February 26, 2021 Edition

Legislature Reaches Bill Introduction Deadline, CHEAC Issues First Bill Chart of 2021

Legislative activities in Sacramento continue to ramp up following last Friday’s deadline for lawmakers to introduce legislative bills in their respective houses. The Assembly introduced nearly 1,600 bills and the Senate introduced over 800 bills that will be considered by the Legislature over the coming months.

In other related news, Governor Gavin Newsom on Tuesday signed six immediate action budget bills providing over $7.6 billion in relief to Californians most impacted by the COVID-19 pandemic. Recall last week, the Governor and Legislative Leaders struck an agreement on the wide-ranging relief package which includes $600 one-time payments to low-income residents, small business relief grants, business fee waivers, and support for individuals and families, among other actions. A statement from the Governor on the pandemic relief package is available here.

The CHEAC Legislative Committee this week met for its first bill review meeting to assess nearly 60 legislative bills impacting local health departments and public health. The committee identified a number of bills of interest, including in areas of COVID-19, health coverage and health care reform, public health emergency preparedness, and tobacco control, among other areas. Our first CHEAC Weekly Bill Chart of 2021 is now published and accessible here. As a friendly reminder, information on CHEAC’s legislative advocacy activities is available on our website here and will be updated throughout the legislative session.

Below, we highlight bills of particular interest now being tracked by CHEAC.

Access to Health Services

AB 32 (Aguiar-Curry) as amended February 12, 2021 – SUPPORT

AB 32 by Assembly Member Cecilia Aguiar-Curry requires the California Department of Health Care Services (DHCS) to indefinitely continue telehealth flexibilities established during the COVID-19 pandemic. The measure requires reimbursement parity for telehealth services, authorizes providers to enroll or recertify beneficiaries in certain Medi-Cal programs remotely, and requires DHCS to convene an advisory group on the subject. CHEAC supports AB 32 to increase access to health services and provide flexibilities to Medi-Cal beneficiaries seeking care through telehealth modalities.

SB 316 (Eggman) as introduced February 4, 2021 – SUPPORT

Senator Susan Talamantes Eggman’s SB 316 would authorize reimbursement for a maximum of two visits on the same day at the same federally qualified health center (FQHC) or rural health center (RHC) if: 1) the patient suffers an illness or injury requiring additional treatment or diagnosis; or 2) if the patient has a medical visit and a mental health visit or dental visit. The measure includes provisions around FQHC/RHC per-visit reimbursement rate adjustments and requires DHCS to seek a state plan amendment from the U.S. Centers for Medicare and Medicaid Services (CMS).

CalAIM

AB 875 (Wood) as introduced February 17, 2021, and SB 256 (Pan) as introduced January 26, 2021 – WATCH

Companion measures AB 875 by Assembly Member Jim Wood and SB 256 by Senator Richard Panwill serve as the legislative vehicles for statutory changes related to California Advancing and Innovating Medi-Cal (CalAIM) initiative proposals set forth by the Newsom Administration. The measures specify enhanced care management (ECM) as a covered Medi-Cal benefit no sooner than January 2022 and require Medi-Cal managed care plans to disclose the availability of in lieu of services (ILOS) and settings available to Medi-Cal beneficiaries.

Cannabis

AB 45 (Aguiar Curry) as introduced December 7, 2020, and SB 235 (Allen) as introduced January 19, 2021 – WATCH

AB 45 by Assembly Member Cecilia Aguiar Curry and SB 235 by Senator Ben Allen would both allow food, beverages, dietary supplements, cosmetics, and pet food to be manufactured with the addition of CBD derived from industrial hemp. Establishes labeling and testing requirements for hemp CBD products and prohibits the inclusion of CBD in medical devices, prescription drugs, processed smokable products, including e-cigarettes with nicotine, hookah and shisha with nicotine, and any product that contains nicotine, tobacco, or alcohol.

Communicable Disease Control

SB 306 (Pan) as introduced February 4, 2021 – SUPPORT

SB 306 by Senator Richard Pan expands a number of services to address sexually transmitted diseases including requiring third trimester congenital syphilis testing for pregnant persons, allowing pharmacists to provide expedited partner treatment (EPT) for STDs, requiring both private and public health insurance coverage to cover home STD kits, adding EPT treatment and liability protections for physicians when diagnosing and treating STDs, allowing HIV counselors to perform rapid STD tests, and allowing reimbursement in the Family PACT program for STD related services to the uninsured, income eligible patients, or patients without healthcare coverage with confidentiality concerns who are not at risk for pregnancy or do not need contraceptive services.

