BILL ANALYSIS
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Date of Hearing: May 5, 2009
ASSEMBLY COMMITTEE ON HEALTH
Dave Jones, Chair
ACR 62 (Galgiani) - As Introduced: April 20, 2009
SUBJECT : Chronic obstructive pulmonary disease awareness.
SUMMARY : Commends the Department of Health Care Services
(DHCS) for implementing a pilot program to provide for the
chronic disease management of Chronic Obstructive Pulmonary
Disease (COPD), encourages, on behalf of the Legislature,
interim updates and reports on the progress of the COPD pilot
program and establishes COPD Awareness Day and Month in November
2009. Specifically, this resolution :
1)Commends DHCS for implementing a pilot program to provide for
the chronic disease management of COPD in an effort to reduce
the financial and clinical burden of this disease on the
Medi-Cal program.
2)Encourages DHCS, upon the program's conclusion, to prepare and
submit a report of the departments respective findings and
recommendations regarding the pilot program to the appropriate
committees of the Senate and Assembly.
3)Declares November 2009 as COPD Awareness Month, and November
18, 2009, as COPD Awareness Day.
4)Makes the following legislative findings related to the
severity, prevalence, impact and costs of COPD:
a) COPD, also known as chronic bronchitis and emphysema, is
the fourth leading cause of death in the United States
(U.S.) and is the only one of the top five causes of death
whose prevalence and death rate is rising;
b) COPD is a chronic and progressive disease that impacts
an estimated 24 million Americans each year, including
approximately five million residents of California;
c) In 2004, the national annual cost for COPD was estimated
to be $37 billion and in that same year, COPD caused
approximately 121,000 deaths nationwide;
d) Many patients suffering with COPD are not diagnosed
until they have reached an advanced stage of COPD, which
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often includes a disabling degree of lung dysfunction;
e) A diagnostic test for COPD, known as spirometry, is
available for office use, allowing early diagnosis of COPD;
f) Early diagnosis and management of COPD can effectively
reduce the overall financial burden of this illness on
publicly funded health care programs, including Medi-Cal
and notes the importance of overcoming various challenges
such as cultural, language and literacy health disparities
to achieve this;
g) Proper management of COPD can lead to improved quality
of life and self-sufficiency on the part of patients who
receive publicly funded benefits; and,
h) Cites conclusions of the "Healthy People 2010" project
of the Centers for Disease Control and Prevention and the
National Institutes of Health stating the need for
additional primary care physician training in the latest
methods for diagnosing and treading COPD. Noting
additionally, a primary care doctor's key position to
providing care to patients with COPD.
EXISTING LAW :
1)Establishes the Medi-Cal Program which provides comprehensive
health benefits to low-income children, their parents or
caretaker relatives, pregnant women, elderly, blind or
disabled persons, nursing home residents, and refugees who
meet specified eligibility criteria.
2)Requires DHCS to apply for a waiver of federal law for the
establishment of a pilot project to test the efficacy of
providing a disease management benefit to beneficiaries in the
Medi-Cal Program.
FISCAL EFFECT : This resolution has not been analyzed by a
fiscal committee.
COMMENTS :
1)PURPOSE OF THIS RESOLUTION . According to the author, this
resolution is intended to commend DHCS for implementing a
pilot program for chronic disease management of COPD.
Additionally, this resolution encourages DHCS to provide
interim updates on the COPD pilot program, as appropriate.
According to DHCS a report of the programs progress is
expected to be submitted early, possibly in July, 2009. This
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resolution is also intended to establish the month of November
2009 and the day of November 18, 2009 as COPD Awareness Month
and COPD Awareness Day, respectively.
2)BACKGROUND . According to the National Heart, Lung and Blood
Institute, COPD is a slowly progressive disease of the airways
that is characterized by a gradual loss of lung function. In
the U.S., the term COPD includes chronic bronchitis, chronic
obstructive bronchitis, or emphysema, or combinations of these
conditions. COPD represents the fourth leading cause of death
in the U.S. The symptoms of COPD can range from chronic cough
and sputum production to severe disabling shortness of breath.
In the U.S., the most important risk factor for COPD is
cigarette smoking. Pipe, cigar, other types of tobacco
smoking, and passive exposure to cigarette smoke are also risk
factors. Other documented causes of COPD include occupational
dusts and chemicals. Outdoor air pollution adds to the total
burden of inhaled particles in the lungs, but its role in
causing COPD is uncertain. The diagnosis of COPD is confirmed
by the presence of airway obstruction on testing with
spirometry, which measures lung function through the speed and
amount of air that can be inhaled and exhaled.
Boehringer Ingelheim Pharmaceuticals, Inc.
(Boehringer-Ingelheim), the sponsor of this resolution,
manufactures several prescription medications for the
treatment of COPD. According to Boehringer-Ingelheim, COPD
places a substantial financial burden on state Medicaid
programs. In a retrospective study using Medicaid claims data
from California and Florida the additional annual cost of
treating a Medicaid patient with COPD was approximately $6,500
in California and $5,200 in Florida compared to treating
patients without COPD. According to a report by the Global
Initiative for Chronic Obstructive Lung Disease, the costs of
treating COPD can be reduced by adhering to established
guidelines for early diagnosis and appropriate management.
3)DISEASE MANAGEMENT PILOT PROGRAM . In August 2006, DHCS
awarded a contract to McKesson Corporation, a health care
services and information technology company, to implement a
disease management pilot program (DMPP) for chronically ill,
Fee-for Service (FFS) Medi-Cal beneficiaries residing in Los
Angeles and Alameda Counties. The goal of DMPP is to provide
eligible beneficiaries with a range of services that enable
them to remain in the least restrictive and most homelike
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environment while receiving the medical care necessary to
protect their health and well being. Eligibility for the
pilot is limited to those who are eligible for Medi-Cal as
aged, blind and disabled persons, or those persons over 21
years of age who are not enrolled in a Medi-Cal managed care
plan or eligible for the federal Medicare program, and who are
determined by DHCS to be at risk of, or diagnosed with, select
chronic diseases, including COPD. Under the McKesson
contract, the program effectiveness will be evaluated annually
by a team at the University of California, Los Angeles.
4)PRIOR AND RELATED LEGISLATION :
a) ACR 127 (Galgiani), Resolution Chapter 158, Statutes of
2008, commends DHCS for implementing a pilot program to
provide for the chronic disease management of COPD and
establishes COPD Awareness Day and Month in November 2008.
b) ACR 13 (Galgiani), Resolution Chapter 23, Statutes of
2007, commends DPH and DHCS for implementing a pilot
program to provide the chronic disease management of COPD
and designated November 2007 as COPD Awareness Month and
November 14, 2007, as COPD Awareness Day throughout
California.
c) SB 470 (Baca) of 1999 would have proposed a study to
determine the potential benefits of
integrated/self-monitoring disease management for Medi-Cal
FFS patients. SB 470 died in the Assembly Appropriations
Committee.
d) AB 1949 (Baca) of 1998 would have authorized a Medi-Cal
pilot project and required the Department of Health
Services (now DPH) to establish a pilot study on an
integrated treatment regime for chronic condition
management.
REGISTERED SUPPORT / OPPOSITION :
Support
Boehringer Ingelheim Pharmaceuticals, Inc. (sponsor)
Opposition
None on file.
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Analysis Prepared by : Christina Romero / HEALTH / (916)
319-2097