August 27, 2021 Edition
We are pleased to announce that registration for the 2021 CHEAC Annual Meeting is now open! See below for additional details.
Revitalizing Public Health: Leveraging Lessons Learned from COVID-19
October 6, 2021 – October 8, 2021
CHEAC welcomes local health department executives and staff to attend the 2021 CHEAC Annual Meeting!
Today, the California State Senate and Assembly fiscal committees met the deadline to hear and report all bills. Pursuant with today’s deadline, both the Senate and Assembly Appropriations Committees yesterday held their suspense file hearings, determining the fate of hundreds of legislative bills that remain in play for this year’s session.
Only two weeks remain in this year’s legislative session, and lawmakers will only be permitted to convene floor sessions until the Legislature’s adjournment for interim recess on September 10. These next two weeks are anticipated to be quite busy as lawmakers work to advance their measures to the desk of Governor Gavin Newsom.
As a reminder, the timeframe for the Governor to sign or veto legislative bills is slightly different at the end of session. Any bill in the Governor’s possession on or before September 9 (the penultimate day of session) must be acted upon within 12 days. Any bill in the Governor’s possession on or after September 10 (last day of session) must be acted upon in 30 days. As a reminder, any bill the Governor does not affirmatively sign or veto becomes law. With the upcoming September 14 Gubernatorial Recall Election, it is anticipated the Legislature will be strategic about which bills and issues are advanced to the Governor’s desk immediately before the election.
While only two weeks remain in the year’s session, lawmakers have their work cut out for them, particularly as they work to finalize and pass any remaining budget trailer bills as part of the FY 2021-22 State Budget. Numerous trailer bills on several high-level subjects are anticipated, and the Assembly Budget Committee has scheduled two hearings for budget clean-up measures over the next two weeks.
Below, we report on this week’s appropriations suspense file results on a handful of measures tracked by CHEAC. As a reminder, bills held on suspense are considered dead and will not move further in the legislative process. Bills that have been designated as a two-year bill will not move forward this year and will be able to be acted upon during a short window in January 2022. For a full update, the latest edition of the CHEAC Weekly Bill Chart is available here.
Access to Health Services
SB 316 (Eggman) – SUPPORT – DO PASS
Authorizes Medi-Cal reimbursements for a maximum of two visits on the same day at a single location if: 1) after the first visit, the patient suffers illness/injury requiring additional diagnosis/treatment; or 2) the patient has a medical visit and a mental health visit or dental visit. Also authorizes FQHC/RHC to apply for a per-visit rate adjustment for a medical visit and mental health visit occurring on the same day at a single location. Requires DHCS to submit state plan amendment to CMS by 07/01/2022.
Built Environment/Climate Change
AB 585 (L. Rivas) – SUPPPORT – HELD ON SUSPENSE
Upon appropriation of the Legislature, establishes the Extreme Heat and Community Resilience Program within the Office of Planning and Research (OPR) to coordinate state efforts and support local and regional efforts to reduce public health risks of extreme heat and would establish priority to disadvantage communities and vulnerable populations, as determined by local health departments, CDPH, or both.
Communicable Disease Control
SB 744 (Glazer) – OPPOSE UNLESS AMENDED – HELD ON SUSPENSE
Requires CDPH to create a program to provide for expedited release, during a declared public health emergency, including the type of housing where the patient resides, the number of people in the household where the patient resides, the occupation and workplace of the patient, and a relevant travel history based on the disease course.
SB 336 (Ochoa-Bogh) – WATCH – DO PASS
Requires local health officers or CDPH, when taking measures to prevent the spread of COVID-19, to have measures published and to specify the date a change or closure would take effect. Requires CDPH or local health officers to create an opportunity for individuals and entities to sign up for an email distribution list regarding the orders. Requirement may be waived if immediate danger or imminent threat to public is present.
Chronic Disease Prevention and Wellness Promotion
AB 619 (Calderon) – WATCH – DO PASS AS AMENDED
Requires CDPH to develop an Air Quality Health Plan with recommendations and guidelines for counties to use in significant air quality caused by wildfires or other sources. Requires counties to use the CDPH Air Quality Plan to develop a county-specific plan.
AB 1276 (Carrillo) – WATCH – DO PASS AS AMENDED
Prohibits single-use food ware accessory or standard condiments to be provided by a food facility unless requested by a customer. Exempts correctional institutions, health facilities, residential care facilities, and school cafeterias.
