February 28, 2020 Edition
Last Friday was
the deadline for new legislative bills to be introduced for 2020. To date, the
Legislature has introduced over 2,200 measures in both houses. CHEAC’s
Legislative Committee also convened on February 21 to review the first batch of
bills of interest to local health departments. The Committee will meet again on
Friday, March 6, to review the final group of newly introduced legislation.
Please see our
updated CHEAC Weekly Bill Chart for specific information on bills of interest to CHEAC.
Access to
Health Services
AB
2007 (Salas) – SUPPORT
AB 2007 by Assembly Member Rudy Salas would specify that an
FQHC/RHC “visit” includes an encounter between a provider or patient using
telehealth in synchronous or asynchronous store-and-forward. The measure also
specifies that an FQHC/RHC would not have to establish an individual as a
patient via a face-to-face encounter prior to providing telehealth services, as
currently required. AB 2007 also sets forth requirements for FQHCs/RHCs to bill
for telehealth services, including that nonbillable clinical staff are present
and that the patient is at an originating clinic site. The measure is sponsored
by the Children’s Partnership, Children Now, California Health+ Advocates, and
the California Dental Association. The measure will be heard in the Assembly
Health Committee on March 31, 2020.
Communicable
Disease Control
AB 2077 (Ting) – SUPPORT
AB 2077, sponsored by HOAC, the San
Francisco AIDS Foundation, and the Drug Policy Alliance, would remove the
sunset from an existing law that allows pharmacies to sell and adults to
possess sterile syringes for personal use without a prescription. The bill has
been referred to the Assembly Health Committee and will be heard on March 17,
2020.
SB 859 (Wiener) – SUPPORT
SB
859 by Senator Scott Wiener would require the California Health and Human
Services Agency (CHHS) Secretary, in coordination with the California
Department of Public Health (CDPH) Office of AIDS Chief, to lead the
development and implementation of the HIV, HCV, and STD Master Plan. A
stakeholder advisory committee, including representation from local
governments, providers, health plans, and community-based organizations, would also
be required to be established. The CHHS Secretary and CDPH OA Chief would be
required to collaborate with various state agencies and departments, including
CDPH, DHCS, and CDSS, to set goals for ending the statewide epidemics. The
measure is sponsored by the San Francisco AIDS Foundation, APLA Health,
Essential Access Health, and Equality California.
SB 932 (Wiener) – SUPPORT
Senator Scott Wiener’s SB 932 would
authorize HIV counselors to conduct rapid sexually transmitted infection (STI)
tests via skin puncture under specified circumstances. Currently, HIV
counselors are authorized to conduct HIV/HCV skin puncture tests. SB 932 would
also modify training requirements established by the CDPH Office of Aids to
allow for training courses that have been approved by CDPH OA. The measure is
sponsored by the San Francisco AIDS Foundation and APLA Health.
Maternal, Child & Adolescent
Health Services
AB 2258 (Reyes) – SUPPORT
AB
2258 by Assembly Member Eloise Gómez Reyes would require the Department of
Health Care Services (DHCS) to establish a full-spectrum doula care pilot
program to operate for three years for all pregnant and postpartum Medi-Cal
beneficiaries residing in 14 counties that experience the highest burden of
birth disparities in California. The measure specifies eligibility for services
which include at least four prenatal visits, continuous support during labor
and delivery, and at least eight postpartum visits without prior authorization
or cost-sharing. DHCS would be required to set reimbursement rates and provide
timely reimbursement to doulas under specified conditions, establish a
centralized registry listing of doulas available to take on new clients, and require
Medi-Cal managed care plans to notify beneficiaries of doula services. DHCS
would be required to convene a doula advisory board to determine core
competencies of doulas related to emotional support, communication,
breastfeeding and lactation, and other pregnant and postpartum topics. The
measure is sponsored by a coalition of health equity and consumer-focused
entities, including Black Women for Wellness, Birthing Project USA, National
Health Law Program, and Western Center of Law and Poverty.
