April 20, 2018 Edition
The California Legislature experienced another whirlwind of a week, holding a series of policy committee hearings and amending measures ahead of significant upcoming deadlines. Recall, policy committees must hear and report fiscal bills introduced in their house of origin by next Friday, April 27. The Legislature will face a similar deadline in early May for non-fiscal measures to be advanced in their house of origin. CHEAC continues to actively track a significant number of measures during one of the busiest times of year in the California Legislature.
Below, we highlight actions that occurred this week on measures of interest to CHEAC Members. For a full update on bills, this week’s edition of the CHEAC Weekly Bill Chart is available here.
AB 1964 (Maienschein) as amended on April 3, 2018 – Oppose Unless Amended
On Tuesday, the Assembly Health Committee heard AB 1964, by Assembly Member Brian Maienschein, which originally sought to add day camps to the existing definition of organized camps, thereby creating an additional mandate on local enforcement agencies and requiring local enforcement agencies to operate beyond their scope of expertise. CHEAC took an ‘oppose unless amended’ with a county coalition consisting of HOAC, CSAC, UCC and RCRC, and specifically sought amendments to limit the role of the local enforcement agency to solely the health and sanitation aspects of a day camp.
The Assembly Health Committee put forth amendments essentially leaving current statute overseeing organized camps – resident camps with stays of five days or more – untouched and creating new statute to define organized day camps. These amendments, as accepted by the author, would now only require local enforcement agencies to inspect and issue a health and sanitation permit to day camps with food service.
While these amendments are a step in the right direction, CHEAC and our county colleagues are seeking additional provisions to clarify the definition of organized day camps and to clarify the role of the local enforcement agency in overseeing a day camp without a facility and/or fixed location. Betsy Armstrong, CHEAC Senior Policy Analyst, and Corwin Porter, San Bernardino County Assistant Public Health Director and former Environmental Health Director, testified on behalf of CHEAC and highlighted our remaining concerns.
The bill was passed with 12 ‘Yes’ votes and three members not voting. CHEAC will continue to work with the Assembly Member Maienschein’s office, who expressed a commitment to address our remaining concerns. The bill will now head to the Assembly Appropriations Committee.
Communicable Disease Control
SB 1325 (Moorlach) as amended April 9, 2018 – Oppose
SB 1325, by Senator John Moorlach, which would allow an individual or a group of individuals to self-quarantine, and in effect, disregard health officer orders, was heard in the Senate Health Committee this week. Kat DeBurgh, Executive Director of HOAC, and Dr. Erica Pan, Deputy Health Officer and Communicable Disease Control and Prevention Division Director for Alameda County, provided excellent expert testimony in opposition to the measure with CHEAC and CSAC also weighing in.
Dr. Richard Pan, the author of SB 277 which passed in 2015 and eliminated the personal belief exemption for school-age vaccinations, spoke very passionately in defense of measures utilized by local health departments to protect the public’s health. SB 1325 failed passage with eight ‘No’ votes and one member not voting. Senator Moorlach did not request the bill be considered again, so it appears SB 1325 is dead. Thank you to CHEAC Members who reached out to their Senators in opposition to this bill.
Health Coverage/Health Care Reform
AB 2275 (Arambula) as amended on April 19, 2018 – Support
AB 2275, by Assembly Member Joaquin Arambula, was heard in the Assembly Health Committee on Tuesday. The measure would require Medi-Cal managed care plans to meet minimum performance levels that improve quality and reduce health disparities beginning January 1, 2021. The Assembly Health Committee passed the measure, which now moves to the Assembly Appropriations Committee.
AB 2965 (Arambula) as amended on March 23, 2018 – Support
The Assembly Health Committee heard AB 2295, by Assembly Member Joaquin Arambula, which seeks to expand Medi-Cal eligibility to undocumented adults in California that would otherwise be eligible except for their immigration status. Assembly Member Arambula began his remarks by emphasizing that he views health care as a human right and that he entered the field of medicine to be able to provide such right to marginalized populations. The bill was strongly supported by plethora of organizations representing health care providers, labor, consumer, immigrant, and community groups, and had no opposition on file.
During the debate, Assembly Member Thurmond, while referencing the passage of Medi-Cal coverage for undocumented children, raised concerns that we in California would segregate coverage for members in the same household. Additional questions around the cost of implementation were raised by Assembly Member Mayes, to which Assembly Member Arambula confidently stated that the cost would be less than the state’s current budget surplus.
CHEAC supports AB 2965, which was passed by the Assembly Health Committee and now moves to the Assembly Appropriations Committee.
AB 2914 (Cooley) as introduced on February 16, 2018 – Support
AB 2914, by Assembly Member Ken Cooley, seeks to clarify the prohibition of tobacco and alcohol retailers from selling cannabis products and further prohibit the sale of cannabis products infused with alcohol. CHEAC supports the measure, which was heard in the Assembly Business and Professions Committee. The Committee unanimously passed AB 2914, which now heads to the Assembly Governmental Organization Committee where it will be heard next week.
