January 21, 2022 Edition

Legislative Committees Meet Two-Year Bill Deadline

The California State Senate and Assembly continue to ramp up their activities for the second year of the 2021-22 Legislative Session. Today, the Legislature met the deadline for any committee to hear and report to the floor bills introduced in that house in the odd-numbered year. These two-year bills face a limited window to remain in play as lawmakers must advance these measures to the next house by the end of the month.

To meet today’s deadline, Assembly and Senate Appropriations Committees held Suspense File hearings for two-year bills. Both committees had relatively short agendas, and we highlight some of the CHEAC-tracked measures that went through the Suspense File below. Lawmakers additionally faced a deadline today to submit bill requests to the Office of Legislative Counsel who will ultimately draft the bill language to meet the Legislature’s February 18 deadline to introduce bills.

In other legislative news this week, Senator Richard Pan announced this week the formation of a Vaccine Work Group to develop “cohesive and comprehensive, evidence-based policies to strengthen our ability to stop the spread of COVID and other diseases while battling misinformation.” In addition to Senator Pan, the six other Democratic lawmakers include Senators Scott Wiener and Josh Newman and Assembly Members Akilah Weber, Buffy Wicks, Cecilia Aguiar-Curry, and Evan Low. While the group has not yet introduced any specific bills, several lawmakers continue to explore the potential of removing the personal belief exemption at schools for vaccines against COVID-19. The Vaccine Work Group will examine data, hear from experts, and engage stakeholders on the best approaches to promoting vaccines that have been proven to reduce serious illness, hospitalization, and death from COVID-19.

Also of note, Senate President pro Tempore Toni Atkins announced Senate leadership changes. Senator Bob Hertzberg will transition from Majority Leader of the Senate to Majority Leader Emeritus after announcing his candidacy for the Board of Supervisors of Los Angeles County. Senator Mike McGuire, who was previously Assistant Majority Leader, was promoted to the Majority Leader position. Senator Susan Talamantes Eggman was subsequently named Assistant Majority Leader of the Senate.

The latest edition of the CHEAC Weekly Bill Chart is available here. Below, we highlight a handful of measures of interest to CHEAC Members.

Communicable Disease Control

AB 93 (E. Garcia) as amended January 12, 2022 – WATCH WITH CONCERNS

Assembly Member Eduardo Garcia’s AB 93 was heard in the Assembly Appropriations Committee this week. The measure would require the California Department of Public Health (CDPH) Medical and Health Coordination Center (MHCC) to include federally qualified health centers (FQHCs) in the organizational response structure established by CalOES. AB 93 would also require CalHHS to maintain inventory of PPE, and CDPH to develop a statewide, outreach and education campaign on COVID-19 topics. The measure was placed on the Assembly Appropriations Suspense File where it was ultimately held under submission, rendering the bill dead for the remainder of the legislative session.

Health Coverage/Health Care Reform

AB 1400 (Kalra) as introduced February 19, 2021 – SPECIAL INTEREST BILL

Assembly Member Ash Kalra’s AB 1400 cleared a major hurdle this week as it was advanced out of Assembly Appropriations Committee on a 11-3 vote with one member not voting. The measure creates the California Guaranteed Health Care Act for All, or CalCare, to provide health coverage to all California residents, regardless of citizenship status. CalCare defines a comprehensive set of health care benefits, including long-term services and supports and mental health and substance use treatment services, and will not charge premiums, deductibles, or copays for services. Amendments to the measure are forthcoming to tie the bill to ACA 11 (Kalra) which would provide the funding mechanism for the sweeping initiative. The measure now moves to the Assembly Floor.

Public Health Emergency Preparedness

AB 805 (Maienschein) as introduced February 16, 2021 – WATCH WITH CONCERNS

AB 805 by Brian Maienschein was heard in the Assembly Appropriations Committee this week. The measure, sponsored by the California Nurses Association (CNA), would require MHOACs to report specified personal protective equipment (PPE) data weekly to CalOES during any health-related state of emergency in California. At all other times, MHOACs would be required to report PPE data on a monthly basis. AB 805 was held on the Appropriations Committee Suspense File and will not move forward for the remainder of the legislative session.

Senate Budget Committee Convenes Overview Hearing on Governor’s 2022-23 Budget

The Senate Budget & Fiscal Review Committee on Wednesday convened an overview hearing to learn more about the Governor’s 2022-23 January Budget proposal. The committee received presentations from the Newsom Administration, primarily the Department of Finance (DOF), as well as the Legislative Analyst’s Office (LAO).

