BILL ANALYSIS                                                                                                                                                                                                    Ó



                                                                    AB 2399


                                                                    Page  1





          Date of Hearing:   April 13, 2013


                        ASSEMBLY COMMITTEE ON APPROPRIATIONS


                               Lorena Gonzalez, Chair


          AB  
          2399 (Nazarian) - As Amended March 28, 2016


           ----------------------------------------------------------------- 
          |Policy       |Health                         |Vote:|17 - 0       |
          |Committee:   |                               |     |             |
          |             |                               |     |             |
          |             |                               |     |             |
          |-------------+-------------------------------+-----+-------------|
          |             |                               |     |             |
          |             |                               |     |             |
          |             |                               |     |             |
          |-------------+-------------------------------+-----+-------------|
          |             |                               |     |             |
          |             |                               |     |             |
          |             |                               |     |             |
           ----------------------------------------------------------------- 


          Urgency:  No  State Mandated Local Program:  NoReimbursable:  No


          SUMMARY:


          This bill extends the umbilical cord collection program and  
          contains related provisions.  Specifically, this bill: 










                                                                    AB 2399


                                                                    Page  2





          1)Extends the state umbilical cord collection program for an  
            additional five years, from January 1, 2018 to January 1,  
            2023.


          2)Extends a $2 fee on certified copies of birth certificates to  
            support the program.


          3)Requires the California Department of Public Health (CDPH) to  
            publish informational materials regarding umbilical cord blood  
            storage, prenatal testing, and prenatal human immunodeficiency  
            virus (HIV) in multiple languages. 


          4)Repeals existing law making the implementation of a community  
            awareness campaign about umbilical cord blood donation by CDPH  
            contingent upon receiving sufficient private donations,  
            thereby making the requirement operative.


          FISCAL EFFECT:


          1)The state would continue to incur costs to the Health  
            Statistics Special Fund and collect about $2.5 million  
            annually in revenues to support the state umbilical cord  
            collection program through calendar year 2022.  The program is  
            currently administered by UC Davis Health System through  
            contract with CDPH.  


          2)Uncertain, significant costs to conduct a public awareness  
            campaign.  The costs would depend on the robustness of the  
            effort, and could easily be millions of dollars ongoing for an  
            effective statewide campaign (GF).  The current statute  
            requires the campaign provide awareness, assistance, and  
            information regarding umbilical cord blood banking options  
            using brochures, television, print media, radio, Internet Web  








                                                                    AB 2399


                                                                    Page  3





            sites, outdoor advertising, and other media.  


          3)Costs to CDPH of approximately $30,000 to translate the  
            prenatal information into the additional languages (Genetic  
            Disease Fund).  








          COMMENTS:


          1)Purpose. According to the author, studies have shown cord  
            blood is a rich source of stem cells that can be used to treat  
            various diseases and disorders.  The author believes this is a  
            worthy program that should be extended, and that proposed  
            changes will increase outreach and awareness, thereby  
            increasing the diversity of cord blood collected by the  
            program and available for California's diverse population.


          2)Uses of Cord Blood. Donated cord blood can be banked for use  
            in transplants. It has been used to treat certain diseases of  
            the blood and immune system, as well as inherited diseases (of  
            red blood cells, the immune system and certain metabolic  
            abnormalities).  Cells from cord blood also demonstrate the  
            potential to help conditions that have no cure today by  
            regenerating damaged tissue and restoring lost function after  
            an injury or illness. Cord blood can be donated to a public  
            bank or can be privately banked for personal use, though  
            private banking is generally not recommended unless there is a  
            family history of specific genetic diseases.










                                                                    AB 2399


                                                                    Page  4





          3)Cord Blood Collection Program. The program whose sunset is  
            extended by this bill was created by AB 52 (Portantino),  
            Chapter 529, Statutes of 2010, and is funded through an  
            additional $2 fee on birth certificate copies.  It is a  
            statewide public program designed to capture the genetic  
            diversity of Californians through the collection of cord  
            blood.  The program does not administer a public cord blood  
            bank, but sets up collection sites in hospitals and  
            facilitates the relationship between a hospital and public  
            bank.  The program attempts to make a hospital's participation  
            in the program cost-neutral by providing contract staff or  
            reimbursing hospitals for their staffing costs, as well as  
            managing the administrative aspects of the collection.  Once  
            collected, the blood is stored at a public bank, such as San  
            Diego Blood Bank. Banks register each unit of collected cord  
            blood under the National Marrow Donor Program, which maintains  
            a global registry of available cord blood units.  


            The collection program targets hospitals that are ethnically  
            diverse, in order to increase the chances that a donor can be  
            found for persons of ethnic heritage that are not currently  
            well-represented among cord blood donors.  Banks attempt to  
            match proteins called Human Leukocyte Antigen (HLA), and a  
            person's HLA typing is related to ethnicity.  A match between  
            a donor's and a patient's HLA markers is essential for a  
            successful transplant outcome.


          4)Staff Comments. The relationship between birth certificates  
            and cord blood donation appears limited to the fact that they  
            both relate to the birth of a child.  In addition, it is  
            unclear what the appropriate ongoing expenditure level is for  
            a program of this type.  If this program model is the best way  
            to ensure a diversity of samples is available for the benefit  
            of California's population, the author may wish to consider  
            whether there are alternative funding sources for this program  
            and ensure there is a match between program needs and  
            revenues. 








                                                                    AB 2399


                                                                    Page  5







            Additionally, while some level of public awareness effort  
            appears to be warranted, the nature of cord blood collection  
            at the time of birth suggests that public education has to be  
            a sustained, ongoing effort to educate new mothers and that  
            targeted approaches may be more cost-effective than large  
            statewide media campaigns. 


          Analysis Prepared by:Lisa Murawski / APPR. / (916)  
          319-2081