BILL ANALYSIS Ó
SB 613
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Date of Hearing: July 14, 2015
ASSEMBLY COMMITTEE ON AGING AND LONG-TERM CARE
Cheryl Brown, Chair
SB
613 (Allen) - As Amended July 6, 2015
SENATE VOTE: 40-0
SUBJECT: State Department of Public Health: dementia
guidelines: workgroup.
SUMMARY: Makes legislative findings describing the public costs
of Alzheimer's disease (AD), and the public benefits of
peer-reviewed, evidence-based research to inform Alzheimer's
disease management; directs the Department of Public Health
(DPH) to convene a "workgroup" to update the physician
" Guidelines for Alzheimer's Disease Management (April, 2008);"
and, requires the Department to report those updates to the
Legislature by March 1, 2017. Specifically, this bill:
1)Makes Legislative findings and declarations that:
a. Approximately 60,000 to 85,000 people enrolled in the
Coordinated Care Initiative (CCI) pilot project suffer from
dementia;
b. The costs of individuals who are dually eligible for
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Medicare (aged 65+ or disabled for 2+ years) and Medi-Cal
(generally, income below 138% of the Federal Poverty
Level/FPL) is nineteen times higher than average spending
for all others on Medi-Cal who are 65 years of age or
older;
c. The three overlapping goals of the CCI, the Patient
Protection and Affordable Care Act/P.L. 111-148 (ACA), and
Medicaid (Medi-Cal) are improved health, better care, and
lower costs; and,
d. Peer-reviewed and evidence-based research proves that
dementia care management achieves each of the three goals.
2)Directs DPH to convene a workgroup consisting of members
determined by the department, including but not limited to
experts in Alzheimer's disease detection, diagnosis, treatment
and support.
3)Sunsets the provisions of the bill on January 1, 2018.
EXISTING LAW:
1)Designates the Secretary of California Health and Human
Services to be responsible for the oversight and coordination
of programs serving people living with Alzheimer's disease and
related disorders and their families, including, but not
limited to state level support and assistance to all programs
within the Health and Human Services Agency and member
departments.
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2)Establishes DPH, which oversees various public health
programs, including programs related to genetic diseases such
as AD, and requires DPH to provide public and professional
education on AD to educate consumers, caregivers, and health
care providers, and to increase public awareness.
3)Establishes geographically dispersed diagnostic and treatment
centers for Alzheimer's disease within every postsecondary
higher educational institution with a medical center to
encourage research to discover the cause of, and a cure for,
Alzheimer's disease, and:
a. To provide diagnostic and treatment services and improve
the quality of care to victims of Alzheimer's disease.
b. To increase research by faculty and students in
discovering the cause of, and a cure for, Alzheimer's
disease.
c. To provide training, monitoring, consultation, and
continuing education to the families of those who are
affected by Alzheimer's disease.
d. To increase the training of health care professionals
with respect to Alzheimer's disease and other acquired
brain impairments to the extent that the centers have the
requisite expertise.
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4)Establishes the Alzheimer's Disease Program (ADP) in DPH to
relieve the human burden and economic costs associated with AD
and related dementias, and to assist in ultimately discovering
the cause, treatment, and prevention of these diseases.
5)Requires the California Health and Human Services Agency to
establish an Alzheimer's Disease and Related Disorders
Advisory Committee consisting of 14 members to:
a. Provide ongoing advice and assistance to the
Administration and the Legislature as to program needs and
priorities; 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.
FISCAL EFFECT: This bill has not yet been analyzed by the
Assembly Committee on Appropriations. The Senate Committee on
Appropriations identified "(M)inor costs to provide support to
the workgroup. The Department has already begun the process for
reviewing the available literature and updating the guidelines
using an existing federal grant. The additional
responsibilities in the bill should impose minor costs on the
Department."
COMMENTS:
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1)Author's Statement: "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 (IHSS). We've seen a 42% 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. SB 613 proposes a statewide working
group under the leadership of the California Department of
Public Health, drawing on the existing resources and expertise
of our state's 10 university-affiliated Alzheimer's Disease
Centers. Our 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. 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 on Alzheimer's Disease: An estimated 550,000
Californians have AD. Research supported by the National
Institute of Aging and the Alzheimer's Association states that
the nation's growing elderly population will drive a 300
percent increase in the number of AD cases over the next four
decades. The organization's estimate that by 2050 there will
be approximately 1.3 million Californians living with AD.
Between 1990 and 2000, mortality rates of persons with AD
increased 74 percent. AD was the 8th leading cause of death
in the state in 2004, with a total of 6,962 deaths, a five
percent increase from the death rate in 2000. Of these
deaths, nearly 70 percent were women, and over 99 percent
occurred among residents 65 years of age and older. In
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California, Caucasians comprised 84.4 percent of the deaths,
followed by Latinos with 6.9 percent, African Americans with
5.1 percent and Asians with 3.4 percent. Data shows the
proportion of deaths increased with age and that over 61
percent of these deaths occurred among residents 85 years of
age and older.
3)State Plan on Aging: In 2003, the California Health and Human
Services Agency issued a strategic plan to address issues
facing the state's growing aging population. The plan cites a
substantial growth in the need for long-term care options,
including options for Alzheimer's patients, and recommends an
expansion of community-based services including home health,
adult day care and Alzheimer's Disease Diagnostic and
Treatment Centers.
