April 27, 2018 Edition
Today is the deadline for the Senate and Assembly policy committees to hear and report all measures with a fiscal impact in their house of origin. While many bills were advanced onto fiscal committees, several other measures met their fate by either failing passage or not receiving a hearing in their policy committees. The Legislature continues to move toward the next deadline of Friday, May 11 for all non-fiscal measures to be heard and reported by policy committees in their house of origin.
Below, we highlight this week’s actions on bills of interest to CHEAC Members. For a full update, the CHEAC Weekly Bill Chart is available here.
Access to Health Services
SB 1125 (Atkins) as introduced on February 13, 2018 – Support
SB 1125 by Senate President pro Tempore Toni Atkins would authorize Medi-Cal reimbursement for a maximum of two visits at a single federally qualified health center (FQHC) or rural health center (RHC) location if: 1) after the first visit, the patient suffers and illness or injury requiring additional diagnosis or treatment; or 2) the patient has a medical visit and another health visit. Currently, if a patient receives treatment through Medi-Cal at an FQHC or RHC from both a medical provider (physician, physician assistant, nurse practitioner, etc.) and another health specialist (clinical psychologist, licensed clinical social worker, dentist, etc.), DHCS will only reimburse the clinic for one visit. The patient would need to return to the clinic on another day in order for the services to be fully reimbursed as a second visit, restricting access to care for patients and creating a financial barrier for clinics.
This measure would allow FQHCs and RHCs to deliver and be reimbursed for other health services, such as mental or dental health services, on the same day the clinic delivers primary care medical services. SB 1125 is sponsored by the Steinberg Institute and California Health+ Advocates, and it was passed on consent in the Senate Health Committee on Wednesday. The measure now heads to the Senate Appropriations Committee.
Cannabis – Medical/Adult Use
AB 2914 (Cooley) as introduced on February 16, 2018 – Support
Assembly Member Ken Cooley’s AB 2914 was heard in the Assembly Governmental Organization Committee on Thursday. The measure would prohibit the sale of cannabis or cannabis products that include alcohol. Assembly Member Cooley accepted committee amendments, and the measure was advanced to the Assembly Appropriations Committee.
AB 3067 (Chau) as introduced on February 16, 2018 – Support
AB 3067 by Assembly Member Ed Chau was heard in the Assembly Business and Professions Committee on Tuesday. The measure would require advertising services to not market cannabis, cannabis products or businesses, or associated cannabis paraphernalia when an internet service, online service, or mobile application is directed to minors. Such prohibitions currently exist for alcohol, firearms and ammunition, spray paint, and tobacco. AB 3067 will be heard next week in the Assembly Privacy and Consumer Protections Committee.
Health Coverage/Health Care Reform
SB 945 (Atkins) as introduced on January 29, 2018 – Support
SB 945 by Senate President pro Tempore Toni Atkins would eliminate the coverage period currently used in the Breast and Cervical Cancer Treatment Program and instead require treatment services to be provided for the duration of cancer treatment, as long as the individual remains eligible for the program. The measure was heard in the Senate Health Committee on Wednesday and received support from a significant number of health coverage-, women’s health-, and cancer-related organizations. No opposition to the measure was filed, and the bill was unanimously advanced to the Senate Appropriations Committee.
AB 3085 (Calderon) as amended on March 19, 2018 – Support if Amended
AB 3085 by Assembly Majority Leader Ian Calderon would establish the New Beginnings California Program in the Department of Community Services and Development to provide matching state General Fund dollars to cities to implement, expand, and continue employment programs for homeless individuals. CHEAC joined CSAC, UCC, RCRC, CBHDA, and the California State Association of Public Administrators, Public Guardians, and Public Conservators (CAPAPGPC) in a ‘support if amended’ position to have counties added as eligible recipients of grant funds. The measure was heard in the Assembly Housing and Community Development Committee this week where a number of amends were proposed by the committee, including adding counties as eligible recipients. Assembly Member Calderon accepted the committee’s amendments, and the measure was advanced to the Assembly Appropriations Committee with six ‘Yes’ votes and one ‘No’ vote.
