BILL ANALYSIS                                                                                                                                                                                                    



                                                                  AB 411
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          Date of Hearing:  April 2, 2013

                            ASSEMBLY COMMITTEE ON HEALTH
                                 Richard Pan, Chair
                   AB 411 (Pan) - As Introduced:  February 15, 2013
           
          SUBJECT  :  Medi-Cal: performance measures. 

           SUMMARY  :  Provides that the Department of Health Care Services  
          (DHCS) require all Medi-Cal managed care plans (MCPs) to analyze  
          Healthcare Effectiveness Data and Information Set (HEDIS)  
          measures, or their External Accountability Set (EAS) performance  
          measure equivalent, by race, ethnicity, and primary language to  
          identify disparities in medical treatment and to implement  
          strategies to reduce disparities.  Requires MCPs to link  
          individual level data to patient identifiers in order to allow  
          for an analysis of disparities in medical treatment by race,  
          ethnicity, and primary language and provide the information  
          annually to DHCS.  Requires DHCS to make the data available for  
          research in a method that complies with the Health Insurance  
          Portability and Accountability Act of 1996 (HIPAA).  

           EXISTING LAW  :  

          1)Establishes the Medi-Cal program, to provide various health  
            and long-term services to low-income women and children,  
            elderly, and people with disabilities.

          2)Authorizes DHCS to enter into contracts with MCPs to provide  
            services to Medi-Cal enrollees. 

          3)Requires most persons eligible for Medi-Cal to enroll in a MCP  
            and establishes a process for informing enrollees regarding  
            plan selection. 

          4)Authorizes DHCS to expand Medi-Cal managed care (MCMC) to the  
            28 mostly rural counties that are currently in the Medi-Cal  
            fee-for-service program. 

          5)Establishes under federal law, through HIPAA various  
            safeguards for the privacy of medical information. 

           FISCAL EFFECT  :  This bill has not been analyzed by a fiscal  
          committee.









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           COMMENTS  :

           1)PURPOSE OF THIS BILL  .  According to the author, as of February  
            2013, approximately 5.2 million Californians are enrolled in  
            Medi-Cal MCPs in 30 counties, the majority of whom are from  
            communities of color.  Additionally, 43% of Medi-Cal enrollees  
            speak a language other than English.  DHCS is in the process  
            of transitioning over 850,000 children from the Healthy  
            Families Program (HFP) to Medi-Cal and most of them will be  
            enrolled in Medi-Cal MCPs.  Of these children 47% are Latino  
            and 9% Asian American or Pacific Islander.  Forty-six percent  
            of these children's households speak a language other than  
            English.  The author points out that when HFP was administered  
            by the Managed Risk Medical Insurance Board (MRMIB), plans as  
            in Medi-Cal, were required to report HEDIS data.  However,  
            MRMIB did more than report the results of the HEDIS measures.   
            For instance MRMIB monitored its plans to ensure that access  
            to quality health care was shared by all members.  In order to  
            accomplish this, MRMIB performed demographic statistical  
            analysis of HEDIS data where all eligible members were  
            counted.  MRMIB then considered groupings of this data by  
            health plan, region, income level, language spoken in the  
            home, ethnicity, and age.  The author explains that this  
            allowed MRMIB to conduct qualitative and comparative analysis,  
            to identify disparities and to develop strategies for  
            improvement or to reduce disparities.  

          According to the author, the purpose of this bill is to ensure  
            that the qualitative aspects of the way MRMIB measured and  
            reported plan data is not lost in the transition to Medi-Cal.   
            The author points out that currently, Medi-Cal MCPs analyze  
            and report HEDIS measures on important dimensions of care and  
            service.  Additionally, demographic data, including race,  
            ethnicity, and primary language, is collected at the time of  
            enrollment for the Medi-Cal program.  However, it is not  
            collected or reported in a manner that allows for the same  
            type of demographic analysis that was conducted at MRMIB.  In  
            addition, it is the author's intent to apply these practices  
            to the other managed care populations in Medi-Cal.  By  
            analyzing utilization, quality, and outcome data by race,  
            ethnicity, and primary language, Medi-Cal MCPs and DHCS will  
            better understand the specific needs of these enrollees, allow  
            plans to better develop culturally and linguistically  
            appropriate interventions, enable plans and the State to  
            allocate resources to more effectively, and ultimately reduce  








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            historic health disparities that communities of color face.

