April 12, 2019 Edition

After Marathon Week of Hearings, Legislature Begins Spring Recess

The California Legislature wrapped up an extremely busy week of committee hearings, bill negotiations, and amendments, breaking for its 10-day Spring Recess upon adjournment of yesterday’s session. Policy committee hearings stretched several hours – some into the evening hours – as committees considered and acted upon a significant number of measures. Advocates packed the halls of the Capitol, coming out in droves to voice their support and opposition to a variety of measures heard this week.

Recall, policy committees have only one week to hear and report fiscal bills introduced in their house of origin upon their return from Spring Recess on Monday, April 22. Given the approaching deadline, the weeks following Spring Recess are expected to be very busy.

Of note this week, AB 766 (Chiu) was set for hearing in the Assembly Health Committee on Tuesday; however, the measure was shelved just prior to the hearing at the request of the author. AB 766 would prohibit retailers from offering for sale an unsealed beverage container that is able to contain more than 16 fluid ounces. The measure was introduced as part of a package of bills intended to reduce consumption of sugar-sweetened beverages (SSBs). The fate of the remaining measures – bills to prohibit SSB financial incentives, require healthy drinks in checkout aisles, establish an SSB fee, and require SSB warning labels – remain unclear, yet the measures continue to make their way through the legislative process.

Below, we highlight actions from this week of particular interest to CHEAC Members. Our full CHEAC Weekly Bill Chart is available here.

Chronic Disease Prevention & Wellness Promotion

AB 138 (Bloom) as amended April 11, 2019 – WATCH

AB 138 by Assembly Member Richard Bloom was heard in the Assembly Health Committee on Tuesday. The measure would impose a $0.02 per fluid ounce fee on specified SSB distributors. The measure specifies expenditures of the revenues to various state agencies and departments, including the California Department of Public Health (CDPH), and the Department of Health Care Services (DHCS), to administer grants and allocations to promote health equity, reduce health disparities, and prevent illness, injury, and premature death. AB 138 was advanced to the Assembly Revenue and Taxation Committee on an 8-6 vote with one member not voting.

Communicable Disease Control

AB 262 (Gloria) as amended March 27, 2019 – WATCH 

Assembly Member Todd Gloria’s AB 262 would require local health officers (LHOs), during a communicable disease outbreak or imminent threat of an outbreak or epidemic, to promptly notify and update governmental entities within their jurisdiction about communicable disease outbreaks that may impact those entities. AB 262 was advanced out of the Assembly Appropriations Committee on Wednesday on a 15-0 vote with one member not voting. The measure is now on the Assembly Floor.

SB 276 (Pan) as amended April 9, 2019 – SUPPORT

SB 276 by Senator Richard Pan would specify that immunization medical exemption request forms may be approved or denied only by the state public health officer or its designee upon determination utilizing U.S. Centers for Disease Control and Prevention (CDC) guidelines. Physicians would be required to utilize a CDPH-developed statewide standardized request form when issuing an immunization exemption for medical reasons, and CDPH must maintain a medical exemption request database.

Advocates in opposition to SB 276 held a rally on the Capitol steps this Wednesday afternoon in anticipation of its upcoming hearing in the Senate Health Committee on Wednesday, April 23. CHEAC supports SB 276 to prevent and control the spread of infectious diseases throughout the state.  

Emergency Medical Services (EMS)

AB 1544 (Gipson) as introduced February 22, 2019 – OPPOSE UNLESS AMENDED

Assembly Member Mike Gipson’s AB 1544 would enact the Community Paramedicine or Triage to Alternate Destination Act to allow local emergency medical services agencies (LEMSAs) to develop local community paramedicine programs. The measure requires LEMSAs to use or establish local emergency medical care committees (EMCCs) and establishes the Community Paramedicine Medical Oversight Committee to advise the EMS Authority on and to approve minimum medical protocols for all community paramedicine programs, among other activities. AB 1544 was unanimously advanced from the Assembly Health Committee on Tuesday and now heads to the Assembly Appropriations Committee. CSAC, RCRC, UCC, CHEAC, EMSAAC, and EMDAC remain in oppose unless amended positions.  

SB 438 (Hertzberg) as amended March 25, 2019 – OPPOSE

SB 438 by Senator Robert Hertzberg would restrict the use of non-governmental-operated public safety answering points (PSAPs), including 9-1-1 EMS dispatching centers. The measure would circumvent existing oversight activities of LEMSA medical directors to ensure the appropriate deployment and use of EMS resources. SB 438 was heard in the Senate Governance and Finance Committee on Wednesday, and witnesses from EMDAC and EMSAAC testified in opposition to the bill. CSAC, RCRC, UCC, CHEAC, EMSAAC, and EMDAC are all opposed to the measure. The measure was advanced to the Senate Health Committee on a 6-1 vote.