AB 3171 (Ting) as introduced on February 16, 2018 – Support if Amended
AB 3171 by Assembly Member Philip Ting would establish the Local Homelessness Solutions Program within the Department of Housing and Community Development for the purposes of providing matching state General Fund dollars to cities to create innovative and immediate solutions to issues caused by homelessness, including but not limited to state and local social services and health care systems. Similar to AB 3085, CHEAC joined CSAC, UCC, RCRC, CBHDA, and CAPAPGPC in a ‘support if amended’ position to have counties added as eligible grant recipients. The measure was set for hearing the Assembly Housing and Community Development Committee this week, but was canceled at the request of the author. Given today’s deadline for policy committees to hear and report fiscal bills in their house of origin and the fact this measure did not receiving a hearing, it will not move further in the legislative process.
Maternal, Child, and Adolescent Health
AB 2785 (Rubio) as amended on April 16, 2018 – Support
AB 2785 by Assembly Member Blanca Rubio was set for hearing on Wednesday in the Assembly Appropriations Committee. The measure would require by January 2020 that all California Community Colleges and the California State University provide reasonable accommodations on all campuses for a lactating student to express breastmilk, breastfeed an infant, or address other breastfeeding needs. The measure also specifies that a student shall not incur an academic penalty for utilizing such accommodations and be provided an opportunity to make-up any missed school work. The author waived presentation and the bill was placed on the Suspense File to be reconsidered at a later date.
Public Health Emergency Preparedness
SB 1495 (Senate Health Committee) as amended on April 10, 2018 – Support
On Wednesday, the Senate Health Committee heard their own committee omnibus bill, SB 1495. Committee bills are typically minor technical amendments to statute over which a committee has jurisdictions, and items must be non-controversial as all members of the committee must sign off on the provisions. SB 1495 contains a provision that would extend the time period county boards of supervisors or city councils, as appropriate, must review the need for a locally-declared health emergency from 14 days to 30 days. As expected, the bill passed out unanimously on the committee’s consent calendar and moves on to the Senate Appropriations Committee.
The Senate Budget Subcommittee No. 3 on Health and Human Services convened a marathon hearing, beginning sometime in the 10 o’clock hour and carrying on through the evening. Members heard budget items under the Department of State Hospitals (DSH), the Department of Health Care Services (DHCS) and the Department of Public Health (CDPH). Discussion on items of particular interest are highlighted below.
Proposition 55 – Calculation of available revenues for Medi-Cal
The first item heard under DHCS was the calculation of available revenues for Medi-Cal under Proposition 55. The Administration estimates roughly $4.9 billion in revenues to be realized in the second-half of FY 2018-19. The Department of Finance provided very brief comments on the calculation, however the Legislative Analyst’s Office followed up with a more comprehensive overview. Highlighting key talking points from the LAO analysis on Proposition 55 released earlier in the budget session, the LAO highlighted two contributing reasons that the Administration identifies a deficit in the workload budget, resulting in less revenue available to Medi-Cal: 1) the optional $3.5 billion additional deposit into the Rainy-Day Fund; 2) broad definition of currently authorized services included in the workload budget. According to the LAO, should those two components be treated differently, there could be millions or billions available for Medi-Cal. However, the LAO did remind the Legislature that the measure granted discretion to the Administration to determine the calculation and stated that Legislature could not take action to independently change the calculation.
Senators raised questions around the calculations and expressed concerns with the lack of funding available for Medi-Cal. The item was held open.
The lengthiest portion of the hearing focused on Proposition 56. Recall, in the 2017-18 Budget Act, the Legislature and Administration dedicated significant resources for the following supplemental payments: $325 million to physician services, $140 million to dental services, $50 million to women’s health services, $27 million to unfreeze reimbursement rates intermediate care facilities for individuals with developmental disabilities, and $4 million to increase reimbursement to providers serving AIDS Waiver beneficiaries. DHCS Director Jennifer Kent noted a delay in implementing supplemental payments due to delays in securing federal approvals and technical programming changes needed for DHCS claiming systems. She noted supplemental payments should now be flowing through managed care plans dating retroactively back to July 2018, however rate increases are still awaiting approval from the federal government.
The hearing featured a provider panel consisting of representatives from UC Health, Planned Parenthood, Western Dental and Orthodontics, the California Medical Association and California Pan-Ethnic Health Network. Each spoke to the need to strengthen provider reimbursement and access for Medi-Cal beneficiaries. A portion of the discussion focus on timely access for both primary care and specialty care. There were also a number of stakeholder proposals for Proposition 56 funding that were heard. All items were held open.