Health Coverage/Health Care Reform
AB 369 (Kamlager) – SUPPORT – DO PASS
Requires DHCS to implement a program for presumptive Medi-Cal eligibility for homeless individuals to the extent federal financial participation is available. Authorizes person experiencing homelessness to receive primary care services and referrals for specialty care from any Medi-Cal enrolled provider.
AB 4 (Arambula) – SUPPORT –TWO YEAR BILL
Expands Medi-Cal to all undocumented adults with income at or below 138% FPL.
AB 362 (Quirk-Silva) – WATCH – DO PASS AS AMENDED
Requires each city or county that receives a complaint regarding a homeless shelter to inspect the shelter and take specified actions based on findings. Specifies responsibilities of shelter owner/operator and authorizes city or county to impose additional civil penalties in specified circumstances. Exempts Project Roomkey facilities.
AB 1017 (Quirk-Silva) – WATCH – HELD ON SUSPENSE
Requires local governments to conduct an inventory of public restrooms both owned and maintained. Local governments would also be required to submit a report to CDPH providing a map and listing of available public restrooms, including hours of operation, maintenance, security presence, and applicable usage fees.
AB 1038 (Gipson) – WATCH – TWO YEAR BILL
Establishes the California Health Equity Program within the CDPH Office of Health Equity for the purpose of awarding competitive grants to community-based organizations (CBOs), community clinics, local health departments, and tribal organizations.
SB 682 (Rubio) – SUPPORT – DO PASS AS AMENDED
Establishes the End Racial Inequities in Children’s Health in California Initiative (EnRICH CA Initiative) and requires the California Health and Human Services Agency to develop a plan to reduce racial disparities in childhood chronic diseases.
Maternal, Child, and Adolescent Health Services
SB 65 (Skinner) – SUPPORT IF AMENDED – DO PASS AS AMENDED
Establishes the Maternal Morbidity Review Committee within CDPH and tasks the committee with specified activities relative to maternal morbidity and mortality. Requires counties to annually report infant deaths to the local health department (LHD). Requires LHDs to establish a Fetal and Infant Mortality Review Committee to investigate and prevent fetal and infant deaths if the county have five or more infant deaths in a single year and if the county has a death rate that is higher than the state’s death rate for two consecutive years. Extends Medi-Cal eligibility for a pregnant person for a total of 12 months after birth. Requires DHCS to offer doula care as a covered Medi-Cal benefit. Increases CalWORKs benefits to specified pregnant persons. Requires OSHPD to conduct specified activities relative to training of nurse-midwives and licensed midwives.
Public Health Infrastructure
AB 240 (Rodriguez) – SUPPORT – TWO YEAR BILL
Requires CDPH to contract with an appropriate and qualified entity to conduct an evaluation of the adequacy of the local health department infrastructure to make future recommendations for staffing, workforce, and resources needed.
Public Health Workforce
AB 1306 (Arambula) – WATCH – HELD ON SUSPENSE
Adds language relative to the Health Professions Careers Opportunity Program (HCOP) under the jurisdiction of OSHPD to incorporate the urgent and growing need for California to expand the pool of diverse health workers.
SB 395 (Caballero) – SUPPORT – DO PASS AS AMENDED
Imposes a 12.5 percent tax on retail sale of electronic cigarettes in California. Requires tax revenues to be allocated to Proposition 99, Proposition 10, and Proposition 56 tobacco programs, and others.
This week, the Legislative Analyst’s Office (LAO) published its annual California Spending Plan to summarize the year’s state budget. The LAO on Tuesday published the overview of the 2021-22 Budget Act and highlights major features of the budget approved by the Legislature and signed by Governor Gavin Newsom. The report published by the LAO is a preliminary version and reflects actions taken through July 15, 2021.
In its report, the LAO details the status of the state’s General Fund, use of COVID-19-related federal funds received by California, the evolution of the state’s budget, and early budget actions taken by the Legislature and Governor. The LAO summarizes the major features of the 2021-22 Spending Plan by subject area and indicates a series of forthcoming publications this fall will provide greater detail on state investments.
In the health space, the LAO indicates the 2021-22 State Budget provides a total of $3.8 billion in new, discretionary General Fund monies for the fiscal year, $1 billion of which is ongoing, for health-related programs. Notably, California is investing $664 million General Fund ($1.1 billion total funds) for the first half-year of implementation of the California Advancing and Innovating Medi-Cal (CalAIM) initiative, as well as $94 million General Fund ($158 million total funds) for three major expansions to the Medi-Cal program (older undocumented adults, pregnant and postpartum persons, and the Medi-Cal “asset limit” disregard).