          2)BACKGROUND  .  DHCS has embarked on an ambitious expansion of  
            the MCMC program.  These program changes include all age  
            groups and all geographic regions.  In 2011 DHCS transferred  
            Medi-Cal only seniors and people with disabilities (SPDs) from  
            voluntary to mandatory enrollment in MCMC as part of the  
            Section 1115(b) Medicaid Demonstration Waiver from the Centers  
            for Medicare and Medicaid Services (CMS) entitled "A Bridge to  
            Reform Waiver."  Enrollment was phased in over a one-year  
            period, beginning on June 1, 2011 in the 16 two-plan and  
            Geographic Managed Care (GMC) counties.  

          DHCS is also participating in a demonstration project authorized  
            by the 2010 federal Affordable Care Act (ACA) to improve  
            coordination of services for persons who are dually eligible  
            for state Medicaid programs (Medi-Cal in California) and  
            Medicare.  Approximately 456,000 potential enrollees will be  
            eligible for enrollment in MCPs in this Coordinated Care  
            Initiative (CCI) in a three-year, eight county demonstration  
            project.  (The eight counties are Alameda, Los Angeles,  
            Orange, Riverside, San Bernardino, San Diego, San Mateo, and  
            Santa Clara).  On March 27, 2013 DHCS signed a Memorandum of  
            Understanding.  Phased in enrollment is currently scheduled to  
            begin no earlier than October 1, 2013.  

          DHCS is currently in the process of transitioning about 863,000  
            children, up to age 19, in families with incomes above the  
            thresholds needed to qualify for Medi-Cal but below 250% of  
            the federal poverty level into the Medi-Cal program from the  
            HFP.  Until January 1, 2013, the HFP was administered by MRMIB  
            and provided coverage by contracting with plans that provide  
            health, dental, and vision benefits to HFP enrollees.  

          AB 1467 (Committee on Budget), Chapter 23, Statutes of 2012,  
            authorized the expansion of MCMC to 28 mostly rural counties  
            which could add approximately 365,000 additional enrollees to  
            MCMC program.  In February 2013, DHCS announced that Anthem  
            Blue Cross and California Health and Wellness Plan, received  
            Notices of Intent to Award for the expansion to the counties  
            of Alpine, Amador, Butte, Calaveras, Colusa, El Dorado, Glenn,  
            Inyo, Mariposa, Mono, Nevada, Placer, Plumas, Sierra, Sutter,  
            Tehama, Tuolumne, and Yuba.  DHCS is also planning an  
            exclusive MCMC contract with Partnership HealthPlan of  
            California for expansion in Del Norte, Humboldt, Lassen,  








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            Modoc, Shasta, Siskiyou, and Trinity counties.  In addition,  
            Lake and San Benito counties will become County Operated  
            Health System (COHS) managed care counties served by  
            Partnership HealthPlan of California and Central California  
            Alliance for Health, respectively.  DHCS is currently working  
            with Imperial County on its managed care plan selection  
            process.