The plan also cites greater needs for early diagnostic testing
for Alzheimer's, recommends more support and respite programs
for caregivers, and proposes dementia training for health
professionals and others who interact with, and provide care
to, persons with AD.
4)Alzheimer's State Plan: In 2011, DPH issued the " California
State Plan For Alzheimer's Disease: An Action Plan for
2011-2021 " to promote person-centered care that is responsive
to individual need, addresses the broad cultural, ethnic,
racial, socio-economic and demographic diversity of
California's population, provides recommendations to integrate
the social and medical needs of this and other aging
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populations. According to the plan, "(T)he number of
Californians living with Alzheimer's disease will nearly
double, growing to over 1.1 million. Due to a rapidly aging
population, the increase will be even more dramatic among
California's Asians and Latinos, who will see a tripling in
those affected by 2030. With the enormous growth in the
number of Californians living with Alzheimer's disease there
will be a substantial increase in family caregiving demands,
both emotionally and financially. The economic value of
unpaid care is expected to rise from $37.2 billion to $72.7
billion. Costs of formal services, including traditional
medical and social supports, are expected to jump from $16
billion to $31.3 billion by 2030. Demographic data indicates
that legions of older Californians are now living alone -
without the support of a spouse, adult child or other relative
- placing new demands on more costly, formal services. The
care and support of people living with Alzheimer's and related
disorders also impacts state and federal governments. Unless
the State takes steps to provide better support in the home
and community for those who are affected by this condition,
volume alone will cripple public resources."
5)Senate Select Committee on Aging and Long-Term Care Findings:
In January, the State Senate Select Committee on Aging and
Long-Term Care released an exhaustive assessment of issues and
challenges confronting the state of California. "A Shattered
System: Reforming Long-Term Care in California" identified ten
critical interrelated policy areas which have a critical
impact upon the services delivery of services for older adults
and people with disabilities. According to the report, AD
incidence will exceed 1,100,000 people in California within 20
years, and that this demographic reality brings with it
significant implications for the health care and long-term
care services delivery system, including substantial increases
in caregiving and service needs.
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6)Disease Management: According to the Disease Management
Association of America, an effective working definition for
Disease management is: "A system of coordinated healthcare
interventions and communications for populations with
conditions in which patient self-care efforts are significant.
Disease management:
Supports the physician or practitioner/patient
relationship and plan of care,
Emphasizes prevention of exacerbations and
complications utilizing evidence-based practice
guidelines and patient empowerment strategies, and
Evaluates clinical, humanistic, and economic
outcomes on an ongoing basis with the goal of improving
overall health.
Disease management components include:
Population identification processes,
Evidence-based practice guidelines,
Collaborative practice models to include physician
and support-service providers,
Patient self-management education (may include
primary prevention, behavior modification programs, and
compliance/surveillance),
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Process and outcomes measurement, evaluation, and
management, and,
Routine reporting/feedback loop (may include
communication with patient, physician, health plan and
ancillary providers, and practice profiling)."
Disease management strategies are often organized throughout
health systems for a range of chronic conditions. In the
"disease management" context, processes that deliver and
provide services are often as important as the service itself,
since the efficient delivery of those services assures the
broadest and most beneficial impact. Health care systems say
they benefit when they focus greater attention on the
development of care processes for common conditions that
afflict many people. Disease management has emerged as a
strategy to enhance the quality of care. Success with cardio
vascular disease management has improved patient outcomes and
significantly reduced costs over time. Further interest in
disease management strategies is due in part to the aging
population, which is creating increasing demand for effective
cost and quality care models.
1)Guidelines for Alzheimer's Disease Management: Since 2000,
the state has overseen the development of, communication,
distribution, and coordination of Alzheimer's Disease
Management. The current report published in 2008 describes
the rapid development of pharmacological interventions which
occurred between 2002 and 2008. These pharmacological
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developments impacted the information primary care providers
and health care providers used to make decisions about patient
care, services and supports. Besides pharmacological
advancements, additional advancements in the way cultural and
linguistic factors impact Alzheimer's disease treatment and
family care; the processes associated with legal capacity
evaluations were impacted; and special needs were identified
for early-stage and late-stage patients and their families.
This year, the Assembly Committee on Aging and Long-Term Care
heard a presentation by Dr. Dale Bredesen regarding
breakthrough research demonstrating improved functioning for
people with AD when a broad, multi-faceted strategy involving
diet, exercise, sleep, and 33 other variables is implemented.
Guidelines for Disease Management may ultimately inform all
health care providers of such strategies in order to assure
that the most people benefit from these and other
developments.
Related Legislation
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,
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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."
SB 491 (Alquist), Chapter 339, Statutes of 2008, established
California's State Plan for Alzheimer's Disease under the
California 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.
SB 321 (Alquist) was passed by the Assembly Aging and
Long-Term Care Committee in 2007, but subsequently held in the
Assembly Appropriations Committee.
SB 639 (Ortiz), Chapter 692, Statutes of 2001, required
development of a strategic plan to improve access to mental
health services for people with AD and related dementias.
REGISTERED SUPPORT / OPPOSITION:
Support
Alzheimer's Association - Sponsor
American Federation of State, County and Municipal Employees
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(AFSCME), AFL-CIO
California Assisted Living Association (CALA)
National Association of Social Workers, California Chapter
(NASW)
On Lok Senior Health Services
Opposition
None on file.
Analysis Prepared by:Robert MacLaughlin / AGING & L.T.C. / (916)
319-3990