January 7, 2022 Edition

Legislature Returns to Sacramento for Second Year of 2021-22 Session

The California State Senate and Assembly returned to the State Capitol in Sacramento on Monday to resume the second half of the 2021-22 Legislative Session. Lawmakers hit the ground running, introducing a raft of new bills and amending previously introduced, two-year measures.

Notably, on Monday, Assembly Member Lorena Gonzalez of San Diego County announced her resignation from the Legislature, effective Wednesday. Gonzalez indicated she will take the helm of the California Labor Federation in July upon the retirement of current executive secretary-treasurer Art Pulaski. Assembly Member Gonzalez is widely recognized as a strong labor advocate, and she held the powerful chair position of the Assembly Appropriations Committee.

Following Gonzalez’s resignation, Assembly Speaker Anthony Rendon announced several changes to committee leadership. Assembly Member Chris Holden of Los Angeles County has now been named the chair of the Assembly Appropriations Committee.

Even as lawmakers returned to Sacramento, they continue to grapple with the impacts of the COVID-19 pandemic. Senate Minority Leader Scott Wilk reported he tested positive for COVID-19 on Monday, and Assembly Member Miguel Santiago indicated his two young children at home also tested positive for the virus.

Then, on Thursday, nearly three dozen lawmakers were absent from Senate and Assembly Floor Sessions after many were exposed to COVID-19. Senator Josh Becker tested positive for the virus on Wednesday morning, causing at least a dozen members to enter quarantine, including Assembly Speaker Anthony Rendon. Other lawmakers were similarly isolating or quarantining due to the virus, including Assembly Member Tasha Boerner Horvath who tested positive over the legislative recess and Senator Steve Glazer who was exposed to a staff member with COVID-19.

As cases surged in both California and the country, pandemic impacts, including cases from the Omicron variant, are expected to be realized amongst the Capitol community over the coming weeks.

As a reminder, lawmakers have until the end of the month to advance measures introduced in the house of origin during the odd-numbered year. As such, legislators will be diligently working to secure final amendments, present bills in committees, and attempt to get their bill to the next house by the upcoming deadline.

Looking ahead, Governor Gavin Newsom on Monday will unveil his FY 2022-23 January Budget, detailing proposed investments and expenditures in the upcoming year. California is anticipated to realize a historic budget surplus again this year, providing the Administration and lawmakers an opportunity to make transformative investments in numerous subject areas.

Below, we highlight several bills of interest to CHEAC Members. For a full update, our first CHEAC Weekly Bill Chart of 2022 is available here.

Animal Care & Control

AB 702 (Santiago) as Amended January 3, 2022 – Watch w/ Concerns

AB 702 by Assembly Member Miguel Santiago was significantly amended early this week. The measure, as amended, enacts the Dog and Cat Bill of Rights and defines “proper care and attention” relative to dogs and cats. The measure would require every public animal control agency, shelter, or rescue group to post a copy of the Dog and Cat Bill of Rights. AB 702 will be heard in the Assembly Business & Professions Committee at a later date, and the CHEAC Legislative Committee will soon be reviewing the bill’s most recent amendments.


AB 93 (E. Garcia) as amended January 4, 2022 – Watch w/ Concerns

Assembly Member Eduardo Garcia’s AB 93 was amended this week to refine provisions relative to emergency response structures. AB 93, as amended, would, during a state of emergency or health emergency, 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 OES. Additionally, the California Health and Human Services Agency is required to maintain an annual inventory of PPE and related supplies in state stockpiles. CDPH is additionally tasked with conducting a statewide comprehensive plan for outreach and education relative to COVID-19. AB 93 will be heard in the Assembly Health Committee next Tuesday.

Health Coverage/Health Care Reform

AB 1400 (Kalra) as introduced February 19, 2021 – Special Interest Bill

Of note, movement on AB 1400 occurred when the Assembly Rules Committee referred the measure for hearing to the Assembly Health Committee. Recall, AB 1400 would create the California Guaranteed Health Care for All Act, or CalCare, to provide health care coverage to all California residents, regardless of citizenship status. CalCare defines a set of comprehensive health care benefits, including long-term services and supports, mental health, and substance use disorder benefits.

AB 1400 will be heard in the Assembly Health Committee on Tuesday. Assembly Member Jim Wood, Chair of the Health Committee, has signaled he intends to advance the bill from his committee. In a press statement, Wood indicated, “I continue to feel the frustration, desperation, and quite frankly, the anger that many Californians experience in their efforts to access quality and affordable health care. … Something’s got to give, so next Tuesday, I’ll be voting for change.”

Assembly Member Ash Kalra and others convened a press conference on Thursday to unveil the measure’s companion, ACA 11, to fund the sweeping proposal. ACA 11 has yet to be reviewed by the CHEAC Legislative Committee. The measure proposes imposing additional excise, payroll, and income taxes to support universal health care coverage.