The LAO in its report includes the $300 million General Fund augmentation to the California Department of Public Health (CDPH) to improve state and local public health systems beginning in FY 2022-23. Recall, the Legislature and Governor ultimately ended up agreeing to the minimum $300 million amount in final negotiations on the state’s budget package for the fiscal year. Notably, the LAO points out that the average annual General Fund budget for CDPH has been approximately $175 million since CDPH became a standalone department in 2007-08.
The LAO summarizes other investments in housing and homelessness, human services, and education, among other topics. The full preliminary overview of the state’s spending plan is available here.
On Monday, the U.S. Food and Drug Administration (FDA) approved the Pfizer-BioNTech COVID-19 Vaccine for the prevention of COVID-19 disease in individuals 16 years of age and older. The vaccine became the first in the nation to receive full FDA approval. The Pfizer-BioNTech vaccine continues to be available under emergency use authorization (EUA), including for individuals 12 through 15 years of age and for the administration of a third dose in certain immunocompromised persons.
According to the FDA, approved vaccines must undergo the agency’s standard process for reviewing the quality, safety, and effectiveness of medical products. For all vaccines, the FDA evaluates data and information included in the manufacturer’s submission of a biologics license application (BLA). The Pfizer-BioNTech COVID-19 Vaccine BLA approved by the FDA this week builds on extensive data and information previously submitted as part of the manufacturer’s EUA and includes other information such as clinical data and vaccine testing results. The FDA then conducts its own analyses of information provided in the BLA to ensure the vaccine’s safety and effectiveness.
Following the FDA’s approval, California Governor Gavin Newsom issued a statement confirming the safety and efficacy of the vaccine. California Department of Public Health (CDPH) Director and State Public Health Officer Dr. Tomás Aragón also issued a statement acknowledging the full federal approval and urging residents to receive the COVID-19 vaccine to protect themselves and help end the pandemic.
The full FDA announcement is available here.
On Thursday, California Department of Public Health (CDPH) Director and State Public Health Officer Dr. Tomás Aragón issued a public health order amending his August 5 order that requires visitors to general acute care hospitals, skilled nursing facilities, and intermediate care facilities, when making indoor visits, to verify their full vaccination status or provide proof of a negative SARS-CoV-2 test.
Under Thursday’s order, Dr. Aragón extended the vaccine verification or testing requirements to apply to all visitors of adult and senior care (ASC) residential facilities licensed by the California Department of Social Services (CDSS), effective September 9, 2021. The latest order also provides language for specific exemptions to visitor requirements and clarifies verification options for unvaccinated or incompletely vaccinated visitors.
The full state public health officer order is available here. PIN 21-40-ASC from CDSS providing guidance to ASC facilities is available here.
On Wednesday, the California Division of Occupational Safety and Health (Cal/OSHA) issued a notice to all employers and workers in California encouraging workplaces to follow the recent update from the California Department of Public Health (CDPH) recommending that all individuals wear face coverings while indoors regardless of vaccination status.
The notice from Cal/OSHA comes after the Cal/OSHA Occupational Safety and Health Standards Board (OSHSB) in June adopted a revised Emergency Temporary Standard (ETS) that generally allowed fully vaccinated persons to go maskless in indoor workplaces and repealed physically distancing requirements. Governor Gavin Newsom shortly after the Board’s adoption issued an executive order to expedite the ETS effective date to align with the state’s June 15 retirement of the Blueprint for a Safer Economy.
The full Cal/OSHA notice recommending face coverings indoors is available here.
Late last week, California State Auditor Elaine Howle issued an update to Governor Gavin Newsom and legislative leaders on statewide issues and state agencies that represent a high risk to California or its residents. By way of background, the State Auditor’s Office maintains a “High Risk Government Agency Audit Program” that enables the auditor to take specified actions to prevent an adverse outcome among an agency or department that is at risk of suffering, producing waste, fraud, abuse, and mismanagement or major challenges associated with economy, efficiency, or effectiveness.
In her office’s latest update, Auditor Howle identifies seven high-risk statewide issues that include aspects of water infrastructure, information security, and state management of federal COVID-19 funds. Five state agencies also met the established criteria for posing a high risk:
- California Department of Corrections and Rehabilitation (CDCR)
- California Department of Technology (CDT)
- California Department of Health Care Services (DHCS)
- California Department of Public Health (CDPH)
- California State Teachers’ Retirement System (CalSTRS)
State agencies with high-risk issues were provided an opportunity to respond to the State Auditor’s report. The full update from State Auditor Howle is available here.
