August 9, 2019 Edition

2019 CHEAC Annual Meeting Registration Closes September 1

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 speakers!

Local health 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 Returns from Summer Recess on Monday, Faces Busy Month Ahead

The California 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.

CHEAC will 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 Committees.

Access to Health Services

AB 1494 (Aguiar-Curry) as amended July 11, 2019 – SUPPORT

Assembly Member 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 Services (DHCS).

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.

Health Coverage/Health Care Reform

SB 29 (Durazo) as amended July 2, 2019 – SUPPORT

Senator Maria 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.

Maternal, Child, and Adolescent Health Services (MCAH)

AB 577 (Eggman) as amended July 11, 2019 – SUPPORT

Assembly Member 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.

State Auditor Releases Report on DHCS Oversight of Regional Model Health Plans

On Tuesday, 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 received.

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. Specifically:

  • DHCS did not enforce state requirements that limit distances health plans may direct their Medi-Cal beneficiaries to travel to receive health services.
  • DHCS failed to hold Regional Model health plans accountable for improving beneficiaries’ access to care.
  • Regional Model beneficiaries have generally received a lower quality of care than beneficiaries in other areas of the state.
  • DHCS 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.

Auditor Howle details a series of recommendations for DHCS to ensure beneficiaries have adequate access and proper oversight of health plans is conducted. Among the recommended actions:

  • DHCS 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:
    • Develop written guidance that specifies conditions under which staff should approve, deny, or contact health plans for clarification regarding their requests for exceptions.
    • Determine a specific minimum number of providers health plans must attempt to contract with before requesting an exception.
    • Require 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.
  • DHCS should do the following by June 2020 to ensure Regional Model beneficiaries have reasonable access to care:
    • Determine specific causes of Anthem and California Health & Wellness’s inabilities to provide reasonable access to care in Regional Model counties.
    • Evaluate 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 contracts expire.
    • Evaluate 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 Legislature.
    • Provide 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.

In responding 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.

Newsom Announces Alzheimer’s Task Force Members

This morning, 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.  

Shriver will 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.

BSCC Solicits Membership to Public Health & Safety Executive Steering Committee

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.

Applications 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.

CDPH CHC Releases Video on Housing Code Enforcement Related to Dampness and Mold

The California 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.

CDC Vital Signs Report Details Naloxone Access, Calls for Increasing Access in Rural Areas

This month’s 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 jurisdictions.

The CDC 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.

Additional information on this month’s edition of CDC’s Vital Signs is available here.

NACCHO Issues Report on LHD Opioid Use Prevention and Response Activities

The National 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.

NASEM Publishes Report on Healthy People 2030 Leading Health Indicator Criteria Selection

The National 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.