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AB-2293 Chronic obstructive pulmonary disease (COPD): research, education, and treatment.(2019-2020)

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Date Published: 02/14/2020 09:00 PM
AB2293:v99#DOCUMENT


CALIFORNIA LEGISLATURE— 2019–2020 REGULAR SESSION

Assembly Bill
No. 2293


Introduced by Assembly Member Mayes

February 14, 2020


An act to amend Section 104515 of, to add Chapter 3 (commencing with Section 104210) to Part 1 of Division 103 of, and to repeal the heading of Chapter 3 (commencing with Section 104210) of Part 1 of Division 103 of, the Health and Safety Code, and to add Section 14132.24 to the Welfare and Institutions Code, relating to public health.


LEGISLATIVE COUNSEL'S DIGEST


AB 2293, as introduced, Mayes. Chronic obstructive pulmonary disease (COPD): research, education, and treatment.
(1) Existing law requires the State Department of Public Health to award and administer, on a competitive basis, grants for projects directed at the prevention of tobacco-related diseases. Existing law requires a local lead agency, as defined, to implement specified health education against tobacco use. Existing law requires the State Department of Education to provide leadership for the successful implementation of tobacco use prevention programs administered by local public and private schools, school districts, and county offices of education. Existing law requires the State Department of Public Health to conduct statewide surveillance of tobacco-related behaviors, knowledge, and attitudes, evaluate local and state tobacco control programs, evaluate the effectiveness of specified tobacco use prevention education directed at schools, and implement a tobacco use prevention media campaign, as specified.
This bill would create the Broadening Research, Education, Awareness, Treatment, and Health (BREATHE) Act of 2020. The bill would require the State Department of Public Health to review, fund, and oversee research projects by grantees from public and private entities in California related to the prevention, treatment, and awareness of chronic obstructive pulmonary disease (COPD).
(2) Existing law states the intent of the Legislature that the University of California establish a scientific advisory committee to provide advice to the president of the university as to the direction, scope, and progress of the Cigarette and Tobacco Products Surtax Medical Research Program. Under existing law, the Legislature has declared that public policy research is of compelling interest because of its potential to determine the best methods for reducing tobacco use in California.
This bill would add to that intent that the Legislature recognizes the importance of public health research to the prevention and treatment of tobacco-related disease, and directs the scientific advisory committee to give high priority to research proposals for public health research on the scope, impact, and awareness of major tobacco-related diseases where that information has not been regularly collected, including COPD.
(3) Existing law, the Cigarette and Tobacco Products Tax Law, the violation of which is a crime, imposes a tax on distributors of cigarettes at the rate of $2.87 per package of 20 cigarettes and a tax on distributors of tobacco products, based on wholesale cost, at a rate determined annually that is equivalent to the combined rate of all taxes imposed on cigarettes, and at a rate equivalent to $0.50 per package of 20 cigarettes.
Under existing law, the Cigarette and Tobacco Products Tax Fund may only be used for specified purposes, including for tobacco-related disease research and tobacco-related disease medical care for those not able to otherwise afford these services.
This bill would, upon appropriation by the Legislature, allow the department to use funds from the Research Account and the Unallocated Account of the Cigarette and Tobacco Products Surtax Fund for COPD and other similar tobacco-related disease research projects. The bill would allow those funds to be used only for tobacco-related disease research grants and for tobacco-related disease treatment for those who cannot otherwise afford these services. The bill would also authorize the department to conduct COPD surveillance and provide COPD education and awareness efforts.
Vote: MAJORITY   Appropriation: NO   Fiscal Committee: YES   Local Program: NO  

The people of the State of California do enact as follows:


SECTION 1.

 The heading of Chapter 3 (commencing with Section 104210) of Part 1 of Division 103 of the Health and Safety Code is repealed.
3.Chronic Obstructive Pulmonary Disease (Reserved)

SEC. 2.