Environmental Health

AB 377 (E. Garcia) as amended March 25, 2019 – SUPPORT

AB 377 by Assembly Member Eduardo Garcia was heard in the Assembly Health Committee on Tuesday. AB 377 is the clean-up measure to AB 626 (Chapter 470, Statutes of 2018) which established microenterprise home kitchens operations. CHEAC, along with CCDEH and HOAC, has engaged extensively over the past several months with the author’s office and original sponsors of the measure to seek clarifying and technical amendments around jurisdictional opt-in procedures, local permitting and inspection activities, and exempted food safety and sanitation provisions. Recall, CHEAC and our county colleague organizations strongly opposed AB 626 last year. While CHEAC remains significantly concerned with the potential for increased risk to the public’s health and safety through the operation of microenterprise home kitchen operations, CHEAC is supportive of AB 377 as it provides greater clarity of critical provisions enacted through AB 626. AB 377 was advanced from the Assembly Health Committee to the Assembly Appropriations Committee on a 13-1 vote with one member not voting.

Health Coverage/Health Care Reform

AB 4 (Bonta) as amended March 28, 2019 – SUPPORT

Assembly Member Rob Bonta’s AB 4 would expand Medi-Cal coverage to all undocumented adults with income at or below 138 percent of the federal poverty level (FPL). AB 4 was heard in the Assembly Health Committee on Tuesday in a packed hearing room, largely consisting of immigrant rights and health access advocates. With no opposition during public comment, the bill was advanced to the Assembly Appropriations Committee on a 11-3 vote with one member not voting.

AB 414 (Bonta) as introduced February 7, 2019 – SUPPORT

AB 414 by Assembly Member Rob Bonta would institute a state-level individual health insurance coverage mandate in California and would require Covered California to determine a penalty for not obtaining health insurance. Revenues generated from fines would be directed to improve the affordability of health coverage in California. The California Nurses Association (CNA) expressed opposition, contending that imposing a penalty fee on individuals who cannot pay for insurance will not push them to purchase coverage they could not afford in the first place. The measure was heard on Tuesday in the Assembly Health Committee and advanced to the Assembly Appropriations Committee on an 11-1 vote with three members not voting.

SB 175 (Pan) as amended April 3, 2019 – SUPPORT

Similar to AB 414 (Bonta), SB 175 by Senator Richard Pan would also institute a state-level individual mandate. SB 175 differs slightly in directing penalty revenues to also cover operational costs of Covered California in administering the individual mandate and financial assistance program, as well as requiring Covered California to conduct specified annual outreach and enrollment efforts among individuals who do not maintain minimal essential coverage. SB 175 was heard in the Senate Health Committee on Wednesday and advanced to the Senate Appropriations Committee on a 6-1 vote with two members not voting.

AB 537 (Wood) as corrected March 21, 2019 – SUPPORT  

AB 537 by Assembly Member Jim Wood would require DHCS, in collaboration with stakeholders, to establish a quality assessment and performance improvement program for all Medi-Cal managed care plans. Plans would be required to meet specified minimum performance levels (MPLs) to improve care quality and reduce health disparities. DHCS would also be required to develop a plan for a value-based financial incentive program for Medi-Cal managed care plans. AB 537 was advanced from the Assembly Health Committee to the Assembly Appropriations Committee on an 11-3 vote with one member not voting.

Injury Prevention

AB 645 (Irwin) as amended March 6, 2019 – SUPPORT

Assembly Member Jacqui Irwin’s AB 645 would require licensed firearms dealers to post and firearm packaging to include information on the National Suicide Prevention Lifeline. The Department of Justice (DOJ) would also be required to update the firearm safety certificate exam to cover the topic of suicide prevention. AB 645 was advanced from the Assembly Appropriations Committee to the Assembly Floor on a 15-0 vote with three members not voting on Wednesday.

Jail and Community Corrections Services

SB 433 (Monning) as amended April 11, 2019 – SUPPORT IN CONCEPT

SB 433 by Senator Bill Monning was heard in the Senate Public Safety Committee on Tuesday. The measure would require the California Department of Social Services (CDSS), in collaboration with CDPH, to establish and oversee the Office of Youth Development and Diversion (OYDD) Grant Program, consisting of up to five three-year pilot programs to be administered by a county health department. Under the grant program, counties would be required to conduct a series of activities in partnership with community-based organizations and local governmental entities related to youth development and diversion programming and services. CHEAC supports the measure in concept and continues to work with the author’s office and sponsors to refine aspects of the measure to make the pilots more workable for county health departments. SB 433 was advanced from the Senate Public Safety Committee to the Senate Human Services Committee on a 6-1 vote.

