BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 1795 (Atkins) - Health care programs: cancer
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|Version: May 31, 2016 |Policy Vote: HEALTH 9 - 0 |
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|Urgency: No |Mandate: No |
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|Hearing Date: August 1, 2016 |Consultant: Brendan McCarthy |
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This bill meets the criteria for referral to the Suspense File.
Bill
Summary: AB 1795 would change the eligibility requirements and
benefit limits for the Every Woman Counts Program and the Breast
and Cervical Cancer Treatment Program.
Fiscal
Impact:
Likely one-time administrative costs of $150,000 to $300,000
to update regulations and make necessary changes to billing
systems (General Fund). The Department of Health Care Services
will likely need to make changes to existing program
regulations and systems for processing claims (for example, no
longer denying claims due to the length of treatment time).
Increased program expenditures in the millions due to extended
eligibility for services in the Breast and Cervical Treatment
Program (General Fund). Under current law, treatment in this
program is limited to 18 months for breast cancer and 24
months for cervical cancer. By deleting the existing time
limits, the bill will allow beneficiaries to access services
for a longer period of time. The Department has not been able
AB 1795 (Atkins) Page 1 of
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to provide information on how many women are being denied
coverage because they have reached the time limits on
coverage. Typically, clinical guidelines for breast cancer
indicate treatment lasts between 12 and 18 months. Assuming
that 10% to 25% of program participants exceed the existing
timelines and using existing caseloads and program costs,
staff estimates that annual costs will likely range between $7
million $17 million per year. The portion of the program that
has time limits being eliminated in this bill is fully funded
from the General Fund.
Ongoing costs of about $200,000 per year from providing
eligibility for the Breast and Cervical Treatment Program for
reoccurring cases of cancer (General Fund). In recent years,
about 20 women per year were denied coverage because the
cancer was a reoccurrence of a previously treated cancer.
Potential increased costs, up to $2 million per year, to
increase eligibility for cancer screening services in the
Every Woman Counts program to symptomatic women under 40 years
of age (Proposition 99 funds, federal funds, General Fund).
Current law does not limit participation in the Every Woman
Counts program based on age. It is not clear whether
symptomatic women who are under 40 years of age are currently
being denied services. To the extent that they are, and this
bill eliminates that limitation, there would be costs to the
state. Based on the reported incidence of cancer in women
under 40 years of age, staff estimates those potential
additional costs being up to $2 million per year. The Every
Woman Counts program is currently funded with Proposition 99
Tobacco Tax funds and federal funds. To the extent that there
are additional costs and those funds are not sufficient to pay
for increased costs, there would be pressure to appropriate
General Fund for this purpose. (Because the Every Woman Counts
program is not an entitlement, the state would not be
obligated to appropriate additional funding.)
Background: Under current law, the Department of Health Care Services
operates the Every Woman Counts program to provide breast and
cervical cancer screening services to women who are not eligible
for Medi-Cal. This program is funded with federal grant funds
and Proposition 99 tobacco tax funds. The Every Woman Counts
program is not an entitlement, and services are only available
AB 1795 (Atkins) Page 2 of
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to the extent that funding is appropriated in the annual Budget
Act. Current law does not explicitly limit coverage by
beneficiary age. About 300,000 women receive screening services
from this program each year.
Under current law, the Department also operates the Breast and
Cervical Cancer Treatment Program. This program provides
treatment for breast and cervical cancers to women who do not
have other health care coverage or who have private health care
coverage, but the treatments are unaffordable under that
coverage (e.g. due to high costs-sharing). There are two parts
of the Program. The federal government provides funding to the
state to provide full-scope Medi-Cal services (at an enhanced
matching rate of 65%) for women who are not otherwise eligible
for Medi-Cal. In addition, the state operates a state-only
version of the program for women who are not eligible for
federal funds (generally undocumented women or those with other
health care coverage with high out-of-pocket costs). The
state-only program includes limitations on coverage. Under
current law, beneficiaries are only eligible for state-only
coverage for 18 months for breast cancer treatment or 24 months
for cervical cancer treatment. Although current law is not
explicit, state policy has been to deny coverage for
reoccurrences of cancer when an individual has exceeded the time
limits. The state-only Program is funded from the General Fund.
In total the Breast and Cervical Cancer Treatment Program
provides services to about 9,000 women per year.
Proposed Law:
AB 1795 would change the eligibility requirements and benefit
limits for the Every Woman Counts Program and the Breast and
Cervical Cancer Treatment Program.
Specific provisions of the bill would:
Specify that eligibility for screening under the Every Woman
Counts program includes individuala of any age who are
symptomatic or individuals within the age range for routine
breast cancer screening as recommended by the United States
Preventative Services Task Force, subject to any federal
action overriding those recommendations;
Delete the existing specific periods of coverage in the Breast
and Cervical Cancer Treatment Program and instead require
services to be covered for the duration of the period of
AB 1795 (Atkins) Page 3 of
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treatment;
Allow eligibility for treatment for a reoccurrence of breast
cancer or cervical cancer.
Staff
Comments: Cost estimates provided by the Department of Health
Care Services are significantly higher than the staff estimates
above. The Department's fiscal estimates imply that 50% of
participants in the program are being denied coverage because
they have reached the statutory time limits. However, the
Department has not been able to provide claims data or other
information to document this assumption. Given that the clinical
guidelines for breast cancer generally indicate a period of
treatment between 12 months and 18 months, it is not clear why
this program would have such a high percentage of participants
requiring treatment beyond the existing time limits.
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