This week, CHEAC held its State Legislative Member Education Days in a virtual format with numerous California State Senators and Assembly Members. 17 jurisdictions participated in this year’s annual event, meeting with 24 legislator offices to urge support of the California Can’t Wait Coalition Public Health Equity and Readiness Opportunity (HERO) Initiative.
CHEAC extends our sincere gratitude to legislators, staff, and CHEAC Members and jurisdictions who participated in this year’s CHEAC Annual Legislative Member Education Days. More photos from legislator meeting are available on CHEAC’s Twitter page.
In other legislative news, one week remains for lawmakers to introduce new bills for the second year of the 2021-22 Legislative Session. Bill introductions have begun to increase this week, and the bulk of bill introductions are anticipated next week. CHEAC will soon hold its two daylong meetings with our Legislative Committee to identify and take positions on measures of most interest to California local health departments and public health.
This week, Senate President pro Tempore Toni Atkins announced committee membership changes after promoting Senator Mike McGuire as the Senate Majority Leader. Senator Richard Roth has been assigned to the Senate Budget & Fiscal Review Committee, and Senator Anna Caballero will assume the chair of the Senate Governance & Finance Committee. Senators Josh Becker and Lena Gonzalez have also been added as presiding officers over Senate Floor proceedings.
On the Assembly side, Assembly Member James Gallagher was unanimously elected as the Assembly Minority Leader by his fellow Assembly Republican members. Gallagher takes the helm from Assembly Member Marie Waldron who has served in the Assembly since 2012 and as Minority Leader since 2018. Gallagher now leads the Assembly’s 19 Republican Members.
For a full update of CHEAC-tracked measures, the latest edition of the CHEAC Weekly Bill Chart is available here.
On Monday, the California State Senate and Assembly acted on a series of early action budget items proposed by the Newsom Administration, including investments to support the continued emergency response to the COVID-19 pandemic and supplemental paid sick leave for California workers. We highlight these actions below:
COVID-19 Emergency Response Funding
SB 115 (Skinner) received final approval from the California Legislature early in the week. Governor Gavin Newsom on Thursday signed the $1.9 billion COVID-19 package to bolster the state’s ongoing emergency response to the pandemic. The measure, initially unveiled in January by the Newsom Administration, initially included a $1.4 billion emergency appropriation request which expanded to $1.9 billion to support the state’s response to the Omicron surge.
The $1.9 billion measure includes:
$806 Million to Bolster Testing
Expand hours and capacity at testing sites throughout the state
Distribute millions of COVID-19 antigen tests to local health departments, community clinics, and county offices of education and schools
Support the state’s testing facilities, including specimen collection
Assist state departments in testing their staff and congregate populations
$400 Million to Promote Vaccines and Combat Misinformation
Continue the “Vaccinate All 58” public education campaign to provide reliable information and build vaccine confidence while combating misinformation
Maintain a robust community outreach and direct appointment assistance campaign by conducting canvassing, phone banking, and texting
Support in-home vaccination and testing programs and transportation assistance
Provide free transportation to vaccination appointments throughout the state
$486 Million for Frontline Workers and Health Care Systems
Support distribution of personnel resources for health systems to help protect frontline workers, patient care, hospital surge capacity, and vaccination site staff
$141 Million to Maintain State Operations
Provide resources to enhance the state’s emergency response and public health capacities, including staffing and information technology at CDPH, Office of Emergency Services, and the Emergency Medical Services Authority
$100 Million to Support Mutual Aid, Contact Tracing, and Personal Protective Equipment
Provide mutual aid to support local governments
Continue statewide contact tracing activities
Procure additional personal protective equipment, including children’s N95 and surgical masks
CHEAC applauds the Legislature and Newsom Administration for enacting this important funding measure to continue the state’s ongoing response to the COVID-19 pandemic.
The California Legislature similarly granted final approval to both SB 114 and SB 113 on Monday as part of the early budget action package. Governor Newsom, in a visit to a small business in Alameda County on Wednesday, signed the measures into law.
SB 114 ensures that employees have access to up to 80 hours of COVID-19 supplemental paid sick leave through September 30, 2022. The additional paid sick leave may be used to support employees who have been advised to quarantine, those care for COVID-19-impacted family members, attending a COVID-19 vaccination appointment, and more. The law does not apply to small businesses employing 25 or fewer workers. The supplemental paid sick leave is retroactive to sick leave taken beginning January 1, 2022.
SB 115 provides California businesses an additional $6.1 billion in tax relief, tax credits, and direct grants to businesses impacted by the pandemic. The measure, among other items, provides a nearly $500 million tax cut for restaurants and venues, restores $5.5 billion in tax credits and deductions for businesses, and invests $150 million in COVID-19 relief grants into small businesses.
