BILL ANALYSIS
HR 31
Page 1
Date of Hearing: June 29, 2010
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
HR 31 (Eng) - As Amended: June 21, 2010
SUBJECT : Legislative Task Force on Chronic Kidney Disease.
SUMMARY : Recommends the establishment of the Legislative Task
Force on Chronic Kidney Disease (CKD) to study the social,
medical, and fiscal issues surrounding CKD and report back to
the Legislature on recommendations for policy changes.
Specifically, this resolution :
1)Makes legislative findings and declarations regarding the
prevalence of CKD, and the social and medical implications and
health disparities that exist related to CKD.
2)Recommends the establishment of the Legislative Task Force on
CKD consisting of specified members.
3)Permits the Legislative Task Force on CKD to use existing
resources to support its activities and to solicit funding
from public and private foundations, and make use of available
federal funds.
4)Permits the Legislative Task Force on CKD to do the following:
a) Develop a plan to educate health care professionals
about the advantage and methods of early screening,
diagnosis, and treatment of CKD and its complications based
on the Kidney Disease Outcomes Quality Initiative (KDOQI)
Clinical Practice Guidelines for CKD or other medically
recognized clinical practice guidelines;
b) Develop a plan to educate health care professionals
about the advantages of end-stage renal disease (ESRD)
modality education, including peritoneal dialysis, prior to
the onset of ESRD when kidney function is declining;
c) Make recommendations on the implementation of a
cost-effective plan for early screening, diagnosis, and
treatment of CKD for the state's population;
d) Study factors contributing to an increasing rate of CKD
among minorities; and,
e) Issue a report to the Department of Health Care Services
no later than December 31, 2011.
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5)Requests the Chief Clerk of the Assembly to transmit copies of
this resolution to the author for appropriate distribution.
EXISTING FEDERAL LAW : The federal HR 6331: Medicare
Improvements for Patients and Providers Act of 2008 (110th U.S.
Congress, 2007-2008) amends Part P of Title III of the Public
Health Service Act (42 U.S.C. 280g et seq.) to include Sec.
399R, Chronic Kidney Disease Initiatives. HR 6331 directs the
Secretary of the federal Department of Health and Human Services
to establish pilot projects to: increase public and medical
community awareness of CKD, increase screening for CKD, and
enhance surveillance systems to better assess prevalence in
incidence of CKD.
FISCAL EFFECT : None
COMMENTS :
1)PURPOSE OF THIS RESOLUTION . According to the author, CKD is
an arduous, insidious, and life-threatening disease that
increases daily in numbers. CKD is frequently a complication
associated with high blood pressure and/or diabetes. Often,
the author maintains, as CKD worsens, nerve damage develops,
heart disease becomes likely, dialysis is a common necessity,
and kidney failure with the need for transplantation is a
reality. The author asserts that California's ethnic minority
communities compose a disproportionate share of CKD cases and
that the disease and the families it affects do not receive
adequate attention or information regarding early detection,
intervention, or patient care. The author argues that other
states, such as Texas, have found a legislative task force on
CKD to be a catalyst for public and private involvement with
long-term results.
2)CKD . According to the National Kidney Foundation (NKF), CKD
has emerged as a major public health threat with an estimated
26 million Americans, currently living with disease,
representing a 30% increase over the past decade. NKF
maintains that over 500,000 patients are being treated for
ESRD, when kidneys fail and dialysis or transplantation is
needed to sustain life and nearly 88,000 Americans die of
kidney failure each year.
Any assessment of CKD predictors is complex because there is
considerable interaction with age and race, as well as with
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other chronic diseases. According to NKD, CKD prevalence
increases with age. The Untied States Renal Data System
reports that Americans over age 60 are 5.9 times more likely
to have CKD than the population under 60 years of age.
Individuals who are 65 years of age and older comprise 44% of
CKD cases. Of the CKD population who are 20-64, the number
one predictor of kidney disease is diabetes, followed by
hypertension. Diabetes and hypertension increase the odds of
progressing to CKD by more than 2.5 and 1.8 times
respectively.
