BILL NUMBER: AB 1640 AMENDED
BILL TEXT
AMENDED IN SENATE JUNE 21, 2010
AMENDED IN ASSEMBLY MAY 28, 2010
INTRODUCED BY Assembly Members Evans and Nava
(Principal coauthor: Senator Oropeza)
(Coauthors: Assembly Members Hall, Huffman, Jones,
Ma, V. Manuel Perez, Saldana, and Torres)
(Coauthor: Senator Wiggins)
JANUARY 11, 2010
An act to amend Section 104150 of , and to add Section
104151 to, add Sections 104151, 104152, and 104153 to
the Health and Safety Code, and to amend Section 30461.6
of the Revenue and Taxation Code, relating to cancer screening.
LEGISLATIVE COUNSEL'S DIGEST
AB 1640, as amended, Evans. Breast and cervical cancer screening.
Existing law , the Every Woman Counts Program, requires
the State Department of Public Health to provide breast cancer and
cervical cancer screening services to eligible low-income individuals
under a federal grant made under the federal Centers for Disease
Control and Prevention breast and cervical cancer early detection
program. Funding for these services is provided by a combination of
federal and state moneys.
Existing law requires these services to be provided at the level
of funding budgeted from state and other resources during the fiscal
year in which the Legislature has appropriated funds to the
department for this purpose.
This bill would express the intent of the Legislature that the
screening services meet the demand based on eligibility requirements
in place as of December 31, 2009, and would require the department to
notify the Joint Legislative Budget Committee at least 90 days prior
to changing eligibility requirements for services or reducing access
to screening services.
This bill would add specified requirements to receive services
under the program. The bill would also require the department, 90
days prior to making policy changes, to send written notice outlining
the proposed changes to contractors providing services pursuant to
this program and to notify the Legislature, in writing, if the
changes would restrict access or reduce services offered.
This bill would specify that funding for the program comes
from the Breast Cancer Fund and is contingent upon an
appropriation by the Legislature.
Existing law establishes the Breast Cancer Fund, which funds
various programs through the Breast Cancer Control Program for the
detection, treatment, and cure of breast and cervical cancer, as
specified. Entities funded by the Breast Cancer Control Program are
required to submit a specified report annually to the Legislature.
This bill would require that report br submitted on or before
February 1 of each year and would add specified information to that
report.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. The Legislature finds and declares all of the
following:
(a) The Every Woman Counts program provides breast and cervical
cancer screening services to low-income, uninsured women.
(b) The State Department of Public Health estimates that the
program serves approximately 350,000 women per year.
(c) In December 2009, the department announced the following
significant policy changes that went into effect January 1, 2010:
(1) The minimum age to receive breast cancer screening services
has been raised from 40 years of age to 50 years of age.
(2) All new enrollment has been frozen for the first six months of
2010.
(d) The two changes set out in subdivision (c) will deny or delay
services to approximately 100,000 women, putting an estimated 1,000
lives at risk by delaying breast cancer diagnosis.
SEC. 2. Section 104151 is added to the
Health and Safety Code , to read:
104151. In addition to the requirements specified in Section
104150, a person who receives breast or cervical cancer screening
through the program established in this article shall meet the
following requirements:
(a) Be 40 years of age or older to receive breast cancer screening
services.
(b) Be 25 years of age or older to receive cervical cancer
screening services.
(c) Be uninsured or underinsured. For purposes of this
subdivision, "uninsured" and "underinsured" shall have the same
meaning as those terms are defined in Section 104161.
(d) Be a resident of California.
SEC. 3. Section 104152 is added to the
Health and Safety Code , to read:
104152. The department, 90 days prior to making policy changes
relating to the program created by this article, shall do both of the
following:
(a) Send written notice outlining the proposed changes to
contractors providing services pursuant to this program.
(b) Notify the Legislature, in writing, of changes if those
changes would restrict access or reduce services offered.
SEC. 4. Section 104153 is added to the
Health and Safety Code , to read:
104153. Funding for the program provided for under this article
shall come from the Breast Cancer Fund, created and distributed
pursuant to Section 30461.6 of the Revenue and Taxation Code, and as
appropriated by the Legislature in the annual Budget Act or other
measure.
SEC. 5. Section 30461.6 of the Revenue
and Taxation Code is amended to read:
30461.6. (a) Notwithstanding Section 30461, the board shall
transmit the revenue derived from the increase in the cigarette tax
rate of one mill ($0.001) per cigarette imposed by Section 30101 on
and after January 1, 1994, to the Treasurer to be deposited in the
State Treasury to the credit of the Breast Cancer Fund, which fund is
hereby created. The Breast Cancer Fund shall consist of two
accounts: the Breast Cancer Research Account and the Breast Cancer
Control Account. The revenues deposited in the fund shall be divided
equally between the two accounts.
