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                                
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          CONSULTANT:                                                
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          Orr                                                        
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                                     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---



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          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 




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          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 




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          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 




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          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 




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          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 




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          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 




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                         Registry


          Oppose:None received.


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