BILL ANALYSIS Ó
AB 1592
Page 1
Date of Hearing: April 22, 2014
ASSEMBLY COMMITTEE ON HEALTH
Richard Pan, Chair
AB 1592 (Beth Gaines) - As Amended: April 2, 2014
SUBJECT : California Diabetes Program.
SUMMARY : Requires the Department of Public Health (DPH) to
create a Diabetes Action Plan and submit biennial reports to the
Legislature which include information on the fiscal impact of
diabetes to the Medi-Cal program, as well as provide proposals
to reduce the impact of diabetes and its complications.
Specifically, this bill :
1)Requires DPH, as part of the California Diabetes Program (CDP)
to submit a report to the Legislature by December 31 of each
odd-numbered year which includes the following:
a) The financial impact of all types of diabetes on the
Medi-Cal program and public health programs, the number of
persons with diabetes and family members impacted by
prevention and diabetes control programs implemented by
DPH, and the financial toll or impact diabetes and its
complications place on DPH in comparison to other chronic
diseases and conditions;
b) An assessment of the benefits of implemented programs
and activities aimed at preventing and controlling diabetes
which documents the amount and source of funding directed
to DPH by the Legislature for programs and activities aimed
at reaching those with diabetes; and,
c) Detailed action plans which identify proposed steps to
reduce all types of diabetes and its complications and
which identify expected outcomes of the proposed steps in
the following biennium, while also establishing benchmarks
for preventing and controlling all forms of diabetes.
2)Requires DPH to make the reports available on its Internet
Website.
3)Requires the Department of Health Care Services (DHCS) to
provide DPH with any relevant data for the report and requires
all data transferred to DPH from DHCS to conform to federal
Health Insurance Portability and Accountability act
requirements.
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4)Requires DPH to ensure that all grant funds from the federal
Centers for Disease Control and Prevention (CDC) and other
federal sources for the CDP are used for the purpose of
diabetes prevention, treatment, and awareness, and the
creation of the biannual reports, pursuant to grant
requirements.
EXISTING LAW : Establishes DPH to protect and improve the health
of communities through education, promotion of healthy
lifestyles, and research for disease and injury prevention.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . According to the author, the state of
California has no plan in place to mitigate the escalating
fiscal impact of diabetes, and while there has been extensive
legislation enacted to promote awareness and cost saving
measures for conditions such as cardiovascular disease and
tobacco addiction, current law is woefully inadequate in
regard to diabetes. The author states that diabetes has
reached epidemic levels in California, and as of 2012, about
one in seven adult Californians have diabetes and many more
will be diagnosed in the near future. Finally, the author
states that this bill would require the CDP to create and
submit to the state a diabetes action plan, which will provide
policy guidance addressing the escalating fiscal impact of
diabetes treatment and care.
2)BACKGROUND . Diabetes is a chronic medical condition marked by
high levels of blood glucose (a form of sugar) resulting from
defects in insulin production, insulin action, or both. Type
1 diabetes, previously known as juvenile diabetes, is an
autoimmune disease in which the body does not produce the
hormone insulin. There is no known way to prevent type 1
diabetes. Type 2 diabetes (previously called
non-insulin-dependent diabetes or adult-onset diabetes) in
adults, accounts for about 90% to 95% of all diagnosed cases
of diabetes. It usually begins as insulin resistance, a
disorder in which the cells do not use insulin properly. As
the need for insulin rises, the pancreas gradually loses its
ability to produce it. Gestational diabetes occurs in
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pregnant women who have never had diabetes before but have
higher than normal blood glucose levels during pregnancy.
Immediately after pregnancy, 5% to 10% of women with
gestational diabetes are found to have diabetes, usually type
2. Women who have had gestational diabetes have a 35% to 60%
chance of developing diabetes in the next 10-20 years.
Prediabetes is a condition in which individuals have blood
glucose levels higher than normal but not high enough to be
classified as diabetes. People with prediabetes have an
increased risk of developing type 2 diabetes, heart disease,
and stroke. Without intervention, about one out of four
people with prediabetes will develop diabetes within 3-5
years. Ethnic minorities and those who are poor or
disadvantaged have especially high rates of diabetes. In
2010, one in seven African American (14.3%), one in nine
American Indian/Alaskan Natives/Native Hawaiian/Other Pacific
Islander (11.6 %), one in 10 Latino (10.9%), one in 11 Asian
American (7.7%), and one in 14 White (7.0%) adults had
diagnosed diabetes.
According to the CDP, diabetes costs in California exceed $24
billion each year. Total health care and related costs for
the treatment of diabetes in California are about $24.5
billion. Direct medical costs (e.g., hospitalizations,
medical care, treatment, supplies) account for about $18.7
billion, the other $5.8 billion include indirect costs such as
disability payments, time lost from work, and premature death.
The average annual treatment cost per case for diagnosed
diabetes in the U.S. was nearly $10,000 in 2007.
There is no known cure for diabetes. Increased risk of heart
disease, stroke, and kidney damage (and the need for dialysis
as a result) are the most deadly effects. Uncontrolled high
blood sugars may also affect the eyes and cause blindness.
