BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: SB 613
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|AUTHOR: |Allen |
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|VERSION: |April 20, 2015 |
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|HEARING DATE: |April 29, 2015 | | |
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|CONSULTANT: |Scott Bain |
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SUBJECT : Department of Public Health: dementia guidelines:
workgroup.
SUMMARY : Requires the Department of Public Health (DPH) to
convene a workgroup to update the 2008 Guidelines for
Alzheimer's Disease Management in California to address changes
in the health care system, and requires DPH to submit a report
of the updates and recommendations from the working group to
the Legislature on or before March 1, 2017.
Existing law:
1.Requires the California Health and Human Services Agency to
establish an Alzheimer's Disease and Related Disorders
Advisory Committee consisting of 14 members, and requires the
Committee to:
a. Provide ongoing advice and assistance to the
Administration and the Legislature as to the program
needs and priorities of the target population.
b. Provide planning support to the Administration
and the Legislature by updating recommendations of the
1987 California Alzheimer's Disease Task Force Report
and regularly reviewing and updating recommendations
as needed.
2.Requires DPH to provide public and professional education on
Alzheimer's disease to educate consumers, caregivers, and
health care providers, and to increase public awareness.
This bill:
1.Requires DPH to convene a workgroup to update the 2008
Guidelines for Alzheimer's Disease Management in California to
SB 613 (Allen) Page 2 of ?
address changes in the health care system, including, but not
limited to, changes in the federal Patient Protection and
Affordable Care Act (ACA), Medicaid, and Medicare.
2.Permits these updates to further draw on evidence-based,
peer-reviewed research and lessons learned from demonstration
and pilot projects.
3.Requires the workgroup to consist of members determined by
the DPH, and permits the workgroup to include
multidisciplinary experts in Alzheimer's disease detection,
diagnosis, treatment, and support.
4.Requires DPH to submit a report of the updates and
recommendations from the working group to the Legislature on
or before March 1, 2017.
5.Makes legislative findings and declarations that:
a. There are between an estimated 60,000 to
85,000 people with dementia in California's
Coordinated Care Initiative;
b. The average per person Medicaid spending for
seniors dually eligible for Medicare with Alzheimer's
disease and other dementias is 19 times higher than
average per person Medicaid spending for all other
seniors;
c. The triple aim of the federal ACA and Medicaid
expansion is improved population health, better
experience of care, and lower per capita health care
costs; and,
d. Dementia care management has proven,
through peer-reviewed, evidence-based
research, to achieve all three aims.
6.Sunsets this bill on January 1, 2018.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1.Author's statement. According to the author, Alzheimer's
disease is a public health crisis in California, but unlike
other public health concerns there is no known cause, cure or
prevention to reduce the impact on individuals, families,
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communities and our state's public programs such as Medi-Cal
and IHSS. The author states we've seen a 42 increase increase
in just the last decade. Experts agree that managing the
course of Alzheimer's disease after a diagnosis is the best
public health strategy we have available today. This bill
proposes a statewide working group under the leadership of
DPH, drawing on the existing resources and expertise of our
state's 10 university-affiliated Alzheimer's Disease Centers.
The author states the state's own experts will update the
physician Guideline for Alzheimer's Disease Management to
systematically improve quality of care, better manage complex
patient populations, and lower public costs associated with
Medi-Cal-funded hospital stays and nursing home placements.
The author concludes that when someone in California learns
they have Alzheimer's, there should be evidence-based, up to
date, guidelines for physicians to follow to ensure the
patients receive the care and support they need.
2.Alzheimer's disease. According to the federal National
Institute on Aging (NIA), Alzheimer's disease is an
irreversible, progressive brain disease that slowly destroys
memory and thinking skills, and eventually even the ability to
carry out the simplest tasks. In most people with Alzheimer's,
symptoms first appear after age 65. Plaques and tangles in the
brain are two of the main features of Alzheimer's disease. The
third is the loss of connections between nerve cells (neurons)
in the brain. Although treatment can help manage symptoms in
some people, currently there is no cure for this disease.