(b) The moneys in the accounts within the Breast Cancer Fund
shall, upon appropriation by the Legislature, be allocated as
follows:
(1) The moneys in the Breast Cancer Research Account shall be
allocated for research with respect to the cause, cure, treatment,
earlier detection, and prevention of breast cancer as follows:
(A) Ten percent to the Cancer Surveillance Section of the State
Department of Public Health for the collection of breast
cancer-related data and the conduct of breast cancer-related
epidemiological research by the state cancer registry established
pursuant to Section 103885 of the Health and Safety Code.
(B) Ninety percent to the Breast Cancer Research Program, that is
hereby created at the University of California, for the awarding of
grants and contracts to researchers for research with respect to the
cause, cure, treatment, prevention, and earlier detection of breast
cancer and with respect to the cultural barriers to accessing the
health care system for early detection and treatment of breast
cancer.
(2) The moneys in the Breast Cancer Control Account shall be
allocated to the Breast Cancer Control Program, that is hereby
created for the provision of early breast cancer detection services
for uninsured and underinsured women. The Breast Cancer Control
Program shall be established in the State Department of Public Health
and shall be administered in coordination with the breast and
cervical cancer control program established pursuant to Public Law
101-354.
(c) The early breast cancer detection services provided by the
Breast Cancer Control Program shall include all of the following:
(1) Screening, including mammography, of women for breast cancer
as an early detection health care measure.
(2) After screening, medical referral of screened women and
services necessary for definitive diagnosis, including
nonradiological techniques or biopsy.
(3) If a positive diagnosis is made, then assistance and advocacy
shall be provided to help the person obtain necessary treatment.
(4) Outreach and health education activities to ensure that
uninsured and underinsured women are aware of and appropriately
utilize the services provided by the Breast Cancer Control Program.
(d) (1) Any entity funded by the Breast Cancer Control Program
shall coordinate with other local providers of breast cancer
screening, diagnostic, followup, education, and advocacy services to
avoid duplication of effort. Any entity funded by the program shall
comply with any applicable state and federal standards regarding
mammography quality assurance.
(2) To the extent required or permitted by federal law, a provider
of breast cancer screening or diagnostic services may employ digital
mammography technology for the purposes of mammography screening and
diagnostic procedures that are conducted prior to January 1, 2014,
when film, otherwise known as analog, mammography technology is
unavailable. To the extent required or permitted by federal law and
notwithstanding paragraph (3) of subdivision (a) of Section 14105.18
of the Welfare and Institutions Code, the payment rate for all
mammography screening that is conducted prior to January 1, 2014,
shall be limited to the Medi-Cal payment rate for film mammography
screening.
(e) (1) The State Department of Public Health shall provide for
breast cancer screening services at the level of funding budgeted
from state and other resources during the fiscal year in which the
Legislature has appropriated funds to the department for this
purpose.
(2) Administrative costs of the State Department of Public Health
shall not exceed 10 percent of the funds allocated to the Breast
Cancer Control Program created pursuant to paragraph (2) of
subdivision (b). Indirect costs of the entities funded by this
program shall not exceed 12 percent. The department shall define
"indirect costs" in accordance with applicable state and federal law.
(f) Any An entity funded
by the Breast Cancer Control Program shall collect data and maintain
records that are determined by the State Department of Public Health
to be necessary to facilitate the state department's ability to
monitor and evaluate the effectiveness of the entities and the
program. Commencing with the program's second year of operation,
on or before February 1 of each year, the State Department of
Public Health shall submit an annual report to the Legislature and
any other appropriate entity. The costs associated with this report
shall be paid from the allocation made pursuant to paragraph (2) of
subdivision (b). The report shall describe the activities and
effectiveness of the program and shall include, but not be limited
to, the following types of information regarding those served by the
program:
(1) The number.
(2) The ethnic, geographic, and age breakdown.
(3) The stages of presentation.
(4) The diagnostic and treatment status.
(5) The cost per individual served.
(6) Information provided to the federal Centers for Disease
Control and Prevention on the number of individuals served based on
the federal funds provided.
(g) The Breast Cancer Control Program shall be conducted in
consultation with the Breast Cancer Research Program created pursuant
to subparagraph (B) of paragraph (1) of subdivision (b).
(h) In implementing the Breast Cancer Control Program, the State
Department of Public Health may appoint and consult with an advisory
panel appointed by the Public Health Officer and consisting of one ex
officio, nonvoting member from the Breast Cancer Research Program,
breast cancer researchers, and representatives from voluntary,
nonprofit health organizations, health care professional
organizations, breast cancer survivor groups, and breast cancer and
health care-related advocacy groups. It is the intent of the
Legislature that breast cancer-related survivors and advocates and
health advocates for low-income women compose at least one-third of
the advisory panel. It is also the intent of the Legislature that the
State Department of Public Health collaborate closely with the
panel.