          There are three models of Medi-Cal MCPs.  The oldest model is  
            the COHS.  COHS plans serve about one million enrollees  
            through six health plans in 14 counties: Marin, Mendocino,  
            Merced, Monterey, Napa, Orange, San Mateo, San Luis Obispo,  
            Santa Barbara, Santa Cruz, Solano, Sonoma, Ventura, and Yolo.   
            In the COHS model, DHCS contracts with a health plan created  
            by the County Board of Supervisors and all Medi-Cal enrollees  
            are in the same health plan.  The second model is the Two-Plan  
            model in which there is a "Local Initiative" and a "commercial  
            plan" (CP).  DHCS contracts with both plans.  The Two-Plan  
            model serves about 3.6 million beneficiaries in Alameda,  
            Contra Costa, Fresno, Kern, Kings, Los Angeles, Madera,  
            Riverside, San Bernardino, San Francisco, San Joaquin, Santa  
            Clara, Stanislaus, and Tulare.  Two-counties employ the GMC  
            model: Sacramento and San Diego.  DHCS contracts with several  
            commercial plans in those counties and there are about 600,000  
            enrollees.

           3)EAS  .  CMS requires that states, through their contracts with  
            MCPs, measure and report on performance to assess the quality  
            and appropriateness of care and services provided to members.   
            In response, DHCS implemented a monitoring system that is  
            intended to provide an objective, comparative review of health  
            plan quality-of-care outcomes and performance measures called  
            the EAS.  DHCS designates EAS performance measures on an  
            annual basis and requires plans to report on them.  DHCS uses  
            the HEDIS as the primary tool.  

          HEDIS is a national, standardized set of measures developed by  
            the National Committee for Quality Assurance.  DHCS selects  
            which HEDIS measures to use after consultation with the plans  
            and with input from an External Quality Review Organization  
            (EQRO).  All current measures are applicable across  
            populations.  For example, well child visits, immunizations,  
            comprehensive diabetes care and annual monitoring of patients  
            on persistent medications are just a few of the currently  
            required HEDIS measures that are applied equally to all  








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            Medi-Cal MCP enrollees.  In 2011 the EAS consisted of 11  
            performance measures.  The EAS for 2012 consisted of 13 HEDIS  
            and 1 DHCS developed measures.  For 2013, MCPs will be  
            reporting on 14 HEDIS measures.  DHCS in collaboration with  
            MCPs and the EQRO, developed a methodology by which to  
            stratify several measures (comprehensive diabetes care,  
            children and adolescent access to Primary Care Providers,  
            annual monitoring for persistent medications, ambulatory care  
            utilization, and all cause readmissions) into SPD and non-SPD  
            groups.  

          MRMIB also collected HEDIS data from the 25 HFP health plans.   
            For 2009, 2010 and 2011 MRMIB collected data on 17 HEDIS  
            measures specific to children and adolescents.  HEDIS results  
            were provided to subscribers in enrollment materials,  
            including the program handbook, so that families could use the  
            information to compare health plan performance in areas  
            important to them.  HEDIS results were also used by MRMIB to  
            monitor plan performance and to inform decision-making  
            regarding quality improvement activities and health plan  
            participation in HFP. 
           4)USE OF DEMOGRAPHIC ANALYSIS  .  MRMIB monitored its HFP health  
            and dental plans to ensure that access to quality healthcare  
            was shared by all of its members.  Demographic statistical  
            analysis of HEDIS data was performed for measures that use  
            administrative data, that is, measures where all eligible  
            members are counted.  Groupings considered by MRMIB for its  
            HEDIS report are health plan, region, income level, language  
            spoken in the home, ethnicity, and age.  This bill would  
            require all MCPs contracting with DHCS to provide information  
            that would allow the same analysis as was done by MRMIB for  
            HFP.  For example MRMIB reported in the 2011 HFP HEDIS Report  
            that 88% of white children saw a PCP at least once; for  
            Black/African American children the rate was 85%; and, for  
            Asian/Pacific Islander children it was 86%.  The HEDIS measure  
            for appropriate medications for asthma, there was a range of  
            95% for Vietnamese speaking to 88% for English speaking.   
            MRMIB was able to accomplish this analysis by requiring the  
            plans to provide patient identifiers with the individual HEDIS  
            measure.  MRMIB matched the information, through an EQRO  
            contractor, with demographic information reported by the  
            enrollee.  This allows demographic analysis, comparison, and  
            reporting without breaching patient confidentiality. 

