BILL NUMBER: AB 1640	ENROLLED
	BILL TEXT

	PASSED THE SENATE  AUGUST 25, 2010
	PASSED THE ASSEMBLY  AUGUST 26, 2010
	AMENDED IN SENATE  AUGUST 18, 2010
	AMENDED IN SENATE  AUGUST 2, 2010
	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 Eng, Hall, Huffman, Jones, Lieu, Ma,
Mendoza, V. Manuel Perez, Saldana, Solorio, Torres, and Yamada)
   (Coauthors: Senators Calderon, Leno, Pavley, Wiggins, and Yee)

                        JANUARY 11, 2010

   An act to add Section 104152 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, 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.
   The bill would 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.
   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 the report be submitted on or before
February 1 of each year and would add specified information to that
report.


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 and underinsured
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) The enrollment freeze scheduled to run from January 1, 2010,
to July 1, 2010, inclusive, has been extended and is still in effect.

   (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.
   (e) According to the American Cancer Society's most recent
estimates for breast cancer in the United States for 2010:
   (1) About 207,090 new cases of invasive breast cancer will be
diagnosed in women, and about 1,970 new cases are expected in men.
   (2) About 54,010 new cases of carcinoma in situ (CIS) will be
diagnosed. CIS is noninvasive and is the earliest form of breast
cancer.
   (3) About 39,840 women and 390 men will die from breast cancer.
   (f) According to the California Cancer Facts and Figures, 2010,
published by the American Cancer Society, it is estimated that about
22,115 new cases of breast cancer will be diagnosed in women and 130
in men, and 4,170 women and 30 men will die from the disease.
   (g) While breast cancer in young women accounts for a small
percentage of all breast cancer cases, breast cancer is the leading
cause of cancer death among women 15 years of age to 50 years of age,
inclusive. Breast cancer in women under 50 years of age is most
likely to be diagnosed in later stages due to lack of breast health
education and access to mammography or other breast cancer screening.
According to the Young Survivor Coalition Statistics, breast cancer
in younger women is generally more aggressive, less responsive to
treatment, and results in lower survival rates.
   (h) Early detection is the best defense against breast cancer. The
American Cancer Society reports that, when breast cancer is detected
early, the five-year relative survival rate for localized breast
cancer, that is cancer that has not spread to lymph nodes or other
locations outside the breast, is 98 percent. The five-year relative
survival rate declines to 84 percent for regional stage cancer,
cancer that has spread to nearby lymph nodes or organs, and to 23
percent for distant stage cancer, cancer that has metastasized or
spread to other parts of the body. Numerous studies have shown that
early detection saves lives and increases treatment options.
   (i) According to The Economic Burden of Breast Cancer in
California, a 2001 study with an updated estimate for 2008, the total
economic cost of breast cancer in California was $1.43 billion in
2001, or $1.91 billion in 2008 dollars. Breast cancer is costly both
in terms of health care dollars and in the value of the lost lives.
Early detection and diagnosis of breast cancer not only saves lives,
it is also less costly than treating women diagnosed with later stage
breast cancer who require more costly, higher risk interventions and
have lower survival rates.
   (j) The Budget Conference Committee for the 2010-11 fiscal year
agreed to appropriate an additional $20.1 million from the General
Fund for the Every Woman Counts program, working to ensure that women
40 years of age and over have access to these critical preventive
services.
   (k) Additionally, the Budget Conference Committee for the 2010-11
fiscal year required the Every Woman Counts program to biannually
submit a program estimate, thereby committing to a higher level of
transparency and oversight of this life-saving program.
  SEC. 2.  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. 3.  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) 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 average 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.