COVID-19

SB 49 (Umberg) as amended February 1, 2021 – WATCH

SB 49 by Senator Tom Umberg would prohibit counties and cities, along with state agencies, from collecting regulatory license fees from any business that has been ordered to close in response to the COVID-19 state of emergency including restaurants/bars or an entity licensed by the State Board of Barbering and Cosmetology.

SB 336 (Ochoa Bogh) as introduced February 8, 2021 – WATCH

SB 336 by Senator Rosilicie Ochoa Bogh, and co-authored by the Senate Republican Caucus, would requires local health officers (LHO) or CDPH, when taking measures to prevent the spread of COVID-19, to have those measures published for 72 hours on their respective websites before taking effect and becoming enforceable. In addition, SB 336 requires CDPH and LHOs to contact all local organizations representing local businesses in each county.

Drug and Alcohol Services

AB 381 (Davies) as introduced February 2, 2021 – SUPPORT

AB 381 authored by Assembly Member Laurie Davies requires licensed adult alcoholism or drug abuse recovery or treatment facilities to administer naloxone and have at least one staff member on premises who knows where facility naloxone is stored and has been trained on the administration of the drug.

SB 57 (Wiener) as introduced December 7, 2020 – WATCH

SB 57 by Senator Scott Wiener, and co-authored by Senator Susan Eggman, would authorize the City and County of San Francisco, the City of Oakland, and Los Angeles County to approve entities to operate overdose prevention programs, including supervised injection sites. Delineates the requirements for these sites and provides prosecutorial immunity for those involved in the operation or use of the site. Specifies required operating procedures.

Environmental Health

SB 296 (Limón) as introduced February 3, 2021 – WATCH

SB 296 by Senator Monique Limón requires each local jurisdiction that employs code enforcement officers to develop code enforcement officer safety standards. The measure is sponsored by the California Association of Code Enforcement Officers.

Health Coverage/Health Care Reform

AB 4 (Arambula) as introduced December 7, 2020 – SUPPORT

AB 4 by Assembly Member Joaquin Arambula expands Medi-Cal to all undocumented adults with income at or below 138% FPL, subject to an appropriation by the Legislature.

SB 56 (Durazo) as introduced December 7, 2020 – SUPPORT

SB 56 authored by Senator Maria Elena Durazo would expands Medi-Cal to all undocumented adults 65 years of age and older with incomes at or below 138% FPL subject to an appropriation by the Legislature effective July 2022.

SB 326 (Pan) as introduced February 5, 2021 – SUPPORT

SB 326 by Senator Richard Pan, and co-authored by Assembly Member Jim Wood, both chairs of their respective Health committees, would codify the remaining Affordable Care Act (ACA) health coverage reforms that are “tied” to federal statute in California statute including essential health benefits, guaranteed issue and renewability provisions, prohibitions on imposing pre-existing conditions exclusions, prohibitions on establishing coverage rules based on certain health status related factors, and limits on premium variations based on an individua, family size, geographic area, age, and tobacco use.

Health Equity

SB 17 (Pan) as amended February 25, 2021 – SUPPORT

Senator Richard Pan’s SB 17 would establish a statewide Office of Racial Equity to be governed by a Racial Equity Advisory and Accountability Council. The measure requires the Office to develop a statewide Racial Equity Framework providing guidelines for inclusive policies and practices that reduce racial inequities, promote racial equity, address individual, institutional, and structural racism, and establish goals and strategies to advance racial equity and address structural racism and racial inequities. Requires each state agency to adopt and implement a Racial Equity Action Plan that aligns with the statewide Racial Equity Framework and report annually on progress. CHEAC strongly supports SB 17. Recall, CHEAC last year issued a statement declaring racism a public health crisis and calling for additional action at federal, state, and local levels.

Public Health Emergency Preparedness

AB 536 (Rodriguez) as introduced February 10, 2021 – WATCH

AB 536 by Assembly Member Freddie Rodriguez requires the California Governor’s Office of Emergency Services (CalOES) to conduct a gap analysis of the state’s mutual aid system on a biennial basis considering the firefighting, law enforcement, emergency medical services, mass care, shelter, and hospital surge capacity required to respond to two simultaneous major disasters in California.

