BILL ANALYSIS Ó SENATE HEALTH COMMITTEE ANALYSIS Senator Ed Hernandez, O.D., Chair BILL NO: AB 1329 A AUTHOR: Davis B AMENDED: May 5, 2011 HEARING DATE: July 6, 2011 1 CONSULTANT: 3 Orr 2 9 SUBJECT Ken Maddy California Cancer Registry SUMMARY Requires the California Department of Public Health (CDPH) to establish a process to receive applications for, and award a grant to, an agency to operate the statewide Ken Maddy California Cancer Registry (CCR). Exempts these grants from being subject to specified provisions of the Public Contract Code (PCC). CHANGES TO EXISTING LAW Existing law: Requires CDPH to conduct a program of epidemiological assessments of the incidence of cancer. Requires the program to encompass all areas of the state for which cancer incidence data are available, and to include monitoring of cancers associated with suspected carcinogens encountered by the general public both in occupational locations and in the environment. Continued--- STAFF ANALYSIS OF ASSEMBLY BILL 1329 (Davis) Page 2 Allows CDPH to contract with an agency, including, but not limited to a health systems agency, single or multiple county health departments, or nonprofit professional associations, representing a designated cancer reporting region for the purposes of collecting and collating cancer incidence data. Requires the Director of CDPH (Director) to establish a statewide system to collect information on the incidence of cancer using population-based cancer registries. Requires these registries to be implemented or initiated by July 1, 1988, and requires that the statewide cancer reporting system be fully operational by July 1, 1990. Authorizes the Director to enter into contracts as necessary to conduct the program, and accept grants of public or private funds for the program on behalf of the state. Requires the Director to analyze available incidence data and prepare reports and perform studies as necessary to identify cancer hazards to the public health and their remedies. Mandates the Director to require the reporting of cancer to CDPH, or its authorized representative, in areas of the state where cancer information is being collected. Requires any hospital or other facility providing therapy to cancer patients to report all cancers diagnosed or treated, in designated cancer reporting areas, to CDPH or an authorized representative, and allows CDPH access to those records. Requires specified health care providers diagnosing or providing treatment for cancer patients to report all cancers to CDPH or an authorized representative, with specified exemptions, and allows CDPH access to those records. Authorizes CDPH to fine entities that do not comply with these record-sharing requirements, and requires that fines collected be deposited into the General Fund. Requires all information collected for the purpose of the registry be kept confidential. Allows for the access of this confidential information to specified entities who STAFF ANALYSIS OF ASSEMBLY BILL 1329 (Davis) Page 3 agree in writing to maintain confidentiality, and who meet other various requirements. Authorizes contracting between state agencies and private contractors. Sets forth requirements for the procurement of goods and services by state agencies. Sets forth the various responsibilities of the Department of General Services (DGS) in implementing state contracting procedures and policies. Permits state agencies to use personal services contracts, when specified conditions are met, in order to achieve cost savings. Specifies that proposals to contract out work can be eligible for approval if the contractor's wages are at the industry's level and do not significantly undercut state pay rates. This bill: Deletes CDPH's authorization to contract with specified entities representing designated cancer reporting regions for the purpose of collecting and collating cancer incidence data. Instead, allows CDPH to establish a competitive process to receive applications for, and issue, the award of a grant to an agency for the purpose of operating the statewide cancer reporting system. Exempts these grants from the State Contract Act in the Public Contract Code that mandate that DGS administer contracts and develop a report describing the need for and terms of the contract. FISCAL IMPACT The Assembly Appropriations Committee analysis estimates a negligible state fiscal effect. BACKGROUND AND DISCUSSION According to the author and sponsors of this bill, the Public Health Institute (PHI) and the University of Southern California (USC), the current CDPH state contract to administer the CCR expires on June 30, 2012. The STAFF ANALYSIS OF ASSEMBLY BILL 1329 (Davis) Page 4 issuance of the contract to administer the CCR has historically been done through a bid process. The author and sponsors maintain that CDPH program officials have stated that permission to rebid the contract has apparently been denied by DGS, despite the fact that CDPH has used competitive contracts to administer the CCR for over 25 years. The author and sponsors argue that if CDPH cannot rebid the contract to administer the CCR, its functions will be disrupted and federal funding could be jeopardized. The author and sponsors further argue that the existing structure of the CCR has been successful as it has leveraged a public/private partnership between the state, the federal government, nonprofits and universities in California to build one of the world's premier cancer registries. According to the author and sponsors, this bill would remedy the current administrative obstacle by allowing CDPH the flexibility to use a competitive grant process, which will protect the flow of federal dollars and the integrity of the operations of the highly successful CCR. CCR The Ken Maddy CCR was established in 1985 and is California's statewide population-based cancer surveillance system. The CCR collects information about almost all cancers diagnosed in California. The information is used to develop strategies and policies for cancer prevention, treatment, and control, such as determining where early detection, educational or other programs should be directed. In addition, health researchers use the data to analyze demographic and geographic factors that affect cancer risk, early detection, and effective treatment of cancer patients. Due to the size and diversity of the California population, more is now known about the occurrence of cancer in