 Chapter 3 (commencing with Section 104210) is added to Part 1 of Division 103 of the Health and Safety Code, to read:
CHAPTER  3. Chronic Obstructive Pulmonary Disease
Article  1. BREATHE with COPD Act of 2020

104210.
 The Legislature hereby declares the following:
(a) COPD is an umbrella term used to describe progressive lung diseases including emphysema, chronic bronchitis, and severe adult asthma, and is characterized by increasing difficulty in breathing, coughing up large amounts of mucus, wheezing, shortness of breath, and chest tightening.
(b) COPD is incurable, but it can be managed to slow the progression of the disease.
(c) Approximately 6.4 percent of Americans (an estimated 15.7 million adults) have been diagnosed with COPD. It is estimated that another 15 million are undiagnosed or developing COPD. Approximately 1 in 10 American adults have symptoms of COPD including coughing, wheezing, and shortness of breath.
(d) California alone has an estimated 1,100,000 adults with the disease (4 percent of the state’s population). Three-fifths of Californians with COPD (59.1 percent) are women (compared to 56 percent nationally), and more than two-fifths (43.7 percent) belong to minority populations.
(e) More than one-third of Californians with COPD (35.7 percent) live below 130 percent of the federal poverty level; another 20.5 percent live between 131 and 249 percent of the federal poverty level.
(f) Nationally, COPD is the fourth leading cause of death; in California, it is the fifth. But in southern California, COPD is the fourth leading cause of death in the County of Los Angeles (accounting for nearly 29 out of every 100,000 deaths), and the third leading cause of death in the County of San Bernardino (60 per 100,000 deaths) and the County of Riverside (49 per 100,000 deaths).
(g) Marked under diagnosis of COPD (estimates are that as many as 50 percent of those with COPD do not know that they have the disease) drives unnecessarily high rates of emergency room visits and hospital admissions for uncontrolled flare-ups. Approximately 43 percent of Los Angeles County residents report having seen a doctor for COPD-related symptoms without a diagnosis over a 12-month period.
(h) The most common cause of COPD is smoking, though exposure to secondhand smoke, air pollution, and occupational chemical fumes or dust may also lead to the disease. A rare genetic condition, known as alpha-1 antitrypsin deficiency, is also known to cause this disease and is usually the cause of COPD in children.
(i) COPD is diagnosed with a simple spirometry test in which a person blows into a tube connected to a small machine (called a spirometer) that measures how much air an individual’s lungs hold and how quickly each person can exhale. Unfortunately, this inexpensive diagnostic tool remains underutilized. Approximately one-third of California’s adults with COPD (30.4 percent) reported never having received a breathing test (spirometry), which is the only approved method for diagnosing COPD.
(j) Compared to Californians without COPD, twice as many Californians with COPD reported that the cost of health care was an obstacle to receiving medical care (27.7 percent versus 14.7 percent).
(k) Among Californians with COPD, 19.4 percent do not have a personal health care provider. Californians with COPD fare less well than their counterparts without COPD.
(l) Around two-fifths (42.9 percent) of Californians with COPD have seen a doctor for symptoms related to COPD, and 17.5 percent have visited an emergency room or been admitted to the hospital due to COPD, in the last 12 months.
(m) Approximately two-fifths (42.8 percent) of surveyed Californians with COPD report poor or fair health status, compared to 17.4 percent among those without COPD.
(n) Nearly one-third (29 percent) of surveyed Californians with COPD report poor mental health, compared to 10.5 percent among those without COPD.
(o) While one-third of adults with COPD in California are 65 years of age and older, one-fourth (25.4 percent) of adults with COPD in California are under 45 years of age.

104211.
 This act shall be known, and may be cited, as the “Broadening Research Education Awareness Treatment and Health for Everyone with COPD (BREATHE with COPD) Act of 2020.”

104212.
 For purposes of this chapter:
(a) “Chronic obstructive pulmonary disease” (COPD) is an umbrella term used to describe progressive lung diseases, most commonly caused by smoking, and include emphysema, chronic bronchitis, and severe adult asthma, and is characterized by increasing difficulty in breathing, coughing up large amounts of mucus, wheezing, shortness of breath, and chest tightening.
(b) “Department” means the State Department of Public Health.
(c) “Grantee” means any qualifying public, private, or nonprofit entity or individual including, but not limited to, colleges, universities, hospitals, laboratories, research institutions, local health departments, voluntary health agencies, health maintenance organizations, and individuals conducting research in California.
(d) “Projects” means any qualifying research study or program related to COPD prevention, treatment, or awareness.