Public Health Infrastructure

AB 240 (Rodriguez) as introduced January 13, 2021 – SUPPORT

AB 240 by Assembly Member Freddie Rodriguez is CHEAC’s sponsored bill requiring the California Department of Public Health (CDPH) to contract with an appropriate and qualified entity to conduct an evaluation of the adequacy of the local health department infrastructure in California and to make recommendations for future staffing, workforce, and resource needs in order to accurately and adequately fund local public health.

Tobacco Control

AB 598 (R. Rivas) as introduced February 11, 2021 – SUPPORT

Assembly Member Robert Rivas’ AB 598 requires the California Attorney General to establish and maintain online a list of tobacco products that lack a characterizing flavor by July 2022. The bill authorizes the Attorney General to require tobacco manufacturers and importers to submit a list of all tobacco brand styles and sets forth other related provisions regarding the determination of a tobacco product with a characterizing flavor. The measure is sponsored by California Attorney General Xavier Becerra.


Legislative and Budget Hearings Cover Telehealth, COVID-19 Impacts, and Homelessness

This week, the California State Assembly and Senate held a number of hearings spanning a wide array of subject areas, including COVID-19, homelessness, telehealth, and proposed budget investments. Below, we provide a high-level overview of hearings held this week:

Assembly Examines Telehealth Policy in California Post-Pandemic

The Assembly Health Committee on Tuesday convened an informational hearing to examine telehealth policy in California following the ongoing COVID-19 pandemic. The informational hearing provided an overview of telehealth law and policy, the current state of evidence on telehealth and telephone visits, policy considerations for telehealth post-pandemic, and an opportunity to evaluate the recently released telehealth policy recommendations document issued by the California Department of Health Care Services (DHCS).

In opening remarks, Assembly Health Committee Chair Jim Wood, as well as Assembly Member Cecilia Aguiar-Curry, discussed the role and importance of telehealth services and telehealth flexibilities made available during the COVID-19 pandemic in increasing access to health services among the state’s residents. Assembly Member Aguiar-Curry has introduced AB 32 requiring DHCS to indefinitely continue telehealth flexibilities established during the COVID-19 pandemic and authorizing enrolled providers to enroll or recertify an individual in certain Medi-Cal programs remotely.

The hearing featured multiple presentations from health policy experts and health providers providing committee members an overview of telehealth law and policy in California, available evidence on the effectiveness of telehealth services, and recommended regulatory and payment changes for telehealth following the COVID-19 pandemic. DHCS Director Will Lightbourne and Chief Deputy Director Jacey Cooper presented the department’s telehealth flexibilities proposed for continuity beyond the COVID-19 public health emergency. Notably, DHCS representatives framed their policy recommendations document as a starting point and expressed a willingness to continue working with lawmakers and stakeholders on which telehealth services and flexibilities should be maintained.

The hearing agenda is available here and a background paper is available here. A video recording of the hearing is available here.

Senate Considers Homelessness Crisis during COVID-19 Pandemic

On Wednesday, the Senate Budget & Fiscal Review Subcommittee No. 3 on Health and Human Services, Subcommittee No. 4 on State Administration and General Government, Senate Governance and Finance Committee, Senate Housing Committee, and Senate Human Services Committee held an informational hearing entitled, “A Perfect Storm: Confronting California’s Homelessness Crisis during the Pandemic.” The hearing provided committee and subcommittee members an opportunity to explore recent efforts to address homelessness during the COVID-19 pandemic, local governments’ experiences in providing homelessness services and programs during the pandemic, and challenges facing vulnerable populations including transition age youth experiencing homelessness.

The committees received an overview of the state’s recent actions to address the homelessness crisis, including Project Roomkey and Homekey, from representatives at the California Homeless Coordinating and Financing Council, Department of Social Services (CDSS), and the Department of Housing and Community Development (DHCD). Representatives from local governments, including Yolo County, Los Angeles County, and Humboldt County, appeared before the committees to discuss local efforts and experiences in serving individuals experiencing homelessness. Additionally, representatives of the Sacramento LGBT Community Center and a youth advocate discussed with the committee their experiences in addressing specific challenges experienced by homeless transitional youth during the pandemic.