During the hearing, DOF Deputy Director Erika Li detailed the Administration’s overall structure of the budget proposal, key investments across various subject areas, and important budget considerations as lawmakers assess proposed investments. Li discussed the Administration’s proposed early action to support the ongoing COVID-19 pandemic response, as well as the budget’s focus on supporting parents and children throughout California, among other high-level summary figures.

Legislative Analyst Gabriel Petek also presented to the committee, providing members an overview of the LAO’s recent publication summarizing the Governor’s January budget proposal. Petek detailed funds proposed for budgetary reserves, surplus projections, and budget-related constitutional requirements, including the State Appropriations Limit (SAL) or Gann Limit. The LAO set forth a series of considerations for lawmakers as they begin to review proposed investments, including considering longer-term planning for COVID-19.

Of note, the LAO’s summary encourages ongoing oversight of major new investments in public health infrastructure. Petek urges lawmakers to seek from the Newsom Administration clarification on how the $300 million ongoing spending proposal ties to findings from a legislative required pandemic response review intended to identify public health system gaps and problems. The LAO additionally recommends requiring annual updates to the Legislature on the use of and outcomes achieved from this public health infrastructure funding to facilitate legislative oversight.

Members of the committee had opportunities to raise questions of DOF and the LAO. Senators inquired about investments in behavioral health, education funding, climate change mitigation, drought and wildfire planning and response, workforce development, and budgetary reserves, among other topics.

Senator Richard Pan applauded the Newsom Administration for honoring the commitment to provide at least $300 million ongoing for public health infrastructure and workforce, as well as the proposed investment to expand full-scope Medi-Cal coverage to all income-eligible individuals regardless of immigration status. Dr. Pan additionally raised consideration of the longer-term implications and need for planning for COVID-19, including paid sick leave, K-12 instruction, childcare, and more.

Also of note, Senator Maria Elena Durazo applauded the Newsom Administration for drawing attention to supplemental paid sick leave for employees in California, particularly amid the latest COVID-19 surge. Durazo urged the Administration and her lawmaker colleagues to expand the supplemental paid sick leave program that was enacted last year and required businesses with 26 or more employees to provide workers with up to 80 extra hours of paid sick leave for instances of COVID-19 infection. Durazo raised concerns that small businesses were excluded from last year’s program and highlighted disproportionate impacts of the pandemic on women, people of color, and immigrants.

The Assembly Budget Committee is set to convene its own overview hearing next Wednesday on the Governor’s budget proposal. Over the coming weeks and months, Senate and Assembly Budget Subcommittees will begin convening hearings to receive more in-depth presentations from the Newsom Administration and further consider proposed investments. CHEAC will continue to keep its Members apprised of relevant budget activities, including through our Budget Advocacy webpage.

A handout from the LAO is available here. A video recording of the hearing is available here.

Assembly Assesses Ambulance Offload Delays

On Wednesday, the Assembly Committee on Emergency Management convened an informational hearing on “The Impact of Ambulance Patient Offload Delays on Emergency Response.” The committee hearing, chaired by Assembly Member Freddie Rodriguez, featured two panels of experts, including representatives from local EMS agencies. In his opening comments, Chair Rodriguez acknowledged the longstanding issue of ambulance offload delays and discussed the importance of ensuring the availability of EMS personnel, particularly amid emergency conditions and events such as the COVID-19 pandemic.

The first panel detailed operational perspectives and potential solutions to lengthy ambulance offload delays. Committee members heard from Los Angeles County EMS Agency Director Cathy Chidester, as well as representatives of fire, EMS providers, and labor. The second panel of the hearing explored current local and state efforts to reduce “wall times” or the amount of time paramedics are waiting in the emergency department for hospital personnel to assume patient care. Representatives from the California Emergency Medical Services Authority (EMSA), the California Department of Public Health (CDPH), hospitals, and health care providers discussed their strategies in reducing ambulance offload times to ensure the continued availability of EMS personnel and resources.

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

Feds Begin Accepting Orders for At-Home COVID-19 Tests

Amid a historic rise in COVID-19 cases throughout the country, the Biden-Harris Administration has begun accepting orders for free at-home, rapid COVID-19 tests. The federal government launched its ordering site www.COVIDTests.gov a day earlier than anticipated on Tuesday, allowing all Americans to receive four free tests per residential address. According to the Administration, tests are anticipated to ship within 7-12 days of ordering.

