August 16, 2019 Edition

California Legislature Returns from Summer Recess, Four Weeks Remain in Session

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.

CHHS Secretary Ghaly Appoints Master Plan for Aging Stakeholder Advisory Committee, Launches Public Engagement Campaign

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.

Trump Administration Issues Public Charge Final Rule, Set to Take Effect in October

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.

FDA Proposes New Graphic Warnings for Cigarette Packages and Tobacco Advertisements

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.