A hearing agenda is available here and a background paper is available here. A video recording of the hearing is available here.

Assembly Explores Impact of Pandemic on Small Businesses

The Assembly Committee on Jobs, Economic Development, and the Economy on Tuesday convened an informational hearing on the economic impact of the COVID-19 pandemic on California small businesses. The hearing featured three separate panels detailing the overall economic losses and impacts of the pandemic, relief opportunities available to small businesses, and program innovations to support the economic recovery of small businesses. Representatives from academia, the Newsom Administration, and business industries presented to the committee, providing insight and recommendations to the Legislature on supporting economic recovery post-pandemic.

A hearing agenda is available here and a background paper is available here. A video recording of the hearing is available here.

Joint Hearing on COVID-19 and the Courts

The Assembly and Senate Committees on Judiciary on Tuesday held a joint informational hearing to assess the pandemic’s impacts on the operation of the judicial branch in California and best practices employed by California courts during the pandemic. As determined by the committees, California courts’ responses to the pandemic have varied and have consisted of a range of activities to balance COVID-19 precautions with the interest of justice. Tuesday’s hearing featured introductory remarks from California Supreme Court Chief Justice Tani Cantil-Sakauye, as well as presentations from representatives of California Superior Courts and judicial stakeholder groups and organizations.

The informational hearing included discussions of the impacts of the pandemic on court users, court operations, and court personnel. Innovative programs and best practices were additionally highlighted, providing insight into actions available to the state to improve access to justice during the ongoing pandemic and future emergencies. The hearing agenda is available here and a background paper is available here. A video recording of the hearing is available here.

Assembly Sub. 1 Reviews Behavioral Health Investments

On Monday, the Assembly Budget Subcommittee No. 1 on Health and Human Services (HHS) convened a hearing to review the Newsom Administration’s proposed budget investments related to behavioral health. The hearing featured representatives from the California Department of Health Care Services (DHCS), California Department of Public Health (CDPH), Department of State Hospitals (DSH), and the Mental Health Services Oversight and Accountability Commission (MHSOAC).

The subcommittee assessed, among other items, the impacts of the COVID-19 pandemic on behavioral health needs and services, suicide and drug overdose prevention activities, behavioral health services for individuals experiencing homelessness, and Medi-Cal behavioral health proposals. Subcommittee members received presentations from state agency and department representatives, as well as the Department of Finance (DOF) and the Legislative Analyst’s Office (LAO). All items were held open for action at a later date. The hearing agenda is available here and a video recording of the hearing is available here.

Senate Sub. 3 Reviews State Hospital Investments

Today, the Senate Budget & Fiscal Review Subcommittee No. 3 on Health and Human Services convened a hearing to review proposed investments falling under the jurisdiction of the Department of State Hospitals (DSH). Subcommittee members received an overview presentation from DSH representatives and reviewed DSH’s response and response expenditures to the ongoing COVID-19 pandemic. Other items assessed by the subcommittee included incompetent to stand trial (IST) program expansions and community-based restoration programming. All items were held open for action at a later date.

A hearing agenda is available here. A video recording of the hearing is available here.


VRBPAC Recommends EUA for Johnson & Johnson Single-Dose COVID-19 Vaccine

Today, the Vaccines and Related Biological Products Advisory Committee (VRBPAC) met to review and discuss the emergency use authorization (EUA) request from Janssen Biotech, Inc. for its Johnson & Johnson COVID-19 vaccine, ultimately recommending on a unanimous vote that the U.S. Food and Drug Administration (FDA) issue an EUA for the single-dose vaccine.

The Johnson & Johnson vaccine was tested in an international study of approximately 40,000 participants. The vaccine was found to be 66 percent effective in preventing moderate to severe COVID-19 cases and 85 percent effective in critical COVID-19 cases. The FDA is anticipated to approve the EUA for the Johnson & Johnson vaccine as early as this weekend with shipping and distribution of the vaccine commencing as early as next week.

The CDC Advisory Committee on Immunization Practices (ACIP) is scheduled to meet on Sunday and Monday to further review the Johnson & Johnson vaccine and issue its recommendations. The Western State Scientific Safety Review Workgroup is similarly anticipated to convene its review of the Johnson & Johnson vaccine over the coming days.