SB 835 (Glazer) as amended March 20, 2018 – Support
SB 835, by Senator Steven Glazer, which would ban smoking in all state parks, was set to be heard in Senate Appropriations Committee this week. Senator Glazer instead waived presentation on the measure, which, according to the Senate Appropriations Committee analysis, would create a one-time cost of roughly $850,000 to $1.12 million in General Fund to purchase and install the signage required in the bill. The bill would also likely create minor annual costs for enforcement and signage maintenance, but might also produce significant revenue from penalties. The bill was placed on the Senate Appropriations Committee’s Suspense File and will be taken up at a later date.
SB 836 (Glazer) as amended March 20, 2018 – Support
SB 836, was also set to be heard in the Senate Appropriations Committee. Similar to previous bills introduced by Senator Glazer, the measure would ban smoking on all state coastal beaches. According to the Senate Appropriations analysis, the SB 836 would contain roughly $190,000 to $250,000 in one time General Fund costs for the Department of Parks and Recreation to purchase and install the signage required in the bill, minor annual costs for signage maintenance, and likely significant revenue resulting from penalties. The author waived presentation and the bill was placed on the Suspense File to be reconsidered at a later date.
On Monday, the Assembly Budget Subcommittee No. 1 on Health and Human Services heard budget issues related to substance use disorder treatment and prevention both under the oversight of the Department of Health Care Services (DHCS) and the California Department of Public Health (CDPH).
CDPH was asked to provide the Legislature with an update on the naloxone funding provided to the department in the 2016 Budget Act. Recall, last year’s Budget Act appropriated $3 million in one-time General Fund to CDPH to purchase and distribute naloxone to local health departments and community-based organizations to prevent opioid overdose deaths. Dr. Karen Smith, CDPH Director, highlighted the distribution of funding, $2.7 million of which went directly to purchasing naloxone and for local administrative costs and $300,000 to support the CDPH’s administrative costs. She noted distributions to local health departments were determined based on need using the average number of deaths resulting from opioid overdoses.
Dr. Smith also shared that their decision to purchase in bulk through the Department of General Services resulted in cost savings and allowed for CDPH to purchase a greater supply for distribution. According to her testimony, roughly 60 local health departments have accepted the naloxone grants, with about 20 jurisdictions opting to forego any administrative cost reimbursement, again to ensure a greater supply. To date, approximately 46 local health departments have received just under 40,000 doses and eight local health departments will soon be receiving roughly 2,000 doses. No action was taken on the item.
Last week, President Donald Trump quietly issued an executive order directing a wide swath of federal agencies, including the Departments of Health and Human Services, Housing and Urban Development, Agriculture, and Education, to review and develop rules for “any program that provides means-tested assistance or other assistance that provides benefits to people, households, or families that have low incomes” requiring beneficiaries to work or lose their benefits. The executive order has been in the works by the Trump Administration for nearly the past year and seeks to vastly restructure the country’s safety net system.
Under the order, all cabinet departments have 90 days to develop plans to impose work requirements on able-bodied federal aid recipients and block ineligible immigrants from such aid. Departments must also provide a list of recommended regulatory and policy changes and other actions to compel certain federal aid recipients out of safety net programs and into employment.
The order has potential to significantly impact an expansive amount of assistance programs including Medicaid, Temporary Assistance for Needy Families (TANF), the Supplemental Nutrition Assistance Program (SNAP), Women, Infants, and Children (WIC), and low-income housing subsidies. According to reports, the Trump Administration intends to use the executive order to urge federal and state officials to take a more stringent approach to aid programs.
Recall earlier this year, the Department of Health and Human Services granted waivers to Arkansas, Indiana, and Kentucky to impose requirements on Medicaid beneficiaries for at least 80 hours of employment, job training, or job search activities each month to maintain benefit eligibility. The Department of Agriculture has also taken steps to pressure states to impose work requirements for SNAP, as well.
Congressional Republicans generally expressed support for the Trump executive order, highlighting the order’s alignment with the Republicans’ long-standing interest in a major overhaul of federal assistance programs. Congressional Democrats, on the other hand, indicated a strong opposition to the order, pointing to the large body of evidence showing that the majority of beneficiaries of federal assistance programs do not avoid work and often have significant barriers to working full time.
While President Trump has directed federal agencies to undertake actions related to federal aid assistance programs, the Administration will likely need legislation from Congress to enact the type of broad, comprehensive aid program reform in which it has expressed interest. The order certainly sets into action a series of administrative activities, and it remains to be seen how Congress might further the intent of the Trump Administration related to work requirements.
The full executive order Reducing Poverty in America by Promoting Opportunity and Economic Mobility is available here.
This week, Senators Lamar Alexander (R-Tennessee) and Patty Murray (D-Washington), Chair and Ranking Member of the U.S. Senate Committee on Health, Education, Labor, and Pensions (HELP), respectively, introduced the “Opioid Crisis Response Act of 2018.” The measure, S. 2680, is the result of 40 various proposals from Republican and Democratic Senators, seven bipartisan hearings over several months, and input from stakeholders and the general public.
