BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 1795
---------------------------------------------------------------
|AUTHOR: |Atkins |
|---------------+-----------------------------------------------|
|VERSION: |May 31, 2016 |
---------------------------------------------------------------
---------------------------------------------------------------
|HEARING DATE: |June 15, 2016 | | |
---------------------------------------------------------------
---------------------------------------------------------------
|CONSULTANT: |Reyes Diaz |
---------------------------------------------------------------
SUBJECT : Health care programs: cancer
SUMMARY : Makes changes to the Breast and Cervical Cancer Early Detection
Program and the Breast and Cervical Cancer Treatment Program
within the Department of Health Care Services regarding
eligibility for screenings, period of treatment, and eligibility
of coverage after reoccurrence of cancer, as specified.
Existing law:
1)Establishes the Medi-Cal program, administered by the
Department of Health Care Services (DHCS), under which
qualified low-income individuals receive health care services.
2)Establishes the Breast and Cervical Cancer Early Detection
Program, administered by DHCS through the Every Woman Counts
(EWC) program, to provide breast and cervical cancer screening
services under the Centers for Disease Control and Prevention
(CDC) grant at the level of funding budgeted from state and
other resources during the fiscal year in which the
Legislature has appropriated funds for this purpose.
3)Establishes the Breast and Cervical Cancer Treatment Program
(BCCTP) to provide coverage for breast and cervical cancer
treatment and services related to cancer diagnosis. Limits the
treatment coverage for breast cancer to a period not to exceed
18 months and for cervical cancer not to exceed 24 months.
Deems an individual's eligibility as having concluded after
the respective limits for each cancer condition have been
reached.
4)Requires a provider or entity that participates in the federal
National Breast and Cervical Cancer Early Detection Program
AB 1795 (Atkins) Page 2 of ?
(NBCCEDP) to provide screening services to an individual only
if the individual's family income has been determined not to
exceed 200% of the federal poverty level.
This bill:
1)Requires individuals to be eligible for breast cancer
screening and diagnostic services through the EWC program if
they meet eligibility requirements and a) are of any age and
"symptomatic," as defined, and b) are within the age range for
routine breast cancer screening, as recommended by the United
States Preventive Services Task Force, subject to any federal
action relating to breast cancer screening that overrides
those recommendations. Defines "symptomatic" as an individual
presenting with an abnormality or change in the look or feel
of the breast, as specified.
2)Deletes the time limits for breast and cervical cancer
treatment, as specified in existing law in 3) above, and
instead requires treatment services to continue for the
duration of the period of treatment, as long as the individual
continues to meet all other eligibility requirements.
3)Requires an individual to be eligible for coverage for the
duration of the period of treatment if diagnosed with a
reoccurrence of breast or cervical cancer, as long as the
individual continues to meet all other eligibility
requirements.
FISCAL EFFECT :
According to the Assembly Appropriations Committee:
1)DHCS has not provided a fiscal estimate for this bill. These
provisions of the bill will result in costs for cancer
treatment funded by state-only dollars:
a) Allowing an individual to remain on the program
longer by deleting the 18- and 24-month limits on the
period of coverage will result in additional months of
eligibility.
b) Specifying an individual is eligible for cancer
treatment for additional cancers at the same cancer site.
This will allow beneficiaries to be eligible for
additional treatment services where they would otherwise
AB 1795 (Atkins) Page 3 of ?
be denied.
c) Allowing screening for symptomatic women under 40
would allow more women to gain eligibility for breast
cancer treatment through the BCCT program.
Staff has estimated this bill could result in costs in the low
millions General Fund in the Fee-For-Service program for
cancer treatment by allowing additional months and courses of
treatment for women who would otherwise not be eligible. For
example, if an additional 1,000 months of treatment are
provided at an average cost of $1,270 per month, costs would
be $1.3 million. Precise costs are difficult to predict based
on limited available data and unknown enrollment take-up.
2)Unclear, potential minor fiscal impact to EWC associated with
the provision requiring screening for symptomatic women under
40. If specifying in statute that screening symptomatic women
under 40 expands the number of women seeking care, staff
estimates additional cost pressure is approximately $100,000
(likely Proposition 99 or Breast Cancer Control funds).
PRIOR
VOTES :
-----------------------------------------------------------------
|Assembly Floor: |77 - 1 |
|------------------------------------+----------------------------|
|Assembly Appropriations Committee: |15 - 4 |
|------------------------------------+----------------------------|
|Assembly Health Committee: |17 - 0 |
| | |
-----------------------------------------------------------------
COMMENTS :
1)Author's statement. According to the author, this bill will
help ensure that women have timely access to life-saving
services to detect and treat cancer early. This bill affects
low-income women in California who are uninsured or
underinsured, and it allows them to complete necessary
treatment for breast and cervical cancer without an arbitrary
deadline to cut-off that critical treatment; it requires that
those in remission for breast and cervical cancer who are
later re-diagnosed with the same cancer not be turned away for
treatment; and it permits those individuals who are
AB 1795 (Atkins) Page 4 of ?
symptomatic for breast cancer to receive necessary breast
cancer screening services.
