BILL ANALYSIS                                                                                                                                                                                                    Ó



          SENATE COMMITTEE ON EDUCATION
                              Senator Carol Liu, Chair
                                2015 - 2016  Regular 

          Bill No:             AB 1823            
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          |Author:    |Bonilla                                              |
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          |Version:   |June 23, 2016                            Hearing     |
          |           |Date:    June 29, 2016                               |
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          |Urgency:   |No                     |Fiscal:    |Yes              |
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          |Consultant:|Kathleen Chavira                                     |
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          Subject:  California Cancer Clinical Trials Program


            SUMMARY
          
          This bill requests the University of California (UC) to  
          establish a board representing institutions and individuals  
          performing, participating in and supporting eligible cancer  
          clinical trials in California to solicit and receive funds from  
          federal or private sources for the California Cancer Clinical  
          Trials Program, as specified, to provide grants to increase  
          patient access to eligible cancer clinical trials in underserved  
          or disadvantaged communities, as specified.

            BACKGROUND
          
          The California Constitution establishes the UC, a public trust  
          to be administered by the Regents of the UC and grants the  
          Regents full powers of organization and government, subject only  
          to such legislative control as may be necessary to insure  
          security of its funds, compliance with the terms of its  
          endowments, statutory requirements around competitive bidding  
          and contracts, sales of property and the purchase of materials,  
          goods and services.  (Article IX, Section (9)(a) of the  
          California Constitution)

            ANALYSIS
          
          This bill establishes the California Cancer Clinical Trials  
          Program. It:







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          1)   Requests the UC to:
                
                    a)             Establish or designate an institute or  
                    office with the university to administer the program.

                    b)             Establish the Board of Trustees of the  
                    California Cancer Clinical Trials Program, as  
                    specified, to represent institutions and individuals  
                    performing, participating in and supporting eligible  
                    cancer clinical trials in California.

                    c)             Publicize the opportunity to submit  
                    nomination for board membership.

                    d)             Publicize the availability of grants  
                    that are available through the Program to  
                    organizations, as specified. 



          2)   Establishes requirements for the board of the program.  It:

                    a)             Requires that appointees to the board  
                    have an interest ability and desire to solicit funds  
                    for purpose of increasing and diversifying access to  
                    clinical trials. 

                    b)             Requires that board members serve  
                    without compensation but be reimbursed for expenses,  
                    as specified. 

          3)   Provides for the use of funds for administrative costs by  
               authorizing adjustment of these costs based on the size of  
               the program and funds received and caps the amount allowed  
               for these costs at 20 percent of funds received cover the  
               costs of administration. 

          4)   Authorizes the University of California (UC) to:

                    a)             Participate as the program  
                    administrator, a beneficiary, or both.

                    b)             Pursue any approvals, authorizations,  








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                    or advice it deems necessary prior to establishing the  
                    program.

                    c)             Decline to establish or participate in  
                    the program.

                    d)             Terminate the program if it is  
                    determined not viable. 

          5)   Authorizes the program administrator to solicit funds, as  
               specified, for the purposes of program administration or  
               awarding grant awards, limits funds for administration to  
               those received from federal or private sources and  
               authorizes the UC to use state source funds for  
               administration and oversight of the program, provided the  
               UC is reimbursed from these sources, and makes  
               implementation of the program contingent upon the receipt  
               of at least $500,000 in funding for this purpose. 

          6)   Requires reimbursement for any resources allocated by the  
               UC for purposes of the program prior to the distribution of  
               any grants. 

          7)   Requires the board to determine criteria to award and  
               administer grants, outlines those entities authorized to be  
               granted awards, encourages consideration of groups that  
               meet specified criteria and outlines the uses of grant  
               awards.

          8)   Authorizes the program administrator to require reporting  
               by grantees, as specified. 

          9)   Authorizes the UC to terminate the program if it determines  
               funds are insufficient to establish/sustain it, authorizes  
               the program administrator to dissolve the program if  
               $500,000 is not received by January 1, 2021, or if the  
               administrative cap of 20 percent is determined to be  
               inadequate.

          10)  Requires that money remaining in the fund after payment of  
               expenses be allocated to an organization that meets the  
               qualifications of a grant recipient as outlined in the  
               bill.  









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          11)  Clarifies that nothing in the bill's provisions precludes  
               the UC from establishing or operating other similar  
               programs under specified federal regulations. 

          STAFF COMMENTS
          
          1)   Need for the bill.  According to the author, this bill  
               seeks to remedy the problem of low patient participation in  
               FDA-approved cancer clinical trials.  More importantly, it  
               is an effort to address the disproportionately low number  
               of patients from underrepresented communities including  
               African Americans, Latinos/Hispanics, Asians and Pacific  
               Islanders, and American Indians. The author contends that  
               nationwide, only 3 percent of eligible cancer patients  
               participate in clinical trials and of those, only 5 percent  
               are from these underrepresented communities.   According to  
               the author, barriers to participation include a lack of  
               awareness, mistrust of research and the medical system,  
               loss of income, and transportation and lodging costs.   
               These ancillary costs of participation fall onto the  
               clinical trial participant who may be unable to pay, and  
               therefore unable to enroll in the trial.  

               This bill proposes to address this issue by creating a  
               privately funded grant program through the University of  
               California (UC) to assist patients in paying for the  
               ancillary costs associated with participation in these  
               trials.  

          2)   Impact on UC and state funds? This bill requires that funds  
               for program administration and grant awards come from  
               federal and private sources. It also authorizes the UC to  
               use state source funds for administration and oversight of  
               the program, provided the UC is reimbursed from federal or  
               private sources.  According to the author, the UC has  
               already expended state funds for purposes of gaining  
               permission from federal regulators and engaging in other  
               administrative activity to establish the program and these  
               provisions are intended to authorize reimbursement of the  
               funds used for these purposes.  There is no intent to use  
               state funds for any ongoing administrative or oversight  
               expenses.  

               Staff recommends the bill be amended on page 7 lines 19-21  








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               to clarify that these provisions apply to "start-up"  
               oversight and administration costs only.   

               Staff notes that the bill authorizes up to 20 percent of  
               funds to be used for administrative costs.  State funded  
               programs typically authorize up to 5 percent of funding for  
               these costs. The 20 percent figure combines all  
               administrative costs (direct, indirect, and administrative)  
               into one.  According to the UC, administrative costs for  
               research programs typically run greater than 20 percent and  
               this cap would be among the lowest in the state for  
               research program administration.  

               Staff also notes that the UC is authorized to establish,  
               decline to establish or participate, or terminate the  
               program.  According to the author, the intent of the bill  
               and for the program is that, once established, the program  
               will operate exclusively on private or federal funds. If  
               the program does not collect sufficient funding to continue  
               operation of the program using private or federal funds,  
               the University is under no obligation to continue program  
               operations. The language in the bill is explicit about the  
               UC's ability to determine whether or not to establish or  
               terminate the program, to ensure the University will not be  
               compelled to expend state-sourced dollars in operation of  
               the program.

          3)   Prior legislation. AB 1060 (Bonilla, 2015) proposed  
               establishment of the Cancer Clinical Trials Foundation in  
               the Health and Human Services Agency, to be governed by a  
               board of trustees, to administer a grant program  
               substantively similar to that proposed by this bill.  AB  
               1060 was vetoed in October 2015, by the Governor whose  
               message read, in pertinent part:

                    "Numerous 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 Health and Human Services Agency which is  
                    managing a huge expansion of our health care  
                    system."
               
            SUPPORT








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          Association of California Healthcare Districts 
          Susan G. Komen California Collaborative

            OPPOSITION
           
           None received. 


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