BILL ANALYSIS Ó
AB 1795
Page 1
(Without Reference to File)
CONCURRENCE IN SENATE AMENDMENTS
AB
1795 (Atkins)
As Amended August 24, 2016
Majority vote
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|ASSEMBLY: |77-1 |(June 2, 2016) |SENATE: |35-0 |(August 17, |
| | | | | |2016) |
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Original Committee Reference: HEALTH
SUMMARY: Changes provisions of the Every Woman Counts program
(EWC) and the Breast and Cervical Cancer Treatment program
(BCCTP) within the Department of Health Care Services (DHCS)
regarding eligibility for screenings, period of treatment, and
eligibility of coverage after reoccurrence of cancer.
Specifically, this bill:
1)Requires DHCS to provide breast cancer screening and
diagnostic services to individuals that meet existing
eligibility requirements and are either symptomatic, as
defined, or whose age is within the range for routine breast
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cancer screening, as recommended by the United States
Preventative Services Task Force (USPSTF), subject to federal
action relating to breast cancer screening that overrides
those recommendations.
2)Deletes existing limits on the period of coverage for
treatment of breast cancer (18 months) and cervical cancer (24
months) and instead requires coverage for both cancers to
remain for the duration of treatment, as long as the
individual continues to meet all other eligibility
requirements.
3)Requires that a patient be eligible for an additional period
of treatment coverage if diagnosed with a reoccurrence of
breast cancer or cervical cancer for both new cancer sites or
the same cancer site, as long as the individual continues to
meet all other eligibility requirements.
The Senate amendments
1)Restore the definition of period of coverage to current law.
2)Delete provisions requiring the period of coverage for breast
and cervical cancers to remain for the duration of treatment,
as long as the individual continues to meet all other
eligibility requirements and restore existing limits on the
period of coverage for treatment of breast cancer to 18 months
of treatment and cervical cancer to 24 months of treatment.
FISCAL EFFECT: According to the Senate Appropriations
Committee:
1)Likely one-time administrative costs of $150,000 to $300,000
to update regulations and make necessary changes to billing
systems (General Fund). DHCS will likely need to make changes
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to existing program regulations and systems for processing
claims (for example, no longer denying claims due to the
length of treatment time).
2)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.
3)Potential increased costs, up to $2 million per year, to
increase eligibility for cancer screening services in the EWC
program to symptomatic women less than 40 years of age
(Proposition 99 funds, federal funds, General Fund). Current
law does not limit participation in the EWC 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 less than 40 years of
age, staff estimates those potential additional costs being up
to $2 million per year. The EWC 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 EWC program is not an entitlement, the state
would not be obligated to appropriate additional funding.)
COMMENTS: According to the author, this bill is needed to
ensure that women have timely access to receive the necessary
services to detect and treat their cancers early. The author
asserts that changes are needed to allow low-income women in
California who are uninsured or underinsured to receive complete
treatment for breast and cervical cancer, provide that she is
not turned away if she is later diagnosed with the same cancer,
and allow women under age 40 who are symptomatic for breast
cancer to receive necessary screening services.
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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. EWC is funded, in part, by
$.01 of the tax on each pack of cigarettes sold in California.
The BCCTP provides cancer treatment and services for eligible
low-income California residents who are screened by the EWC or
Family Planning, Access, Care and Treatment program and found to
be in need of treatment for breast and/or cervical cancer.
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 the state
BCCTP, treatment coverage is limited to 18 months for breast
cancer and 24 months for cervical cancer, while federal funding
has no time limit and remains in effect for the duration of
treatment. State-funding for BCCTP 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.
As of January 2016, the USPSTF recommends, with a B grade,
biennial screening mammography for women aged 50 to 74 years.
USPSTF also recommends, with a C grade, that the decision to
start screening mammography in women prior to age 50 years
should be an individual one. Women who place a higher value on
the potential benefit than the potential harms may choose to
begin biennial screening between the ages of 40 and 49 years.
According to Susan G. Komen California Affiliates, sponsor of
the bill, changes in the EWC and BCCTP specified in this bill
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will ensure that women have timely access to necessary services
to detect and treat their cancers early. Health Access states
that despite expansion of Medi-Cal under the Patient Protection
and Affordable Care Act and subsidized health coverage through
Covered California, many low income Californians remain
uninsured and under-insured; limited benefit programs such as
BCCTP and EWC continue to be an important resource for them.
There is no known opposition to this bill.
Analysis Prepared by:
Paula Villescaz / HEALTH / (916) 319-2097 FN:
0004889 0003276