BILL ANALYSIS �
AB 1731
Page 1
ASSEMBLY THIRD READING
AB 1731 (Block)
As Amended May 25, 2012
Majority vote
HEALTH 15-4 APPROPRIATIONS 12-5
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|Ayes:|Monning, Ammiano, Atkins, |Ayes:|Fuentes, Blumenfield, |
| |Bonilla, Eng, Gordon, | |Bradford, Charles |
| |Hayashi, | |Calderon, Campos, Davis, |
| |Roger Hern�ndez, Bonnie | |Gatto, Ammiano, Hill, |
| |Lowenthal, Mitchell, | |Lara, Mitchell, Solorio |
| |Nestande, Pan, | | |
| |V. Manuel P�rez, Smyth, | | |
| |Williams | | |
| | | | |
|-----+--------------------------+-----+--------------------------|
|Nays:|Logue, Garrick, Mansoor, |Nays:|Harkey, Donnelly, |
| |Silva | |Nielsen, Norby, Wagner |
| | | | |
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SUMMARY : Establishes the Newborn Critical Congenital Heart
Disease (CCHD) Screening Program and requires hospitals to offer
a pulse oximetry test for the identification of CCHD to parents
of newborns prior to discharge. Specifically, this bill :
1)Applies the requirement to general acute care hospitals with
licensed perinatal services.
2)Requires the hospital to use protocols approved by the
Department of Health Care Services (DHCS).
3)Requires DHCS to begin phasing in implementation of a
requirement to offer CCHD screening by hospitals on or after
July 1, 2013, and requires 100% participation rate by 2016.
4)Requires hospitals to develop a screening program with the
following elements:
a) Competent CCHD screening;
b) Appropriate staff and equipment;
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c) Referral of infants with abnormal screening results for
appropriate care;
d) Reporting and maintenance of data as required; and,
e) Physician and family-parent education.
5)Requires the pulse oximetry test to be performed by a licensed
physician, licensed registered nurse, or an appropriately
trained individual who is supervised by a licensed health care
professional.
6)Exempts a newborn if the parent or guardian objects on the
grounds that the test is in violation of his or her beliefs.
7)Makes legislative findings and declarations regarding the
incidence of CCHD, current methods of detection, and pulse
oximetry.
FISCAL EFFECT : According to the Assembly Appropriations
Committee:
1)One-time implementation costs of $75,000 (50% General Fund
(GF), 50% federal funds) to consult with stakeholders, develop
a phase-in plan, review research and guidance, and work with
relevant federal agencies.
2)Minor one-time costs for training and process development, as
well as ongoing costs to University of California hospitals in
the range of $100,000 system-wide.
3)Additional costs that would be incurred, or saved, as a result
of this bill are not straightforward to estimate because the
extent to which screening is currently performed in hospitals
is not tracked. Assuming half of all babies in California are
currently screened, the following effects are projected:
a) $450,000 in increased Medi-Cal and Healthy Families
Program (HFP) cost pressure related to screening (49% GF,
51% federal funds) and follow-up care.
b) Potential offsetting cost savings in the range of
$350,000 (49% GF, 51% federal funds) annually associated
with earlier detection of heart defects among Medi-Cal and
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HFP eligible babies.
c) Uncertain, but potentially significant savings to
various health care and developmental services programs
from prevention of life-long disability related to earlier
diagnosis.
4)Ongoing administrative costs to hospitals could range from
negligible up to several thousand dollars per hospital,
depending whether the hospital has initiated CCHD screening in
absence of this bill.
COMMENTS : Congenital heart disease (CHD) involves defects of
the walls, valves, arteries, or veins of the heart and occurs in
seven to nine of every 1,000 live births in the United States.
According to the author, this bill is designed to ensure that
newborns are screened for CCHD, which is a subset of CHD. This
bill accomplishes this purpose by requiring DHCS to establish
statewide screening of newborns by means of pulse oximetry
screening. The author explains that pulse oximetry screening is
a test that occurs at the bedside and is a non-invasive test
that estimates the percentage of hemoglobin in the blood that is
saturated with oxygen. The author argues that many newborn
lives could potentially be saved by earlier detection and
treatment of CCHD if hospitals were required to perform this
simple, noninvasive screening method. Once identified, babies
with a CCHD can be seen by cardiologists and receive special
care and treatment to prevent death or disability. According to
the CDC, certain hospitals routinely screen all newborns using
pulse oximetry screening. However, currently it is not included
in most state newborn screening panels.
The Secretary of the federal Department of Health and Human
Services (HHS) Advisory Committee on Heritable Disorders in
Newborns and Children (SACHDNC) is charged with making
systematic evidence-based and peer-reviewed recommendations to
advise the HHS Secretary regarding the most appropriate
application of universal newborn screening tests, technologies,
policies, guidelines and standards for effectively reducing
morbidity and mortality in newborns and children having, or at
risk for, heritable disorders. In 2010, the Secretary adopted
the SACHDNC's Recommended Uniform Screening Panel (RUSP) as a
national standard for newborn screening programs and to
facilitate the adoption of the SACHDNC's RUSP by all state
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newborn screening programs. RUSP included 29 core conditions
and 25 secondary conditions which are disorders that can be
detected in the differential diagnosis of a core disorder. At
the same time, the Secretary adopted the recommendation to add
Severe combined immunodeficiency (SCID) as a core condition and
related T-cell lymphocycte deficiencies as a secondary condition
to RUSP. California is in the process of adding the SCID
screening as directed by AB 695 (Pan), Chapter 461, Statutes of
2011, which will conform California's Newborn Screening Program
to the Secretary's recommendations. On September 21, 2011, the
Secretary decided to adopt the SACHDNC recommendation to add
CCHD to RUSP.
Analysis Prepared by : Marjorie Swartz / HEALTH / (916)
319-2097
FN: 0003941