February 28, 2020 Edition

Bill Introduction Deadline Passes, Legislature Gets to Work

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.

Senate Rules Committee Advances Marko Mijic Appointment

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.

Senate Budget and Fiscal Review Committee Convenes Informational Hearing on Homelessness

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.

Senate Convenes Informational Hearing on Health Plan Oversight and CalAIM

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. 

Newsom Administration Returns to CalAIM Name

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.

LAO Issues Report on Taxation of Electronic Cigarettes

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.

Asthma Preventive Services Project RFP Announced, Webinar to be Held March 4

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.

BSCC Announces CalVIP Funding Opportunity RFP

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.