Subcommittees of both the Senate Budget & Fiscal Review Committee and the Assembly Budget Committee continue to ramp up their activities as part of the 2022 Budget Act, examining budget proposals and investments detailed in the Governor’s January Budget Proposal. Below, we highlight several subcommittee activities from this week:
Assembly Sub. 1 Assesses Health Care Affordability This Week, Health Care Access Next Week
On Monday, the Assembly Budget Subcommittee No. 1 on Health and Human Services convened a hearing on investment proposals related to health care affordability and COVID-19 response. The subcommittee received an informational report from representatives of the California Department of Public Health (CDPH) and the Department of Health Care Services (DHCS) regarding early budget action items to support the continued COVID-19 pandemic response statewide.
The subcommittee additionally assessed a variety of programs and budget change proposals within the Department of Health Care Access and Information (HCAI), including the proposed Office of Health Care Affordability. The subcommittee also received an update on the Medi-Cal Rx initiative, which launched at the beginning of the year.
All items covered during Monday’s hearing were either informational or held open for action at a later date. The agenda from Monday’s Assembly Subcommittee No. 1 hearing is available here. A video recording of the hearing is available here.
Looking ahead, the Assembly Budget Subcommittee No. 1 will convene another hearing on Monday focused on budget proposals related to health care access. Among the items to be considered are the Newsom Administration’s proposal to sunset the Child Health and Disability Prevention (CHDP) Program, expand full-scope Medi-Cal coverage to all income-eligible residents ages 26-49 regardless of immigration status, and add the HPV vaccine as a covered benefit under the Family PACT Program.
The agenda for next Monday’s Assembly Subcommittee No. 1 hearing is available here.
Senate Sub. 4 Examines OPR Community Partnerships and Strategic Communications
On Wednesday, the Senate Budget & Fiscal Review Subcommittee No. 4 on State Administration and General Government convened a hearing focused on budget proposals under the jurisdiction of the Governor’s Office of Planning and Research (OPR), Commission on State Mandates, and the State Controller, among others.
Of note, the Subcommittee considered the Newsom Administration’s proposal for $65 million General Fund ongoing to create and implement the Office of Community Partnerships and Strategic Communications (OCPSC) to manage the state’s highest priority public awareness and community outreach campaigns. Per the Newsom Administration, the state has made significant communication and community outreach efforts in recent years, including through the 2020 Census and ongoing communications related to the COVID-19 pandemic and related public health issues.
The Newsom Administration anticipates splitting the funding between resources to stand up the new OCPSC to coordinate and manage statewide communications campaigns and contracting resources to establish and maintain a network of community-based organizations with which to partner on communications efforts in impacted communities throughout the state.
Relatively few details were provided by the Newsom Administration during the hearing, and Subcommittee members raised a series of questions about the role and function of the office, as well as its ability to coordinate communications and programming across state government.
All items were held open during the hearing. The full agenda from the Sub. 4 hearing is available here. A video recording of the hearing is available here.
The California Department of Public Health (CDPH) this week announced it will allow temporary measures imposed during the most recent COVID-19 surge to expire. The move comes as CDPH notes COVID-19 conditions continue to improve across the state and the Omicron surge subsides, including a 65 percent decrease in case rates since the peak of the Omicron surge.
The changes include:
Additional visitation requirements that took effect on January 7 for long-term care facilities were allowed to expire on Monday
Definitions for indoor and outdoor mega events will return to pre-surge guidance (from 500 to 1,000 attendees for indoor events and from 5,000 to 10,000 attendees for outdoor events) after February 15
The universal indoor masking requirement will also expire after February 15, reverting the state to previous guidance which requires masking for unvaccinated persons in all indoor public settings and required masking for all individuals regardless of vaccination status in high-risk and congregate settings
CDPH notes California workplaces should continue to follow the COVID-19 prevention standards established by CalOSHA. Local health jurisdictions retain the authority to impose stricter standards. Additional adjustments to the state’s pandemic-related policies, including those for schools, are anticipated over the next week.
On Thursday, California Department of Public Health (CDPH) Director and State Public Health Officer Dr. Tomás Aragón issued a State Public Health Officer Order temporarily modifying certain COVID-19 reporting requirements for health care providers and laboratories.
Under the order that took effect immediately:
Health care providers must report hospitalization and/or death of a patient due to COVID-19 within one working day; previously, providers were required to report all COVID-19 cases immediately.
Laboratories must report all COVID-19 test results within 24 hours from the time the laboratory notifies the health care provider or other person authorized to receive the report; previously, laboratories were required to report results more expeditiously.