The federal government will additionally launch a call line to help those unable to access the online website to place orders and work with the most impacted communities nationwide in accessing testing supplies. To support the additional demand for at-home rapid tests, the Biden-Harris Administration announced it will purchase an additional 500 million over-the-counter (OTC) for distribution.

Additional information from the White House is available here.

White House Forms Pandemic Innovation Task Force

The Biden-Harris Administration recently formed a new Pandemic Innovation Task Force within the White House Office of Science and Technology Policy (OSTP) to develop new countermeasures against possible future COVID-19 variants and other pandemic threats. The task force will not be responsible for day-to-day pandemic response activities but longer-term projects, including vaccinate, therapy, diagnostic, and other endeavors to be used to respond to emergent variants or other public health threats.

The Pandemic Innovation Task Force will be led by OSTP Director Eric Lander and Health and Human Services Assistant Secretary for Preparedness and Response (ASPR) Dawn O’Connell. Additional information on the newly formed task force is available here.

Biden-Harris Administration Unveils 10-Year Wildfire Crisis Strategy

The U.S. Department of Agriculture (USDA) Forest Service, under the Biden-Harris Administration, recently unveiled a 10-year strategy to address wildfire dangers in places where fires pose the most immediate threats to communities. The strategy, called “Confronting the Wildfire Crisis: A Strategy for Protecting Communities and Improving Resilience in America’s Forests,” combines historic Congressional investments with years of scientific research and planning into a national effort to dramatically increase the scale of forest health treatments over the next decade.

The Forest Service will collaboratively implement its new strategy across jurisdictions and landownerships to protect communities, critical infrastructure, watersheds, habitats, and recreational areas. According to the Forest Service, overgrown forests, a warming climate, and a growing number of homes and buildings in the wildland-urban interface have contributed to what is now a “full-blown wildfire and forest health crisis.”

The strategy is made in part by the Bipartisan Infrastructure Law that provides nearly $3 billion to reduce hazardous fuels and restore forests. Vice President Kamala Harris today traveled to San Bernardino County to announce the availability of up to $600 million to California to support wildfire prevention and mitigation activities. This funding is anticipated to be used by local communities to address hazardous materials, address forest management, and repair infrastructure damaged by wildfires.

Additional information on the federal government’s new forest health strategy is available here.

ITUP Publishes Fact Sheet on Intersection of Public Health and Health Care

The Insure the Uninsured Project (ITUP) recently published a fact sheet that “purposefully brings the public health and health care systems” in one publication to explore their different funding sources, separate government structures, and future opportunities to enhance coordination between the two systems. The fact sheet details historical state funding trends in health care and public health, as well as a case study on how the COVID-19 pandemic exposed the need for improved coordination and communication between systems.

The full ITUP Fact Sheet is available here.

CDPH Publishes Data Brief on Older Adult Suicides in California

The California Department of Public Health (CDPH) Injury and Violence Prevention Branch (IVPB) recently published a new data brief detailing trends and statistics on suicide among older adults in California. The publication provides 2018 data on suicides among residents ages 65 and older in California, as well as highlights from counties participating in the California Violent Death Reporting System (CalVRDS).

The full CDPH data brief is available here.

UCLA Evaluates Impact of COVID-19 Pandemic on WPC Program

The University of California, Los Angeles (UCLA) Center for Health Policy Research (CHPR) recently published an evaluation report that assessed how the COVID-19 pandemic impacted service utilization under the Whole Person Care (WPC) Program, the statewide Medi-Cal demonstration launched in 2016 to integrate medical, behavioral health, and social services for high-utilizing Medi-Cal beneficiaries.

The report found that 4.1 percent of WPC enrollees, or 8,738 participants, received at least one COVID-19-related service. Findings also demonstrated demographic and health differences between those with and without a COVID-19 diagnosis. For example, individuals with severe mental illness or substance use disorders (5.5 percent) had COVID-19 diagnoses. Patients with a COVID-19 diagnosis were further found to have a higher use of primary care (42 percent) vs emergency department visits (33 percent).

Researchers found reduced use of primary and specialty care services following stay-at-home orders issued in 2020 and compared to 2019, followed by an increase in the number of telehealth visits later in the pandemic. Changes in service use occurred with the 25 WPC Pilots participating in the program. Pilots reported challenges in delivering WPC services because of pandemic-related shutdowns and physical distancing requirements (20 pilots), hiring freezes (17 pilots), reduced ability to conduct field-based outreach to engage patients experiencing homelessness (16 pilots), and safety concerns and staff being reassigned to other COVID-19 response activities (17 pilots). Despite these challenges, pilots reported continued enrollment under WPC, easier access to enrollees at their homes (18 pilots), increased opportunities to house enrollees, and improved relationships with community partners to deliver care to individuals at higher-risk of contracting COVID-19.