Diabetes frequently affects circulation, and a simple cut on
the foot can lead to an amputation due to infection.
Diabetics tend to experience longer hospitalizations and
mortality rates. California has an estimated 3.9 million
adults with diabetes (2010) , and the numbers are rising
rapidly.
3)THE CALIFORNIA DIABETES PROGRAM . The CDP was established in
1981 within DPH (then the California Department of Health
Services) and is primarily funded by the CDC. On July 1,
2013, a new CDC-funded program "State Public Health Actions to
Prevent and Control Diabetes, Heart Disease, Obesity and
Associated Risk Factors and Promote School Health" began.
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Funding allocated to pre-diabetes and diabetes decreased by
$250,000. With this new grant, CDC funding for California
chronic disease prevention overall decreased by $2.2 million.
The new collaborative grant, known as Prevention First,
Advancing Synergy for Health, requires coordination among
programs that historically were categorically funded and
stand-alone programs. Prevention First addresses individuals
with pre-diabetes and diabetes.
4)THE CALIFORNIA WELLNESS PLAN . This year DPH published the
California Wellness Plan (Plan), the result of a statewide
process led by DPH to develop a roadmap with partners and
create communities in which people can be healthy through
improving the quality of clinical and community care,
increasing access to usable health information, assuring
continued public health capacity to achieve health equity, and
empowering communities to create healthier environments. The
Plan contains short, intermediate, and long-term objectives
with measurable effects on a variety of chronic diseases,
including diabetes. DPH's chronic disease programs plan to
collaborate with local and state partners, including the
Office of Health Equity, engaged in diabetes prevention to
implement the objectives. DPH intends to monitor the progress
of Plan objectives and publish regular reports on outcomes.
5)DIABETES BURDEN REPORT . DPH is currently working on a
Diabetes Burden Report with anticipated completion of December
31, 2014. The report will include information on the
prevalence of diabetes in California compared to the rest of
the U.S., risk factors for developing diabetes and diabetes
complications, as well as the prevalence of obesity,
inactivity, and cardiovascular disease risk factors (smoking,
hypertension, hypercholesterolemia) among diabetics as
compared to non-diabetics in California. The report will
address the prevalence of pre-diabetes, complications of
diabetes, and diabetes mortality in California compared to the
rest of the nation. The report will also outline DPH programs
and activities that address the burden of diabetes in
California.
6)SUPPORT . The Advanced Medical Technology Association supports
this bill, stating that it will help provide the public with
an understanding of what the state is doing to combat diabetes
and will help legislators when prioritizing resources
available to battle diabetes and its complications. The
California Healthcare Institute also supports this bill
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because it will help identify approaches to contain diabetes
today while concurrently helping state agencies plan for the
growing impact of the disease going forward.
7)RELATED LEGISLATION . SB 1316 (Cannella) would require DHCS,
DPH, and the Board of Administration of the Public Employees'
Retirement System to submit a report to the Legislature
regarding their diabetes-related programs, and states it is
the intent of the Legislature to coordinate a response that
assesses the quality of care and manages the costs paid for by
state-financed health programs relating to diabetes. SB 1316
is pending in the Senate Rules Committee.
8)PREVIOUS LEGISLATION .
a) AB 2226 (Garcia), Chapter 235, Statutes of 2006,
requires, on or after July 1, 2010, school districts to
provide an information sheet regarding type 2 diabetes to
the parent or guardian of incoming 7th grade pupils and
authorizes the sheet to be provided with other materials
distributed at the beginning of the school year.
b) SB 64 (Solis), Chapter 540, Statutes of 1999, requires
every health care service plan and disability (health)
insurer to provide coverage for the management and
treatment of diabetes including equipment, supplies,
medications, outpatient self-management education, and
medical nutrition therapy, as medically necessary,
determined by the plan and insurers in conjunction with the
treating physician.
9)SUGGESTED AMENDMENTS . Given the recent publication of the
California Wellness Plan, and the fact that DPH/CDP is
currently working on a Diabetes Burden Report with an
anticipated completion on December 31, 2014, which will
contain much of the information required by this bill, the
Committee may wish to delete the report and action plans
required by the bill, and instead amend this bill to require
CDP to work to implement the diabetes specific components of
the Plan with existing funds. CDC grant funding agreements
and reporting requirements already specify how grant funds are
to be spent. Placing additional state requirements on federal
grantees may put them out of compliance with federal
guidelines and prevent the state from accepting federal funds.
The Committee may wish to delete the provision of this bill
relating to federal grants.
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REGISTERED SUPPORT / OPPOSITION :
Support
Advanced Medical Technology Association
American Diabetes Association
AstraZeneca Pharmaceuticals LP
BayBio
BIOCOM
California Association of Area Agencies on Aging
California Chronic Care Coalition
California Healthcare Institute
Novo Nordisk
One individual
Opposition
None on file.
Analysis Prepared by : Lara Flynn / HEALTH / (916) 319-2097