April 28, 2017 Edition

State Released Proposed Medical Cannabis Regulations

Earlier today, the State released their proposed regulations for medical cannabis. There are three state agencies involved in the regulatory process – the Bureau of Medical Cannabis Regulation, California Department of Public Health and the California Department of Food and Agriculture. Each agency is responsible for various components of the regulations have posted their drafts on their respective websites. Links have been provided below. Additionally, updates will be posted to the State’s cannabis website located at www.cannabis.ca.gov.

In the coming weeks, CHEAC will provide a summary of the proposed regulations and will also be soliciting comments/feedback from members. CHEAC will gladly coordinate a statewide response on behalf of all of our members and will follow-up next week with a timeline for submissions. Please note local health departments can also provide comments directly to any of the agencies. Should you wish to comment directly, we would ask that you please provide us with a copy of your response. Comments can be sent to admin@cheac.org.

The State has allowed for a 45-day comment period.

Bureau of Medical Cannabis Regulation – transporters, distributors, dispensaries and laboratories

 Notice of Proposed Rulemaking

Proposed Text

Other resources can be found here.

To comment on the BMCR Proposal, please refer to this guide.

*Please note, the proposed regulations related to laboratories will be posted next Friday.

 

California Department of Public Health – manufacturers

Notice of Proposed Rulemaking

Proposed Text

Other resources can be found here.

To comment on the CDPH Proposal, please follow the steps below:

Send a letter by mail to: California Department of Public Health, Office of Regulations, 1415 L Street, Ste. 500, Sacramento CA 95814

FAX: (916) 440-5747

Email: regulations@cdph.ca.gov

Attend a Public Hearing and submit comments verbally or in writing.  The public hearings will be held:

June 8, 2017 10:00 am, 50 D Street, Room 410A/410B, Santa Rosa, CA 95404

June 13, 2017, 10:00 am, 1350 Front Street, Auditorium, San Diego, CA 92101

 

California Department of Food and Agriculture – cultivation

Notice of Proposed Rulemaking

Proposed Text

Other resources can be found here.

To comment on the CDFA proposal, please refer to this guide.


Policy Committees hear Single-Payer bill and Remaining Bills with Fiscal Implications

This week, hearing agendas were packed with the most complex bills to meet the legislative deadline for bills with fiscal implications to be heard in policy committees. Several key bills were heard, including SB 562 – the Healthy California Act – by Senators Lara and Atkins, which was heard during a Special Order of the Senate Health Committee. The measure would create a program to provide single-payer health care coverage and a health care cost control system for the all Californians. Advocates filled the room as discussions continued for well over two hours. The measure was passed by the Committee, however not without several questions surrounding how the bill would be financed.

Updates on other key bills of interest are provided below. An updated bill chart can be found here.

Environmental Health

 AB 626 (Garcia) as amended on 4/6/17 – Oppose

On Tuesday, the Assembly Health Committee heard AB 626 by Assembly Member Garcia, which would create a new type of food facility under the California Retail Food code for “microenterprise home kitchens.” Entities would be allowed to prepare and sell meals from private home to the general public, with limitations on the number of meals sold and gross sales. The operations would be subject to local approval.

Current law allows the preparation and sale of non-hazardous foods as approved under Cottage Food Laws in 2012. This bill would allow the preparation and sale of potentially hazardous foods within the home.

Representatives of CHEAC and HOAC testified as lead opposition on the measure. Others in opposition included CSAC, UCC and RCRC. Unfortunately, the measure passed with 12 ‘aye’ votes and 3 members abstaining – Assembly Members Wood (Chair), Bonta and Quirk-Silva. The measure now moves to the Assembly Appropriations Committee. CHEAC and HOAC sent out a request for fiscal data related to AB 626. Your feedback is greatly appreciated.

Drug & Alcohol Services

AB 186 (Eggman) as amended on 3/23/17 – Watch

This week, the Assembly Public Safety Committee heard AB 186 by Assembly Member Eggman, which would authorize counties or cities within the counties of Alameda, Fresno, Humboldt, Los Angeles, Mendocino, San Francisco, San Joaquin and Santa Cruz to establish and operate supervised injection sites for those who consume intravenous drugs. The author and sponsors noted findings that given a safe place to use, people are more likely to get into treatment and view this bill as extending harm reduction strategies in California.