Other key findings from evaluation include:

  • Overall enrollment in the WPC Program increased by 25.1 percent from December 2019 through December 2020 – 77,198 vs. 96,563 enrollees, respectively.
  • Patients with a COVID-19 diagnosis were more often women (47 percent vs. 44 percent), ages 50 to 64 (35 percent vs. 31 percent), and Latino (42 percent vs. 26 percent) compared to those without.
  • The number of emergency department visits declined in April 2020 compared to April 2019 and stayed lower in December 2020 compared to December 2019.
  • Trends in daily hospitalizations from COVID-19 mirrored trends in confirmed cases, peaking at 18 and 52 hospitalizations per 100,000 in July 2020 and December 2020, respectively.
  • Before the pandemic, less than 0.1 percent of primary and specialty health services were delivered via telehealth; the rate increased to two percent of primary and three percent of specialty services in March 2020, and nine percent of primary and 10 percent of specialty services in December 2020.

The program evaluation findings are intended to be used by the Department of Health Care Services (DHCS) to guide the implementation of the Enhanced Care Management (ECM) benefit under the sweeping CalAIM Initiative. Additional information on the evaluation report is available here.

CDC Issues Updated Maps Detailing America’s High Levels of Inactivity

The U.S. Centers for Disease Control and Prevention (CDC) this week published updated maps and data on physical inactivity among adults, defined as not participating in any physical activities outside of work over the last month. More than one in five adults is inactive in all but four U.S. states.

State and territorial-level maps of physical inactivity range from 17.7 percent of people in Colorado to 49.4 percent in Puerto Rico. Seven states and one territory had 30 percent or more of all adults physically inactive. By region, the South had the highest prevalence of inactivity (27.5 percent) and the West had the lowest prevalence of inactivity (21.0 percent). CDC reports that California’s prevalence of inactivity is 21.2 percent of adults.

The CDC notes that physical inactivity contributes to poor outcomes related to sleep, blood pressure and anxiety, heart disease, several cancers, and dementia (including Alzheimer’s disease). The new maps published by CDC are based on combined 2017-2020 data from the Behavioral Risk Factor Surveillance System (BRFSS).

The updated maps demonstrate notable differences in physical inactivity levels by race and ethnicity. Overall, Hispanic adults (32.1 percent) had the highest prevalence of physical inactivity outside of work, followed by non-Hispanic Black (30.0 percent), non-Hispanic American Indian/Alaska Native (29.1 percent), non-Hispanic white (23.0 percent), and non-Hispanic Asian adults (20.1 percent).

The CDC further details various solutions and strategies to improve physical activity. Additional information from the CDC is available here.

CDC, NACCHO Launch RFP for Suicide, Overdose, and ACEs Prevention

With support from the U.S. Centers for Disease Control and Prevention (CDC), the National Association of County and City Health Officials (NACCHO) recently announced a new funding opportunity intended to support local health departments build and sustain capacity to address the intersection of suicide, overdose, and adverse childhood experiences (ACEs).

The funding opportunity provides awardees with one-on-one technical assistance to help local health departments translate their results from the newly developed Suicide, Overdose, and Adverse Childhood Experiences Prevention Capacity Assessment Tool (SPACECAT) into actionable guidance. The SPACECAT tool assesses agency capacity across the three domains to help departments identify crosscutting strengths, needs, and gaps in prevention strategies.

NACCHO will award up to 10 local health departments, providing up to $20,000 each for the funding opportunity. All interested applicants must complete the SPACECAT tool and include assessment results as a part of their application package.

Applications are due February 18, 2022, and are accessible through the NACCHO portal. Questions should be directed toIVP@naccho.org.

Applications Open for Consumer Protection Award for Excellence in Food Protection

Applications are now open for the 2022 Samuel J. Crumbine Consumer Protection Award for Excellence in Food Protection at the local level. This award is bestowed annually to local environmental health jurisdictions that demonstrate unsurpassed achievement in providing outstanding food protection services to their communities.

Eligibility is open to local government organizations responsible for food protection in a county, district, city, town, or like jurisdiction. Applicant guidelines and additional information are available here. The deadline for application submission is March 15, 2022.