The reporting of hospitalizations and deaths by health care providers is in addition to weekly reporting of hospitalized COVID-19 cases by hospitals, required under All Facilities Letter 21-25. Health care providers conducting point-of-care testing must still report test results consistent with requirements for laboratories.
The U.S. Food and Drug Administration (FDA) announced today it is postponing the Vaccines and Related Biological Products Advisory Committee (VRBPAC) meeting originally scheduledfor Monday, February 15 to review the emergency use authorization (EUA) request from Pfizer and BioNTech for the COVID-19 vaccine in children six months through four years of age.
The FDA notes that it has been notified by Pfizer that new data have recently emerged from its ongoing clinical trial among young children. Based on the FDA’s preliminary assessment, and to allow more time to evaluate additional data, the FDA states, “we believe additional information regarding the ongoing evaluation of a third dose should be considered as part of our decision-making for potential authorization.”
Today, the U.S. Food and Drug Administration (FDA) granted emergency use authorization (EUA) for a new monoclonal antibody for the treatment of COVID-19 that retains activity against the Omicron variant. The new monoclonal antibody bebtelovimab has been authorized for treatment of mild to moderate COVID-19 in adults and pediatric patients with a positive COVID-19 test and who are at high risk for progression of severe COVID-19. Bebtelovimab, manufactured by Eli Lilly and Company, is not authorized for patients who are hospitalized due to COVID-19 or require oxygen therapy due to COVID-19.
U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra announced this week that the federal government has purchased 600,000 treatment courses of the new monoclonal antibody treatment that is effective against the COVID-19 Omicron variant. HHS has indicated the therapeutic will be provided to states free of charge.
Under the purchase agreement announced this week, HHS would receive approximately 300,000 treatment courses in February and approximately 300,000 treatment courses in March. The contract also includes a future option for 500,000 more doses.
The U.S. Government Accountability Office (GAO) this week released a report entitled, “COVID-19: Federal Efforts to Provide Vaccines to Racial and Ethnic Groups” as part of its ongoing oversight efforts related to the COVID-19 pandemic. GAO examined COVID-19 vaccination efforts by the Centers for Disease Control and Prevention (CDC), the Health Resources and Services Administration (HRSA), and the Federal Emergency Management Agency (FEMA) as part of its report.
The GAO notes each of the agencies’ programs took steps to provide COVID-19 vaccines to underserved and historically marginalized racial and ethnic groups, such as by using data on race and ethnicity when selecting vaccination sites. CDC, HRSA, and FEMA data suggest that the agencies’ efforts vaccinated varying shares of racial and ethnic groups. Specifically, GAO’s analysis of the CDC’s retail pharmacy program found that 43 percent of people vaccinated through the program were from racial and ethnic groups other than non-Hispanic White populations, as of September 2021.
The CDC exceeded its goal to administer at least 40 percent – the approximate percent of the U.S. population comprised of racial and ethnic groups other than non-Hispanic White – of COVID-19 vaccines through its retail pharmacy program. However, comparisons between program vaccination data and U.S. population percentages suggest that some racial and ethnic groups, such as non-Hispanic Black persons, represented a smaller share of persons vaccinated through each of the three federal agencies.
The U.S. Health Resources and Services Administration (HRSA) announced this week it has awarded $66.5 million in American Rescue Plan Act (ARPA) funding to eight grantees to expand outreach efforts in 38 states and the District of Columbia to increase COVID-19 vaccine confidence and vaccinations.
According to HRSA, nearly $390 million has been issued to 158 organizations nationwide for the Community-Based Workforce for COVID-19 Vaccine Program to support outreach, events, translation, education, and community health worker support in underserved areas in all 50 states. Awardees of the funding are utilizing various strategies to address access issues, implement culturally and linguistically appropriate outreach campaigns, and organize mobile vaccination clinics. Among the most recently announced grantees is the Association of Asian/Pacific Community Health Organizations based in San Francisco.
The National Association of County and City Health Officials (NACCHO) recently announced it is accepting applications for the Medical Reserve Corps (MRC) COVID-19 Respond, Innovate, Sustain, and Equip (RISE) Awards. The awards are intended to provide resources to the MRC network to support COVID-19 response efforts.
RISE awards will prioritize building capacity for the MRC to respond, innovate to evolving requirements, sustain staffing, and equip MRC units or state coordinators with resources needed to support their mission. Awards will be available at three tier levels ranging from $25,000 to $75,000 with approximately 350 total awards available to MRC units and MRC state coordinators.
Applications are open until Friday, March 4. Additional information is available here.
