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 AB 1731 (Block) Page 1 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 AB 1731 (Block) Page 2 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.