BILL ANALYSIS �
AB 1893
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Date of Hearing: May 14, 2014
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Mike Gatto, Chair
AB 1893 (Stone and Eggman) - As Amended: May 1, 2014
Policy Committee: HealthVote:11-4
Urgency: No State Mandated Local Program:
No Reimbursable: No
SUMMARY
This bill requires sharps sold to the general public to be sold
with a sharps waste container that meets specified criteria.
It also encourages the administrative director of the Division
of Workers' Compensation (DWC) within the Department of
Industrial Relations to incorporate the use of specific data
elements that can identify puncture wounds caused by sharps in
non-healthcare occupations.
FISCAL EFFECT
1)This bill results in cost pressure on the Medi-Cal program to
cover sharps containers. Although this bill does not require
the state or health insurance plans to cover the costs of
containers, it is likely the state would cover the cost of
containers, as not covering the cost could pose a barrier to
care for chronic conditions like diabetes. In addition,
federal rules limit the cost-sharing that can be imposed in
Medicaid programs to a nominal amount per service. To the
extent a Medi-Cal enrollee was required to purchase sharps and
that purchase price was greater than nominal, it would amount
to a de facto cost-sharing requirement in Medi-Cal that
exceeded federal limits. In addition, it is unclear whether
federal approval may be necessary to impose this requirement
on Medi-Cal enrollees and, if so, if it would be granted.
The California Health Interview Survey indicates there are
53,000 Medicaid-only enrollees who take insulin for diabetes,
for example. Assuming 2 containers per year are provided to
each person with diabetes at $2.50 per container, cost
pressure of $260,000 annually (GF/federal). Costs would
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likely be larger, as this estimate would exclude individuals
with other conditions. If, on the other hand, Medi-Cal does
not cover the costs associated with containers and this bill
resulted in reduced access to medications required to control
chronic conditions, costs for Medi-Cal services related to
treating uncontrolled diabetes, for example, could be much
greater.
2)One-time cost pressure to DWC potentially exceeding $50,000 to
upgrade data collection systems and develop processes to
incorporate data elements that allow for collection of data on
puncture wounds caused by sharps in non-healthcare
occupations. The bill is permissive and does not require DWC
to collect this data. However, to the extent DWC does,
additional costs will be incurred.
COMMENTS
1)Purpose . According to the author, this bill is intended to
reduce cost to taxpayers, reduce needlestick injuries, and
help sharps users comply with current disposal laws by
ensuring that sharps users have proper disposal containers,
and are more informed of how to dispose of them.
2)Background . An estimated one million Californians inject
medications outside traditional health care facilities, which
generate approximately 389 million sharps each year. The
numbers of patients using injectable medications is projected
to grow as prevalence of diabetes increases. The most common
home use of sharps is to manage diabetes. Other reasons to
home-inject include allergies, infertility, arthritis,
hepatitis, HIV, blood clotting disorders, migraines and
cancer. California was one of the first states to address the
problems of sharps disposal with the passage of SB 1305
(Figueroa, Chapter 64, Statutes of 2006), which prohibited the
disposal of medical sharps in California's landfills. Although
illegal, most of these used needles still end up in household
trash and pose a significant risk of injury and infection to
children, custodial workers and solid waste employees.
3)Current Efforts . Many pharmacies, hospitals, and local
household hazardous waste programs accept home-generated
sharps waste. Department of Resources Recycling and Recovery
(CalRecycle) states it is working to help develop a safe,
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convenient, and cost-effective infrastructure for collecting
and properly disposing of home-generated sharps waste.
Pursuant to SB 486 (Simitian), Chapter 591, Statutes of 2009,
CalRecycle currently collects information on manufacturer
actions to provide for the safe collection and proper disposal
of the waste devices, and to educate consumers about safe
sharps management and collection opportunities. CalRecycle
also maintains a web-based search function consumers can use
to locate legal disposal sites for sharps waste.
4)Cost-Sharing in Medicaid . Cost-sharing for individuals under
100% of the federal poverty level, which comprises the
majority of enrollees, is generally limited to "nominal"
amounts established in federal regulations. Services also
cannot be withheld for failure to pay. For prescription drugs
specifically, states are allowed to charge copayments of up to
$3.90, with some exceptions for those enrollees over 150% of
the FPL. However, research shows that cost sharing can act as
a barrier to obtaining health care services, particularly for
individuals with low-incomes and significant health care
needs.
Analysis Prepared by : Lisa Murawski / APPR. / (916) 319-2081