Earlier this week, the Senate Rules Committee convened to
review the appointment of Marko Mijic, for his role as Deputy Secretary,
Program and Fiscal Affairs, for the California Health and Human Services
Agency. Mr. Mijic in his opening remarks noted that he came to the United
States 22 years earlier as a refugee with his family, speaking no English, and
how his commitment to public service is “rooted in the idea that government can
and must look to build an equitable, just, and tolerant society.”
Members of the committee questioned Mr. Mijic on subjects
such as foster care, impacts of the public charge rule, budget proposals
relating to homelessness, and they were also very interested in hearing from
him about California’s response to Coronavirus. Mr. Mijic briefly walked them
through the Health and Human Services Agency’s activities including working
with their local partners in counties and cities, health care providers, and
schools and universities, and he noted that though it was an evolving situation,
he felt California was prepared and ready to respond to the novel virus.
The Senate Rules Committee voted unanimously to confirm Mr.
Mijic. His confirmation now goes before the full Senate for consideration.
On Thursday, the Senate Budget and Fiscal Review Committee,
chaired by Senator Holly Mitchell, convened an informational hearing on
homelessness. The hearing commenced with the Legislative Analyst’s Office
framing the issue of homelessness in California, highlighting historical state
and local efforts, and walking through some of the Governor’s related budget
proposals. Ali Sutton, representing the Homeless Coordinating and Financing
Council, briefly highlighted the Council’s priorities, which include: 1) the
implementation and development of a statewide homelessness data warehouse; 2) the
development of a data-driven, evidence-based, action-oriented strategic plan; and
3) continuing the oversight of the housing first mandate. Ms. Sutton also
provided brief updates on the Homelessness Emergency Aid Program (HEAP)and Housing
Assistance Program (HAP).
The next panel featured representatives from the Newsom
Administration, starting with brief remarks from Health and Human Services Undersecretary
Michelle Baass, who attended on behalf of Secretary Ghaly who was tending to
recent developments around coronavirus. Ms.
Baass noted the Governor’s efforts to address homelessness, including the
creation of the California Access to Housing and Services (CAAHS) Fund, CalAIM,
and the Community Care Collaborative Project. She also discussed the regional
approach and the Administration’s desire to ensure robust collaboration and
coordination across city and county lines. Following her comments, Kim Johnson,
Department of Social Services Director provided additional detail around the
CAAHS fund and permissible uses. State Medicaid Director Jacey Cooper,
elaborated on the opportunities under CalAIM, including enhanced care
management, in-lieu-of-services, county inmate eligibility pre-release, and
population health. Finally, Stephanie Clendenin, Director of the Department of
State Hospitals, elaborated on their department’s thinking for the Community
Care Collaborative project to move individuals deemed incompetent to stand
trial into community-based placements.
The final panel touched on current activities at the local
level to address homelessness, efforts to expand housing and services, and
continued challenges/needs in their communities. The panel included
representatives from the City of Sacramento, Los Angeles Homeless Services
Authority, San Bernardino County Community Development and Housing Agency, the
Mariposa County Health and Human Services Agency and Brilliant Corners – a statewide
non-profit organization.
There was a robust dialogue during the question and answer
portion of the hearing. Committee members raised questions about how disparities
in homelessness would be addressed – including minority and older adults, how
to ensure funding equity across diverse jurisdictions, and how the needs of
lower acuity individuals would be addressed.
For more information, please refer to the agenda
and/or the recording
of the hearing.
On Wednesday, the Senate Budget and Fiscal Review
Subcommittee No. 3 on Health and Human Services and the Senate Health Committee
convened a joint hearing to discuss oversight and accountability of Medi-Cal
managed care plans and new responsibilities for health plans included in CalAIM.
Dr. Bradley Gilbert began serving as director of the
Department of Health Care Services (DHCS) this week and was joined by Jacey
Cooper, State Medicaid Director and Chief Deputy Director of Health Care
Programs to provide a presentation on DHCS oversight and accountability of
health plans for part 1 of the hearing. Dr. Gilbert briefly highlighted his
previous experience as a physician who has treated patients in jail settings,
methadone clinics and has cared for the most vulnerable populations. He also
noted his previous experience as a Public Health Officer in two counties and
his experience as Chief Medical Officer and most recently Chief Executive
Officer of Inland Empire Health Plan. He expressed his excitement about the
potential CalAIM brings and acknowledged the work ahead for both the department
and health plans.