Concerns were raised in Committee about unintentional loopholes the bill would create and that safe injection sites would incentivize continued drug use versus encouraging individuals to seek treatment. However, despite the concerns raised, members of the Assembly Public Safety Committee passed the measure with a vote of 4 to 3. AB 186 now moves to the Assembly Floor for a full vote.

AB 40 (Santiago) as amended on 4/19/17 – Support

The Assembly Public Safety Committee also heard AB 40 by Assembly Member Santiago, which would allow the Controlled Substance Utilization Review and Evaluation System (CURES) database to integrate with other health information technology systems. This measure would allow prescription information to be included in the same patient record information that providers already receive to provide better care and combat the prescription opioid epidemic. AB 40 was passed unanimously by the Assembly Public Safety Committee and now moves to the Assembly Appropriations Committee.

Chronic Disease Prevention & Wellness Promotion

AB 1003 (Bloom) as amended on 4/19/17 – Watch

AB 1003, the sugar-sweetened beverage tax measure introduced by Assembly Member Bloom, was brought before the Assembly Health Committee this week. The measure would establish the California Community Health Fund to support programming and interventions related to chronic disease, physical activity, and access to healthy foods through a tax on sugar-sweetened beverages. The bill was not discussed in committee, but instead moved to an interim study. CHEAC will continue to watch the measure.

SB 300 (Monning) as introduced on 2/13/17 – Support

SB 300, by Senator Monning, which would require safety warning labels on sugar-sweetened beverages, vending machines, and dispensing machines, was scheduled to be heard on April 19; however, the measure was canceled at the request of the author. SB 300 does not appear to be moving forward at this time.

Tobacco

AB 62 (Wood) as amended on 3/27/17 – Support

The Assembly Housing and Community Development Committee heard AB 62, by Assembly Member Wood, which would require all public housing agencies to implement policies prohibiting the smoking of tobacco products in all public housing units, interior areas, and outdoors within 25 feet of public housing and administrative buildings. The measure was unanimously approved by the Assembly Housing and Community Development Committee and now moves to the Assembly Appropriations Committee.


Cannabis Trailer Bill Heard in Assembly

On Tuesday, the Assembly Budget Subcommittee No.4 on State Administration held a lengthy hearing on the Administration’s implementation of the Medical Cannabis Regulation and Safety Act (MCRSA) and Proposition 64, the Adult Use of Marijuana Act (AUMA), as well as a presentation on the Administration’s rationale for the Cannabis Trailer Bill.  Representatives of the Department of Finance, Department of Consumer Affairs – Bureau of Cannabis Regulation, Department of Public Health, Department of Food and Agriculture, and the Board of Equalization, provided updates about their implementation activities, followed by a presentation from the Department of Finance on the proposed budget trailer bill.  The Legislative Analyst’s Office (LAO) also offered an overview on the proposed trailer bill and their general finding that aligning MCRSA and AUMA is appropriate.  The LAO noted trade-offs associated with eliminating the Medical Marijuana ID Card program mentioning that shifting the responsibility to the counties “on a voluntary basis” could potentially impact state and local sales tax revenues.

Budget subcommittee members asked very pointed questions about the Administration’s proposal to essentially create one regulatory structure for the oversight of cannabis in California.  Questions focused on the vertical integration of the industry as envisioned in the trailer bill language.  Concerns were also expressed that the trailer bill removes most of the major provisions of the MCRSA; in a somewhat unusual move, one of the MCRSA lead authors, Assembly Member Ken Cooley testified before the committee, on behalf of the other author/members (who all remain in the Legislature), about their concerns with the bill.

A variety of stakeholders provided input during public comment.  CHEAC weighed in with support for eliminating the Medical Marijuana ID Card program, and noted the lack of infrastructure to support a local identification card program. However, CHEAC also noted our support for the local discretion provided in the trailer bill.  The drafters of Proposition 64/AUMA, as well as the California Cannabis Industry Association, were in support of the Administration’s proposal whereas the Cannabis Growers Association was concerned about provisions that could allow the marketplace to become dominated by a few large conglomerates.  The League of California Cities and the California Police Chiefs Association are opposed to the proposal for a myriad of reasons; of note to CHEAC members, the League is not in favor of eliminating the State ID card program.


