
regulations to ensure minimum standards for a system of coordinated
care by emergency departments, trauma centers, emergency transport
services, and nontransport advanced life support services by December
31, 2002.
SEC. 10. Section 1797.108 of the Health and Safety Code is amended
to read:
1797.108. (a) Subject to the availability of funds
appropriated therefor, the authority may contract with local EMS
agencies to provide funding assistance to those agencies for
planning, organizing, implementing, and maintaining regional
emergency medical services systems.
!I
r
(b) In addition, the authority may provide special funding
to multicounty EMS agencies •—�— that
serve rural areas with extensive tourism, as determined by the
authority, to reduce the burden on the rural EMS agency of providing
the increased emergency medical services required due to that
tourism.
Nasiit
(c) (1) Each local or multicounty EMS agency receiving
funding pursuant to this section shall make a quarterly report to the
authority on the functioning of the local EMS system. The authority
may continue to transfer appropriated funds to the local EMS agency
upon satisfactory operation.
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SB 254 Senate Bill- INTRODUCED Page 6 of 9
(2) Any single or multicounty EMS agency receiving funds for
critical emergency services shall report quarterly to the authority
the disbursement of funds utilizing a simplified form developed by
the authority.
(d) Subject to the availability of funds appropriated therefor,
the authority shall annually contract with single or multicounty EMS
agencies to provide funding assistance to those agencies that
designate critical emergency service facilities pursuant to
subdivision (a) of Section 1797.251.
SEC. 11. Section 1797.115 is added to the Health and Safety Code,
to read:
1797.115. (a) The Critical Emergency Services Facility Fund is
hereby created in the State Treasury. The moneys in the fund, upon
appropriation by the Legislature, shall be expended by the authority
to implement a critical emergency service program in accordance with
Section 1797.251.
(b) The total amount of funding for services authorized by this
section shall not exceed two hundred million dollars ($200,000,000)
annually.
(c) The authority shall allocate funds from the fund to each local
EMS agency for designated critical_ emergency service facilities
according to the following formula:
(1) Forty percent of the fund shall be distributed evenly among
all counties with a designated critical emergency service facility.
(2) Sixty percent of the fund shall be distributed according to
population statistics as published by the Department of Finance.
(d) A local EMS agency may not use more than 10 percent of funds
allocated to the agency for purposes of this section for the
administration of its critical emergency service program.
(e) (1) A hospital, if designated as an critical emergency service
facility, may receive funding for the provision of emergency and
trauma services from the local EMS agency. These funds may be used
only for the continuation of critical emergency services and trauma
care and may include reimbursements for on-call physician
specialists.
(2) The authority shall establish a funding formula to ensure that
emergency care services at a designated hospital are maintained.
Factors to be considered in developing the funding formula shall
include, but not be limited to, all of the following:
(A) Geographic isolation.
(B) Number of 911 transports.
(C) Number of paramedic contacts per month.
(D) Number of trauma patients received per month.
(E) Specialty emergency services provided by the hospital.
(F) Number of county indigent visits per month.
(3) A hospital receiving funding under this section shall
demonstrate efficiency in operations to ensure the provision of
emergency services to the public based upon minimum standards as
established by regulation.
(4) In order to receive funding under this section, a hospital
shall report to both the local EMS agency and the authority the
number of patients served and the cost of providing services.
SEC. 12. Section 1797.200 of the Health and Safety Code is amended
to read:
1797.200. Each county may— shall
develop an emergency medical services program. Each county
shall designate a local EMS
agency which shall be the county health department, an agency
established and operated by the county, an entity with which the
county contracts for the purposes of local emergency medical services
administration, or a joint powers agency created for the
administration of emergency medical services by agreement between
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SB 254 Senate Bill- INTRODUCED Page 7 of 9
counties or cities and counties pursuant to the provisions of Chapter
5 (commencing with Section 6500) of Division 7 of Title 1 of the
Government Code.