NKF maintains that CKD disproportionately affects certain racial
and ethnic populations, and generally results in worse
outcomes and higher costs of treatment for minority
populations. African-Americans and Hispanic patients are 3.8
and 1.5 times more likely respectively than white patients to
progress to kidney failure, and develop ESRD at an earlier
age. According to NKF, CKD and ESRD prevalence are also high
among Native Americans and Asian/Pacific Islanders. Native
Americans are two times more likely to progress to kidney
failure than whites, and Asian/Pacific Islanders are 1.3 times
more likely than whites to develop ESRD. Diabetes and
hypertension are also more prevalent among the populations and
tend to be hereditary.
According to NKF, Medicare is the primary payor for ESRD
patients of all ages; however, Medicare predominately pays for
CKD patients who are 65 years and older. Based on Medicare
data, costs associated with CKD and ESRD are rising
exponentially. In 2006, Medicare costs for CKD exceeded $49
billion, nearly five times greater than costs in 1993. The
NFK maintains that while CKD patients represent 8.7% of the
Medicare population, they consume 24.5% of the total Medicare
budget.
3)TEXAS TASK FORCE . Recognizing the significant burden of CKD
and ESRD in Texas, the 80th Texas Legislature passed House
Bill 1373 in 2007. House Bill 1373 established the CKD Task
Force, which composed a team of experts in the fields of
nephrology, family practice medicine, pediatrics, dietetics,
transplantation, education, and state government. National
and state kidney organizations are also represented on the
committee. According to a report submitted to the Texas
Legislature by the Texas CKD Task Force their recommendations
include a public health approach across health care systems to
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establish timely, coordinated, and comprehensive prevention
and patient care. The report states that the Texas CKD Task
Force, adapting a KDOQI model, applied evidenced- based public
health methods to address problems and develop recommendations
at each stage of disease progression. The Texas CKD Task
Force established the following five priorities:
a) Data and Surveillance;
b) Clinical Prevention and Treatment;
c) Professional Education;
d) Policy Change;
e) Public Education and Outreach; and,
f) Administration.
4)KDOQI . KDOQI are clinical practice guidelines for all stages
of CKD and related complications that are developed by NKF.
According to NKF, KDOQI is recognized throughout the world for
improving the diagnosis and treatment of kidney disease. To
date, KDOQI has developed and disseminated 13 guidelines for
the care of kidney disease patients, such as: Diabetes and
CKD; Anemia and CKD; and, Nutrition in Chronic Renal Failure.
5)SUPPORT . According to NKF, sponsors of this resolution, the
social and financial costs of CKD are considerable,
particularly for the state's minority populations where the
disease has continually been on the rise. And yet, according
to NKF, there is little known about the disease, its
prevention, or treatment. NKF argues that the task force
proposed in this resolution will allow stakeholders from
different perspectives on CKD to meet, discuss strategies for
improving outreach and education, identify gaps in care, and
present a report to the Legislature recommending state policy
changes.
6)RELATED AND PREVIOUS LEGISLATION :
a) SCR 111 (Wright) of 2010 proclaims November 7 through
November 13, 2010, as California CKD Education Week, and
urges all Californians to familiarize themselves with the
causes of CKD and the importance of intervention to promote
sustained health and a better quality of life. SCR 111 is
currently in the Senate Rules Committee.
b) SJR 13 (Oropeza) of 2009 urges the President and the
federal Centers for Medicare and Medicaid Services to enact
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legislation to expedite the process for dialysis clinic
licensure. SJR 13 has been sent to enrollment.
c) SR 16 (Leno) adopted in 2009 recognizes March 12, 2009,
as World Kidney Day, and the important role World Kidney
Day plays in helping health care professionals, kidney
patients and their families, and patient advocates in their
efforts to stress the importance of early screening and
detection of chronic kidney disease.
d) HR 26 (Leno) adopted in 2008 recognizes March 13, 2008,
as World Kidney Day and the important role World Kidney Day
plays in helping health care professionals and others in
their efforts to stress the importance of early screening
and detection of CKD.
e) HR 21 (Hernandez) adopted in 2007 declares September 12,
2007, as Chronic Kidney Disease Awareness Day for the State
of California and encourages the citizens of California to
become aware of the causes of chronic kidney disease, its
risk factors, and contributing health problems.
REGISTERED SUPPORT / OPPOSITION :
Support
National Kidney Foundation (sponsor)
Opposition
None on file.
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097