August 16, 2019 Edition
The California
Legislature returned to Sacramento on Monday from its month-long summer recess,
resuming bill negotiations, committee hearings, and floor deliberations. Senate
and Assembly Appropriations Committees face an August 30 deadline to hear and
report fiscal bills to their respective floors. Appropriations Committees are
expected to hold suspense file hearings the last week of August just prior to the
Senate and Assembly entering two weeks of floor sessions only.
Looking ahead,
the last day to amend bills is September 6, and the final day of this year’s
session is September 13. Lawmakers face several extremely busy weeks ahead,
particularly with a number of high-profile issues remaining outstanding,
including labor, homelessness, wildfires, and vaccinations.
Below, we
highlight several actions of interest from this week. For a full update on
bills, the CHEAC Weekly Bill Chart is available here.
Access to
Health Services
AB 1494 (Aguiar-Curry) as amended July 11, 2019 – SUPPORT
Assembly Member
Cecilia Aguiar-Curry’s AB 1494 was set for hearing in the Senate Appropriations
Committee for Monday. The measure would require Medi-Cal reimbursement for
telehealth, telephonic, or off-site services when delivered by an enrolled community
clinic, including city or county clinics exempted from licensure, or
fee-for-service Medi-Cal provider during or up to 90 days after an expiration
of a state of emergency, as deemed appropriate by the Department of Health Care
Services (DHCS). Assembly Member Aguiar-Curry waived presentation and the
measure was placed on the suspense file where it will be acted upon at a later
date.
Emergency
Medical Services (EMS)
SB 438 (Hertzberg) as amended July 11, 2019 – NEUTRAL
SB 438 by
Senator Robert Hertzberg originally sought to prohibit local EMS agencies from
contracting with private entities for EMS 9-1-1 dispatch services and reduce
local EMS agency medical control. After months of negotiations, the measure, as
amended on July 11, now allows local EMS agencies to continue private contractual
arrangements but allows a public safety agency to operate medical dispatch for
their own jurisdiction. In addition, recent amends further clarifies that EMS medical
dispatch, including call processing, falls within the medical control of the
local EMS medical director
CHEAC, along
with our county colleague organizations CSAC, UCC, and RCRC, has been
extensively engaged with the author and sponsors of the measure to negotiate
amendments to ameliorate county concerns. Based on those negotiations, CHEAC,
CSAC, UCC, and RCRC this week have moved from an oppose to a neutral position
on the measure.
Health
Coverage/Health Care Reform
AB 1004 (McCarty) as amended July 8, 2019 – SUPPORT
Assembly Member
Kevin McCarty’s AB 1004 would require screening services under the Early and
Periodic Screening, Diagnosis, and Treatment (EPSDT) Program to include
developmental screening services for individuals zero to three years of age.
The measure was set for hearing in the Senate Appropriations Committee on
Monday. However, Assembly Member McCarty waived presentation and the measure
was placed on the suspense file where it will be acted upon at a later date.
Maternal,
Child, and Adolescent Health Services (MCAH)
AB 577 (Eggman) as amended August 14, 2019 – SUPPORT
AB 577 by
Assembly Member Susan Talamantes Eggman was set for hearing in the Senate
Appropriations Committee on Monday. The measure would permit the completion of
covered services associated with a maternal mental health condition for up to
12 months by a terminated or nonparticipating healthcare provider. The
individual would be required to provide written documentation of a maternal
mental health diagnosis to their health plan or insurer. AB 577 was directly
reported to the Senate Floor via Senate Rule 28.8 on Monday.
Tobacco
Control
SB 39 (Hill) as amended April 10, 2019 – SUPPORT
SB 39 by
Senator Jerry Hill would require mail-order and online tobacco products to be
packed in a container with specified conspicuous labeling and require the
signature of a person 21 years of age or older upon or before completing the
delivery of the products. SB 39 was heard in the Assembly Appropriations
Committee on Wednesday and unanimously advanced to the Assembly Floor on an
18-0 vote.
California Health and Human Services (CHHS) Secretary Dr. Mark Ghaly on Thursday announced the establishment of a Master Plan for Aging Stakeholder Advisory Committee. Recall, Governor Gavin Newsom in January called for the creation of a statewide master plan and issued an executive order tasking CHHS with the development and issuance of a plan by October 2020.
The Master Plan
for Aging Stakeholder Advisory Committee will work across sectors to develop a
roadmap that envisions a future in which all Californians can grow old safely,
with dignity and independence. The committee will also advise Governor Newsom’s
Cabinet Workgroup on Aging in the development of the statewide plan.
Specifically, the committee will assist in the development of best practices
and data metric and guidance of work by the state government, local
communities, and private organizations and philanthropy to build environments
that promote an age-friendly California.
Stakeholders
appointed to the committee represent local governments, healthcare providers
and systems representatives, health plans, academia, and older adult-related
organizations. Additional information on the committee, including the appointed
membership, is available here.
Additionally,
Secretary Ghaly today announced the launch of the public engagement campaign, Together We ENGAGE. The engagement campaign is intended to solicit feedback
from all Californians on their ideas and suggestions on how to collectively
build an age-friendly California.