(i) It is the intent of the Legislature in enacting the Breast
Cancer Control Program to decrease cancer mortality rates
attributable to breast cancer among uninsured and underinsured women,
with special emphasis on low-income, Native American, and minority
women. It is also the intent of the Legislature that the communities
served by the Breast Cancer Control Program reflect the ethnic,
racial, cultural, and geographic diversity of the state and that the
Breast Cancer Control Program fund entities where uninsured and
underinsured women are most likely to seek their health care.
(j) The State Department of Public Health or any entity funded by
the Breast Cancer Control Program shall collect personal and medical
information necessary to administer this program from any individual
applying for services under the program. The information shall be
confidential and shall not be disclosed other than for purposes
directly connected with the administration of this program or except
as otherwise provided by law or pursuant to prior written consent of
the subject of the information.
The State Department of Public Health or any entity funded by the
Breast Cancer Control Program may disclose the confidential
information to medical personnel and fiscal intermediaries of the
state to the extent necessary to administer this program, and to
other state public health agencies or medical researchers when the
confidential information is necessary to carry out the duties of
those agencies or researchers in the investigation, control, or
surveillance of breast cancer.
(k) The State Department of Public Health shall adopt regulations
to implement this act in accordance with the Administrative Procedure
Act (Chapter 3.5 (commencing with Section 11340) of Part 1 of
Division 3 of Title 2 of the Government Code). The initial adoption
of implementing regulations shall be deemed an emergency and shall be
considered as necessary for the immediate preservation of the public
peace, health and safety, or general welfare, within the meaning of
Section 11346.1. Emergency regulations adopted pursuant to this
section shall remain in effect for no more than 180 days.
( l ) It is the intent of the Legislature in enacting
this section that this section supersede and be operative in place of
Section 30461.6 of the Revenue and Taxation Code as added by
Assembly Bill 478 of the 1993-94 Regular Session.
(m) To implement the Breast Cancer Control Program, the State
Department of Public Health may contract, to the extent permitted by
Section 19130 of the Government Code, with public and private
entities, or utilize existing health care service provider enrollment
and payment mechanisms, including the Medi-Cal program's fiscal
intermediary. However, the Medi-Cal program's fiscal intermediary
shall only be utilized if services provided under the program are
specifically identified and reimbursed in a manner that does not
claim federal financial reimbursement. Any contracts with, and the
utilization of, the Medi-Cal program's fiscal intermediary shall not
be subject to Chapter 3 (commencing with Section 12100) of Part 2 of
Division 2 of the Public Contract Code. Contracts to implement the
Breast Cancer Control Program entered into by the State Department of
Public Health with entities other than the Medi-Cal program's fiscal
intermediary shall not be subject to Part 2 (commencing with Section
10100) of Division 2 of the Public Contract Code.
SEC. 2. Section 104150 of the Health and Safety
Code is amended to read:
104150. (a) A provider or entity that participates in the grant
made to the department by the federal Centers for Disease Control and
Prevention breast and cervical cancer early detection program
established under Title XV of the Public Health Service Act (42
U.S.C. Sec. 300k et seq.) in accordance with requirements of Section
1504 of that act (42 U.S.C. Sec. 300n) may only render screening
services under the grant to an individual if the provider or entity
determines that the individual's family income does not exceed 200
percent of the federal poverty level.
(b) The department shall provide for breast cancer and cervical
cancer screening services under the grant at the level of funding
budgeted from state and other resources during the fiscal year in
which the Legislature has appropriated funds to the department for
this purpose. These screening services shall not be deemed to be an
entitlement.
(c) It is the intent of the Legislature that the screening
services provided under this section fully meet the demand based on
eligibility restrictions in place as of December 31, 2009. The
department shall provide notification to the Joint Legislative Budget
Committee at least 90 days prior to changing eligibility
requirements for services or reducing access to screening services.
(d) To implement the federal breast and cervical cancer early
detection program specified in this section, the department may
contract, to the extent permitted by Section 19130 of the Government
Code, with public and private entities, or utilize existing health
care service provider enrollment and payment mechanisms, including
the Medi-Cal program's fiscal intermediary. However, the Medi-Cal
program's fiscal intermediary shall only be utilized if services
provided under the program are specifically identified and reimbursed
in a manner that does not claim federal financial reimbursement. Any
contracts with, and the utilization of, the Medi-Cal program's
fiscal intermediary shall not be subject to Chapter 3 (commencing
with Section 12100) of Part 2 of Division 2 of the Public Contract
Code. Contracts to implement the federal breast and cervical cancer
early detection program entered into by the department with entities
other than the Medi-Cal program's fiscal intermediary shall not be
subject to Part 2 (commencing with Section 10100) of Division 2 of
the Public Contract Code.
SEC. 3. Section 104151 is added to the Health
and Safety Code, to read:
104151. Funding for the program provided for under this article
is contingent on an appropriation in the annual Budget Act or other
measure.