2)Background. In 1990, the CDC created the NBCCEDP through
Public Law 101-354. This law authorized CDC to grant funds to
states to screen a reasonable number of low income, uninsured
women for breast and cervical cancers, provide referrals for
follow-up and medical treatment for women with abnormal test
results, develop and disseminate information for preventing
breast and cervical cancers, improve the training of health
professionals in preventing these cancers, and monitor the
quality of screening procedures. The mission of the EWC
program is to save lives by preventing and reducing the
devastating effects of cancer through early detection and
diagnostic services. EWC provides free clinical breast exams,
mammograms, pelvic exams, and Pap tests to California's low
income uninsured and underserved women. These screening
services facilitate early detection that may prevent untimely
cancer deaths. Each year, EWC provides care for approximately
300,000 individuals. According to information available on
DHCS's Web site, EWC is funded, in part, by $.01 of the $.02
tax on each pack of cigarettes sold in California that is
allocated to the Breast Cancer Fund (BCF).
The state's BCCTP provides coverage for breast and cervical
cancer treatment and services related to cancer diagnosis.
BCCTP provides treatment coverage for approximately 9,000
individuals each year, through both federal and state funding.
Currently, the state-funded BCCTP is not aligned with the
federally funded BCCTP, causing gaps in service and treatment
for women diagnosed and treated through the state-funded
program. Under California's BCCTP, treatment coverage is
limited to 18 months for breast cancer and 24 months for
cervical cancer. Federal funding provides coverage for the
duration of treatment. State funding also does not allow
coverage to a woman who is re-diagnosed with the same cancer
at the original cancer site while the federally funded program
does.
3)Prior legislation. AB 49 (Buchannan, Chapter 351, Statutes of
2014), established the breast cancer awareness special
interest license plate program to generate funds to raise
awareness of early breast cancer screening. Requires the
proceeds from the license plate sales to be deposited in the
Breast Cancer Control Account to fund EWC programming.
AB 1795 (Atkins) Page 5 of ?
SB 1348 (Cedillo of 2008), would have required DPH to provide
breast cancer screening services to women who are 38 years of
age and older and who meet other eligibility standards for
breast cancer screening services under existing state and
federal law. SB 1248 was held under submission in the Senate
Appropriations Committee.
AB 478 (Friedman, Chapter 660, Statutes of 1993), established
a $.02 tax on each pack of cigarettes sold, with the revenue
deposited in the BCF and the proceeds to be divided equally
between the Breast Cancer Research Account and the Breast
Cancer Control Account.
AB 2055 (Freidman, Chapter 661, Statutes of 1993), established
the Breast Cancer Control Account for purposes of breast
cancer research, detection services, and education. Modified
the allocation of tobacco tax funds so that 50% of the funds
are devoted to research and 50% for early detection services
for uninsured and underinsured women.
4)Support. Supporters of this bill, largely health providers,
advocates, and numerous individuals, argue that the
state-funded BCCT program is not aligned with the federally
funded program, causing gaps in service and treatment for
women diagnosed and treated through the EWC program.
Supporters also argue that while the Affordable Care Act (ACA)
has expanded coverage and reduced California's rate of
uninsured, up to 3.4 million Californians remain uninsured,
and limited benefit packages, such at the EWC and BCCT
programs, continue to be an important resource for that
population. Supporters state that this bill will help ensure
that women have timely access to receive the necessary
services to detect and treatment their cancers early.
5)Opposition. The California Department of Finance (DOF) argues
that this bill creates an ongoing General Fund cost, and the
size of the population that will benefit from this expansion
is indeterminate. DOF states that with the implementation of
the ACA and the optional expansion of Medi-Cal, individuals
have greater access to preventive cancer screenings and
treatment.
SUPPORT AND OPPOSITION :
Support: Susan G. Komen (sponsor)
AB 1795 (Atkins) Page 6 of ?
American Cancer Society Cancer Action Network
American Congress of Obstetricians and Gynecologists
(ACOG-IX), District IX (California)
American Federation of State, County and Municipal
Employees
Association of California Healthcare Districts
Barbells for Boobs
Black Women for Wellness
Brown Temple Christian Methodist Episcopal Church
California Academy of PAs
California Association for Nurse Practitioners
CaliforniaHealth+ Advocates
California Health Collaborative
California Life Sciences Association
California National Organization for Women
California Nurses Association
California Radiological Society
California Society of Plastic Surgeons
Cambodian Family Community Center
Cancer Support Community Benjamin Center
Cancer Support Community San Francisco Bay Area
Carrie's TOUCH
Central City Community Health Center
County Health Executives Association of California
Doctors for America
Health Access
Health Center Partners of Southern California
Hope Wellness Center
Johnson Chapel African Methodist Episcopal Church
Junior Leagues of California
MANA de San Diego
North Orange County Regional Health Foundation
Orange County Women's Health Project
Planned Parenthood Affiliates of California
Planned Parenthood Orange and San Bernardino Counties
Sacramento Community Cancer Coalition
Samoan National Nurses Association
Serve the People Community Health Center
Shanti
St. Mary Medical Center Foundation
Numerous Individuals
Oppose:California Department of Finance
-- END --
AB 1795 (Atkins) Page 7 of ?