          Medi-Cal does not analyze and report the HEDIS data from its  








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            contracting plans in the same way and does not require the  
            plans to report the data in a way that would allow similar  
            analysis.  Nonetheless, some plans are conducting similar  
            analysis on their own.  For instance, the Anthem Blue Cross  
            Partnership Plan Performance Evaluation Report, September 2011  
            reported on Anthem's continued efforts to improve performance  
            on the Breast Cancer Screening measure.  The Report lists the  
            intervention efforts implemented by the plan and states that  
            Anthem conducted additional analysis and found statistically  
            significant differences based on members' spoken languages and  
            race.  As the strategies included newsletter articles and  
            other written materials, this is particularly useful  
            information in designing the strategy for improvement.  Anthem  
            also reported statistically significant differences based on  
            language and ethnicity in the rates of childhood immunizations  
            in Sacramento County.  With regard to prenatal and postpartum  
            care, the Report states that Anthem continues to struggle with  
            prenatal and postpartum care performance measure rates and  
            that additional analysis noted differences in language and  
            ethnicity in some of the counties which should be considered  
            when exploring additional approaches to interventions.  The  
            L.A. Care Health Plan Performance Evaluation Report, December  
            2011 reported on follow-up from the prior year's EQRO  
            recommendation which was to analyze performance measure data  
            and explore opportunities to increase rates for measures where  
            performance had remained stable.  LA Care's plan included  
            analyzing HEDIS results by several variables including plan  
            partner, region, language, gender, ethnicity, and age cohort.   


          On the other hand the lack of this break down can interfere with  
            a plan's efforts to improve.  For instance, the Inland Empire  
            Health Plan (IEHP) Performance Evaluation Report, October  
            2011, found that member satisfaction related to access to care  
            was low across adult and child global and composite ratings,  
            with the exception of customer service.  The Report states  
            that health plan performance in customer service impacts  
            access to care.  However, in the absence of a breakdown by  
            race, ethnicity, and language spoken, it is impossible to tell  
            whether there are disparities within this plan or to identify  
            improvement strategies to target a specific population.  In  
            addition, the Report found a statistically significant  
            decrease in the Comprehensive Diabetes Care measure.  IEHP  
            identified Diabetes as the second most common chronic  
            condition in its Medi-Cal population.  Given that rates of  








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            diabetes are twice as high among Native Americans and African  
            Americans as among whites, IEHP could be more effective in  
            assessing strategies to improve this measure if there was a  
            comparative analysis by race and ethnicity. 

          CPs in other states have conducted similar analysis and used the  
            data to improve the quality of care and health outcome of  
            their members.  For example, Aetna sought to decrease breast  
            cancer death rates among African American and Hispanic women  
            by increasing the number of yearly mammograms.  Aetna analyzed  
            race, ethnicity, and language data collected at enrollment and  
            claims data to identify 34,000 African American and Latina  
            members who had not had a necessary mammogram.  The rate of  
            mammograms following outreach to these women increased from  
            12% to 27%. 

           5)Let's Get Healthy California Task Force (Task Force ).   On May  
            3, 2012, Governor Jerry Brown issued Executive Order B-19-12  
            establishing the Task Force to "develop a 10-year plan for  
            improving the health of Californians, controlling health care  
            costs, promoting personal responsibility for individual  
            health, and advancing health equity."  The Executive Order  
            directed the Task Force to issue a report by mid-December,  
            2012, with recommendations for how the state can make progress  
            toward becoming the healthiest state in the nation over the  
            next decade.  