According to Johnson & Johnson, four million doses of the vaccine could be available in the U.S. as soon as the FDA issues its EUA, increasing to 20 million doses by the end of March. Johnson & Johnson has maintained its commitment to providing the U.S. federal government with 100 million doses by the end of June.

The VRBPAC meeting materials are accessible here.


President Biden Extends COVID-19 National Emergency, Takes Other Related Actions

This week, President Joseph R. Biden, Jr. took a series of actions to support the ongoing response to the COVID-19 pandemic. Below, we provide a brief summary of these actions:

  • National Emergency Extended: President Biden on Wednesday issued a notice continuing the national emergency declared in response to the ongoing COVID-19 pandemic beyond March 1, 2021. The extension notice is available here.
  • Masks to Health Centers and Food Banks: Under the direction of President Biden, the Department of Health and Human Services (HHS), in partnership with the Department of Defense (DoD), will deliver millions of masks to over 1,300 community health centers nationwide. Anyone in the community will be eligible to pick up masks from their local community health center and recipients will be encouraged to take an individually wrapped package of two masks for each person in their household. In addition to masks to health centers, the DoD, in partnership with the Department of Agriculture (USDA), will provide masks to many of the country’s nearly 300 food banks. Food banks reach a network of over 60,000 food pantries, soup kitchens, and other food distribution points. Recipients will similarly be encouraged to take an individually wrapped package of two masks for each person in their household. Of note, the masks will be no cost, high-quality, washable, and consistent with the mask guidance from the CDC. All of the masks will be made in America and will be available beginning in March and into May. The Biden Administration anticipates distributing more than 25 million masks total. Additional information on the mask announcement is available here.
  • Supply Chains Executive Order: President Biden issued an executive order this week aimed at strengthening the U.S.’ supply chains for critical and essential goods. As part of the order, specified federal agencies are directed to conduct an immediate 100-day review of supply chains of four key products to address vulnerabilities. The order additionally calls for a one-year review of a broader set of U.S. supply chains, which include a focus on key sectors such as public health and biological preparedness products. Federal agencies are further directed to address threats to supply chains and improve resiliency of supply chains. A fact sheet on the executive order is available here.
  • 50 Millionth Vaccine Delivered: President Biden convened an event on Thursday to commemorate the 50 millionth COVID-19 vaccine administered in the country. A video recording of the event is available here and remarks from the event are available here.
  • Update on Community Vaccine Sites: The Biden-Harris Administration this week issued information on the progress its Administration has made in distributing and administering COVID-19 vaccines through over 400 community vaccination centers across 37 states, territories, and the District of Columbia. According to the Administration, 171 sites are supported by 2,225 federal personnel, 312 sites are supported by federally-funded National Guard member deployments, 177 sites have received federal funding, and 62 sites have received federal equipment. The update from the Administration additionally details federal pilot community vaccination centers, two of which have been established in California in Alameda and Los Angeles counties. The information is available here.

DOF Notifies Legislature of DREOA Extension to Support COVID-19 Response

This week, the Department of Finance (DOF) notified legislative budget leaders of the Newsom Administration’s intent to extend use of the state’s Disaster Response-Emergency Operations Account (DREOA) for COVID-19-related emergency operations costs for an additional 120 days. In a memo to the legislature, the DOF highlights the Newsom Administration’s ongoing response efforts to the pandemic, including activities related to vaccine distribution, hospital and medical surge capacity, and other emergency response functions.

The full DOF memo on the 120-day DREOA extension is available here.

In related news, the DOF also notified legislative budget leaders of the Newsom Administration’s intent to use up to $28 million from the Rapid Response Fund for COVID-19 shelter and other service needs for newly arriving migrants from the U.S. Department of Homeland Security’s (DHS) Migrant Protections Protocols (MPP) program at the Port of Entry at San Ysidro, California, in San Diego County. The funding is anticipated to cover quarantine and isolation shelter, wraparound services, medical screenings and care, and other state operations costs.


State Issues Additional Information on TPA Framework, Identifies County Onboarding Waves

Today, the California Department of Public Health (CDPH) issued additional information on the statewide vaccine network to be operated by third-party administrator (TPA) Blue Shield of California. The announcement details the forthcoming changes that will occur as the TPA framework is gradually implemented over the month of March. According to the state, it remains on track to establish the capacity to administer three million vaccinations per week by March 1.