SEC. 13. Section 1797.251 is added to the Health and Safety Code,
to read:
1797.251. (a) A local EMS agency .shall designate a minimum of one
hospital emergency department or designated trauma center as a
critical emergency service facility necessary to meet the needs of
the community. Any acute care hospital shall be eligible to receive
designation as a critical emergency service facility.
(b) A local EMS agency shall evaluate the capabilities of
hospitals within its jurisdiction to meet emergency services and care
needs and periodically review the hospital's capability based upon
regulations established by the authority.
(c) A local EMS agency shall periodically evaluate the service
demand of the community and the ability of providers of emergency
services and care to meet the demand.
SEC. 14. Section 1797.254 of the Health and Safety Code is amended
to read:
1797.254. (a) Local EMS agencies shall annually submit
no later than January 31 of each year, an emergency
medical services plan for the EMS area to the authority, according to
EMS Systems, Standards, and Guidelines established by the authority.
(b) The plan shall include, but not be limited to, all of the
following:
(1) A designation of a minimum of one hospital emergency
department or designated trauma Center as a critical emergency
service facility.
(2) A process for the coordination of the emergency care and
trauma system.
(3) Information requested from and submitted by hospitals,
physicians, ambulance services, and first responders concerning the
prior fiscal year that shall include, but not be limited to, the
number of patients receiving emergency services and care and the cost
of providing the care.
(c) The requirements of subdivision (b) shall become operative
January 1, 2003.
SEC. 15. Section 1798.161 of the Health and Safety Code is amended
to read:
1798.161. (a) The authority shall -Ralem;t ^'-NaF}
adopt regulations specifying minimum standards for the
implementation of trauma care systems #^ }';R
9N iiipg6Np dolt' 1, 19511-, aR4-all adept toe c-R -r ippger=
doh —1-, 9 . These regulations shall provide specific
requirements for the care of trauma cases and shall ensure that the
trauma care system is fully coordinated with all elements of the
existing emergency medical services system. The regulations shall be
adopted as provided in Section 1799.50, and shall include, but not
be limited to, all of the following:
(1) Prehospital care management guidelines for triage and
transportation of trauma cases.
(2) Flow patterns of trauma cases and geographic boundaries
regarding trauma and nontrauma cases.
(3) The number and type of trauma cases necessary to assure that
trauma facilities will provide quality care to trauma cases referred
to them.
(4) The resources and equipment needed by trauma facilities to
treat trauma cases.
(5) The availability and qualifications of the health care
personnel, including physicians and surgeons, treating trauma cases
within a trauma facility.
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J ,
SB 254 Senate Bill- INTRODUCED Page 8 of 9
(6) Data collection regarding system operation and patient
outcome.
(7) Periodic performance evaluation of the trauma system and its
components.
(b) The authority may grant an exception to a portion of the
regulations adopted pursuant to subdivision (a) upon substantiation
of need by a local EMS agency that, as defined in the regulations,
compliance with that requirement would not be in the best interests
of the persons served within the affected local EMS area.
SEC. 16. Section 1798.166 of the Health and Safety Code is
repealed.
Eegalati!eAe esta,1914 84e6gt4er- to t4e
SEC. 17. Section 10126.7 is added to the Insurance Code, to read:
10126.7. (a) Every policy of disability insurance issued,
amended, or renewed on or after January 1, 2002, that covers
hospital, medical, or surgical benefits shall contain a provision
requiring that reimbursement be provided for initial stabilizing
medical services provided to any insured or other person covered in
response to medical emergencies.
(b) For purposes of this section, "initial stabilizing medical
services" means that component of emergency medical services that is
provided by the EMT-Is, EMT-IIs, and EMT-Ps who first arrive on the
scene of the medical emergency and provide any emergency medical
services needed to stabilize the medical emergency, other than
transport services.
(c) The reimbursement for initial stabilizing medical services
pursuant to this section shall be provided to the EMS provider of the
services. This reimbursement shall be in addition to any
reimbursement that might be provided to the providers of
transportation services.
