BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                    AB 1823


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          Date of Hearing:  April 27, 2016


                        ASSEMBLY COMMITTEE ON APPROPRIATIONS


                               Lorena Gonzalez, Chair


          AB  
          1823 (Bonilla) - As Amended April 12, 2016


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          Urgency:  No  State Mandated Local Program:  NoReimbursable:  No


          SUMMARY:


          This bill requests the University of California (UC) establish  
          and designate a nonprofit public benefit corporation with the  
          authority to solicit and receive funds from business, industry,  
          foundations, and other private and public sources for the  
          purpose of administering the Cancer Clinical Trials Program (the  
          program) to increase patient access to cancer clinical trials.    
          Specifically, this bill:









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          1)Allows the program administrator to solicit and receive funds  
            from business, industry, foundations, research organizations,  
            government agencies, individuals, and other private and public  
            sources, to be deposited in a fund established by the program  
            administrator for these purposes. 


          2)Requires that the UC be reimbursed from the fund for any money  
            allocated by the UC to establish and operate the program. 


          3)Requires a board, upon receipt of $500,000 funding, to  
            establish the program to increase patient access to cancer  
            clinical trials in underserved or disadvantaged communities  
            and populations, including among women and patients from  
            racial and ethnic minority communities. 





          4)Requires the board to determine the criteria to award grants,  
            and authorize grants to be awarded to either research  
            institutions or nonprofits. 



          5)Requires grants to be used for activities to increase patient  
            access to cancer clinical trials, including, but not limited  
            to: patient navigator services or programs; education and  
            community outreach; translation and interpretation services of  
            clinical trial information; patient-friendly technical tools  
            to assist patients in identifying available clinical trials;  
            payment of ancillary costs for patients and caregivers.



          6)Authorizes the UC to terminate the program if it determines  
            that moneys in the fund are insufficient to establish or  
            sustain the program. Specifies that all moneys in the fund  







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            (after repayment of expenses) must be distributed to  
            appropriate organizations before such dissolution. 

          7)Requires that if the fund has not received $500,000 by January  
            1, 2021, then all moneys (after repayment of startup expenses)  
            shall be returned to the donors on a pro rata basis.


          


          FISCAL EFFECT:


          1)One-time costs in the range of $500,000 to establish the  
            nonprofit foundation, develop grant guidelines, provide  
            initial administrative support to the foundation, and begin  
            the program (GF or other unknown public and private funds).   
            Any costs to UC would be reimbursed by the fund specified in  
            the bill.  



          2)Unknown annual cost pressure to award grants and provide  
            administrative support to the new foundation (GF or other  
            unknown public and private funds). The amount of grant funding  
            the foundation will be able to award will depend on future  
            donations, as will the level of administrative support needed  
            to award the grants and manage the foundation.  Given the  
            types of direct services that the grants are expected to fund,  
            it is reasonable to assume the level of funding required to  
            make this a meaningful program would be in the millions  
            annually. 


          COMMENTS:


          1)Purpose. This bill is intended to improve the diversity of  
            patients participating in FDA-approved cancer clinical trials.  







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             The author asserts underrepresentation of certain ethnic and  
            socioeconomic groups will be addressed by creating a privately  
            funded state grant program to help patients pay for the  
            ancillary costs associated with participation in these trials.  
             The bill is supported by oncologists, the California Chronic  
            Care Coalition, Health Access California, and other groups,  
            and has no opposition. 


          2)Background. Clinical trials are a critical step in the  
            discovery of new prevention, diagnostic, and treatment methods  
            for cancer.  Racial and ethnic minorities, older adults, rural  
            residents, and individuals of lower socioeconomic status are  
            underrepresented among participants in cancer-related trials.   
            Without adequate representation of these populations in  
            clinical trials, researchers cannot learn about potential  
            difference among groups and cannot ensure the generalization  
            of results.  In addition, participation in clinical trials  
            increases access to state-of-the-art cancer care. 


            Barriers to participation include lack of awareness,  
            language/linguistic differences, mistrust, practical  
            obstacles, public misconception, and physician lack of  
            awareness.


          3)Prior legislation.  AB 1060 (Bonilla) of 2015, was similar to  
            this bill, but housed the program within the California Health  
            and Human Services Agency (CHHSA).  It was vetoed by Governor  
            Brown, stating "[n]umerous private organizations already  
            perform this fundraising function. While I support eliminating  
            barriers to take part in clinical trials, I am hesitant to  
            place this new burden on the [CHHSA] which is managing a huge  
            expansion of our health care system."  This bill establishes  
            the program in the UC instead of within a state agency. 


          4)Staff Comments. It appears the intent of the bill is that the  
            program be privately funded through donations. The author may  







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            wish to clarify that the program is not envisioned to be  
            funded by the state. 


          Analysis Prepared by:Lisa Murawski / APPR. / (916)  
          319-2081