BILL ANALYSIS
ACR 168
Page 1
Date of Hearing: June 29, 2010
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
ACR 168 (Galgiani) - As Introduced: May 24, 2010
SUBJECT : Chronic obstructive pulmonary disease awareness.
SUMMARY : Encourages the State Department of Health Care
Services (DHCS) to partner with private entities to improve
education regarding chronic obstructive pulmonary disease (COPD)
and designates November 2010, as COPD Awareness Month in
California. Specifically, this resolution :
1)Encourages DHCS to, whenever possible, partner with private
entities to improve education regarding COPD.
2)Designates November 2010 as COPD Awareness Month in
California.
3)Encourages public officials and the citizens of California to
increase awareness about symptoms of, and the methods of
preventing COPD.
4)Requests the Chief Clerk of the Assembly to transmit copies of
this resolution to the author for appropriate distribution.
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 yet been reviewed by a
fiscal committee.
COMMENTS :
ACR 168
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1)PURPOSE OF THIS RESOLUTION . According to the author, this
resolution represents the Legislature's annual observation and
promotion of COPD Awareness and Education through the
designation of November 2010, as COPD Awareness Month in
California.
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 . The health budget trailer
bill of 2003 (AB 1762 (Committee on Budget), Chapter 230,
Statutes of 2003) established the Disease Management Waiver to
test the effectiveness of providing a Medi-Cal disease
management benefit. In August 2006, DHCS awarded a contract
to McKesson Health Solutions (McKesson), a healthcare services
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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 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. As of February 11, 2010, Mekesson
has provided disease management services to approximately
3,668 enrollees in Alameda County and 15,376 enrollees in
slightly over 120 Zip Codes in Los Angeles County under a
three-year $4 million contract. The McKesson contract is in
its third year of operation. Under the McKesson contract, the
program effectiveness is to be evaluated annually by a team at
the University of California, Los Angeles (UCLA). The first
year results from the UCLA evaluation were expected in July
2009, but have not yet been released.
AB 6 X4 (Evans), Chapter 6, Statutes of 2009, requires DHCS to
pursue a waiver to the Social Security Act that will
restructure the organization and delivery of health care for
the same population currently participating in the DMPP. A
key element of the waiver is to establish organized delivery
system of care through existing managed care plans or a County
Alternative Option to ensure better coordination of care for
those with chronic diseases. The roll-out of the waiver
restructuring will take place through 2012.
4)SUPPORT . According to Boehringer Ingelheim., AstraZeneca
Pharmaceuticals LP, GlasxoSmithKline, Talecris
Biotherapeutics, and Breathe California, supporters of this
bill, COPD is a slow debilitating disease, whose prevalence
and deadliness is on the rise in the U.S., and
internationally. Supporters argue that COPD is largely
preventable, but not curable and the appropriate management
improves symptoms and helps people improve their quality of
life. Supporters are in favor of increased education and
designating November 2010 as COPD Awareness Month in
California.
ACR 168
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5)PRIOR AND RELATED LEGISLATION :
a) AB 1606 (Coto) of 2010 would have required DHCS to allow
services provided through DHCS-approved Chronic Disease
Self-Management Program to be reimbursable under Medi-Cal.
AB 1606 dies on the Suspense File in the Assembly
Appropriations Committee.
b) ACR 62 (Galgiani), Resolution Chapter 91, Statues of
2009, commends DHCS for implementing a pilot program to
provide for the chronic disease management of 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.
c) ACR 137 (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.
d) ACR 13 (Galgiani), Resolution Chapter 23, Statutes of
2007, commends the Department of Public Health (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.
e) SB 470 (Baca) of 1999 would have proposed a study to
determine the potential benefits of
integrated/self-monitoring disease management for Medi-Cal
fee-for-service patients. SB 470 died in the Assembly
Appropriations Committee.
f) 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)
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AstraZeneca Pharmaceuticals LP
Breathe California of Los Angeles County
GlaskoSmithKline
Talecris Biotherapeutics
Opposition
None on file.
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097