Estimates vary, but experts suggest that as many as five
million Americans age 65 and older may have Alzheimer's
disease.
Alzheimer's disease is the most common cause of dementia among
older people. Dementia is the loss of cognitive
functioning-thinking, remembering, and reasoning-and
behavioral abilities, to such an extent that it interferes
with a person's daily life and activities. Dementia ranges in
severity from the mildest stage, when it is just beginning to
affect a person's functioning, to the most severe stage, when
the person must depend completely on others for basic
activities of daily living.
3.2008 Guidelines for Alzheimer's Disease Management. The
"Guideline for Alzheimer's Disease Management - California
Workgroup on Guidelines for Alzheimer's Disease Management
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Final Report 2008" was published to update and expand previous
guidelines issued in 2002 and 1998. The 1998 effort was paid
for through a Health Resources and Services Administration
grant. The guidelines were based upon work begun by the Ad Hoc
Standards of Care Committee of the Alzheimer's Disease
Diagnostic and Treatment Centers (ADDTCs) of California and
were supported in part by the State of California, Department
of Health Services, and the Alzheimer's Association,
California. Southland Chapter. The California Council of the
Alzheimer's Association sponsored the Alzheimer's Disease
Education Initiative (ADEI) and secured a one-time $2.4
million budget augmentation in FY 2000-01 to launch a public
education campaign centered on the Guidelines for Alzheimer's
Disease Management. The funds from the ADEI were used to pay
for the 2002 update.
The 2008 Guidelines state that most older adults, including
those with Alzheimer's Disease, receive their medical care
from Primary Care Practitioners (PCPs) who may lack the
information and other resources they need to treat this
growing and demanding population. The 2008 Guideline was s
intended to provide assistance to PCPs in offering
comprehensive care to patients with Alzheimer's Disease and
those who care for them over the course of their illness. The
Guideline's recommendations are organized by major care issues
(assessment, treatment, patient and family education and
support, and legal considerations). Each section of the
guidelines deals with one of the four care issues and provides
an overview of the issue, followed by the care recommendations
and a review of the literature supporting them. The language
used throughout the report reflects the strength of the
supporting evidence, either "strong" (e.g., randomized
clinical trial) or "moderate." In some instances,
recommendations that are not evidence-based are nevertheless
supported by expert opinion and workgroup consensus, and are
labeled as such.
4.Support. This bill is sponsored by the Alzheimer's Association
to update California's physician Guideline for Alzheimer's
Disease Management to improve quality of care and support for
individuals diagnosed with dementia, manage complex, costly
populations in our health care delivery system, and reduce
individual, family and government health care costs. The
Alzheimer's' Association states this bill draws on the
existing resources and expertise within DPH's ten
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university-affiliated Alzheimer's Disease Centers to review
and analyze evidence in support of a state-of-the-art
guideline for Alzheimer's disease management.
Under this bill, DPH will convene a statewide workgroup to make
recommendations in the areas of assessment, treatment, patient
and family education, and legal considerations such as
advanced care planning. Physicians and key stakeholders will
develop a 2016 guideline for release to the Legislature and
for dissemination to PCP, medical groups, health plans and
hospitals for voluntary adoption. The Alzheimer's Association
states that Medi-Cal beneficiaries with a diagnosis of
Alzheimer's disease have 19 times higher costs than those
without a cognitive impairment. Likewise, patients with
dementia use hospitals and nursing facilities at more than
triple the rate without Alzheimer's. The Alzheimer's
Association writes that the development of a physician
Guideline for Alzheimer's Disease Management advances public
policy for patients, physicians and government payors.
SUPPORT AND OPPOSITION :
Support: Alzheimer's Association (sponsor)
California Commission on Aging
Leading Age California
Oppose: None received
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