BILL ANALYSIS
AB 359
Page 1
ASSEMBLY THIRD READING
AB 359 (Nava)
As Amended June 2, 2009
Majority vote
HEALTH 17-0 APPROPRIATIONS 12-5
-----------------------------------------------------------------
|Ayes:|Jones, Fletcher, Adams, |Ayes:|De Leon, Ammiano, |
| |Ammiano, Block, Carter, | |Charles Calderon, Davis, |
| |Conway, De Leon, | |Fuentes, Hall, John A. |
| |Emmerson, Hall, Hayashi, | |Perez, Price, Skinner, |
| |Hernandez, Bonnie | |Solorio, Torlakson, |
| |Lowenthal, Nava, V. | |Krekorian |
| |Manuel Perez, Salas, | | |
| | Audra Strickland | | |
|-----+--------------------------+-----+--------------------------|
| | |Nays:|Nielsen, Duvall, Harkey, |
| | | |Miller, Audra Strickland |
| | | | |
-----------------------------------------------------------------
SUMMARY : Requires the Department of Public Health (DPH) Every
Woman Counts (EWC) Program, until January 1, 2014, to reimburse
for digital mammography screening at the Medi-Cal reimbursement
rate for analog mammography, and allows an EWC provider to
provide digital mammography when analog mammography services are
not available.
EXISTING LAW :
1)Creates, under federal law, the National Breast and Cervical
Cancer Early Detection Program and authorizes the Centers for
Disease Control and Prevention to administer grants to states
for screening services for eligible underserved women, age 40
years and older.
2)Requires DPH to provide for breast and cervical cancer
screening services under the grants in 1) above, at the level
of funding budgeted from state and other resources during the
fiscal year (FY) in which the Legislature has appropriated
funds for this purpose. These screenings are provided under
the EWC Program and are not deemed an entitlement. Provides
that analog mammography is covered by the EWC Program.
AB 359
Page 2
FISCAL EFFECT : According to the Assembly Appropriations
Committee, one-time cost of less than $10,000 General Fund for
the Department of Health Care Services to update payment
systems.
COMMENTS : The author states the EWC Program reimburses for
breast cancer screening only if performed on analog equipment.
However, the author reports mammography providers are
increasingly converting to digital equipment, leaving large
areas of the state without an analog provider and requiring
women in some areas to travel over two hours for a free
mammogram. The author argues that this barrier has reduced the
number of women who obtain mammograms, thereby reducing early
detection and treatment and putting their lives at risk. The
author states this bill will be an important step towards
ensuring California's underinsured and uninsured women are
receiving the coverage they need to diagnose and treat breast
cancer at its earliest stage.
According to a California Cancer Registry (CCR) report, "Cancer
in California, 2008," among women, breast cancer is the most
commonly diagnosed cancer and the second most common cause of
cancer death. CCR estimated that in 2008, more than 21,000
California women would be diagnosed with primary breast cancer,
and more than 4,200 California women would die from the disease.
According to the California Breast Cancer Research Program
(CBCRP), because of early detection through widespread mammogram
screening, a California woman diagnosed with breast cancer today
has a better chance of surviving than in the past. However,
according to CBCRP, minority and low-income women are less
likely to survive breast cancer, in part because their tumors
are more likely to be caught later, when treatment is less
successful.
According to DPH's Internet Web site, the Cancer Detection
Section of DPH administers the EWC program and has provided
access to breast and cervical cancer screening and diagnostic
services to medically underserved women since 1991. Breast
cancer screening services are provided free to women who meet
the following qualifications: 1) Are 40 years or older; 2) Live
in California; 3) Have no health insurance or a co-payment or
deductible they cannot afford; and, 4) Have a family income
below 200% of the federal poverty level. According to DPH,
approximately 1.2 million women were eligible for breast cancer
AB 359
Page 3
screening services under the EWC program. Approximately 270,000
women, or 20-24% of the eligible women actually obtained EWC
services in FY 2007-08. To date, the Cancer Detection Section
of DPH has been able to serve all eligible women seeking
services. The EWC program is funded by the federal Breast and
Cervical Cancer Mortality Prevention Act of 1990 (Public Law
101-354), the California Breast Cancer Act of 1993 and
Proposition 99 tobacco tax funds. Every $3 of federal funds
must be matched by $1 of nonfederal resources. Medi-Cal
reimbursement for analog mammography is currently $72 and for
digital mammography, $127.
Digital (computerized) mammography, a recent advance in X-ray
mammography, is similar to standard (analog) mammography in that
X-rays are used to produce detailed images of the breast, but
the system is equipped with a digital receptor and a computer
instead of a film cassette. Studies of digital mammography and
standard analog mammography have shown that digital mammography
is generally comparable to analog in detecting breast cancer.
The National Cancer Institute (NCI) initiated a large trial
comparing the two types of mammography; preliminary findings
showed no difference in detecting breast cancer for the general
population of women. However, NCI reported that women who had
dense breasts, were younger than age 50, or had reached or were
near menopause, may benefit from digital, rather than analog
mammography. Digital mammography might also lead to fewer
callbacks (repeat mammograms) than analog mammography, as well
as other benefits. Digital mammography systems cost
approximately one and one-half to four times as much as standard
analog mammography systems. Medi-Cal reimbursement for analog
mammography is currently $72 and for digital mammography, $127.
The County of Santa Barbara, sponsor of this bill, writes that
its public health department administers EWC for Santa Barbara,
Ventura, and San Luis Obispo Counties. The County of Santa
Barbara and the City and County of San Francisco write in
support of a prior version that their clients are impacted by
the lack of access to analog mammography, and this bill would
allow access to digital mammography in areas where there is no
access to analog mammography. The American College of
Obstetricians and Gynecologists, District IX (California) writes
in support of a prior version of this bill that as radiologists
replace their old equipment with newer digital equipment, there
may be communities where only digital mammography is available.
AB 359
Page 4
The American Cancer Society writes it is important to ensure
coverage for analog mammography is still an available option
when offered. The Medical Oncology Association of Southern
California, Inc. writes in support of a prior version that this
bill will ensure California's uninsured and underinsured women
are getting the coverage needed to diagnose and treat breast
cancer in its earliest stage. The California Primary Care
Association writes in strong support of a prior version of this
bill that in rural areas; often only digital mammography is
available. The American Federation of State, County, and
Municipal Employees, AFL-CIO writes it supports a prior version
of this bill because it ensures people of color, who make up the
majority of Californians in poverty, are provided with care.
Analysis Prepared by : Allegra Kim / HEALTH / (916) 319-2097
FN: 0001374