Amid Surge in Omicron, California Reimposes COVID-19 Safeguards

The California Department of Public Health (CDPH) over the past several weeks has taken a series of steps to mitigate the surge in COVID-19 cases, including those cased by the Omicron variant, throughout the state. Below, we highlight these changes in guidance.

Booster Doses Required for Certain Occupations

Just prior to the winter holidays, state officials announced updates to existing state public health officer orders requiring certain workers in the state to receive a COVID-19 vaccine booster. Specifically, health care workers and employees in high-risk congregate settings (e.g., correctional health settings, nursing homes) will be required to receive their booster by February 1, 2022. Health care workers that have not yet received a booster dose must test for COVID-19 twice weekly until they are “up to date” on their vaccine regimen.

The Governor’s Office issued the following press statement about the update in guidance, and the following orders have been amended: health care workers; correctional health facility workers; and adult care facilities and direct care workers.

Hospital and Nursing Home Visitation

State officials additionally updated guidance for visitation at hospitals and skilled nursing facilities just prior to the New Year. The guidance takes effect today, January 7, and supersedes existing requirements for visitors in these settings. The order, issued by CDPH Director and State Public Health Officer Dr. Tomás Aragón, amends a previous visitation order from this past fall by requiring visitors to hospitals and nursing facilities to be boosted.

For unvaccinated or incompletely vaccinated persons, indoor visits can occur at hospital settings with documentation of a negative test or recovery. In nursing facilities, visitors without a booster dose are eligible only for outdoor visitation with documentation of a negative test or recovery. The visitation order remains in effect through February 7, 2022, and is available here.

Mega Event Thresholds

To reduce the risk of COVID-19 transmission in large event settings, such as concerts and sporting events, CDPH last week updated its guidance for mega events. The updated guidance lowers the occupancy thresholds of 10,000 attendees to 5,000 for outdoor events and 1,000 attendees to 500 for indoor events. Venues must be in full compliance with the order by January 15, 2022, though state officials are urging venues to adopt the protocols as quickly as possible.

Under the updated guidance, attendees must provide either proof of vaccination, a negative antigen COVID-19 test within one day of the event, or a negative PCR test within two days of the event. The updated mega event guidance is available here.

Isolation & Quarantine Guidance

Following an unanticipated move by the U.S. Centers for Disease Control and Prevention (CDC) to shorten the isolation and quarantine period for the general population in late December, California similarly updated its isolation and quarantine guidance. However, given the uncertainty associated with the Omicron variant, CDPH deviated from the federal government by adding additional testing recommendations to exit isolation and quarantine and improved masking measures to protect Californians from the virus.

CDPH’s updated isolation and quarantine guidance is available here.

Newsom Issues Executive Order on COVID-19 Pandemic Response

Governor Gavin Newsom on Wednesday issued Executive Order N-1-22 to protect residents against increasing COVID-19 cases and hospitalizations largely driven by the COVID-19 omicron variant. The order extends the sunset of AB 361 that the Governor signed in September to extend flexibilities provided in a prior executive order enabling public agencies to meet remotely during the pandemic emergency.

Under the issued order, state bodies are permitted to continue holding public meetings via teleconference through March 31, 2022.

FDA, CDC Take Steps to Expand Use of COVID-19 Vaccines

Early this week, the U.S. Food and Drug Administration (FDA) took steps to expand the use of the Pfizer-BioNTech COVID-19 Vaccine among key populations throughout the country. The FDA amended the emergency use authorization (EUA) for the vaccine to:

  • Expand the use of a single booster dose to include use in individuals ages 12-15
  • Shorten the time between the completion of primary vaccination series and a booster dose to at least five months
  • Allow for a third primary series dose for certain immunocompromised children ages 5-11

Following the actions by the FDA, the U.S. Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) convened to review the latest available data and update its vaccine recommendations. The ACIP voted 13-1 to recommend that the CDC support booster doses for 12–15-year-olds at least five months after their primary series.

CDC Director Dr. Rochelle Walensky on Wednesday endorsed the ACIP’s recommendation, paving the way for adolescents aged 12 to 17 years old to receive a booster dose against COVID-19. The Western States Scientific Safety Review Workgroup similarly recommended booster eligibility for adolescents ages 12-15 in California. The Office of Governor Gavin Newsom issued a statement following the workgroup’s decision. California Health and Human Services Secretary Dr. Mark Ghaly and California Department of Public Health (CDPH) Director and State Public Health Officer Dr. Tomás Aragón also issued a statement following the group’s recommendation and urged residents to receive their vaccine when eligible.  

The CDC additionally updated its recommendations to align with the FDA’s shortened Pfizer booster timeframe from six months to five months and allow for at third primary series dose for certain immunocompromised children.

Today, the FDA took a similar step for the Moderna COVID-19 booster dose, updating the emergency use authorization (EUA) to shorten the timeframe between a primary series and booster dose from six months to five months. The CDC is anticipated to soon update its recommendations for the Moderna vaccine to align with the FDA.