Denti-Cal and Oral Health Programs heard in Assembly Budget Subcommittee No. 1

On Monday, the Assembly Budget Subcommittee No. 1 on Health and Human Services heard items related to the Department of Health Care Services (DHCS) and the California Department of Public Health(CDPH). As asked, DHCS provided an update on the newborn hearing screening program and the progress with restoring the automated system.

DHCS also provided an overview of the Denti-Cal program followed by member and stakeholder proposals. Members of the Committee discussed low reimbursement rates for Denti-Cal providers and also inquired about the coordination of Denti-Cal and managed care.

CDPH discussed allocations related to the passage of Proposition 56, which increased the excise tax on cigarettes by $2.00 per pack and imposed an equivalent tax on other tobacco products. The Proposition allocated $6 million per year to CDPH for enforcement and $30 million per year for CDPH’s state dental programs. Remaining revenues are allocated as follows:

  • 82% to DHCS
  • 13% to CDPH and the Department of Education for tobacco prevention; and
  • 5% to the University of California for medical research.

Dr. Kumar, the State Dental Director with CDPH, conveyed to members that CDPH has and will continue to work directly with local health departments to allocate resources and create flexibility through multi-year contracting.

All items noted above were held open. The agenda can be viewed here.


Medi-Cal 2020 Waiver, CCI, CCS and CHDP heard in Senate Budget Subcommittee No. 3

Yesterday, the Senate Subcommittee No. 3 on Health and Human Services convened a day-long hearing on issues related to both the Office of Statewide Health Planning and Development and the Department of Health Care Services.

DHCS representatives provided members with an update on the implementation of the various components of the Medi-Cal 2020 Waiver, including Whole Person Care and the Dental Transformation Initiative. During the discussion on the Coordinated Care Initiative, members did inquire about the fiscal impact on counties, to which the Administration’s response noted ongoing discussions between the state and counties related to mitigation.

The department also noted their intent to delay the implementation of the CCS Whole Child Model, which advocates supported. Lastly, DHCS presented their proposed elimination of the state-only component of the Child Health Disability Prevention Program. Members expressed concern with eliminating this component and noted that should the ACA be repealed, a need for CHDP state-only would be present.

All items were held open. An agenda can be viewed here.


Vote Delayed to Repeal and Replace the Affordable Care Act

Despite pressure to vote on the recently amended American Health Care Act (ACHA) prior to the President’s 100th day in office, House Republican leadership has signaled that the vote would be delayed until next week. Recall, an overview of the MacArthur amendment was shared earlier; however, official language was introduced this week. The amendments allow for limited waivers from certain federal standards including the essential health benefits and community rating rules. While the amendments have won over support from the Freedom Caucus, a number of moderate House Republicans are opposed.


California Budget & Policy Center Release County Budget Process Guide

The California Budget & Policy Center (CBPC) released a guide outlining how county budgeting works at the local level.  The guide provides a basic overview of the county population, governance, and services provided.  The guide further explores county revenues and spending, state and local influences on county budgeting practices, and the county budget timeline.  CBPC intends to conduct trainings on the county budget process with various partners around the state in the coming months.


Accreditation and Quality Improvement Resources Available

The Association of State And Territorial Health Officials (ASTHO) just recently released two leadership guides, one on public health accreditation and one on performance management.  We’re pleased to note both documents are authored by Ron Chapman, MD, MPH, Health Officer, Yolo County, and former CDPH Director.  Dr. Chapman, along with Leslie M. Beitsch, MD, JD, also authored a journal article in the Journal of Public Health Management and Practice entitled “Performance Management Systems: A Public Health Model Practice.”


Maternal, Infant, and Child Health Webinar to be held on May 18

Healthy People 2020 is hosting a webinar exploring the progress made toward achieving the  maternal, infant, and child health leading health indicators, on Thursday, May 18, 2017 from 9:00 – 10:00 a.m. PST. The webinar will highlight efforts in Cincinnati to reduce infant mortality and preterm birth rates.  For more information and to register for the webinar, visit the Healthy People 2020 website.