Article  2. Funding

104213.
 (a) The COPD Research Fund is established in the State Treasury, which shall be used, upon appropriation by the Legislature, by the department to fund COPD research and pilot project grants, as described in Articles 3 and 4 of this chapter.
(b) The fund shall consist of moneys accepted by the department from grants and donations from private entities, and of public moneys transferred to the fund. After an initial appropriation made in the Budget Act of 2020, the fund shall be enhanced by annual allocations appropriated in subsequent budget acts through:
(1) The General Fund.
(2) The Research Account of the Cigarette and Tobacco Products Surtax Fund, as defined in Section 30122 of the Revenue and Taxation Code.
(3) The Unallocated Account of the Cigarette and Tobacco Products Surtax Fund, as defined in Section 30122 of the Revenue and Taxation Code.
(c) The moneys from the Research Account and the Unallocated Account of the Cigarette and Tobacco Products Surtax Fund transferred to the COPD Research Fund, established pursuant to this section, shall be expended solely for the purpose of basic, translational, clinical, and public health and public policy research on tobacco-related COPD, emphysema, and chronic bronchitis.
(d) Notwithstanding subdivision (c), moneys from the Unallocated Account of the Cigarette and Tobacco Products Surtax Fund transferred to the COPD Research Fund, may also be expended for medical or hospital care and treatment of patients affected by COPD and similar tobacco-related diseases who cannot afford to pay for needed COPD and related disease care and treatment, and for whom payment will not be made through any private coverage or by any program funded in whole by the federal government.
(e) For all other purposes described in Articles 3 and 4 of this chapter, only private donations and General Fund moneys may be used.

104214.
 (a) The COPD Awareness Fund is established in the State Treasury, which shall be used, upon appropriation by the Legislature, by the department to fund COPD awareness and education efforts, as described in Article 5 (commencing with Section 104225).
(b) The fund shall consist of moneys accepted by the department from grants and donations from private entities, and of public moneys transferred to the fund.

Article  3. Research

104215.
 (a) Contingent upon appropriation in the annual Budget Act, the department shall regularly collect, conduct, and fund research on COPD, and make public the data collected. The data collected and publicized shall include all of the following:
(1) Morbidity and mortality data on COPD, and an assessment of the burden of COPD on the state’s medical and economic resources.
(2) The general population, and subsets of the general population, diagnosed with COPD, at risk of being diagnosed with COPD, suffering from early-stage COPD, suffering from late-stage COPD, symptoms, and statistical information, which shall include, but not be limited to, age, ethnicity, region, and socioeconomic status of those in the state in relation to COPD.
(3) A survey of factors known to cause or worsen COPD in order to estimate the relative importance of these factors in California. The factors surveyed shall include, but not be limited to, the following:
(A) Tobacco smoke.
(B) E-cigarette aerosol.
(C) Air pollutants, including ground-level ozone, particulate matter, and air toxics.
(D) Chemical fumes from household goods.
(E) Chemical fumes from cleaning products, paint, plastics, and textiles.
(F) Common allergens, including dust, pollen, molds, smog, and pet dander.
(G) Wood smoke.
(H) Odors and pollution from road construction and industrial plants.
(I) Perfumes.
(4) An assessment of patterns of medical care and population-based health services, and the extent of ongoing local, regional, educational, environmental, and other COPD interventions and related activities.
(5) Information on, and an assessment of, the number of pulmonary rehabilitation services available for COPD patients, how many patients are served through these programs, how those patients’ services are funded, whether more pulmonary rehabilitation services are needed, and what areas have the greatest need.
(b) In 2021, and every eight years thereafter, the department shall conduct a statewide COPD census to collect information on, and assess the extent of, the population of those diagnosed with COPD in California. The census shall include information on, but not be limited to, the following patient information:
(1) Age at first onset of COPD symptoms and age at time of first COPD diagnosis.
(2) Whether they had (or have) other pulmonary or respiratory diseases.
(3) Whether they have allergies.
(4) What circumstances led to their COPD diagnosis.
(5) What symptoms they had, and for how long they had symptoms, before being diagnosed with COPD.
(6) Whether they were a regular cigarette smoker, and if so, how many packs of cigarettes they smoked per day, how many years they were a regular smoker, and whether they are still a regular smoker. If they were never a regular smoker, what other factors may have caused their COPD, including living in a highly polluted area, working in and around chemicals, or exposure to secondhand smoke.
(7) Whether they currently use oxygen, and if so, how often.
(8) Whether they live alone, have a regular caregiver, or are cared for by a family member or friend.
(9) Any additional information that would be useful to improve diagnosis and treatment of COPD.
(c) Information gathered pursuant to subdivisions (a) and (b) shall be used in the development of public health programs, COPD policy, and the outreach and awareness campaigns required pursuant to Article 5 (commencing with Section 104225).

