BILL ANALYSIS
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
359 (Nava)
Hearing Date: 8/27/2009 Amended: 7/15/2009
Consultant: Katie Johnson Policy Vote: Health 11-0
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BILL SUMMARY: AB 359 would permit a provider for the Every
Woman Counts (EWC) breast cancer screening program to employ
digital mammography commencing January 1, 2010, and to be
reimbursed by the EWC program.
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Fiscal Impact (in thousands)
Major Provisions 2009-10 2010-11 2011-12 Fund
Provider claims cost unknown, potentially in the Federal/
pressure due to increased tens of millions of
dollarsSpecial*
access to mammograms
Cost pressure to treat unknown, potentially in the
General/**
additional BCCTP beneficiaries hundreds of thousands toFederal
referred by EWC millions of dollars
*Proposition 99/Unallocated Account, Breast Cancer Control
Account, CDC Grant
**October 1, 2008 - December 31, 2010 FMAP = 38%GF / 62%FF
January 1, 2011 - ongoing FMAP = 50%GF / 50%FF
FMAP = Federal Medical Assistance Percentage-the percent of
total costs paid by the federal government.
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STAFF COMMENTS: SUSPENSE FILE.
Existing federal law creates, under the Breast and Cervical
Cancer Mortality Prevention Act of 1990, the national Breast and
Cervical Cancer Early Detection Program and authorizes the
Centers for Disease Control and Prevention (CDC) to administer
grants to states for screening services for underserved eligible
women.
Existing state law establishes the Breast Cancer Control
Program, administered by the California Department of Public
Health (CDPH), for purposes of providing breast and cervical
cancer screening with the CDC grant and other state funds. These
screening services are provided by the Every Woman Counts
program (EWC) and are not an entitlement. Existing law requires
EWC providers to be reimbursed for screenings at a rate
identical to Medi-Cal reimbursement rates. EWC provides free
screening and diagnostic services to women who are 40 years of
age or older, live in California, have no health insurance or a
co-payment or deductible that they cannot afford, and have a
family income below 200 percent of the federal poverty level. In
2007-2008, the program screened approximately 250,000 women and
is experiencing growth in increased costs through claims for
reimbursements from providers.
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AB 359 (Nava)
The EWC is funded with CDC grants and revenues from tobacco
taxes from the Breast Cancer Control Account and Proposition 99
funds. Funding for the program is finite; the program may
provide only as many mammograms as it has funds. To date, EWC
claims have come close, but have not exceeded its annual
appropriations. EWC's budget was approximately $45 million in FY
2008-09 and is approximately $40 million in FY 2009-2010. Since
tobacco taxes are a declining source of revenue-fewer people use
tobacco each year-EWC's budget declines each year.
Currently, the EWC is required to reimburse providers for analog
mammography services at rates identical to the Medi-Cal rates
for such services, which is $72.12 per screening and $68.76 -
$85.80 per diagnostic. This bill would permit an EWC provider to
use digital mammography when analog mammography is unavailable,
provided that he or she agrees to receive reimbursement in full
at the analog rate even if digital mammography is used. Medi-Cal
reimbursement rates for digital mammography are $127.24 per
screening and $107.57 to $132.97 per diagnostic.
Currently, 17 counties provide mammographic services in only
digital form. This bill would increase access to mammographic
services and would therefore put pressure in the tens of
millions of dollars on the federal and special funds that fund
EWC.
Additionally, if an EWC mammography recipient is diagnosed with
breast cancer and requires treatment, there would be significant
increased cost pressure in the hundreds of thousands to millions
of dollars on the state's Breast and Cervical Cancer Treatment
Program (BCCTP), which is administered by the Department of
Health Care Services (DHCS), the state's Medicaid agency.
BCCTP provides breast and cervical cancer treatment and
full-scope Medi-Cal services to women under age 65 with a family
income under 200 percent of the federal poverty level and who
have no other health insurance. It is funded by the state
General Fund and the federal government and currently provides
benefits to 7,665 people. BCCTP state-only program covers breast
and cervical cancer treatment for up to 18 continuous months for
men of any age and immigration status, women over age 65, women
under age 65 with unsatisfactory immigration status, or
individuals with health insurance. BCCTP is solely funded by the
General Fund and has 652 enrollees.
Medi-Cal costs are generally shared equally between the federal
government (FF) and state General Fund (GF). However, as a
result of the passage of the American Reinvestment and Recovery
Act (ARRA) in February of 2009, the Federal Medical Assistance
Percentage (FMAP) increased from 50 percent to 61.59 percent.
Thus, retroactively from October 1, 2008 through December 31,
2010, the federal government would pay for approximately 62
percent and the state General Fund would pay for 38 percent of
benefit-related Medi-Cal expenditures. After December 31, 2010,
the FMAP reduces to 50 percent FF, 50 percent GF.