On Tuesday, State Auditor Elaine Howle issued a report, “California Department of Housing and Community Development: It Failed to Expedite Access to Federal Funding to Address the Impact of the COVID-19 Pandemic on California’s Homeless Population.” The auditor’s report comes as part of her office’s classification of the state’s management of certain federal funds related to the COVID-19 pandemic as a high-risk issue.
Specifically, Auditor Howle assessed the Department of Housing and Community Development’s (DHCD) Emergency Solutions Grant (ESG) program which received $316 million in federal funding to prevent, prepare for, and respond to the COVID-19 pandemic (ESG-CV) for individuals who are at risk of or experiencing homelessness. The State Auditor found that DHCD did not take critical steps to ensure funds promptly benefited the intended population, including by taking an extended period of time to finalize contracts with local Continuum of Care (CoC) entities and hiring a contractor to manage the program 14 months after the passage of the funding by Congress. Further, Howle indicates DHCD is not collecting information needed to measure the effectiveness of the state’s use of the funds and it does not have plans to evaluate the impact and value of CoC projects in addressing or mitigating homelessness.
As a result of delays in allocating federal funds, Auditor Howle expresses concern that many CoC entities may struggle to spend their full allocations within the federally mandated timeframes. The state must spend at least 20 percent of its total $316 million award, or $63 million, by September 30, 2021. If California does not spend that amount, the federal government may reallocate up to $63 million of those funds elsewhere.
The State Auditor sets forth a variety of recommendations for DHCD which include:
- To ensure that CoC entities are able to use ESG-CV fund allocations effectively to address the impact of the pandemic before upcoming federal deadlines, DHCD should:
- Work with its contractor to assist CoCs that are at risk of not spending their funds by the federal deadline; DHCD should also establish a contingency plan to reallocate funds among CoCs to ensure the state maximizes the intended benefit of the funding.
- Develop a formal plan and procedures for how it will monitor the contractor’s progress in completing contract tasks
- To ensure it has the data necessary to measure the effectiveness of the ESG-CV program in addressing homelessness, DHCD should immediately develop and implement a plan to collect outcome information either independently or through the Homeless Information Management System (HMIS). DHCD is also recommended by March 2022 to begin reporting annually the outcome information it collects to demonstrate the effectiveness of the program and so that policymakers can use the reported data to inform budget and policy decisions.
DHCD “strongly disagrees” with the State Auditor’s findings, though it plans to implement the above recommendations. The full State Auditor report is available here.
Given recent wildfires throughout the state, California this week secured federal resources and support to support the state’s ongoing response and recovery efforts. Earlier in the week, California requested and successfully received from President Joseph R. Biden, Jr. a Presidential Major Disaster Declaration for the Dixie and River fires in Lassen, Nevada, Placer, and Plumas counties.
The declaration assists residents in impacted counties through eligibility for programs and support, such as housing assistance, counseling, medical services, and legal support. The declaration includes public assistance to help state, tribal, and local governments with ongoing emergency response and recovery costs and hazard mitigation.
Governor Newsom this week also announced that California secured a Fire Management Assistance Grant (FMAG) from the Federal Emergency Management Agency (FEMA) to ensure availability of resources to address the French Fire in Kern County.
In addition to the federal support secured by the state, Governor Gavin Newsom late last week issued Executive Order N-13-21 to support communities impacted by recent wildfires and bolster response and recovery efforts. Specifically, the order expedites debris removal and hazardous waste cleanup efforts, extends the state’s prohibition on price gouging in impacted counties through October 20, 2021, and helps ensure adequate staffing for fire response by waiving work hour limitations for specified professionals. Additional information on the Governor’s order is available here.
On Thursday, the U.S. Supreme Court invalidated the nationwide emergency moratorium on residential evictions issued by the U.S. Centers for Disease Control and Prevention (CDC). Recall, Congress established a temporary moratorium on evictions at the onset of the COVID-19 pandemic. Upon Congress’ moratorium expiration in July 2020, the CDC issued an order halting evictions throughout the country utilizing authorities provided in the Public Health Service Act of 1944. In its order, the CDC cited the increased likelihood of COVID-19 transmission in congregate living settings, such as homeless shelters, or among those experiencing unsheltered homelessness.
The CDC extended its order several times until it last lapsed on July 31. In light of the increased presence of the COVID-19 delta variant throughout the country, the CDC issued earlier this month a limited eviction moratorium order in areas “experiencing substantial and high levels of community transmission levels of SARS-CoV-2” that would last for 60 days.