104216.
 (a) The department shall establish a grant program to fund grantee research on COPD.
(b) The department shall do all of the following in connection with awarding research grants under the program established pursuant to this article:
(1) Draft and circulate requests for grantee project applications.
(2) Determine selection criteria, consult with applicants, and monitor the progress of projects.
(3) Provide funding for research on issues related to COPD diagnosis, treatment, prevention, awareness, morbidity, mortality, the progression of the disease, early interventions, and any other topics that will provide a better understanding of COPD and those who are suffering from COPD.
(4) Require specific evaluations of projects, require grantees to have a plan for implementation of effective programs, and prepare a summary of findings from all projects conducted.
(c) Specific research projects that the department shall fund within 12 months of enactment of this chapter shall include:
(1) Research on the standard of care for diagnosis of COPD, including whether the standard of care should be modified to increase earlier diagnosis of COPD.
(2) Research on whether annual spirometry testing of everyone 45 years of age and older would increase earlier diagnosis of COPD without being overly burdensome.
(3) Research on public awareness of COPD and how to conduct public education that will increase awareness of the disease and its symptoms.

Article  4. Diagnosis and Treatment

104220.
 (a) The department shall offer public and professional education to disseminate the most current information on COPD.
(b) The department shall fund medical education targeting primary care providers, including, but not limited to, primary care physicians and physician assistants, on COPD and related diseases. The medical education shall include, but not be limited to, the following:
(1) Incidence of COPD.
(2) Statistical information.
(3) The need to perform lung screenings.
(4) The latest treatment methods and research.
(c) The department shall assist health care organizations, including managed care organizations, in identifying or developing effective COPD diagnosis and treatment protocols. The department shall improve clinical practice by working with experts, partnering with health care organizations, and conferring with stakeholders, including lung health nonprofit organizations with experience serving individuals with COPD.
(d) The department shall promote the utilization of evidence-based COPD guidelines, including the National Heart, Lung, and Blood Institute (NHLBI) and the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, to carry out the purposes of the chapter.

104221.
 (a) Despite the need for more information about the causes of COPD, there is also an urgent need to apply existing knowledge to reduce the burden on state resources from COPD. The department shall establish a grant program to fund grantee intervention programs that propose promising, innovative COPD interventions that benefit persons with COPD, their caregivers, and their families by increasing community awareness, improving patient education and COPD self-management skills, improving clinical practice, coordinating services, and developing local policies that support prevention and control of COPD, including by eliminating, or reducing the impact of, environmental factors that exacerbate COPD.
(b) The department shall ensure that the intervention programs are scientifically based and practical, and address a range of significant COPD prevention and control issues. Programs may include, but need not be limited to, the following:
(1) Clinical quality improvement.
(2) Disease management.
(3) Public and professional education, including information on COPD self-management skills and ways to reduce or eliminate irritants that exacerbate COPD.
(4) Mobilization of communities, including local health departments, community agencies, and other organizations.
(5) Unique interventions for special or at-risk populations.
(6) Innovative collaborations between managed care organizations, local organizations, health systems, academic institutions, voluntary health organizations, and local governments.
(7) Reducing environmental factors that exacerbate COPD.

104222.
 (a) The department shall establish a grant program to fund grantee pilot programs for evidence-based COPD patient self-management programs.
(b) The department shall do all of the following in connection with awarding COPD patient self-management pilot program grants under the program established pursuant to this section:
(1) Consult with community stakeholders related to the development, implementation, and evaluation of COPD projects.
(2) (A) Monitor the projects and related clinical and public health interventions required by this section, and report successful and unsuccessful interventions in clinical and public health practice.
(B) The department shall post the findings required pursuant to this paragraph on its internet website.

104223.
 The department shall increase access of those with COPD to disease management programs, by providing funding for:
(a) Pulmonary rehabilitation services and other programs to improve the quality of life of those diagnosed with COPD.
(b) Construction and operation of five new pulmonary rehabilitation facilities annually.

104224.
 The department shall fund innovative treatments and technologies that will help diagnose, treat, assist, promote wellness, and improve the quality of life of those with COPD and their caregivers.

