April 30, 2021 Edition

Legislature Reaches Deadline for Fiscal Bills, Focus to Shift to State Budget

Today, the California Legislature reached the deadline for bills with fiscal implications to be heard and advanced by policy committees to appropriations committees. Next week, the Legislature faces a similar deadline to hear and advance non-fiscal bills to the floor in the bills’ house of origin. Over the coming weeks, Senate and Assembly Appropriations Committees will hear bills and refer most to the Suspense File where bills will be acted upon in mid-May. Given today’s deadline, many bills with fiscal implications will no longer move forward through the legislative process this year and will become two-year bills, able to be acted upon in January 2022.

The Legislature next week will begin shifting its focus back to the state budget ahead of the release of the Governor’s May Revise budget, which is expected during the second week of May. Senate and Assembly Budget Subcommittees will hold hearings over the next two weeks review open issues from state agencies and departments, as well as stakeholder requests. CHEAC continues leading the California Can’t Wait Coalition, comprised of HOAC, SEIU California, UCC, RCRC, and Public Health Advocates, among others, requesting $200 million ongoing General Fund for Public Health Workforce and Infrastructure, as well as support for our sponsored measure AB 240 (Rodriguez) to conduct an evaluation of the state’s local health department infrastructure.

Given rosy state tax revenue collections and an anticipated $26 billion from the American Rescue Plan, Assembly Budget Committee Chair Phil Ting updated the committee’s budget priorities plan that was previously released in December 2020. Under the revised priority document, the Assembly Budget Committee is calling for restoration of state services and greater investments in key areas, including health and human services. Notably, the Assembly calls for a significant investment in public health infrastructure as the state maintains its ongoing COVID-19 response. The California Can’t Wait Coalition released a statement applauding the inclusion of a public health infrastructure investment in the Assembly’s budget priority plan. The Coalition looks forward to continued advocacy efforts among the Legislature as the May Revise and June budget deadlines approach.

In other news this week, Governor Gavin Newsom signed AB 80 providing $6.2 billion in state tax relief over the next six years to small businesses that received federal Paycheck Protection Program (PPP). Under the measure, forgiven PPP loans received by small businesses during the pandemic will not be counted as taxable income, and businesses can also deduct costs of expenses associated with the loans. Additional information from the Governor’s Office is available here.

Below, we note several bills of interest to CHEAC Members. For a full update, the latest edition of the CHEAC Weekly Bill Chart is available here.

Access to Health Services

AB 32 (Aguiar-Curry) as amended April 22, 2021 – SUPPORT

Assembly Member Aguiar-Curry’s AB 32 would require the Department of Health Care Services (DHCS) to indefinitely continue telehealth flexibilities established during the COVID-19 pandemic. The bill requires health services provided by an enrolled clinic through telehealth to be reimbursed by Medi-Cal on the same basis, to the same extent, and at the same payment rate as in-person services. Providers would be authorized to enroll or recertify Medi-Cal program beneficiaries using telehealth services, and DHCS would be required to both seek necessary federal approvals and to convene an advisory group that includes specified representatives, including designated public hospitals and counties. Additionally, DHCS is required to consult with stakeholders to develop one or more federally permissible alternative payment method for FQHCs and RHCs for specified services. AB 32 was heard in the Assembly Health Committee on Tuesday where it was advanced to the Assembly Appropriations Committee on a 13-0 vote with two members not voting.

Communicable Disease Control

SB 744 (Glazer) as amended April 22, 2021 – OPPOSE UNLESS AMENDED

This measure, authored by Assembly Member Steve Glazer, was heard in Senate Judiciary Committee this week. SB 744 would require the California Department of Public Health (CDPH) to create a program to provide for expedited release, during a declared public health emergency, of certain health care data to researchers of specified institutes of higher education. The measure would require that any electronic tool used by a local health officer for the purpose of reporting communicable diseases to include the capacity to collect and report data including the type of housing where the patient resides, the number of people in the household, the occupation and workplace of the patient, and the cities that the patient has traveled to within the previous 14 days. AB 744 was advanced out of the Senate Judiciary Committee on a unanimous 11-0 vote and now moves onto Senate Appropriations Committee.

Health Equity

AB 1407 (Burke) as amended March 18, 2021 – SUPPORT

AB 1407, authored by Assembly Member Autumn Burke, was heard this week in Assembly Health Committee. The measure would require nursing schools and programs to include implicit bias coursework within their curriculum. The measure would require nurse licensees to complete one hour of direct participation in an implicit bias course within the first 2 years of holding their license. Hospitals would also be required to implement an evidence-based implicit bias program as part of its new graduate training program that hires and trains new nursing graduates. AB 1407 was passed out of the committee on a 13-0 vote with two members not voting and now moves on to Assembly Appropriations Committee.