DHCS Director Jennifer Kent shared that dental utilization for children has increased since 2016. She noted the State’s goal to increase the dental utilization rate for children to 47 percent by the end of 2020 and proudly shared that current utilization for children is at 45 percent. Less encouraging was the adult utilization, which currently stands at roughly 20 percent, however Director Kent highlighted a number of efforts underway to increase the low utilization through increasing provider participation and enrollment. She mentioned efforts to simplify the provider enrollment application, making provider enrollment through an online portal available, and outreach to eligible beneficiaries. She also noted ongoing discussions with the department and stakeholders around strategies to increase the number of patients seen, in addition to improving continuity of care and access. The issue was held open.
1115 ‘Medi-Cal 2020’ Waiver
DHCS is soliciting the continuation of positions to support continued compliance and administration of the Medi-Cal 2020 Waiver. Director Kent highlighted a few programs including PRIME, Whole Person Care and Substance Use Disorder Waiver as the first of their kind in the nation. She provided complimentary remarks regarding the extraordinary work being done by counties and partners, particularly in working with the homeless and recently incarcerated populations. During public comment, Disability Rights California provided comments around how amazing the work of Whole Person Care has been and urged the continuation of the program. All items were held open.
California Children’s Services
During the overview on the Family Health Estimate, Director Kent provided the Subcommittee with a brief update on the Whole Child Model transition. She highlighted the beneficiary notices that have been issued and provider network certification work being done. Director Kent spoke confidently regarding the Department’s ability to meet the July implementation date for Phase 1 Whole Child Model counties.
This week, the California Department of Public Health (CDPH), the California Maternal Quality Care Collaborative (CMQCC), and the Public Health Institute (PHI) released a comprehensive statewide review of maternal deaths from 2002-2007, offering key insights to improving care and strategies to further reduce preventable maternal mortality.
The report determined that California has experienced a significant decline in maternal mortality from a high of 16.9 deaths per 100,000 live births in 2006 to a low of 7.3 deaths per 100,000 live births in 2013. Key findings of the Pregnancy-Associated Mortality Review include:
- According to comprehensive data review, cardiovascular disease was the leading cause of pregnancy-related deaths during the study period; death certificate analysis, however, showed pre-eclampsia, obstetric hemorrhage and amniotic fluid embolism as the leading causes of death
- Racial disparities were evident in the review with African-American women dying at three-to-four times the maternal mortality rate of women of other races and ethnicities and as high as eight times the rate when deaths from pregnancy-related cardiovascular disease is considered
- Multiple patient, facility, and health care provider factors contributed to pregnancy-related deaths, such as obesity and hypertension, delayed recognition of and response to clinical warning signs, and a lack of institutional readiness for obstetric emergencies
- 41 percent of pregnancy-related deaths has a good-to-strong chance of preventability
The overall goal of the review was to inform and translate findings into strategies to reduce preventable maternal mortality and morbidity. Additional information and the full review are available here.
The Insure the Uninsured Project (ITUP) will be holding three regional workshops in northern rural counties in May. Recall, the ITUP workshops will be held to provide updates on state and federal health reform and share local challenges and best practices. The upcoming workshops locations include:
- North Rural – Mendocino: Tuesday, May 15, 11:30 am – 2:00 pm, Mendocino County Department of Public Health, Ukiah, CA
- North Rural – Humboldt: Wednesday, May 16, 11:30 am – 2:00 pm, Humboldt Area Foundation, Bayside, CA
- North Rural – Shasta: Thursday, May 17, 11:30 am – 2:00 pm, Redding Public Library, Redding, CA
Additional information on the regional workshops, including other dates and locations throughout the state, are available on ITUP’s website here.
The National Association of County and City Health Officials (NACCHO) is accepting submissions for several local health department and public health practitioner awards. Submissions are due next Friday, May 4 at 11:59 PST for the following awards:
- 2018 National Advocate of the Year Award: This award seeks to recognize outstanding accomplishments of LHD staff related to advocacy and outreach to member of the United States Congress to better health policy outcomes in calendar year 2017. Nomination form available here.
- 2018 Maurice “Mo” Mullet Lifetime of Service Award: This award honors current or former local health officials for noteworthy service to NACCHO that has reflected the commitment, vigor, and leadership exemplified by Mullet’s distinguished career. Nomination form available here.
- 2018 Local Health Department of the Year Award: This award recognizes the outstanding work conducted by LHDs around the nation. Nomination form available here.