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