Maternal, Child, & Adolescent Health Services

SB 464 (Mitchell) as amended April 11, 2019 – SUPPORT

SB 464 by Senator Holly Mitchell was heard in the Senate Health Committee on Wednesday. SB 464 would require specified health facilities providing perinatal care to implement an implicit bias program for all health care providers involved in perinatal care within those facilities. Hospitals would be required to provide patients with information on filing a discrimination complaint, and CDPH would be required to track and publish specified maternal morbidity and mortality data, among other activities. SB 464 was advanced to the Senate Appropriations Committee on an 8-0 vote with one member not voting.

Tobacco Control

AB 1718 (Levine) as introduced February 22, 2019 – SUPPORT

Assembly Member Marc Levine’s AB 1718 would ban smoking and disposal of cigar and cigarette waste at all state coastal beaches or in state parks. AB 1718 was heard in the Assembly Water, Parks, and Wildlife Committee on Tuesday and was advanced to the Assembly Appropriations Committee on a 10-4 vote. Recall, this measure has been introduced the past several years and vetoed each time by then-Governor Jerry Brown.

SB 538 (Rubio) as amended March 28, 2019 – SUPPORT

SB 538 by Senator Susan Rubio would require manufacturers of electronic cigarettes to submit a written physical description and a photograph of each type of electronic cigarette device to CDPH. CDPH would then be required to make available online all written descriptions and photographs of these products and conduct a public outreach campaign to notify schools and parent organizations of the listings’ availability. CHEAC has taken a support position on SB 538.

Assembly Subcommittee No. 1 Considers Health Coverage, AB 85 Budget Proposals

On Monday, the Assembly Budget Subcommittee No. 1 on Health and Human Service, led by Acting Chair Assembly member Eloise Gómez Reyes, heard several items related to health coverage affordability, expanding Medi-Cal coverage to undocumented adults and the proposed increased to the redirection of 1991 Health Realignment under AB 85 (Statutes of 2013). Highlights from the hearing are provided below:

Individual Mandate and Affordability. The Department of Finance (DOF) provided a high-level summary of the Governor’s January budget proposal to create a state-level individual mandate and additional affordability subsidies under Covered California. These subsidies would be solely be funded by penalties generated by the individual mandate. DOF noted that their proposals were modeled after the federal government. In addition, DOF indicated that though the federal individual mandate resulted in roughly $500 million for the federal mandate in 2016, that California would likely see a lower amount of revenue from the penalty given the higher federal filing threshold.

Legislators were skeptical around the details of the Administration’s proposal and raised questions around the variability in the subsidies year over year and the lack of additional General Fund investment into the subsidy program beyond penalty revenues. Assembly Member Wood was particularly concerned around the individual mandate not being tied to the sunsetting of the affordability subsidies. According to DOF, penalty revenues received after the sunsetting of the affordability subsidies would be deposited into the General Fund. Assembly Member Wood encouraged that the Administration consider those revenues continue to be earmarked for health care affordability.

A myriad of stakeholders including, but not limited to health advocates, hospitals, and health plans expressed support for a state-level individual mandate and affordability subsidies.

Medi-Cal Expansion to Undocumented Young Adults. Representatives from the California Immigrant Policy Center and Health Access expressed their appreciation and support for the Administration’s proposal to expand Medi-Cal to undocumented young adults ages 19-25 and further urged the Legislature build upon this proposal and support expanding coverage to all undocumented adults. The Department of Health Care Services (DHCS) affirmed the Governor’s support of health coverage for all and framed the proposal for young adults as an initial down payment. DHCS shared their estimates of $194 million in net General Fund costs to implement this proposal under the assumption that roughly 130,000 individuals would be enrolled in full-scope coverage. Lastly, the department noted their continued work to refine their estimates for the May Revision.

Again, a wide array of stakeholders, indicated a strong support of all proposals to expand coverage to undocumented adults. CHEAC expressed support of the proposals and indicated concerns with the financing mechanism.

Increased AB 85 Redirection. DOF briefly described the Administration’s proposals to increase the redirection of the CMSP Board and key counties from 60 percent to 75 percent in light of the Governor’s proposal to expand Medi-Cal to undocumented young adults. This increased redirection would result in $63 million in additional General Fund savings. DOF indicated the 34 CMSP counties would not be directly impacted, yet of the $63 million, roughly $14 million would be redirected from five non-CMSP counties.

The Legislative Analyst’s Office shared their perspective that some level of redirection may be appropriate, however did underscore concerns around both the impact to non-CMSP counties’ public health services and the continued viability of the CMSP Board.

