BILL ANALYSIS
AB 359
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Date of Hearing: May 13, 2009
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Kevin De Leon, Chair
AB 359 (Nava) - As Amended: April 15, 2009
Policy Committee: Health Vote:17-0
Urgency: No State Mandated Local Program:
No Reimbursable:
SUMMARY
This bill requires digital mammography screening be covered
under the "Every Woman Counts" (EWC) Cancer Detection Program
administered by the California Department of Public Health (DPH)
when analog mammography is not available. In addition, the bill
authorizes the use of digital mammography when both modes of
screening are available. This bill specifies that digital
mammography will only be a covered benefit pursuant to this bill
if the provider accepts the lower, analog, reimbursement rate.
FISCAL EFFECT
1)Annual increased costs of $2.3 million (special fund, federal
funds, and grants) to provide digital mammography to 15% of
the 270,000 women currently served in the EWC program. Such
increases in mammography costs could result in 32,000 women
losing analog screening coverage each year. This estimate
assumes the rate differential that exists under current law
with analog mammography reimbursement at $72 and digital
mammography reimbursement at $127.
2)This bill raises concerns about provider billing fraud. This
bill is intended to increase access to digital mammography in
areas where analog mammography is being phased out in favor of
digital technology. This bill gives willing providers the
authority to provide digital mammography and be reimbursed at
analog rates. However, such billing behavior, providing one
service and requesting reimbursement for another, may result
in alleged billing fraud.
COMMENTS
AB 359
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1)Rationale . This bill, sponsored by Santa Barbara County,
increases access to digital mammography in a publicly
supported breast cancer screening program. Under current law,
the EWC program only provides coverage for analog mammography.
The Medi-Cal Program currently provides coverage for digital
mammography and this bill aligns the EWC program with Medi-Cal
coverage for breast cancer screenings.
2)Background . Analog mammography stores images directly on film
and was introduced 90 years ago. In contrast, digital
mammography was approved by the Federal Drug Administration
(FDA) in 2000. Digital mammography takes an electronic image
of the breast and stores it in a computer. Electronic storage
allows the recorded data to be enhanced, magnified, or
manipulated for further evaluation. In large clinical studies,
digital mammography has not consistently or broadly been shown
to be effective or cost-effective. However, the technology has
been shown to be particularly effective when targeted to
certain groups, such as younger women, for whom analog
screening identifies fewer areas of cancer risk.
3)Breast Cancer in California . One in nine women in California
has a lifetime risk of being diagnosed with breast cancer. The
breast cancer death rate in California has dropped 20% over
the last two decades, but California women are more likely to
be diagnosed with breast cancer today. While the death rate
for breast cancer has dropped, the gains have not been shared
equally among all women. Women of color and low-income women
are less likely to be diagnosed at an early stage of cancer
and receive effective treatment. Therefore their survival
rates are lower than other groups of women. For example,
African-American women, although less likely to be diagnosed
with breast cancer, have one of the highest breast cancer
death rates.
4)Related Legislation . AB 2887 in 2008 was similar to this bill
and held on the Suspense File of this committee.
Analysis Prepared by : Mary Ader / APPR. / (916) 319-2081