Vital Statistics

AB 751 (Irwin) as introduced February 16, 2021 – SUPPORT

This measure, authored by Assembly Member Jacqui Irwin, was heard in the Assembly Health Committee this week. AB 751 would remove the sunset date provisions allowing local registrars to accept electronic requests sworn under penalty of perjury, that the requester of a marriage, birth, or death certificate is an authorized person. Additionally, this measure would authorize officials to accept an electronic request from applicants using a process that authentically identifies applicants using National Institute of Standards and Technology Digital Identity Guidelines and other requirements. AB 751 was advanced from Assembly Appropriations Committee on consent to the Assembly Floor.

CDPH Issues COVID-19 Guidance for Waterparks, Community Sporting Events

This week, the California Department of Public Health (CDPH) issued COVID-19 guidance for waterparks and community sporting events. Below, we highlight the state’s most recent COVID-19 guidance:

  • Waterparks Guidance – On Wednesday, CDPH released COVID-19 guidance for waterparks. The guidance aims to support a safe, clean environment for workers and customers and limits attendance at waterparks based on county risk levels. Use of face coverings is mandatory throughout parks in all settings indoor and outdoor, unless actively eating or drinking or while on a ride or in a setting that would case the face covering to become wet. The guidance is available here.
  • Community Sporting Events Guidance – Today, CDPH issued guidance to support a safe environment for community sporting events, which applies to all organized community endurance and running/walking events including runs, walks, marathons, and triathlons, and endurance events. The guidance does not apply to outdoor and indoor youth and recreational sports or collegiate or professional sports. Community sporting events are able to resume in California beginning May 1, 2021, following these guidelines. The guidance is available here.

CDC Issues Updated COVID-19 Outdoor Masking Guidance

This week, the U.S. Centers for Disease Control and Prevention (CDC) issued updated COVID-19 guidance, relaxing rules on the use of face coverings in certain settings among certain populations. Under the revised guidance, individuals who are fully vaccinated against COVID-19 no longer need to wear a face covering outdoors while walking, running, hiking, or biking alone, or when in small gatherings, including with members of their own households. The CDC advises that face coverings are still necessary in crowded outdoor settings, such as stadiums.

Following the release of the revised guidance, Governor Gavin Newsom issued a statement indicating California will be moving to align its guidance with the CDC’s revised guidance. The Governor additionally pointed to California’s COVID-19 vaccination progress, as well as the state’s lowest positivity rate in the country. CDPH Director and State Public Health Officer Dr. Tomás Aragón also issued a statement indicating the state supports CDC’s updated masking guidance.

Additional information from the CDC is available here.

CDC Finds mRNA Vaccines Reduce COVID-19-Related Hospitalizations Among Older Adults

The U.S. Centers for Disease Control and Prevention (CDC) this week released an assessment finding that fully vaccinated adults from the Pfizer-BioNTech and Moderna mRNA vaccines 65 years of age and older were 94 percent less likely to be hospitalized with COVID-19 than people of the same age who were not vaccinated. People 65 and older who were partially vaccinated were 64 percent less likely to be hospitalized with COVID-19 than people who were not vaccinated.

The CDC indicates these findings are the first real-world results in the U.S. confirming clinical trial data showing mRNA vaccines prevent severe COVID-19 illness. The findings additionally support the CDC’s recommendation for COVID-19 vaccination among people 65 and older in the U.S. population. The CDC’s assessment explored hospitalizations in two U.S. hospital networks covering 24 hospitals in 14 states. Vaccine effectiveness was assessed by comparing the odds of COVID-19 vaccination among hospitalized people who tested positive for the virus that causes COVID-19 versus those who tested negative.

Additional information is available here.

California, U.S. Send Supplies to India Amid COVID-19 Surge

Amid a significant surge of COVID-19 cases, California and the United States this week sent supplies and materials to India to support the country’s emergency needs and ongoing response to the pandemic. California sent hundreds of oxygen concentrators, cylinders, regulators, and related supplies to India which will be provided directly to health care providers and frontline workers, facilitated by the U.S. Agency for International Development (USAID).

Similarly, the U.S. federal government is delivering supplies worth more than $100 million to provide urgent and immediate relief to India. Among the supplies sent to India are oxygen support, personal protective equipment (PPE), vaccine manufacturing supplies, and COVID-19 testing supplies. The CDC has also deployed experts to India to assist in response efforts to the latest surge in COVID-19 cases.

Additional information from the California Governor is available here. Information from the White House is available here.

