August 9, 2019 Edition
As a friendly
reminder, registration for the 2019 CHEAC Annual Meeting will close on
September 1. This year’s annual meeting will be held from October 9 – October
11 at the Westin Pasadena and will provide local health department
professionals representing a wide variety of disciplines throughout California
with networking and learning opportunities.
We are pleased
to once again offer expanded keynote sessions with guest speakers and a myriad
of workshops intended to stimulate best practice sharing and discussions around
shared issues in the field. Stay tuned for forthcoming announcements on key
department leadership and staff are strongly encouraged to register as soon as possible.
More information on this year’s CHEAC Annual Meeting, including registration
and room reservations, is available here.
Legislature is set to return to Sacramento from its month-long summer recess on
Monday and will face a busy month ahead as it rounds out the first year of the
2019-20 Legislative Session. Upon the Legislature’s return, Senate and Assembly
fiscal committees will have until August 30 to hear and report all fiscal
measures to their respective floors. The Legislature will then have two weeks
of floor session only before concluding for the year on September 13.
resume publishing the CHEAC Weekly Bill Chart next week detailing actions on
measures of interest to local health departments. Below, we highlight several
bills of interest set for hearing in Senate and Assembly Appropriations
AB 1494 (Aguiar-Curry) as amended July 11, 2019 – SUPPORT
Cecilia Aguiar-Curry’s AB 1494 is set for hearing in the Senate Appropriations
Committee on 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
SB 66 (Atkins) as revised July 3, 2019 – SUPPORT
SB 66 by Senate
President pro Tempore Toni Atkins is set for hearing in the Assembly
Appropriations Committee next Wednesday. The measure would authorize Medi-Cal
reimbursement for a maximum of two visits on the same day at a single FQHC or
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 a mental health visit or dental visit.
Coverage/Health Care Reform
SB 29 (Durazo) as amended July 2, 2019 – SUPPORT
Elena Durazo’s SB 29 is set for hearing in the Assembly Appropriations
Committee on Wednesday. The measure would expand Medi-Cal coverage to all
undocumented adults 65 years of age or older with incomes at or below 138
percent of the federal poverty level (FPL). The measure was previously amended
to expand coverage to those older than 65 years old after the 2019-20 Budget
Act included coverage expansion for undocumented adults ages 19-25.
Child, and Adolescent Health Services (MCAH)
AB 577 (Eggman) as amended July 11, 2019 – SUPPORT
Susan Talamantes Eggman’s AB 577 is 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 for an individual by a terminated or nonparticipating healthcare
provider. The individual would be required to provide written documentation of
a maternal mental health condition diagnosis to their health plan or insurer.
SB 464 (Mitchell) as amended June 27, 2019 – SUPPORT
SB 464 by
Senator Holly Mitchell is set for hearing in the Assembly Appropriations
Committee on Wednesday. The measure would require specified health facilities
providing perinatal care to implement an evidence-based implicit bias program
for all healthcare providers involved in perinatal care within those
facilities. Hospitals would also be required to provide patients with
information on filing a discrimination complaint. The California Department of
Public Health (CDPH) would be required to track and publish specified maternal
morbidity and mortality data.
California State Auditor Elaine Howle released the audit report, “Department of
Health Care Services: It Has Not Ensured That Medi-Cal Beneficiaries in Some
Rural Counties Have Reasonable Access to Care.” The audit came at the request
of Senator Jim Nielsen and was approved by the Joint Legislative Audit
Committee in August 2018. The audit examined DHCS’ oversight of managed health
care in the 18 small and rural counties under the Regional Model. In these
counties, two commercial health plans contract with DHCS to provide health
coverage to Medi-Cal beneficiaries. Further, the report explores whether
Regional Model beneficiaries have received an acceptable level of care and
evaluates how that care compares to the care beneficiaries in other models have
In the 67-page
report, Auditor Howle determines that Regional Model health plans have not
provided all Medi-Cal beneficiaries with adequate access to care and DHCS has
not adequately conducted oversight activities of the health plans.
did not enforce state requirements that limit distances health plans may direct
their Medi-Cal beneficiaries to travel to receive health services.
failed to hold Regional Model health plans accountable for improving
beneficiaries’ access to care.
Model beneficiaries have generally received a lower quality of care than
beneficiaries in other areas of the state.
did not adequately educate Regional Model counties about the options available
to them regarding their transition to managed care. DHCS was found to not have
assisted Regional Model counties that wanted to create or join a
County-Organized Health System (COHS), which may have provided beneficiaries
with better access to care.
details a series of recommendations for DHCS to ensure beneficiaries have adequate
access and proper oversight of health plans is conducted. Among the recommended
should immediately do the following to obtain assurance that health plans
throughout the state have exhausted all options to meet access requirements
before seeking exceptions:
written guidance that specifies conditions under which staff should approve,
deny, or contact health plans for clarification regarding their requests for
a specific minimum number of providers health plans must attempt to contract
with before requesting an exception.
health plans to authorize out-of-network care if they do not demonstrate they
have exhausted all of their reasonable options to meet access requirements.
should do the following by June 2020 to ensure Regional Model beneficiaries
have reasonable access to care:
specific causes of Anthem and California Health & Wellness’s inabilities to
provide reasonable access to care in Regional Model counties.
whether structural characteristics of a COHS model would be better suited to
providing reasonable access to care in these counties and notify the counties
of its conclusions. If some or all of the counties desire to transition to a
COHS, DHCS should assist them in making that change after their current
whether it has the financial resources to provide assistance to counties
interested in establishing a COHS or other managed care model after the current
Regional Model contracts expire. If DHCS does not have the required financial
resources, it should seek an appropriate amount of funding from the
counties with reasonable opportunities to decide whether to change their
managed care models after the expiration of their current contracts. DHCS
should provide counties that choose to do so sufficient time to establish their
new models before the expiration of their current agreements to ensure
continuity of service.
to the audit, DHCS Director Jennifer Kent indicated that the department agreed
with nine of the 13 recommendations, disagreed with three of the
recommendations, and believed they are already in compliance with the remaining
one recommendation. DHCS has indicated that it has prepared corrective action
plans to implement the recommendations with which they agree. The full audit
report is available here.