SEC. 18. Section 14106.6 of the Welfare and Institutions Code is
amended to read:
14106.6. (a) The director shall establish and update
annually a Eate separate schedule of
reimbursement for
_r,,,...eAt advanced life support and basic life
support ambulance transportation services that are based upon
reasonable cost standards of the department and that are not
less than 60 percent of the rate applicable to the medicare median
allowable charge for the current year for all California providers of
advanced life support and basic life support ambulance
transportation services
(b) Notwithstanding any other provision of law, and to the
extent federal financial participation is available, any city,
county, or special district providing paramedic services as set forth
in subdivision -(9) (r) of Section
14132, shall reimburse the Health Care Deposit Fund for the state
costs of paying -Qac- the medical
claims. Funds allocated to the county from the County Health
Services Fund pursuant to former, Part 4 .5 (commencing with
Section 16700) of Division 9 of the Welfare and Institutions Code
, as that part read before January 1, 2000, may be
utilized by the county or city to make sueh-
the reimbursement. Nothing in this chapter shall be construed
to require a city, county, or special district providing, or
contracting for, paramedic services as part of a program established
under Article 3 (commencing with Section 1480) of Chapter 2.5 of
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SB 254 Senate Bill- INTRODUCED Page 9 of 9
Division 2 of the Health and Safety Code, to seek Medi-Cal
reimbursement for services rendered to eligible Medi-Cal recipients.
Tlg.
(c) This section shall be P94e,.4
implemented only to the extent federal financial participation
is available.
SEC. 19. Section 14106.65 is added to the Welfare and Institutions
Code, to read:
14106.65. (a) Reimbursement shall be made pursuant to this
chapter for initial stabilizing medical services in response to
medical emergencies. The director shall establish and annually update
a separate schedule of reimbursement rates for advanced life support
and basic life support initial stabilizing medical services.
(b) The director shall seek the appropriate federal waivers or
approval to apply federal funds to the reimbursement of initial
stabilizing medical services in response to medical emergencies.
Until these federal funds may be applied to reimburse these services,
the director shall reduce the reimbursement rates provided under
this section by 50 percent.
(c) For purposes of this section, "initial stabilizing medical
services" means that component of emergency medical services that is
provided by the EMT-Is, EMT-IIs, and EMT-Ps who first arrive on the
scene of the medical emergency and provide any emergency medical
services needed to stabilize the medical emergency, other than
transport services.
(d) The reimbursement for initial stabilizing medical services
pursuant to this section shall be provided to the EMS provider of the
services. This reimbursement shall be in addition to any
reimbursement that might be provided to the providers of
transportation services.
SEC. 20. (a) The sum of two hundred million dollars ($200,000,000)
is hereby appropriated from the General Fund to the Emergency
Medical Services Authority to provide funds to single and multicounty
EMS agencies that designate critical emergency service facilities
pursuant to Section 1797.251 of the Health and Safety Code for
services provided by the designated critical emergency facility and
the implementation of Section 1797.251 of the Health and Safety Code.
(b) The sum of one hundred million dollars ($100,000,000) is
hereby appropriated from the General Fund to the Emergency Medical
Services Authority. The authority shall distribute the funds to each
county that has established a Maddy Emergency Medical Services (EMS)
Fund based on the number of county indigent emergency department
visits reported during the prior fiscal year.
SEC. 21. No reimbursement is required by this act pursuant to
Section 6 of Article XIIIB of the California Constitution for certain
costs that may be incurred by a local agency or school district
because in that regard this act creates a new crime or infraction,
eliminates a crime or infraction, or changes the penalty for a crime
or infraction, within the meaning of Section 17556 of the Government
Code, or changes the definition of a crime within the meaning of
Section 6 of Article XIIIB of the California Constitution.
However, notwithstanding Section 17610 of the Government Code, if
the Commission on State Mandates determines that this act contains
other 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.
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