Relatedly, in light of the COVID-19 emergency present in India, President Joseph R. Biden, Jr. today issued a proclamation suspending entry of non-U.S. citizens or permanent residents from India into the United States. The policy will take effect next Tuesday and will not apply to U.S. citizens or lawful permanent residents. Additional information is available here.

FDA Takes Steps to Ban Menthol, Flavored Cigar Tobacco Products

This week, the U.S. Food and Drug Administration (FDA) announced its commitment to advancing two tobacco product standards to significantly reduce disease and death caused by using combustible tobacco products. The two standards – a menthol product standard and a flavored cigar standard – will aim to ban menthol as a characterizing flavor in cigarettes and ban all characterizing flavors (including menthol) in cigars. The FDA indicated it will be working to issue proposed product standards within the next year.

The FDA’s announcement builds on previous actions that banned other flavored cigarette products in 2009. Below, additional details on the forthcoming standards are provided:

  • Menthol Product Standard – The FDA has granted a citizen petition requesting that the agency pursue rulemaking to prohibit menthol in cigarettes. The 2009 Tobacco Control Act (TCA) did not include menthol in its ban on characterizing flavors in cigarettes, leaving menthol cigarettes as the only flavored combustible cigarettes available on market. Since then, the FDA has explored the presence and differences between menthol and non-menthol cigarettes and the impact of menthol on population health. Notably, the FDA indicates there are nearly 19 million current smokers of menthol cigarettes. However, significant racial disparities exist as nearly 85 percent of all Black smokers use menthol cigarettes compared to 30 percent of White smokers.
  • Flavored Cigar Standard – After the 2009 TCA ban on flavors in cigarettes other than menthol, the FDA notes use of flavored tobacco cigars increased dramatically. Flavored mass-produced cigars and cigarillos are combustible products that can closely resemble cigarettes, pose many of the same public health problems, and are disproportionately popular among youth and other populations. The FDA’s standard would prohibit sales of any characterizing flavor (including menthol) in these cigar products.

In announcing these steps, the FDA points to the significant and disproportionate public health implications associated with the use of these flavored products, particularly on certain populations like African Americans. If the product standards are implemented, FDA enforcement of any ban on menthol cigarettes and all flavored cigars will address manufacturers, distributors, wholesalers, importers, and retailers. The FDA cannot and will not enforce against individual consumer possession or use of any menthol cigarettes or any tobacco product.

The next step for the FDA will be publishing the proposed rules in the Federal Register, allowing an opportunity for public comment. Following the FDA’s announcement, Governor Gavin Newsom issued a statement applauding the Biden Administration’s move and urging “the federal government to follow California’s leadership to protect public health and advance racial equity by moving to ban menthol-flavored cigarettes.” The Governor additionally called on the federal government to pursue other actions to limit the availability of tobacco products, including by banning flavored electronic cigarettes.

Recall, Governor Newsom signed into law SB 793 (Hill) last year which prohibits the sale of all electronic cigarette products with characterizing flavor (including menthol). However, tobacco industry representatives filed a referendum against the measure, successfully collecting enough signatures to stop the bill from taking effect until voters have a chance to weigh in during the November 2022 General Election. Since the referendum’s filing, a number of California public health organizations formed the “Campaign to Protect California Kids” to lead the effort to oppose the ballot measure. Committee Co-Chair Malia Cohen issued a statement following the FDA’s announcement this week similarly applauding the move and indicating “we have a moral obligation to continue advocating at the local and statewide level for policies that protect our kids’ health and save Black lives by ending the sale of minty-menthol cigarettes and candy-flavored tobacco across California.” U.S. Health and Human Services Secretary Xavier Becerra also issued a statement about the important public health benefits of banning menthol and flavored tobacco products.

Additional information from the FDA is available here.

HHS Releases New Opioid Use Disorder Treatment Guidelines

On Tuesday, the U.S. Department of Health and Human Services (HHS) released new buprenorphine practice guidelines that, among other actions, remove a long-established requirement tied to health care provider training. According to HHS, many providers have cited the training requirements associated with the prescribing and use of buprenorphine as a significant barrier to treating more individuals with opioid use disorder.

The Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder, signed by HHS Secretary Xavier Becerra, exempt specified health care providers from federal certification requirements related to training, counseling, and other ancillary services that are part of the process of obtaining a waiver to treat up to 30 patients with buprenorphine.

The HHS points to the significant numbers of opioid-related conditions and deaths that have occurred nationwide over the past several years. More than 90,000 drug overdose deaths are predicted to have occurred in the U.S. in the 12 months ending in September 2020, representing the highest number of overdose deaths ever recorded in a 12-month period, according to the U.S. Centers for Disease Control and Prevention (CDC).

Additional information is available here.