On Wednesday, the Senate Rules Committee convened to consider the appointment of Dr. Rohan Radhakrishna as Deputy Director of the California Department of Public Health (CDPH) Office of Health Equity (OHE).
Dr. Radhakrishna presented to the committee, discussing his background in a local health department and safety net clinic, as well as his goals and vision for the CDPH OHE. Dr. Radhakrishna identified his overarching priorities in his role relative to advancing racial and socioeconomic equity, climate action and resiliency, and behavioral wellness to support an equitable pandemic recovery.
Senators queried Dr. Radhakrishna about his office’s priorities, how advancements in health equity will be measured, and various strategic pandemic recovery efforts being carried out by CDPH OHE, among other topics.
The Senate Rules Committee unanimously advanced Dr. Radhakrishna’s appointment to the full Senate on a 5-0 vote. The full Senate is anticipated to vote on his confirmation in the coming weeks.
On Monday, Governor Gavin Newsom announced his appointment of Office of Digital Innovation Director Amy Tong to serve as the Secretary of the California Government Operations (GovOps) Agency. Tong has served in her most recent role since earlier this year and was the Director of the California Department of Technology from 2016 and 2021. Tong was previously the Chief Deputy Director of the Office of Systems Integration and Agency Chief Information Officer at the California Health and Human Services (CalHHS) Agency. She has additionally served in other technology-related roles with the state.
Tong is anticipated to take over leadership of GovOps upon the departure of current-Secretary Yolanda Richardson who recently announced her resignation to lead the San Francisco Health Plan. Ms. Tong’s appointment requires Senate confirmation.
On Wednesday, the California Department of Health Care Services (DHCS) released a Request for Proposal (RFP) for its commercial Medi-Cal managed care plan (MCP) contracts. DHCS is seeking MCPs committed and able to advance equity, quality, access, accountability, and transparency to reduce health disparities and improve health outcomes for Californians.
While the release RFP is only for commercial Medi-Cal MCPs, the updated contract language will be executed with all Medi-Cal MCPs, including County Organized Health Systems (COHS), Local Initiatives (LIs), and the new Single Plan Model. The updated MCP contract, released with the RFP, additionally serves as the minimum definition of requirements.
According to DHCS, health plans will be expected to deliver person-centered care that addresses the physical and mental health needs of enrollees, as well as unmet social needs that impact an individual’s health outcomes, such as food insecurity and housing. The RFP will be California’s first statewide procurement, and all managed care plans must commit to a range of new requirements that advance health equity and improve population health. Priorities include the delivery of high-quality, culturally competent care and access to providers and coordination of care across settings and at all levels. All managed care plans will also be expected to engage and coordinate with local community partners, invest resources into communities, and make public their performance and health equity activities.
Proposals from managed care plans are due on April 11, 2022. DHCS expects to award contracts to selected plans in August 2022, and plans will have more than a year to prepare their Medi-Cal delivery systems to meet new contract requirements that take effect in January 2024.
DHCS will host a Medi-Cal MCP Voluntary Pre-Proposal Web Conference on February 24 from 1:00 pm to 2:30 pm. Webinar registration is available here.
The California Department of Health Care Services (DHCS) recently released a proposal to enter into a direct contract with Kaiser Permanente as a Medi-Cal managed care plan within new geographic regions of the state, effective January 1, 2024, for a five-year contract term with potential contract extensions. Under the new proposed contract, subject to federal approvals, Kaiser Permanente would operate as a full-risk, full-scope Medi-Cal managed care plan, consistent with other Medi-Cal managed care plans.
The proposed arrangement would allow Kaiser Permanente to bypass the state’s recently announced MCP RFP process. Kaiser Permanente would no longer be granted specific exceptions or alternative standards. The only exception, according to DHCS, will be that Kaiser Permanente will not be open through the traditional Medi-Cal plan choice methods.
DHCS is proposing trailer bill language to clarify its statutory authority to maintain and expand direct, full-risk contracts with Kaiser Permanente. Subject to federal approval, direct contracts would be available in any geographic areas in which Kaiser Permanente operates, including COHS/single plan model counties, two-plan model counties, regional model counties, and Geographic Managed Care model counties.
The California Department of Health Care Services (DHCS) late last week released its Telehealth Policy Proposal for the post-public health emergency period due to the COVID-19 pandemic. AB 133 (Chapter 142, Statutes of 2021) required DHCS to convene an advisory group to provide recommendations to DHCS in establishing and adoption billing/coding and utilization management protocols for telehealth in the Medi-Cal program. DHCS’ proposal document takes into account input received through the Department’s stakeholder process.