Generally speaking, the measure aims to address the significant nationwide opioid epidemic by improving the ability of various federal departments and agencies, including the Department of Health and Human Services and the U.S. Centers for Disease Control and Prevention (CDC), to respond to the crisis through additional funding, research and innovation, medical product and prescription drug safety, treatment and recovery services, and prevention activites. Notable provisions of the Opioid Crisis Response Act include:
- Authorization for the CDC to issue expanded grants to states, localities, and tribes to establish or enhance evidence-based prevention activities
- Authorization for the CDC to support states in collecting and reporting data related to adverse childhood experiences (ACEs) through public health surveys
- Public and health care provider education and awareness outreach around opioid prescription risks and prescribing guidelines
- Three-year reauthorization and expansion of grants initially authorized in the 21st Century Cures Act to states and Indian Tribes most significantly impacted by the crisis for prevention, response, and treatment activities
- Grant programs and best practices for comprehensive opioid recovery centers and opioid addiction recovery housing facilities
- Increased flexibility to the National Institutes of Health (NIH) to research and develop non-addictive painkillers and other strategies to prevent, treat, and manage pain and substance use disorders
- Clarification of FDA authority to encourage responsible prescribing behavior and require packaging and disposal options for specified prescription drugs
- Authorization for the Department of Labor to address the economic and workforce impacts to communities affected by the opioid crisis, including mental health and health care workforce shortage grants
The expansive bill also includes strategies to address the rise in illicit synthetic opioid drugs, such as fentanyl, trauma-informed care necessary for conditions associated with addictions, and access to health services for mental health and substance use disorders.
S. 2680 is set to be marked-up in the Senate HELP Committee next week. The full bill text is available here and a summary overview is available here.
Recently, the California Department of Health Care Services (DHCS) held a webinar regarding the California Children’s Services (CCS) CMSNet Cleanup Initiative. The webinar was used to address concerns among counties, provide an update on proper contact information with DHCS, detail the progress of the CCS service authorization request (SAR) backlog cleanup effort, and clarify instructions of the process. A recording of this webinar is available here.
The California Department of Public Health (CDPH) is sponsoring two new workshops on public health accreditation topics. The first workshop on workforce development entitled “Discovering and Working with Your Talents and Strengths” will be held on Tuesday, May 22 in Sacramento, and the second workshop on community health assessments (CHA) and community health improvement plans (CHIP) will be held on Tuesday, June 26 also in Sacramento. More information, including registration information is available here.
The Insured the Uninsured Project (ITUP) recently announced its series of 2018 regional workshops to be held throughout the state. The workshops convene local leaders for constructive dialogue and creative problem-solving related to health reform. This year’s workshop topics will feature:
- Behavioral health integration and improvement
- Health reform in California
ITUP utilizes workgroup findings to inform its policy work and future convenings. To view the full regional workshop schedule and register, visit here.
The Robert Wood Johnson Foundation (RWJF), in collaboration with the University of Kentucky, recently released its annual National Health Security Preparedness Index which identifies strengths and weaknesses in the protections needed to keep individuals safe and healthy in the event of a large-scale public health emergency. The Index combines a series of measures from various sources and perspectives to detail health protections in place for the entire U.S. and by state and how those protections change over time.
Notable findings from the most recent Index scores indicate:
- A 7.1 score (out of 10) for national preparedness; a 6.9 score for California
- A 2.9 percent increase in overall national health security preparedness scores since 2016
- Five-year upward trends in the domains of Community Planning and Engagement, Health Security Surveillance, and Incident Management
California’s 6.9 overall health security level remains below the national average of 7.1. Notably, California’s overall score increased 7.8 percent since 2013, most notably in the area of Health Security Surveillance. However, the state’s lowest health security level existed in Healthcare Delivery at a score of 4.2.
The full U.S. National Health Security Preparedness Index Scores are available here, and California’s scores are available here.
This week, the Trust for America’s Health (TFAH) published an updated issue brief detailing how public health and education sectors can work together to address the nationwide alcohol, drug, and suicide crises. The brief builds upon the existing Pain in the Nation report released last year which projected deaths from drugs, alcohols, and suicides could account for 1.6 million fatalities over the coming decade.
This most recent issue brief explores partnership opportunities between public health practitioners and educators and school administrators to engage broader stakeholders, improve school climate, screen students for risk factors, increase access to health professionals in school settings, and foster a culture of well-being. The latest issue brief is available here.
Safe States, an alliance to strengthen the practice of injury and violence prevention, recently issued an injury and violence prevention toolkit as an online resource guide for public health practitioners and related professionals. The toolkit includes a curated compilation of training resources and materials centered on the core competencies of injury and violence prevention and can be used to orient individuals new to the field or expand competencies among current practitioners. The full toolkit is available here.