Framing the
move as a way to protect public resources and preserve
the social safety net, the Trump Administration this week
issued a final rule on public charge, drastically reshaping the process in
which the federal government determines whether an immigrant is likely to
utilize public benefits. The rule, published in the Federal Register on Wednesday, will require individuals applying for or
seeking adjustment to an immigration status or visa must establish that they
are not likely at any time to become a public charge under the proposed rule.
All individuals seeking an extension of a stay or change of immigration status
must demonstrate that they have not received, are not currently receiving, and
are not likely to receive public benefits.
The expanded
public charge test as set forth in the final rule will weigh whether an
immigrant is receiving one ore more specified public benefits, including
non-emergency Medicaid, Temporary Assistance for Needy Families (TANF), housing
subsidies, and Supplemental Nutrition Assistance Program (SNAP) benefits, among
other considerations. Notably, the final rule does not explicitly include as
public benefits Women, Infants, and Children (WIC) program benefits, public
health assistance for immunizations and testing and treatment of symptoms of
communicable diseases, Children’s Health Insurance Program (CHIP) benefits, or
subsidies for Affordable Care Act (ACA) Marketplace coverage. The public charge
determination will also not take into account benefits used by other family
members, including children, of the person for whom officials are making a
final determination.
Recall, the
Trump Administration issued a proposed rule in October 2018. CHEAC solicited feedback from members regarding
the proposed rule’s potential impact to local health department services and
operations. CHEAC submitted a letter to the U.S. Department of Homeland
Security (DHS) expressing concerns with the proposed rule’s likely impact on
immigrant residents of California, including a likely decrease in utilization
of essential public services, an increase in general mistrust toward public
institutions, and an increase in reluctance among lawful immigrants to engage
with or receive services from LHDs for which they are lawfully eligible.
Under the new
final rule, DHS will find an individual “inadmissible” to the country if it is
determined that the individuals are more likely than not at any time in the future
to become a public charge based on the totality of the person’s circumstance.
Considerations to be made include a person’s age, health, family status, assets
and resources, financial status, and education and skills. Through positively
and negatively weighted factors, the new regulations will tend to favor
individuals who are healthier, younger, employed, and well-resourced. For
example, heavily weighted negative factors include whether an individual has a
medical condition that requires extensive treatment and is unemployed or does
not have sufficient resources to pay for medical costs. A heavily weighted
positive factor is whether an individual’s household has financial
assets/resources of at least 250 percent of the federal poverty level ($53,325
for a family of three in 2019).
The final rule
will have the greatest impact on individuals seeking to become lawful permanent
residents (i.e. green card holders) and individuals seeking to immigrate to the
United States. The rule is also widely expected to increase confusion and
anxiety among immigrant populations regarding the utilization of public
programs for themselves and their families, regardless of whether they are
directly impacted by the rule’s changes. According to experts, including the Kaiser Family Foundation (KFF), the final rule is likely to lead to far-reaching decreases
in participation in Medicaid and other public benefit programs across immigrant
families, including their primarily U.S. born children.
A number of
immigrant rights, healthcare provider, and health and social services
organizations have underscored the importance of public outreach and education
among immigrant families and communities to potentially reduce fears and
confusion caused a result of the issuance of the Trump Administration’s final
rule.
Response to the
Trump Administration’s final rule has been swift and negative among a wide variety
of individuals and organizations. A number of state and local governments and
immigration groups have pledged to take legal action against the Trump
Administration. Already on Tuesday, the County and City of San Francisco and
Santa Clara County filed a lawsuit in the United States District Court in San
Francisco, arguing local governments will be forced to provide and pay for
services that would have otherwise been covered by the federal government
absent the Trump Administration’s final rule.
Today,
California Attorney General Xavier Becerra, leading a multistate coalition of
Attorneys General from Maine, Oregon, Pennsylvania, and the District of
Columbia, also filed suit against the Trump Administration. The
coalition’s argument centers around how the final rule violates equal
protection guaranteed through the Fifth Amendment, punishes immigrants for utilizing
public benefits designed to mitigate economic inequality, and interferes with
states’ rights to protect their residents.
Pending court
intervention, the Trump Administration’s final rule will take effect 60 days
after its publication in the Federal Register, which will be in mid-October
2019. Additional immigration-related information and resources are available on
the CHEAC website.
On Thursday,
the U.S. Food and Drug Administration (FDA) issued a proposed rule to require
tobacco companies to include graphic warnings on cigarette packages and tobacco
advertisements in an attempt to promote greater public understanding of the
negative health consequences of smoking. Recall, the photo-realistic images and
detailed health warnings were required under the 2009 Family Smoking Prevention
and Tobacco Control Act, the comprehensive federal law that widely governs tobacco marketing
and sales, enforcement, and oversight.
However, the
tobacco industry successfully sued the FDA, claiming the labeling were scare
tactics and that their First Amendment rights were violated. In the latest
regulation proposal released this week, the FDA indicates the images and health
warnings closely align with the factual dangers of tobacco use, including
increased risks of health and neck cancer, lung disease, and diabetes.
Should the
FDA’s proposed labeling move forward, it will be the first mandated update in
35 years to required warning on cigarette packaging and in tobacco
advertisements. The earliest the new labeling and warnings could appear on
tobacco products is 2021. The 13 proposed graphics and additional information,
including a public comment opportunity, are available here.