However, landlords, real estate entities, and trade associations affiliated with the Alabama Association of Realtors challenged the CDC’s moratorium, arguing the agency did not have proper authority to issue such an order under the 1944 federal law. The plaintiffs in the case pointed to significant economic impacts experienced by landlords and property owners as a result of the moratorium.
In Thursday’s SCOTUS ruling, the court’s conservative majority ruled that the CDC lacked authority to issue such an order without explicit authorization from Congress. The court’s majority indicated the CDC relied “on a decades-old statute that authorizes it to implement measures like fumigation and pest extermination. It strains credulity to believe that this statute grants the CDC the sweeping authority that it asserts.”
The three dissenting justices – Breyer, Sotomayor, and Kagan – penned an opinion that faulted the court for making such a sweeping move during a public health emergency. In his opinion, Justice Breyer indicated, “The public interest is not favored by the spread of the disease [COVID-19] or a court’s second-guessing of the CDC’s judgment.” As a result of the ruling, residential eviction protections for hundreds of thousands of Americans are no longer in place.
However, in several states, including California, residential evictions remain prohibited through September 30, 2021, due to economic hardship caused by the COVID-19 pandemic. Recall, legislators and Governor Gavin Newsom finalized a budget agreement in late June cementing the extended moratorium and providing other residential relief efforts.
The full SCOTUS opinion on the CDC’s eviction moratorium is available here.
The U.S. Food and Drug Administration (FDA) this week announced it had issued the first marketing denial orders (MDOs) for electronic nicotine delivery system (ENDS) products after determining the applications for approximately 55,000 flavored electronic cigarette products lacked sufficient evidence that they have a benefit to adult smokers to overcome the public health threat posed by using such products. The FDA’s actions represent a step toward making progress on the unprecedented number of premarket applications for new tobacco products.
To date, the FDA has received applications from over 500 tobacco companies comprising more than 6.5 million tobacco products. This week’s steps were the first set of MDOs issued for applications that have reached the substantive scientific review of the FDA’s premarket review process. As the FDA indicates, products subject to an MDO for a premarket application are prohibited from being introduced or delivered for introduction into interstate commerce. Products already on the market must be removed or risk enforcement actions.
The full FDA announcement is available here.
U.S. Vice President Kamala Harris on Wednesday this week launched the U.S. Centers for Disease Control and Prevention (CDC) Southeast Asia Regional Office in Hanoi, Vietnam, during a ceremony that featured the U.S. Secretary of Health and Human Services (HHS), U.S. CDC Director, and Deputy Prime Ministers and Health Ministers from 11 countries. According to the CDC, the new regional office strengthens CDC’s ability to meet its mission of protecting Americans and people of the region by responding more rapidly to health threats wherever they occur and building key relationships to address shared health priorities.
The CDC indicates the regional office will increase American engagement and collaboration with Southeast Asian leaders to enhance regional capacity to prevent, detect, and respond to infectious diseases and other emerging health threats. Priorities for the new office including developing the public health workforce, expanding regional public health laboratory training, developing innovating programs to improve health for mobile and migrant populations, ensuring a coordinated response to public health emergencies, and strengthening the early warning system for the detection of zoonotic and emerging infectious diseases.
John MacAurthur, M.D., has been named the CDC Southeast Asia Regional Director after serving as the CDC Thailand country director for more than six years. The CDC recently established regional offices in Eastern Europe/Central Asia (Georgia), the Middle East/North Africa (Oman), and South America (Brazil).
The full announcement on the CDC Southeast Asia Regional Office is available here.
This week, the Trust for America’s Health (TFAH) launched a new series of case studies examining efforts by states and localities in conceptualizing and implementing climate change adaptation programs that are focused on equity. The case series follows a December 2020 TFAH and Johns Hopkins Bloomberg School of Public Health Report, “Climate Change & Health: Assessing State Preparedness.”
TFAH made available an Introduction and Part I of the series, Advancing Procedural Equity in Climate Adaptation. The first installment highlights case studies that advance procedural equity, or the degree to which the process undertaken to conceptualize, design, and administer adaptive policies and programs that are inclusive and accessible to the community. Included in the first installment is a case study on SB 1072 (Chapter 377, Statutes of 2018) in Californiawhich established a regional climate collaborative program under the direction of the Strategic Growth Council.
Part II of the case studies series will be released this fall and will focus on distributional equity. More information on the series is available here.