          According to the Task Force Report, issued December 2012, the  
            Task Force developed an overarching Framework.  The Framework  
            identified six goals, organized under two strategic  
            directions: Health Across the Lifespan and Pathways to Health.  
             The Report states that the Framework makes clear that health  
            equity should be fully integrated across the entire effort.   
            The Report also states that health outcomes vary dramatically  
            by demographics, geography and a host of socioeconomic  
            conditions.  According to the Report, California is the most  
            populous and diverse state in the country.  Significant health  
            disparities, or differences in health outcomes, exist by  
            race/ethnicity, income, educational attainment, geography,  
            sexual orientation and gender identity, and occupation.  These  
            disparities relate to differences in social, economic, and  
            environmental conditions, as well as to issues within the  
            health care system itself.  For California to be the  
            healthiest state in the nation, health disparities must be  
            reduced and, ultimately eliminated.  The underlying principle  








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            guiding the establishment of 10 year targets is that these  
            gaps can be closed.  Many of the recommendations relate to the  
            collection of additional data and refer to metrics similar to  
            those used in HEDIS data.  For instance, the Report identifies  
            childhood asthma as  pressing issue and the most prevalent  
            chronic condition for children.  According to the Report  
            asthma can result in higher school absenteeism and lead to  
            lower levels of physical activity, in addition to the other  
            effects of the condition.  The Report states there are  
            significant disparities in asthma prevalence and in the  
            utilization of health services resulting from asthma.  For  
            example, African American children utilize the emergency  
            department more than eight times as frequently as Asian  
            American children for asthma.  

            The Report concludes that the underlying principle that guided  
            the establishment of the 10-year targets is that California  
            can only become the healthiest state in the nation if we close  
            the race and ethnicity gaps by raising everyone's health to  
            the highest outcomes that we know can be achieved.  It is  
            seems that the requirements of collecting and analyzing  
            Medi-Cal HEDIS data by race, ethnicity and language spoken  
            would be an essential piece of the effort to achieve this goal  
            and with as applied to the Medi-Cal program would be difficult  
            to  accomplished without this bill.

           6)SUPPORT  .  The California-Pan Ethnic Health Network (CPEHN),  
            sponsor of this bill writes in support that even though the  
            majority of Medi-Cal enrollees (73%) are from communities of  
            color, there are no requirements to analyze quality data by  
            race, ethnicity, and primary language.  CPEHN points out  
            racial and ethnic health disparities are prevalent and  
            pervasive.  For example in California, African Americans and  
            Native Americans have at least twice the rate of diabetes as  
            whites, and Latinos and African Americans have over twice the  
            rate of preventable hospital admissions for diabetes with  
            long-term complications as whites.  According to CPEHN, data  
            also show that African Americans have almost four times the  
            rate of preventable hospital admissions among children with  
            asthma compared to whites, and three times the rate of  
            preventable hospital admission for congestive heart failure.   
            Specifically with regard to Medi-Cal, CPEHN points to a study  
            conducted by Dr. Andrew Bindman, Professor of Medicine,  
            University of California, San Francisco.  In his study, Health  
            Plan Auto-Assignment Incentives in Medi-Cal and Health Care  








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            Disparities for Children, Dr. Andy Bindman found that there  
            were average deviances from a health plan's overall  
            performance among racial and ethnic subpopulations on each of  
            the HEDIS measures they analyzed.  CPEHN argues the experience  
            of such stark racial and ethnic health disparities among  
            communities of color necessitates MCMC to begin to seriously  
            and systematically identify and address the disparities of its  
            diverse enrollee population.  The data and process exist for  
            Medi-Cal MCPs to conduct such an analysis and the information  
            could be instrumental in helping to improve the quality of  
            care and health outcome for millions of Californians.  Other  
            supporters such as the Western Center on Law and Poverty, the  
            California Center for Public Health Advocacy, and the  
            California School Health Centers Association, Worksite  
            Wellness LA write in support that beginning in 2014, 1.4  
            million adults are expected to enroll in Medi-Cal as a result  
            of the expansion through the ACA of that 67% will be from  
            communities of color and 35% speak English less than very  
            well.  These supporters and others, such as Asian Journal  
            Publications, AnewAmerica Community Corporation, Manila-U.S.  
            Times, Chicana/Latina Foundation state that to address  
            on-going and persistent health disparities experienced by  
            communities of color, Medi-Cal MCPs must begin to analyze and  
            report in quality data measures by race, ethnicity, and  
            language.  This data will help them to develop culturally and  
            linguistically appropriate interventions, enable them to  
                                                    allocate resources more effectively, and ultimately reduce  
            historic health disparities.  

