Maddy Emergency Medical Services Fund

About the Maddy EMS Fund

The Fund is authorized by California Health and Safety Code sections 1797.98a–1797.98g. It is supported primarily by portions of court-collected fines, forfeitures, penalty assessments and traffic-violator-school fees as provided by state law. Funding therefore varies according to the revenue collected and is not guaranteed from year to year.

After allowable administrative costs and reserves, state law directs Maddy Fund revenue among three purposes:

• 58% for physician and surgeon reimbursement
• 25% for hospitals providing disproportionate trauma and emergency care
• 17% for other county-designated EMS purposes

Certain supplemental revenue may also support pediatric trauma and emergency services under the Richie’s Fund provisions of state law.

Physician Reimbursement Program

Physician reimbursement is the principal focus of San Mateo County’s Maddy Fund Program. Eligible physicians and surgeons may submit claims for unpaid emergency services personally provided onsite at a qualifying hospital emergency department or other facility permitted under state law. Reimbursable care may include emergency medical screening, evaluation, treatment and stabilization, subject to statutory limitations and the County’s current Program Guidelines.

Claims are limited to services provided to patients who:

• Do not have insurance covering the emergency services
• Cannot afford to pay for the services
• Will not receive payment from another responsible third party

Before submitting a claim, the physician or billing representative must make the inquiries, billing attempts and collection efforts required by state law. Upon accepting Maddy Fund reimbursement, the physician must discontinue further collection from the patient for the reimbursed services. Any later payment received from the patient or another payer must be reported and may need to be returned or credited to the Fund.

Physicians and surgeons employed by county hospitals are not eligible for reimbursement from this portion of the Fund. An authorized billing or collection agent may submit claims on behalf of an eligible physician or physician group.

Reimbursement Amounts

Maddy Fund reimbursement is based on the County’s adopted fee schedule and methodology—not necessarily the physician’s billed charges. State law permits reimbursement of up to 50% of an eligible claim during the initial annual payment cycle.

Payment is subject to available funding. When approved claims exceed the amount available, payments must be prorated fairly among eligible claimants. Reimbursement is therefore not guaranteed and may represent only a portion of the allowable claim.

Complete and accurate claims are processed according to the County’s published submission schedule, with payments made at least quarterly. The County may request supporting documentation, audit claims, deny unsupported requests and recover payments made on claims that are inaccurate or ineligible.

How to Submit a Claim

Physicians, physician groups and authorized billing representatives should review the current Program Guidelines before submitting a claim. Claims must be complete, supported by the required records and certifications and received by the applicable deadline.

Patients do not apply directly to the Maddy Fund. Reimbursement is paid to eligible physicians or their authorized billing representatives for qualifying uncompensated emergency services.

Program Materials

Current Program Guidelines

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Claim Submission Schedule

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Physician Certification Form

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Governing Authority and State Guidance

California Health and Safety Code, Maddy EMS Fund—Sections 1797.98a–1797.98g

California EMS Authority—Maddy EMS Fund

California EMSA Maddy Fund Statewide Report, FY 2022–2023