Inter-Departmental Correspondence

Health Services Agency



November 26, 2003


December 16, 2003



Honorable Board of Supervisors


Margaret Taylor, Director of Health Services

Barbara Pletz, EMS Administrator


Appropriation Transfer Request (ATR) in the amount of $1,000,000



Approve an Appropriation Transfer Request (ATR) in the amount of $1,000,000 within the EMS Fund's FY 2003-04 budget.



California law permits counties to establish an EMS Fund (Maddy Fund/SB12 Fund) for the purposes of reimbursing physicians and hospitals for uncompensated emergency medical care and for other EMS purposes as determined by the County. San Mateo County established its Maddy Fund 20 years ago. The source of the fund is fines on moving traffic violations. The law restricts use of the fund to 1) uncompensated emergency medical care provided by physicians, 2) hospitals providing disproportionate trauma and emergency medical care services, and 3) other emergency medical services purposes determined by the County.

The Health Services Agency administers the Fund and is paid up to 10% of collections into the Fund for the costs of administering the Fund. Use of the remaining 90% is as follows:

    · 58% is placed in a Physician Services account that reimburses physicians for uncompensated emergency medical care. All physician services provided within the first 48 hours of hospitalization are eligible. However, if the physician has a gross billings arrangement with a hospital the physician's services are eligible only if the physician is an emergency department physician. Since SMMC physicians have gross billings arrangements with the hospital, only the emergency department physicians are eligible for Maddy Fund reimbursement.

    · 25% is distributed to hospitals providing "disproportionate trauma and emergency medical services." For the last five years we have split this portion between San Mateo Medical Center (SMMC) and the two trauma centers, with SMMC receiving 50%.

    · 17% is used for "EMS purposes" as determined by the County. This provides partial funding for the EMS Program budget.

The largest portion of the fund (58%) is the Physicians Services Account. The law requires that each county establish a fee schedule to establish a uniform reasonable level of reimbursement to physicians but does not mandate any specific fee schedule.

Legislation effective January 2004 (SB 476) limits the amount of reserves that can be maintained within the Physician Services Account to no more than 15% of the account. We have had a substantial reserve in the account and have accelerated the payment schedule and increased our fee schedule in order to reduce our reserves and stay within the 15% limit. Presently there is $1,022,220 in the Physician Services Account of the Maddy Fund. Payments are made quarterly.



We have worked with the Medical Society and local hospital medical staffs to encourage physicians to take advantage of the Maddy Fund.

We believe that the increased payments to physicians during FY 2003/04 should exhaust most of the available funds in the physician services account, including the additional $1,000,000. Any unused portion of these funds at the end of the fiscal year will be rolled over into Physician Services Account for the next fiscal year.

The State Auditor's Office is conducting an audit of Maddy Funds. San Mateo County is one of four Counties being audited.


Fiscal Impact

The attached ATR increases the EMS Fund's Physician Services line item (5876) by $1,000,0000. SMMC emergency physicians should receive increased reimbursement from the Maddy Fund this year as a result of this ATR. There is no net county cost associated with this ATR.