          The March of Dimes (MOD), California Chapter, points out that  
            nearly 50% of births in California are paid for by Medi-Cal.   
            Pointing to statistics on significant health disparities  
            related to prenatal care, premature birth and infant  
            mortality, MOD states in support of this bill that it has the  
            potential to close the gap on these disparities.  For example,  
            MOD reports that the infant mortality rate for all births is  
            5.1 infant deaths for 1,000 live births, but the rate for  
            Black infants is more than double at 10.7 infant deaths per  
            1,000 live births.  The preterm birth rate for white infants  
            is 9.3%, but is higher for infants of other races including  
            Blacks (14.4%), Native Americans (11.4%), Hispanics (10.3%),  
            and Asians (9.6%).  MOD concludes that in addition to the  
            overall health benefits for infants, improvements could also  
            generate significant cost savings as the average first-year  
            medical costs for a preterm infant are nearly 10 times the  








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            costs for a term infant. 

           7)OPPOSITION  . The Local Health Plans of California and the  
            California Association of Health Plans writes in opposition  
            that this bill will create new costs and administrative  
            burdens by requiring Medi-Cal MCPs to use inherently limited  
            data to address health disparities.  The opposition writes  
            that while they appreciate the intent of this measure, they do  
            not believe this bill will achieve the intended results.  This  
            opposition further states that in theory, this bill could  
            result in valuable information.  However, they argue in  
            practice, the reliance on limited cultural and linguistic data  
            is problematic.  This is due to the voluntary nature of the  
            data.  According to the opposition, new Medi-Cal enrollees  
            often do not self-disclose this information.  Therefore,  
            insufficient data would not yield statistically significant  
            results, nor is this data enough to implement meaningful  
            strategies to identify or reduce disparities.  In order to  
            sort and analyze the data required under this bill, they argue  
            MCPs will incur new programming and reporting expenses.  This  
            expense comes at a time when all of California's health plans  
            are focused on the crucial task of implementing the ACA.  

           8)RELATED LEGISLATION  .  

             a)   AB 209 (Pan) enacts the Medi-Cal Managed Care Quality  
               and Transparency Act of 2013 and requires the DHCS to  
               develop and implement a plan to monitor, evaluate, and  
               improve the quality and accessibility of health care and  
               dental services provided through MCMC.  AB 209 is pending  
               in the Assembly Health Committee. 

             b)   SB 508 (Ed Hernandez) requires the Office of Statewide  
               Health Planning and Development (OSHPD), with support from  
               the California Health and Human Services Agency (CHSSA),  
               based on the inpatient hospital discharge data set, to  
               develop a health disparity report to assess the levels of  
               measurable health disparities in the state among  
               minorities.  SB 508 is pending in the Senate Health  
               Committee.

           9)PREVIOUS LEGISLATION  .  

             a)   AB 1494 (Committee on Budget), Chapter 28, Statutes of  
               2012, provides for the transition of children from HFP to  








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               Medi-Cal starting no earlier than January 1, 2013.

             b)   AB 1467 (Committee on Budget), Chapter 23, Statutes of  
               2012, authorizes the expansion of MCMC to 28 mostly rural  
               counties.

             c)   AB 2002 (Cedillo) of 2012 would have defined "safety net  
               provider" for the purpose of determining which MCMC plan a  
               beneficiary will be assigned to if they do not choose a  
               plan.  AB 2002 was held in Assembly Appropriations at the  
               author's request.  

