BILL ANALYSIS Ó
AB 859
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Date of Hearing: April 28, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
AB 859
(Medina) - As Amended March 26, 2015
SUBJECT: Medi-Cal: obesity treatment plans.
SUMMARY: Requires the Department of Health Care Services (DHCS)
to create an Obesity Treatment Action Plan (OTAP) to diagnose,
treat, and reduce the incidence of adult obesity in the Medi-Cal
program, and report the plan and recommendations to the
Legislature, as specified. Specifically, this bill:
1)Requires DHCS to create an OTAP by December 31, 2016, that
applies to only noncapitated Medi-Cal payment plans.
2)Requires the OTAP to include evidence-based principles based
on guidelines provided by recognized provider associations, as
specified.
3)Requires the OTAP to include all of the following:
a) A plan for educating fee-for-service physicians
regarding the importance of screening for obesity and
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treatment options available in Medi-Cal;
b) A plan for identifying and screening patients for
obesity; and,
c) A review of current coverage of services to treat
obesity and recommendations with evidence-based rationale
on the continuum of coverage of additional obesity
treatment services, including nutritional, exercise, and
lifestyle counseling and pharmacotherapy.
4)Requires a report to be submitted to the Legislature and for
the section to be repealed by January 1, 2021.
EXISTING LAW:
1)Requires the Department of Public Health (DPH) to investigate
and apply for federal funding opportunities regarding the
promotion of healthy eating and preventing obesity, and
authorizes DPH, upon receipt of federal funds, to provide
in-kind support and award grants to local governments,
nonprofit organizations, and local education agencies as
deemed appropriate.
2)Establishes the Medi-Cal program under the direction of DHCS,
as California's Medicaid program, to provide qualifying
low-income individuals with health care and a uniform schedule
of benefits.
3)Establishes the Urban Community Health Institute: Centers to
Eliminate Health Disparities at the Charles R. Drew University
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of Medicine and Science to address the problem of disparate
health care in the Los Angeles County Planning Area and other
multicultural communities that have the worst health care
status indicators, medical outcomes, and death rates in Los
Angeles County. Establishes the Obesity and Nutrition Center
as one of the three centers at the Institute.
FISCAL EFFECT: This bill has not yet been analyzed by a fiscal
committee.
COMMENTS:
1)PURPOSE OF THIS BILL. The author points to DHCS studies that
have shown the proportion of adults with obesity is highest
among adults enrolled in Medi-Cal, with rates higher than
individuals in the privately insured market and the uninsured
population. The author contends that California is behind
other states with regard to obesity treatment; while the
majority of other states cover nutritional consultation under
Medicaid, California explicitly excludes this type of
coverage. The author asserts that California could receive
significant cost savings on healthcare and improve the health
of patients by investing on obesity treatments. The author
concludes this bill will provide a plan to diminish obesity as
an epidemic in California and will improve state health and
ensure long-term savings of taxpayer dollars.
2)BACKGROUND.
a) Impacts of obesity on health. Obesity is a chronic
disease that can have serious negative effects on the
internal systems of the body. There are a variety of
factors that play a role in obesity, which makes it a
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complex health issue to address. Behavior, environment,
and genetic factors all have an effect on causing people to
be overweight and obese. People who are obese have an
increased risk of developing serious medical conditions,
including heart disease, type 2 diabetes, and bone or joint
disease. The U.S. Surgeon General has declared that
obesity has reached epidemic levels within the U.S., with
approximately 35% of women and 31% of men considered
seriously overweight.
b) Obesity in California. California now has the fifth
lowest adult obesity rate in the nation, according to The
State of Obesity: Better Policies for a Healthier America.
However, the state's adult obesity rate has increased up to
24.1%, up from 9.9% in 1990. In 2007, 33.6% of children
ages two to five were overweight or obese.
c) Previous Efforts to Fight Obesity in California.
Previous initiatives have been established in California to
prevent obesity. In 2000, the Center for Weight and Health
collaborated with DPH's predecessor to establish the
California Obesity Prevention Initiative (COPI). The COPI
program was part of a national effort from the federal
Centers for Disease Control and Prevention (CDC) to prevent
obesity among children in California. Part of the program
involved pilot testing an innovative strategy to reduce
television viewing among children in select communities
that could subsequently be implemented on a larger scale.
Funding for COPI lasted for only five years.
DPH has launched more recent initiatives. The 2005-06
Budget mandated DPH create a strategic plan to coordinate
existing resources and to guide a statewide response to the
obesity crisis. In 2006, DPH published its first Obesity
Prevention Plan (OPP) in response to the legislative
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mandate. Since its publication, DPH reports there has been
significant progress in the implementation of policies
supporting obesity prevention.
In 2010, DPH updated the OPP to focus on the importance of
implementing policy and environmental change strategies, as
well as addressing health inequities and disparities. The
2010 OPP Plan is a broader array of obesity prevention
strategies, as well as highlights of successful actions
currently being implemented across the state.
3)SUPPORT. The Obesity Action Coalition, the sponsor of the
bill, states that Medi-Cal fee-for-service patients who are
affected by obesity should have access to the same medically
necessary and covered treatment avenues afforded to others who
receive care through managed care, or public or private health
plans. The sponsor asserts it is critical for DHCS to address
the disease of obesity and provide evidence-based treatments
to those who lack the economic means or resources to gain
access themselves. The sponsor concludes this bill will
provide for a thorough review of current coverage policies
surrounding evidence-based obesity treatment avenues and
highlight gaps in treatment avenues that should be addressed.