Governor Gavin Newsom announced membership to the new statewide Alzheimer’s
Prevention and Preparedness Task Force, a group tasked with developing a plan
to address and manage Alzheimer’s disease and other aging-related conditions
throughout California. Recall, Newsom announced the creation of the task force
during his State of the State address in February and appointed former state
first lady Maria Shriver to lead the group’s efforts.
Members of the
task force consist of scientists, health care professionals, government
officials, industry leaders, and members of the public. Among those announced
on Friday are former Secretary of State George Schultz, former Secretary of
Defense Leon Panetta, and Blue Zones author Dan Buettner. Others include
Dr. Keith Black, a neurosurgeon at Cedars-Sinai Medical Center, Dr. Wynnelena
Canio, a Kaiser Permanente gerontologist, Susan DeMarois, state government
affairs representative for the Alzheimer’s Association, Dr. Oanh Le Meyer, a
neurological researcher at UC Davis School of Medicine, Dr. Howard Rosen, a
behavioral neurologist at UC San Francisco, and Dr. Kristine Yaffe, a professor
of psychiatry, neurology, and epidemiology at UC San Francisco.
convene the task force for its first meeting in November as part of the
national Alzheimer’s Awareness month. The task force must release a report by
next fall, near the time Newsom’s statewide master plan on aging is expected to
be released. Additional information, including the full membership of the task
force, is available here.
The Board of
State and Community Corrections (BSCC) recently announced an opportunity for
individuals to serve on a new Executive Steering Committee (ESC) for the
Proposition 64 Public Health & Safety Grant Program (Prop. 64 PH&S
Grant Program). Recall, this funding is directed to local governments to assist
with law enforcement, fire protection, or other local programs addressing
public health and safety associated with the implementation of the Control,
Regulate and Tax Adult Use of Marijuana Act.
for the ESC are due to the BSCC by Friday, August 23, at 5:00 pm. Please note,
any participation by a government employee makes their local government
ineligible for this funding. For more information on applying, please see this announcement from the BSCC.
Department of Public Health (CDPH) Center for Healthy Communities (CHC)
recently released an 11-minute public health video on indoor dampness and mold,
providing science-based advice aimed at county and city housing code enforcers.
The video was produced by a microbiologist and an epidemiologist from the
Indoor Air Quality Program in CDPH’s Environmental Health Laboratory (EHL).
The video is
designed for code enforcement officers and anyone interested in the current
science around dampness and mold in buildings. The video details the indicators
of dampness and mold in buildings and the linked health effects, the underlying
cause of mold problems in buildings, and the important public health benefits
of enforcing mold and dampness standards in housing. The video is available here,
and additional information from CDPH is available here.
edition of Vital Signs from the U.S. Centers for Disease Control and
Prevention (CDC) details access to naloxone, the life-saving medication used to
reverse the effects of an opioid overdose. Specifically, the report examines
naloxone access from pharmacists and other healthcare providers without a
prescription under a standing order. Naloxone dispensing has increased
significantly in recent years, contributing to lowering deaths caused by opioid
overdoses. High-dose opioid prescriptions have decreased by 21 percent from
2017 to 2018, and naloxone prescriptions have increased from 270,000 to 556,000
from 2017 to 2018. Despite these figures, the CDC indicates additional
improvements need to be made in naloxone access, particularly in rural
recommends a series of actions to improve naloxone access, including following
the CDC Guideline for Prescribing Opioids for
Chronic Pain to
consider offering naloxone to patients with high opioid dosages, keeping
naloxone in stock in pharmacies, and educating patients, caregivers, and the
community about the benefits of having naloxone readily available to more
people. The CDC report goes on to detail state and local actions, such as
reducing insurance co-pays for patients, increase providing training and
education, targeting naloxone distribution in rural areas, and creating harm
reduction programs and improving access to medication-assisted treatment (MAT)
for opioid use disorders.
information on this month’s edition of CDC’s Vital Signs is available here.
Association of County and City Health Officials (NACCHO) recently released a
report, “Local Health Department Approaches to Opioid Use Prevention and
Response: An Environmental Scan.” The report examines the critical role of LHDs
in opioid use disorder-related programming and services throughout the country.
By surveying nearly 200 LHDs, the report creates a foundational understanding
of opioid use prevention and response efforts to inform priorities at the
local, state, and national levels. Topics covered in the report include opioid
workforce, partnerships, programmatic and clinical services, policy, and data
collection and evaluation activities. The full report is available here.
Academies of Sciences, Engineering, and Medicine (NASEM) recently published the
report, “Criteria for Selecting the Leading Health Indicators (LHIs) for
Healthy People 2030.” The Department of Health and Human Services (HHS) Office
of the Assistant Secretary for Health has charged NASEM to convene an ad hoc
committee to assist in the development of the Leading Health Indicators (LHIs)
for Healthy People 2030. In its first report, the committee discusses the
background materials relevant to the HHS directive and makes recommendations
regarding the criteria for selecting LHIs for the upcoming Healthy People 2030
initiative. Additional information and the full report are available here.