As counties and providers are onboarded to the TPA over the coming weeks, MyTurn.ca.gov will become the primary source for state residents to sign up for COVID-19 vaccination appointments. As part of today’s announcement, the state and Blue Shield detailed an updated implementation timeline for the statewide vaccine network. This includes:

On March 1:

  • All providers and local health jurisdictions will move to a uniform, state-directed eligibility criteria.
  • Blue Shield of California will begin making allocation recommendations to state officials for doses delivered the following week. The state will make final allocation decisions, continuing to utilize the existing split prioritizing 70 percent of doses for residents age 65 and older and 30 percent of doses for specified sectors.
  • Wave 1 and Wave 2 counties will continue onboarding.
  • The TPA, in partnership with counties, will continue targeted equity strategies, including farmworker mobile and pop-up sites and opening clinics in lowest quartile HPI tracts.

On March 7:

  • Wave 2 and Wave 3 counties will continue onboarding.

On March 31:

  • Blue Shield of California will take full management responsibility for the statewide vaccine network and continue providing vaccine allocation recommendations to the state to assist in allocation decisions.

Additional information, including the listing of counties included in the three TPA onboarding waves, is available here.


Newsom Administration Releases Details on Vaccines for Education Personnel

On Thursday, the Newsom Administration issued its plan to execute on the Governor’s recent commitment to provide 10 percent of the state’s COVID-19 vaccine supply to education personnel beginning Monday, March 1. The Administration plans to provide education personnel access to COVID-19 vaccines through existing county-led initiatives, dedicated access to MyTurn, and state-FEMA partnerships.

As part of the state’s plan to provide dedicated access to MyTurn, the state will allocate up to 75,000 single-use codes to county offices of education which will allow education personnel to schedule a vaccination appointment online. Single-use codes will be allocated by the state on the basis of communities’ number of education workers and the extent to which those education workers serve children who have been disproportionately impacted by the pandemic. Further, education personnel will qualify for an expedited appointment based on whether they are or will soon be exposed to occupational COVID-19 risks by working in-person in a school setting.

Additional information on the Newsom Administration’s plan for COVID-19 vaccines for education personnel is available here. A statement from the Governor’s Office is available here.


CDPH Issues Health Alert on COVID-19 Virus Variants, Posts Weekly Data

On Thursday, the California Department of Public Health (CDPH) issued a Health Alert regarding the increasing identification of COVID-19 virus variants in California, in the U.S., and internationally. CDPH’s alert details the current virus variants of concern, consisting of the B.1.1.7, B.1.351, and P.1 variants, as well as current variants of interest, consisting of the B.1.429 and B.1.427 variants. CDPH provides guidance to local health departments and health care providers on collecting and submitting specimens for whole genome sequencing to identify potential virus variants.

As part of the CDPH Health Alert, CDPH has created a new webpage providing additional information on the COVID-19 virus variants. CDPH will post online each Thursday the number of identified variant cases in California. As of February 25, 2021, California has identified the following:

  • Variants of Concern
    • B.1.1.7: 206 cases
    • B.1.351: 2 cases
    • P.1: 0 cases
  • Variants of Interest
    • B.1.429: 1,088 cases
    • B.1.427: 2,771 cases

The CDPH Health Alert is available here. CDPH’s webpage on virus variant tracking is available here.


CHHS Announces VBL Received Licensing Report, Vows Improvements

The California Health and Human Services (CHHS) Agency this week released an announcement regarding the recent findings of the California Department of Public Health (CDPH) Laboratory Field Services (LFS) Division revealing a number of significant deficiencies at the Valencia Branch Laboratory (VBL). CDPH, during an initial routine inspection of the laboratory, identified a series of issues at the VBL which is operated by PerkinElmer on contract with the State of California.

CHHS notes that VBL is currently seeking accelerated accreditation through the College of American Pathologists (CAP), a third-party accreditation entity, to ensure the quality of services being provided at the state laboratory. CHHS further expressed confidence in the laboratory’s ability to address and correct identified deficiencies. The full CDPH LFS report with PerkinElmer’s responses to the identified deficiencies is anticipated to be made available in mid-March.

The statement from CHHS is available here.