Dr. Peter Beilenson, Director of the Sacramento County Department of Health Services, illustrated the impact that this proposal would have on the provision of public health services for all impacted non-CMSP counties and the provision of services to undocumented adults for counties currently doing so.  

DOF committed to continue discussions around the impacts to counties. As such, Assembly Member Reyes voiced concerns around the harm to impacted counties and noted there is “more work to do.”

CHEAC, CSAC, HOAC and others representing impacted counties and the CMSP Board expressed considerable concerns with this proposal.

All items were held open.

Hearing materials can be found here. A recording of the hearing can be found here.

NACo to Host 2019 Healthy Counties Forum on April 23 in San Diego

The National Association of Counties (NACo) will be hosting the 2019 Healthy Counties Forum on Tuesday, April 23 in San Diego. NACo President and San Diego County Supervisor Greg Cox will welcome attendees to the full day collaborative learning opportunity which will provide attendees with tools and strategies to support counties’ efforts in maintaining and expanding work related to health equity. Attendees will have the opportunity to engage with policy experts, health providers, and local government leaders to learn how to use available data and free online tools to identify health disparities, build real-time snapshots, and use the information to forecast change, increase community-level coordination, and evaluate local strategies.

Additional information and registration are available here.

NACCHO Solicits 2019 Annual Award Nominations

The National Association of County and City Health Officials (NACCHO) welcomes nomination applications for its 2019 NACCHO Awards. Each year, NACCHO recognizes the accomplishments of local health departments and health officials throughout the country. Award recipients are honored at a special ceremony and reception at the NACCHO Annual Conference. Applications for Local Health Department of the Year, the Maurice “Mo” Mullet Lifetime of Service, and the National Advocate of the Year awards are open through April 22. Additional information and nomination application materials are available here.

HHS Seeks Input on STD Federal Action Plan

The U.S. Department of Health and Human Services (HHS) Office of HIV/AIDS and Infectious Disease Policy (OHAIDP) is seeking input on the development of an inaugural federal action plan for STD prevention, diagnosis, care, and treatment designed to meet specified goals to improve outcomes and employ strategies that maximize long-term population impact.

Public health practitioners, local health departments, and the public are welcome to submit written comments to inform the vision, goals, and strategies of the STD Federal Action Plan, as well as each agency’s actions for implementing them.

Two listening sessions are to be held on April 17, 2019, and May 9, 2019. Registration is required.

ITUP Announces 2019 Regional Workgroup Convenings

The Insure the Uninsured Project (ITUP) has announced the dates and locations of its 2019 Regional Workgroup Convenings. ITUP regional workgroups bring together local leaders and community members to engage in constructive dialogue, problem-solving, and identification of creative policy solutions that expand access and improve the health of Californians. The workgroup findings are used to inform ITUP’s broader policy work and future convenings.

This year’s workgroups will focus on:

  • Health Reform in California – Workgroups will share and discuss federal and state reform updates, including state efforts to cover the remaining uninsured and stabilize the individual market.
  • Care Coordination – Local attendees will be engaged in a discussion on the status of local care coordination efforts for Medi-Cal beneficiaries. This topic will build on the recently-concluded state-level discussions organized by DHCS and will further explore screenings, health assessments, case management, data, transitions in care, communication, governance, training, and monitoring.

Local experts and stakeholders are invited to share information about county and regional programs and initiatives, including Whole Person Care, Whole Child Model, Coordinated Care Initiatives, and other programs to ensure meaningful access to care through the managed care delivery system.

Regional workgroup dates begin in June and run through October. Registration and additional information, including specific dates and locations, are available here.

CDPH Oral Health Webinar Scheduled for April 24

The California Department of Public Health (CDPH) Office of Oral Health (OOH) will host a webinar on Wednesday, April 24 from 1:30 pm-2:30 pm and will detail the process of developing a community health improvement plan (CHIP). Dr. Jay Kumar, CDPH State Dental Director, will discuss essential elements of a CHIP, including the alignment of plan objectives with the State Oral Health Plan and priority areas for prevention and intervention. The webinar will also feature a presentation by Calaveras County on their experience in developing a community oral health improvement plan. Information will be provided on various themes and nuances discovered through community needs assessments and how these matters were addressed in the oral health improvement plan.

Webinar registration is available here.

PPIC Issues Fact Sheets on Health Care Access in California

The Public Policy Institute of California (PPIC) recently issued two fact sheets that detail the Medi-Cal program and the current health care landscape for immigrants in California. The Medi-Cal fact sheet explores enrollment figures, beneficiary makeup, and services delivered, and the immigrant health care landscape fact sheet examines current coverage gaps, sources of care, and potential solutions for closing coverage gaps.

The Medi-Cal Fact Sheet is available here and the Immigrants and Health Fact Sheet is available here.