DHCS will convene the Telehealth Advisory Workgroup on February 16 to present the final DHCS Telehealth Policy Proposal and solicit workgroup feedback. The workgroup meeting will be open to the public in listen-only mode and a public comment period will be offered.
The U.S. Centers for Disease Control and Prevention (CDC) National Center for Injury Prevention and Control is in the process of updating the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain. This week, the draft updated clinical practice guideline for prescribing opioids is available for public comment in the Federal Register.
The public comment period will be open for 60 days through April 11, 2022. According to the CDC, the guideline is intended to be a clinical tool to improve communication between providers and patients and empower them to make informed, patient-centered decisions related to safe and effective pain care. The guideline recommendations are voluntary and are not intended to be applied as inflexible standards.
Additional information, including the link to the Federal Register, is available here.
The U.S. Food and Drug Administration (FDA) this week unveiled new steps aimed at fostering the development of non-addictive alternatives to opioids to manage acute pain and decreasing exposure to opioids and decreasing exposure to opioids. The agenda issued draft guidance to provide recommendations to companies developing non-opioid analgesics for acute pain lasting up to 30 days. The new guidance supports the HHS Overdose Prevention Strategywhich focuses on primary prevention, harm reduction, evidence-based treatment, and recovery support.
The draft guidance identifies the FDA’s current thinking about various aspects of non-opioid analgesic drug development for acute pain. The FDA is accepting public comments on the draft guidance for industry until April 11, 2022.
The U.S. Department of Health and Human Services (HHS) this week released a new report highlighting the economic impact of the American Rescue Plan Act (ARPA), specifically the role ARPA played in reducing poverty. The report, issued by the Office of the Assistant Secretary for Planning and Evaluation (ASPE), projects that economic relief efforts – including economic impact payments, unemployment compensation, and the monthly child tax credit – kept 20.1 million people out of poverty, including 7.8 million children.
Other key findings from the report include:
Federal and state economic stimulus reduced overall poverty by 45 percent in 2021 (20.1 million people)
Federal and state economic stimulus reduced child poverty by 56 percent (7.8 million children)
Poverty reductions were larger for groups with historically higher poverty rates – American Indians/Alaska Native (7.6 percentage points), Black non-Hispanic people (7.0 percentage points), and Hispanic people (6.9 percentage points)
The University of California, San Francisco (UCSF) California Technical Assistance Center (COHTAC) recently published the Tobacco Cessation Toolkit for California Dental Providers. The toolkit was created in partnership with the San Joaquin County Public Health Services Smoking & Tobacco Outreach and Prevention Program (STOPP) and Local Oral Health Program and the California Department of Public Health (CDPH) Office of Oral Health.
The toolkit aims to provide dental professionals in the state with tools and resources to help guide and improve tobacco cessation-related practices. To complement the toolkit, a free, on-demand, one-hour webinar has been made available. The webinar discusses the oral and overall health implications of tobacco use and strategies for implementing tobacco cessation interventions in dental practice, including the role of the entire dental team. All dental providers are eligible to view the webinar and have the option of receiving 1.0 CDE credit upon completion.
Additional information, including the full toolkit and webinar, is available here.
The Newsom Administration recently announced a series of actions related to homelessness and housing. Below, we highlight these actions:
Homekey Awards Issued to More Jurisdictions
Governor Gavin Newsom this month announced additional awards for new Homekey projects to provide housing units to people exiting homelessness. Homekey, launched in 2020, seeks to provide more permanent housing in California by acquiring and renovating apartment buildings, hotels, and other similar buildings.
Additional Homekey awards will be announced in the coming weeks. Applications from local jurisdictions are being accepted on a rolling basis until funds are exhausted or May 2, 2022, whichever comes first.
Housing Accelerator Program Issues Over $900M in Awards
The Newsom Administration also recently announced it has provided more than $923 million in awards for affordable housing projects as part of the state’s California Housing Accelerator, a $1.75 billion investment to provide bridge funding to shovel-ready projects that were otherwise unable to begin construction because of a shortage of federal tax credits and bonds.
In total, 27 statewide projects have been approved to date with nearly all of the projects expected to break ground this summer. When fully completed, the projects will create 2,300 housing units, 500 of which will be designated for those experiencing homelessness. The Housing Accelerator Program prioritizes projects for those experiencing homelessness and for those below 30 percent of the Area Median Income.
The California Department of Housing and Community Development (DHCD) oversees the Housing Accelerator Program with funding derived from the Coronavirus State Fiscal Recovery Fund, enacted by the American Rescue Plan Act (ARPA). The next round of Accelerator projects will be a competitive process with an additional $735 million available.