BILL ANALYSIS                                                                                                                                                                                                    Ó




                   Senate Appropriations Committee Fiscal Summary
                           Senator Christine Kehoe, Chair


          AB 1731 (Block) - Newborn screening program: critical congenital 
          heart disease.
          
          Amended: July 6, 2012           Policy Vote: Health 8-0
          Urgency: No                     Mandate: No
          Hearing Date: August 6, 2012                           
          Consultant: Brendan McCarthy    
          
          SUSPENSE FILE.  AS PROPOSED TO BE AMENDED.
          
          
          Bill Summary: AB 1731 requires hospitals to offer newborn 
          screening for critical congenital heart defects.

          Fiscal Impact: 
              One-time costs up to $150,000 (50% General Fund, 50% 
              federal funds) to the Department of Health Care Services to 
              develop protocols for screening.

              Ongoing costs, likely in the low hundreds of thousands of 
              dollars (50% General Fund, 50% federal funds) to the 
              Department to monitor compliance by hospitals. 

              Increased costs to state health coverage programs 
              (including Medi-Cal, CalPERS, and other programs) to pay for 
              screening, between $600,000 and $1.8 million per year 
              (various funds), depending on the current level of screening 
              and the cost to conduct the screening. 

              Potential cost savings to Medi-Cal and other state health 
              programs, due to earlier diagnosis and intervention for 
              newborns with critical congenital heart defects. For 
              newborns diagnosed under the bill as well as those newborns 
              who would be diagnosed late without screening, state health 
              programs would incur substantial treatment costs. However, 
              when a newborn is diagnosed late, there can be substantial 
              costs to stabilize the newborn before surgery can be 
              attempted. While it is not possible to say definitively that 
              total costs will be less with screening under the bill, that 
              appears likely.

          Background: Under current state law, the Department of Public 








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          Health operates a newborn screening program to test for certain 
          heritable or congenital diseases. A blood sample is collected 
          from newborns and tested by the Department at off-site 
          laboratories. The Department coordinates follow up services if 
          test results are positive.

          In addition, the Department of Health Care Services manages the 
          Newborn Hearing Screening Program. Under this program, newborns 
          are screened for hearing problems by hospital personnel, prior 
          to discharge. If a problem is diagnosed, the Department is 
          responsible for directing parents to appropriate follow up 
          services.

          Critical congenital heart defects are a group of conditions 
          characterized by defects in the structure of the heart at birth. 
          There are seven conditions that are typically classified as 
          critical congenital heart defects. According to the Centers for 
          Disease Control and Prevention, about 12 newborns per 10,000 
          have a critical congenital heart defect.

          Proposed Law: AB 1731 would require hospitals to offer newborn 
          screening for critical congenital heart defects. 

          Specifically, the bill:
              Would require hospitals to offer pulse oximetry screening 
              for critical congenital heart defects.
              Would require the Department of Health Care Services to 
              specify protocols for testing, based on Centers for Disease 
              Control and Prevention protocols.
              Would require the Department to begin phasing in the 
              requirement by July 1, 2013, with full participation by 
              2016.
              Would require hospitals to be responsible for screening, 
              referral for appropriate care, and reporting data to the 
              Department.
              Would specify which health care personnel can perform the 
              test.
              Would not require a newborn to be screened if the test 
              violates the parents' beliefs.
              Would authorize the Department to designate 
              responsibilities to the Department of Public Health.

          Related Legislation: SB 1072 (Strickland) would have required 
          the Department of Public Health to screen for two additional 








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          types of genetic diseases. That bill was held on this 
          committee's Suspense File.

          Proposed Author Amendments: The author proposes to eliminate the 
          Department of Health Care Services' authority to designate 
          responsibilities under the bill to the Department of Public 
          Health.