diverse populations than ever before. To date, the CCR has collected detailed information on over 3.4 million cases of cancer among Californians diagnosed from 1988 forward, and more than 162,000 new cases are added annually. CCR is recognized as one of the leading cancer registries in the world, and has been the cornerstone of a substantial amount of cancer research. More than 450 funded research STAFF ANALYSIS OF ASSEMBLY BILL 1329 (Davis) Page 5 projects, and 1,900 publications have used CCR data. CCR is managed by the CDPH Cancer Surveillance and Research Branch (CSRB), which is responsible for collecting statewide data about cancer and cancer risk factors, conducting surveillance and research into the causes, cures, and controls of cancer, and communicating the results to the public. CSRB also manages the Survey Research Group, which specializes in conducting scientific health-related surveys, and California's Comprehensive Cancer Control Program, which oversees the California Dialogue on Cancer, a statewide comprehensive cancer control coalition. Similar programs that CDPH administers include the Birth Defects Monitoring Program, the Parkinson's Disease Registry, and the California Immunization Registry. CDPH also operates a voluntary stroke registry through the California Heart Disease and Stroke Prevention Program. CCR funding The state General Fund provided $8.8 million in fiscal year 2010-11 for the state contract to provide partial support for state-level CCR functions, and a portion of the data collection costs incurred in the regional registries. Federal funding is essential to the CCR. The majority of the funding to support the statewide registry comes from grants and contracts currently awarded to the regional registries, with consent by the National Cancer Institute's Surveillance, Epidemiology, and End Results Program (SEER) and the federal Centers for Disease Control and Prevention's (CDC) National Program of Cancer Registries. Current federal SEER funding is $8 million per year over seven years to three California SEER registries. These registries are also able to draw down an additional $10 million in CDC funds. State contracts The state enters into different types of contracts, including contracts for public works projects, information technology projects, and contracts for personal services and consultants. These contracts are usually subject to a competitive selection process. Generally, personal services are required to be performed by civil service employees whenever feasible, pursuant to Government Code Section 19130. The State Constitution generally requires STAFF ANALYSIS OF ASSEMBLY BILL 1329 (Davis) Page 6 contracting to be limited to those services that cannot be performed by civil service employees, except as provided for in statute. Related bills AB 861 (Hill and Nestande) would establish the California Stroke Registry (CSR) within CDPH to serve as a centralized repository for stroke data to promote quality improvement for acute stroke treatment. Would require that CSR only be implemented to the extent funds from federal or private sources are made available for this purpose. Would exclude contracts with the program's fiscal intermediary from specified provisions of the Public Contract Code. To be heard in the Senate Health Committee on July 6, 2011. Prior legislation AB 48 (Cedillo), Chapter 368, Statutes of 2000, renames the California Cancer Registry the Ken Maddy California Cancer Registry, after the late state Senator Kenneth Maddy, former Minority Leader of the State Senate. AB 136 (Connelly), Chapter 841, Statutes of 1985, establishes the California Cancer Registry. PRIOR ACTIONS Assembly Health: 19- 0 Assembly Appropriations: 16- 0 Assembly Floor: 78- 0 Arguments in support USC states that AB 1329 has been introduced in response to CDPH's inability to release a request for proposal/agreement for the operation of the CCR due to administrative barriers. Since its inception in 1985, the CCR has been a partnership between the state, nonprofit research entities, and health providers to collect, analyze, and disseminate information on cancer incidence and mortality. The current five-year grant is set to expire in July 2012, and USC claims that in previous years, the request for proposal/agreement would have been released months ago. USC claims that if CDPH cannot rebid the contract in time, registry functions would be disrupted. AB 1329 seeks to alleviate the current administrative obstacles that CDPH has encountered by giving authorization STAFF ANALYSIS OF ASSEMBLY BILL 1329 (Davis) Page 7 to CDPH to issue a competitive granting process for the administration of the program in order to protect the flow of federal funds and streamline the process of funding the registry. COMMENTS 1. Public Contract Code (PCC) exemption. The PCC is intended to provide fair and competitive bidding opportunities for public contracts, including ensuring that a fair proportion of the total number of contracts or subcontracts are awarded to minority, women, and disabled veteran business enterprises, and to also protect the public from the misuse of public funds. The PCC is enforced by DGS. AB 1329 deletes CDPH's authorization to contract, and instead allows CDPH to establish a competitive process to award grants for the purpose of the registry. AB 1329 also excludes the awarding of these grants from specified provisions of the PCC. Contracts are subject to several provisions in state law that may require oversight, auditing, non-discrimination clauses, among others. Grants are not subject to similar requirements. One suggestion to address this would be to incorporate provisions similar to the requirements that apply to contracts into this bill to ensure the state can sufficiently oversee this grant. An alternative solution would be to amend the bill back to a contract instead of a grant, but exempt the contract from Section 19130 of the Government Code, which requires that personal services be performed by civil service employees whenever feasible. POSITIONS Support: Public Health Institute (co-sponsor) University of Southern California (co-sponsor) American Cancer Society, California Division Cancer Prevention Institute of California City of Hope Desert Sierra Cancer Surveillance Program, Region 5 of California of the California Cancer STAFF ANALYSIS OF ASSEMBLY BILL 1329 (Davis) Page 8 Registry Oppose:None received. -- END --