Article  5. Outreach and Awareness

104225.
 (a) Subject to subdivision (d), the department shall conduct the COPD Awareness Campaign to do all of the following:
(1) Increase awareness of COPD in the general public, as well as targeted population subsets with higher incidences of COPD. The awareness campaign shall include information about COPD symptoms, prevention, treatment, and the need for early diagnosis.
(2) Improve provider education aimed at promoting early diagnosis of COPD, options for screening and testing, current research on the causes of COPD, current research on COPD triggers, and the costs of diagnosis and treatment.
(b) For purposes of the COPD Awareness Campaign, the department shall establish a study of, and compile research regarding, COPD, emphysema, and chronic bronchitis awareness.
(c) The department may partner with, or subcontract to, local, regional, or California-based national nonprofit organizations to conduct the COPD Awareness Campaign. These organizations shall have experience providing public and provider education on COPD.

104226.
 (a) The department shall conduct outreach to primary care providers, including primary care physicians and physician assistants, to increase knowledge of COPD diagnosis and treatment among primary care providers.
(b) The department shall develop community engagement partnerships with organizations to disseminate information and broaden opportunities for education on COPD to a wider segment of the state population.
(c) The department shall conduct outreach, and provide training and support, to family caregivers and in-home service caregivers of COPD patients.

SEC. 3.

 Section 104515 of the Health and Safety Code is amended to read:

104515.
 It is the intent of the Legislature that the university establish a scientific advisory committee to provide advice to the president of the university as to the direction, scope, and progress of the research program.
(a) Responsibilities of the committee may include, but are not limited to:
(1) Provision of advice on program priorities and emphasis.
(2) Provision of advice on overall program budget.
(3) Participation in periodic program evaluation.
(4) Assistance in developing guidelines to assure fairness, neutrality, and adherence to the principles of merit and quality in the conduct of the program.
(5) Assistance in developing appropriate linkages to nonacademic entities, including, but not limited to, voluntary organizations, health care delivery institutions, industry, government agencies, and public officials.
(b) Responsibilities of the committee may additionally include:
(1) Development of criteria and standards for grant awards.
(2) Development of administrative procedures relative to the solicitation, review, and award of grants to ensure an impartial, high quality peer review system.
(3) Development and supervision of research review panels.
(4) Review of research review panel reports and recommendations for grant awards.
(5) Development and oversight of mechanisms for the dissemination of research results.
(c) It is the intent of the Legislature that the committee consist of at least nine members representing a range of scientific expertise and experience appointed by the president of the university from nominations submitted by relevant organizations, as follows:
(1) Three members from voluntary health organizations dedicated to the reduction of tobacco use.
(2) One member with expertise in the field of biomedical research.
(3) One member with expertise in the field of behavioral or social research.
(4) One member from professional medical or health organizations.
(5) One member from an independent research university in California.
(6) One member drawn from other institutions engaged in research directed at tobacco-related diseases.
(7) One member representing tobacco control for the department.
(8) One member representing a community-based provider of health education and prevention services.
(d) Committee membership shall be drawn from the ranks of bona fide scientists and individuals fully conversant with the norms of scientific inquiry.
(e) Members shall serve at the pleasure of the President of the University of California. Membership may be staggered in such a way as to maintain that maintains a full committee while ensuring a reasonable degree of continuity of expertise and consistency of direction.
(f) Members shall serve without compensation, but may receive reimbursement for travel and other necessary expenses actually incurred in the performance of their official duties.
(g) The Legislature hereby declares that public policy research is an area of compelling interest because of its potential to determine the best methods for reducing tobacco use on a wide scale among Californians. The scientific advisory committee shall give a high priority to proposals for grant awards to fund public policy research.
(h) The Legislature declares that public health research is of compelling interest because of its potential to improve understanding of the scope of the impact of tobacco on the general public, and on discrete subsets of the population. The scientific advisory committee shall give a high priority to proposals for grant awards to fund public health research on the scope, impact, and awareness of major tobacco-related diseases where this information has not been regularly collected, including research on chronic obstructive pulmonary disease (COPD).

SEC. 4.

 Section 14132.24 is added to the Welfare and Institutions Code, to read:

14132.24.
 By December 1, 2021, the department shall:
(a) Increase the Medi-Cal reimbursement rates for the following and make the rates equivalent to, or greater than, the rates for comparable services provided for other chronic diseases:
(1) Testing and screening of respiratory illnesses, including chronic obstructive pulmonary disease (COPD).
(2) Pulmonary rehabilitation services.
(3) Use of gaseous and liquid oxygen.
(4) Patient self-management programs for those with COPD.
(b) Fund the development and implementation of programs that encourage diagnostic screening and testing for COPD.
(c) This section shall be implemented only to the extent that federal financial participation is available and any necessary federal approvals have been obtained.