             d)   SB 1008 (Committee on Budget and Fiscal Review), Chapter  
               33, Statutes of 2012, and SB 1036 (Committee on Budget and  
               Fiscal Review), Chapter 45, Statutes of 2012, enacts the  
               CCI.

             e)   SB 208 (Steinberg), Chapter 714, Statutes of 2010,  
               contained the provisions implementing Section 1115(b)  
               Medicaid Demonstration Waiver from CMS entitled "A Bridge  
               to Reform Waiver."  Among the provisions, this waiver  
               authorized mandatory enrollment into Medi-Cal MCPs of over  
               600,000 low-income SPDs who are eligible for Medi-Cal only  
               (not Medicare) in 16 counties.

             f)   ACR 29 (Jones), Resolution Chapter 9, Statues of 2009,  
               requests CHHSA to provide leadership to ensure that, within  
               existing resources and programs, departments within the  
               agency implement programs, activities, and strategies that  
               place a priority focus on preventing, reducing, and  
               eliminating health disparities among racial and ethnic  
               population subgroups.

             g)   AB 330 (Hayashi) of 2007 would have required OSHPD, in  
               conjunction with CHHSA, to develop a health disparity  
               report by January 1, 2009, based on patient hospital  
               discharge data.  This bill was held on suspense in the  
               Assembly Appropriations Committee.

             h)   AB 1142 (Dymally), Chapter 403, Statutes of 2005,  
               establishes the Statewide African American Initiative to  
               address the disproportionate impact of HIV/AIDS on the  
               health of African Americans by coordinating prevention and  
               service networks around the state and increasing the  
               capacity of core service providers.








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             i)   ACR 112 (Chan), Resolution Chapter 103, Statutes of  
               2006, encourages public health and medical officials to  
               target vaccination efforts toward Asian Pacific Islander  
               (API) children to decrease the incidence rate of this  
               disease in California's API communities.  

             j)   ACR 114 (Coto), Chapter 151, Statutes of 2006,  
               establishes the Legislative Task Force on Diabetes and  
               Obesity, consisting of 20 members, as specified, to study  
               the factors contributing to the high rates of diabetes and  
               obesity in Latinos, African Americans, Asian Pacific  
               Islanders, and Native Americans in this country, and  
               requires the Legislative Task Force on Diabetes and Obesity  
               to prepare a report containing recommendations, no later  
               than December 31, 2007, regarding ways to reduce the  
               incidence of those debilitating conditions.

             aa)  AB 2047 (Machado) of 2002 would have created the Chronic  
               Disease Prevention Council (Council) within the Department  
               of Health Services (DHS) (now DPH) to coordinate and  
               prioritize disease prevention programs.  AB 2047 was vetoed  
               by Governor Gray Davis, who stated that committees similar  
               to the Council already existed within DHS.  The message  
               directed DHS to utilize an existing advisory committee or  
               council to fulfill the objectives of the bill.


           REGISTERED SUPPORT / OPPOSITION  :  

           Support  
          American Federation of State, County and Municipal Employees
          AnewAmerica Community Corporation
          Asian Pacific Islander Caucus for Public Health
          Asian & Pacific Islander American Health Forum
          Asian Journal Publications
          Asian Law Alliance
          Azul Management Systems Institute
          Black Economic Council
          California Black Health Network
          California Coverage & Health Initiatives
          California Center for Public Health Advocacy
          California Immigrant Policy Center
          California Rural Legal Assistance Foundation
          California School Health Centers Association








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          Chicana/Latina Foundation
          Children's Defense Fund California
          Children Now
          The Children's Partnership
          Full Gospel Business Men's Fellowship International
          Greenlining Institute
          Health Access California
          Manila-US Times
          March of Dimes, California Chapter
          PICO California
          United Ways of California
          Western Center on Law and Poverty
          Worksite Wellness LA
          One individual
           
          Opposition  

          Local Health Plans of California
          California Association of Health Plans
           
          Analysis Prepared by  :    Marjorie Swartz / HEALTH / (916)  
          319-2097