BILL ANALYSIS Ó
SB 613
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Date of Hearing: June 30, 2015
ASSEMBLY COMMITTEE ON HEALTH
Rob Bonta, Chair
SB
613 (Allen) - As Amended April 20, 2015
SENATE VOTE: 40-0
SUBJECT: State Department of Public Health: dementia
guidelines: workgroup.
SUMMARY: Requires the Department of Public Health (DPH) to
convene and appoint the members of a workgroup to update the
2008 Guidelines for Alzheimer's Disease Management in California
to address changes in the health care system. Requires DPH to
submit a report on the workgroup updates and recommendations to
the Legislature on or before March 1, 2017.
EXISTING LAW:
1)Establishes DPH, which oversees various public health
programs, including programs related to genetic diseases such
as Alzheimer's Disease.
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2)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; and,
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.
3)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.
FISCAL EFFECT: According to the Senate Appropriations
Committee, minor costs to provide support to the workgroup.
COMMENTS:
1)PURPOSE OF THIS BILL. 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,
communities, and our state's public programs such as Medi-Cal
and In-Home Supportive Services. The author states that there
has been a 42% increase in Alzheimer's diagnosis in just the
last decade.
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The author further states that experts agree 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 the DPH,
drawing on the existing resources and expertise of our state's
10 university-affiliated Alzheimer's Disease Centers. 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)BACKGROUND.
a) Alzheimer's disease. California's aging population is
growing rapidly and also becoming more racially and
culturally diverse. The population of individuals over age
65 will increase by 27% for young retirees (aged 65-74) and
10% for mature retirees (aged 75-84) by the year 2017.
Additionally, the number of adults with disabilities in
California is expected to grow by approximately 20% in the
next 20 years. Alzheimer's disease and other dementias are
on the rise and projected to affect an estimated 1.1
million Californians by 2030. 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,
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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.
b) 2008 Guidelines for Alzheimer's Disease Management. The
"Guideline for Alzheimer's Disease Management - California
Workgroup on Guidelines for Alzheimer's Disease Management
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 fiscal year 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
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growing and demanding population. The 2008 Guideline was
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.
c) Select Committee on Long-term Care and Aging Report.
The Select Committee on Aging and Long Term Care's
published a 2014 report, "A Shattered System: Reforming
Long Term Care in California".
i) The Patient Protection and Affordable Care Act
(ACA): The ACA presents opportunities to improve long
term care (LTC), concurrently creating and strengthening
linkages between medical care and supportive services.
Critical reforms spelled out in the ACA include the
establishment of the Center for Medicare and Medicaid
Innovation and the Federal Coordinated Health Care Office
(informally known as the "Office of the Duals"). These
ACA provisions create the space to test ideas that can
lead to improvements in coordination across the multiple
payment and delivery systems, including mechanisms to
break through regulatory barriers and integrate funding
sources and mitigate fragmentation in the current system.
Efforts to transform payment and delivery system models
also offer the promise to expand beyond a narrow Medi-Cal
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scope of practice toward connecting older adults in need
of LTC to supportive services in their community.
ii) The Coordinated Care Initiative (CCI): California's
CCI reflects a new approach to delivering services
whereby Medi-Cal managed care entities maintain
responsibility for delivering both health and LTC
services. This new model of care requires the medical
community, supportive service providers, and health plans
to change how they do business and develop the skills to
deliver person-centered, coordinated services. Through
the CCI, the state contracts with Medi-Cal managed care
plans to administer an array of services across the
medical and LTC systems, with an incentive to avoid
institutional care whenever possible. The CCI is being
implemented in seven counties, starting with San Mateo,
which began on April 1, 2014; other counties include Los
Angeles, Orange, Riverside, San Bernardino, San Diego,
and Santa Clara.
3)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 10
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. The Alzheimer's
Association further 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 concludes that the development of a physician
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Guideline for Alzheimer's Disease Management advances public
policy for patients, physicians and government payors.
The National Association of Social Workers - California Chapter,
and the American Federation of State, County and Municipal
Employees, AFL-CIO state in support of the bill that currently
over 60,000 people with dementia are enrolled in California's
Coordinated Care Initiative. Supporters further state that
the Medicaid cost of care for seniors with Alzheimer's disease
and other dementias is 19 times higher than the average per
person spending for all seniors. Supporters conclude that
dementia care management has been proven to improve the
affected population's health, provide a better experience of
care, and lower per capita health care costs.
4)PREVIOUS LEGISLATION.
a) AB 1744 (Brown) of 2014 proposed to require, until
January 1, 2018, the California Department of Aging to
establish a blue-ribbon task force comprised of at
least 13 members, as specified, to make legislative
recommendations to improve services for unpaid and
family caregivers. AB 1744 was vetoed by the
Governor, who stated:
"The California State Plan on Aging, the California Plan
for Alzheimer's Disease, the significant reports and
action plans developed by the 33 Area Agencies on
Aging, the Alzheimer's Association, the AARP and so
many others have produced ample evidence for
knowledgeable and caring people to recommend ways to
improve support for family caregivers. Establishing
another task force in state law simply isn't
necessary."
b) SB 491 (Alquist), Chapter 339, Statutes of 2008,
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established California's State Plan for Alzheimer's
Disease under the CA Health and Human Services Agency.
The State Plan called for an update to the 2008
physician Guideline and made physician education a top
priority for California.
5)DOUBLE REFERRAL. This bill is double referred; upon
passage in this Committee, this bill will be referred to
the Assembly Committee on Aging and Long-Term Care.
REGISTERED SUPPORT / OPPOSITION:
Support
Alzheimer's Association (sponsor)
American Federation of State, County and Municipal Employees,
AFL-CIO
California Commission on Aging
Leading Age California
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Opposition
None on file.
Analysis Prepared by:Paula Villescaz / HEALTH / (916)
319-2097