Supporters of this bill assert that those affected by obesity
should follow the same continuum of coordinated care as those
with suffering from other chronic diseases, such as heart
disease. Supporters state the complex nature of obesity and
its variety of impacts on both physical and mental health
requires coordinated services of providers from several
disciplines and professions in order to provide effective
treatment. The supporters contend this bill will provide
valuable information as to the latest treatments and costs
associated with obesity, and will help the state mitigate its
impact as one of the biggest drivers of preventable chronic
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disease and healthcare costs in the U.S.
4)RELATED LEGISLATION.
a) AB 572 (Gaines) requires DPH to create a diabetes action
plan for the state, and to report the results of the plan
to the Legislature biennially. AB 572 was heard in the
Assembly Health Committee on April 14, 2015 and passed out
with a vote of 17-0. AB 572 is pending in the Assembly
Appropriations Committee.
b) AB 1357 (Bloom) establishes the Children and Family
Health Promotion Program in DPH and requires the program to
consist of a competitive grant process in which grants are
awarded by the department to counties, cities, nonprofit
organizations, community-based organizations, and licensed
clinics that seek to invest in childhood obesity and
diabetes prevention activities and oral health programs.
AB 1357 is pending in the Assembly Health Committee.
c) SB 203 (Monning) requires a safety warning to be affixed
to sugar sweetened beverages that states "STATE OF
CALIFORIA SAFETY WARNING: Drinking beverages with added
sugar(s) contributes to obesity, diabetes, and tooth
decay." SB 203 is pending in the Senate Health Committee.
d) SCR 34 (Monning) proclaims the month of September 2015,
and each year thereafter, as Childhood Obesity Awareness
Month, and would express the Legislature's support of
various programs that work to reduce obesity among
children. SCR 34 was recently heard on the Senate Floor
and passed with a vote of 29-4. SCR 34 is pending at the
Assembly Desk.
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5)PREVIOUS LEGISLATION.
a) AB 1592 (Beth Gaines) of 2014 would have required DPH to
complete and submit to the Legislature a Diabetes Burden
Report by December 31, 2015. AB 1592 was vetoed by
Governor Brown, stating that DPH had already submitted its
Diabetes Burden Report to the CDC, as required, and is
unable to withdraw the report to include additional
information prescribed by AB 1592.
b) SB 1000 (Monning) of 2014 would have established the
Sugar-Sweetened Beverages Safety Warning Act, to be
administered by DPH and required a safety warning on sugar
sweetened beverages. SB 1000 failed passage in the
Assembly Health Committee.
c) AB 200 (Hayashi) of 2011 would have required the State
Board of Education, to establish the Health and Fitness
Award Program to provide an award to one school in each
legislative district that conducts their physical education
courses pursuant to the model content standards and
demonstrates that increasing numbers of pupils meet minimum
standards on the physical performance test. AB 200 was
vetoed by the Governor Brown, who stated that although
health and fitness are important, schools should be allowed
to design their own awards programs.
6)POLICY COMMENTS.
a) The author states part of the purpose of this bill is to
have the state realize cost savings to healthcare, in part
due to a preventive treatment plan for obesity. As
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currently written, this bill does not provide a funding
source for this plan. Existing law requires DPH to
investigate and request federal financial assistance to
help create programs to reduce obesity. The author may
wish to consider future amendments that would require DHCS
to investigate and request similar funding specifically for
the Medi-Cal population, as there is no existing funding
source for this bill.
b) The author indicates the intent of the bill is to apply
the OTAP to only Medi-Cal fee-for-service patients, rather
than being inclusive of both the Medi-Cal fee-for-service
and managed care population. Fee-for-service beneficiaries
account for approximately 25% of the estimated total of 12
million beneficiaries within the Medi-Cal program. The
remaining 75% are Medi-Cal managed care beneficiaries.
Although the managed care system is designed to include
care for obesity diagnoses and treatments, the obesity
rates of the overall Medi-Cal population is still high.
The author may wish to consider including Medi-Cal managed
care beneficiaries within the requirements of the bill.
7)TECHNICAL AMENDMENTS.
a) This bill requires DHCS to create an OTAP to diagnose,
treat, and reduce the incidence of adult obesity in the
Medi-Cal program; however it is unclear whether or not the
establishment of this program is allowable under federal
law. The Committee may suggest amending this bill to
authorize DHCS to apply for a waiver or any necessary
federal approvals from the Centers for Medicare and
Medicaid Services, if the OTAP is in fact not, and help
address the funding issue by insuring the program is
eligible for federal financial participation.
b) This bill requires the provisions to apply only to
noncapitated payment plans in Medi-Cal. The author
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indicates the intent of the bill is to apply only to
Medi-Cal fee-for-service, however the current language of
the bill does not explicitly indicate the program should be
applied to only this population and the wording could be
somewhat confusing. The Committee may suggest amending
this bill to clarify that the provisions only apply to the
Medi-Cal fee-for-service population.
REGISTERED SUPPORT / OPPOSITION:
Support
Obesity Action Coalition (sponsor)
American Society for Metabolic and Bariatric Surgery -
California State Chapter
Biocom
Biotechnology Industry Organization
California Communities United Institute
California Healthcare Institute
Obesity Care Continuum
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Opposition
None on file.
Analysis Prepared by:An-Chi Tsou / HEALTH / (916) 319-2097