Jacey Cooper discussed the various ways in which the
department provides oversight and monitoring of health plans. She also laid out
the department’s plan for the upcoming procurement for commercial plans in 36
counties. She indicated the department will be looking for plans that have a
history of providing high quality care and that can ensure an adequate network
and focus on preventive and early intervention services. In terms of timeline,
Ms. Cooper announced the department would host a stakeholder webinar in April
to solicit initial feedback on the procurement and areas of focus, followed by
a 30-day comment period. In December, the department will be releasing a draft
request for proposals (RFP) with another 30-day comment period. The official
RFP would be released in June 2021, proposals would be due in August and
contracts would be awarded in December/January 2022.
The following panels featured health plan representatives
and Medi-Cal providers and consumers. The health plans shared details about the
members they serve, local partnerships and investments and/or grant programs
offered to their communities. Committee members inquired about barriers to ensuring
adequate networks. Representing Medi-Cal providers, the California Medical
Association discussed the added complexity with delegated entities, while the
San Francisco Community Clinic Consortium discussed data challenges and the
need to receive timely and useful data. On the consumer end, the California Pan
Ethnic Health Network raised the need to ensure disparities in access to care
and health outcomes are addressed and Children Now expressed the need to ensure
children are accessing the recommended preventative services.
The second part of the hearing focused on CalAIM. Jacey
Cooper walked the joint committee through key aspects of the initiative to
transform Medi-Cal. A panel of county providers, consumers and plans followed.
The California Association of Public Hospitals and Health Systems (CAPH) discussed
CalAIM opportunities and areas of concern, including the voluntary nature of
in-lieu-of services (ILOS), limitations on supplemental payments that can be
accessed, and external political environment at the federal level. Service
Employees International Union (SEIU) discussed the role and value of county
workers and the impact of CalAIM on the county workforce. Anthem Blue Cross expressed
their interest and excitement for CalAIM and noted intent to continue close
collaboration with counties to leverage and/or expand the existing
infrastructure to provide services. Finally, the Local Health Plans of
California (LHPC), also excited about CalAIM opportunities, highlighted four vital
areas to ensure success: 1) strong relationships [with counties]; 2) building
from existing services and infrastructure; 3) maximizing incentives to expand
ILOS; and 4) continued DHCS leadership – including policy guidance and timely
rates.
For additional information regarding the hearing, please
refer to the agenda
and/or recording
of the hearing.
One of the most well-received announcements in the Medi-Cal world this week was that Medi-Cal Healthier California for All would return to its original name, CalAIM. Recall last November, the Department of Health Care Services (DHCS) released their multi-year proposal transform and enhance the Medi-Cal program, entitled California Advancing and Innovating Medi-Cal (CalAIM). However, the Governor, by way of his January budget proposal, renamed the initiative to Medi-Cal Healthier California for All. While speaking at the Insure the Uninsured Project’s Annual Conference earlier this week, California Health and Human Services Secretary Mark Ghaly announced the shift back to CalAIM. There is overwhelming support for the return of CalAIM as the health policy crowd quickly erupted in applause and cheers.
The Legislative
Analyst’s Office (LAO) published a report this week exploring the taxation of
electronic cigarettes as proposed by Governor Gavin Newsom’s FY 2020-21 Budget.
The report details the current taxes levied on electronic cigarette products,
analyzes the Governor’s proposal, and poses several areas for consideration by
the Legislature as its budget subcommittees begin their work over the coming
weeks.
In assessing
the current landscape related to electronic cigarettes, the LAO provides
background on electronic cigarette usage, health concerns (including the recent
EVALI outbreak), and overall tobacco utilization trends and rates. The LAO
assesses the current cigarette and electronic cigarette policies related to
taxation, stamps, and federal and state regulatory actions. California
currently levies $2.87 per pack excise tax on combustible cigarettes.
Electronic cigarettes, on the other hand, are currently taxed at 59 percent of
the wholesale price in California. A number of other states similarly impose a
tax as a percentage of the wholesale price, while others base taxes on a
percentage of the retail price, volume-based electronic cigarette liquid, or
cartridge-based liquid.
