BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                     SB 613


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          SENATE THIRD READING


          SB  
          613 (Allen)


          As Amended  July 6, 2015


          Majority vote


          SENATE VOTE:  40-0


           ------------------------------------------------------------------ 
          |Committee       |Votes|Ayes                  |Noes                |
          |                |     |                      |                    |
          |                |     |                      |                    |
          |                |     |                      |                    |
          |----------------+-----+----------------------+--------------------|
          |Health          |18-0 |Bonta, Maienschein,   |                    |
          |                |     |Bonilla, Burke, Chiu, |                    |
          |                |     |Gomez, Gonzalez,      |                    |
          |                |     |Roger Hernández,      |                    |
          |                |     |Lackey, McCarty,      |                    |
          |                |     |Nazarian, Patterson,  |                    |
          |                |     |Ridley-Thomas,        |                    |
          |                |     |Rodriguez, Steinorth, |                    |
          |                |     |Thurmond, Waldron,    |                    |
          |                |     |Wood                  |                    |
          |                |     |                      |                    |
          |----------------+-----+----------------------+--------------------|
          |Aging           |7-0  |Brown, Hadley,        |                    |
          |                |     |Gipson, Gray, Levine, |                    |
          |                |     |Lopez, Mathis         |                    |
          |                |     |                      |                    |
          |----------------+-----+----------------------+--------------------|








                                                                     SB 613


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          |Appropriations  |17-0 |Gomez, Bigelow,       |                    |
          |                |     |Bloom, Bonta,         |                    |
          |                |     |Calderon, Chang,      |                    |
          |                |     |Nazarian, Eggman,     |                    |
          |                |     |Gallagher, Eduardo    |                    |
          |                |     |Garcia, Holden,       |                    |
          |                |     |Jones, Quirk, Rendon, |                    |
          |                |     |Wagner, Weber, Wood   |                    |
          |                |     |                      |                    |
          |                |     |                      |                    |
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          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 (Guidelines)  
          in California to address changes in the health care system and  
          requires DPH to submit a report on the workgroup updates and  
          recommendations to the Legislature on or before March 1, 2017.  


          FISCAL EFFECT:  According to the Assembly Appropriations  
          Committee, a negligible fiscal impact, including a total  
          estimated cost to update the Guidelines of $120,000. 


          COMMENTS:  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.


          1)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  








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            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.  Estimates vary, but experts suggest that as many as  
            five million Americans age 65 and older may have Alzheimer's  
            disease. 


          2)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 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  
            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  








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            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.


          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 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  








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          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.


          There is no known opposition on file.




          Analysis Prepared by:                                             
                          Paula Villescaz / HEALTH / (916) 319-2097  FN:  
          0001672