The LAO
analyzes the Newsom Administration’s proposal to impose a new tax on electronic
cigarettes with the goal of reducing youth use of electronic cigarettes. Based
on the LAO’s review, it is anticipated that the proposed tax would reduce both
youth and adult electronic cigarette substantially; however, the tax would also
likely increase adult combustible cigarette smoking.
The Governor’s
proposed tax would be in addition to existing taxes on the products and would
be $1 for every 20 milligrams of nicotine in a product. The exact tax of the
product would be established by 1) rounding up the total amount of nicotine to
the next highest multiple of 20 milligrams, and 2) assessing a $1 tax per 20
milligrams. For example, a tax on an item containing 92 milligrams of nicotine
– roughly the amount in a four pack of three percent nicotine JUUL pods – would
be $5.
The LAO
discusses the structure of the proposed tax and indicates that the Newsom
Administration has not presented a compelling case in estimating that its
proposed tax would result in roughly the same state tax rate on nicotine
intake, regardless of whether the intake comes from electronic cigarettes or
conventional cigarettes. Ultimately, the LAO recommends that if the Legislature
agrees with the Newsom Administration focus on reducing youth electronic
cigarette use, it should consider alternative nicotine-based taxes that place
higher rates on products that tend to encourage or enable youth use.
As the
Legislature begins its consideration of the proposed tax, the LAO outlines
several key questions, including:
- How
harmful are electronic cigarettes?
- To
what extent to vapers’ choices account for these harms?
- How
would the tax rate affect electronic cigarette use?
- How
would the tax rate affect other outcomes, such as cigarette smoking?
- How
would the tax rate affect compliance with the tax?
- How
would the tax interact with other state and federal policies?
The LAO goes on
to further recommend that the Legislature index the tax rate to inflation to
keep its economic value steady over time and that the Legislature revisit the
rate frequently in coming years. The LAO discusses the proposed revenue
allocation and recommends that the revenue allocation should prioritize
flexibility, primarily through depositing revenues in the General Fund. Lastly,
the LAO discusses the Governor’s proposed tax stamp proposal for electronic
cigarettes but finds the Newsom Administration does not appear to have
considered the complexity of such an approach enough to justify its requested
appropriation of $8 million.
The full LAO
report on electronic cigarette taxation is available here.
The Center at
the Sierra Health Foundation recently announced a request for proposals for the
Asthma Preventive Services Project, which will support a statewide network of entities
providing asthma home visiting, education, and environmental mitigation with a
focus on serving Medi-Cal patients. Funding will be focused on services for
individuals with poorly controlled asthma to improve self-management, as well
as to decrease exposure to environmental triggers and improve asthma outcomes.
The Center is
seeking applications from a variety of entities, including local health
departments, community-based organizations, community-based providers, and
Medi-Cal managed care organizations that will work on specific culturally and
linguistically appropriate asthma home visiting programs. Grants will be
awarded in amounts up to $500,000 over three years.
The Center at
the Sierra Health Foundation will host one webinar to review the request for
proposals and allow attendees to answer questions. The webinar will be held on
Wednesday, March 4 from 10:00 am to 11:30 am; registration is available here. Participation on the webinar is not
required but is strongly encouraged.
Final RFPs are
due to The Center at the Sierra Health Foundation by Tuesday, April 28 at 1:00
pm. Additional information is available here.
This week the
Board of State and Community Corrections (BSCC) announced the release of the
California Violence Intervention & Prevention (CalVIP) request for
proposals to support local jurisdictions and community-based organizations in
evidence-based violence reduction initiatives. A total of $27.5 million is
available for three-year grants for specified local jurisdictions and
community-based organizations that have been disproportionately impacted by
community violence.
Prospective
applicants are encouraged to attend one of two bidders’ conferences that will
provide an overview of the RFP and allow for technical answers and questions.
The conferences will be held on March 3 in Los Angeles and March 6 in
Sacramento. Applicants must submit a finalized RFP by April 10, 2020, at 5:00
pm.
Additional
information on the funding opportunity is available here.