CMS Approves CalAIM, HCBS Initiatives

The U.S. Centers for Medicare and Medicaid Services (CMS), under the U.S. Health and Human Services Agency, recently granted approval of California’s sweeping health and human services initiatives. On December 29, CMS signed off on the state’s sweeping “California Advancing and Innovating Medi-Cal” (CalAIM) initiative, consisting of two federal waivers – the Section 1115 Medicaid Demonstration Waiver and the 1915(b) Managed Care Waiver – and several state plan amendments.

CalAIM seeks to shift Medi-Cal to a population health approach by prioritizing prevention, addressing social drivers of health, and transforming services for individuals who have been historically under-resourced and marginalized. CalAIM builds upon successes of previous pilot programs, including the Whole Person Care (WPC) Program, and aligns how care is provided across delivery systems.

CMS approved new, statewide Medi-Cal services to help keep individuals healthy and in the community. Notably, these components include:

  • Enhanced Care Management – This new service seeks to address clinical and non-clinical needs of the highest-need Medi-Cal enrollees through intensive coordination of health and health-related services. Enrollees will be met primarily through in-person engagement where they live, seek care, or choose to access services.
  • Community Supports – This optional benefit provides new statewide services covered by managed care plans as medically appropriate alternatives to traditional medical services or settings, including assistance with housing supports, caregiver respite, food insecurity, and transitioning from the nursing home to the community.

State officials, including those with the Department of Health Care Services (DHCS), continue to work with federal officials on several aspects and components of CalAIM. The state’s proposed justice-involved youth and adult initiative and traditional and natural healer proposals have yet to receive final approval from CMS.

CMS additionally granted conditional approval of California’s Home- and Community-Based Services (HCBS) spending plan this week. The state’s CalAIM initiative is designed to complement the state’s HCBS plan. HCBS will additionally draw down federal funding appropriated through the American Rescue Plan Act (ARPA) Providing Access and Transforming Health (PATH) component. PATH is anticipated to provide funding to counties, providers, and community-based organizations to support capacity building as they work to implement and scale ECM and Community Supports services. PATH will also support justice-involved adults and youth by sustaining pre- and post-release services.

A full press release announcing the CMS approval from DHCS is available here.

HRSA Announces Availability of Funds for Public Health Workforce in Rural and Tribal Communities

The U.S. Department of Health and Human Services’ (HHS) Health Resources and Services Administration (HRSA) Federal Office of Rural Health Policy is announcing the availability of nearly $48 million in American Rescue Plan Act (ARPA) funds for local organizations to expand public health capacity in rural and tribal communities through health care job development, training, and placement. Awardees can use funding to address workforce needs related to the long-term effects of COVID-19 as well as health information technology (IT) needs and other key workforce issues.

The Rural Public Health Workforce Training Network Program is intended to increase the number of well-trained health care professionals and connect them with future employers, including hospitals and clinics participating in the program. Awardees will establish community health networks comprised of education, health care, and workforce development industries. HRSA anticipates more than 30 award recipients will be able to develop formal training and/or certification programs to increase capacity across the following tracks:

  • Community health support
  • Health IT and/or telehealth technical support
  • Community paramedicine
  • Case management staff and/or respiratory therapists

Applicants can begin the application process online with materials due by Friday, March 18.

Additional information is available here.

CDC Warns Against Increase in Human Rabies Cases Linked to Bats

The U.S. Centers for Disease Control and Prevention (CDC) this week issued a warning raising awareness of risks of rabies from bats in the U.S. after three people, including one child, died from rabies between late September and early November 2021. The three cases, detailed in this week’s CDC Morbidity and Mortality Weekly Report (MMWR), bring the total number of rabies cases in 2021 to five compared to no reported cases in people during 2019 and 2020.

Three people, one each in Idaho, Illinois, and Texas, were confirmed to have rabies after direct contact with bats in or around their homes and died. Two of the cases were considered avoidable exposures, and none of the three individuals that died received post-exposure prophylaxis shots that can prevent rabies from developing if received before symptoms begin.

The CDC urges people to take preventive measures to avoid or lessen the risk of infection with rabies, including avoiding direct contact with bats.

Additional information is available here.

CalHPS Issues Report on California’s Overdose Crisis

California Health Policy Strategies (CalHPS) recently published a policy brief detailing the overdose crisis in California between 2017 and 2021. The report calls attention to the significant increase in drug overdose deaths throughout the state.

The policy brief’s topline findings include:

  • Preventable drug-related overdose deaths have doubled since 2017 – Between 2020 and 2021, nearly 9,500 Californians died from drug-related overdose deaths, which is equivalent to 23 preventable drug-related overdose deaths per 100,000 residents.
  • The COVID-19 pandemic was associated with an acceleration of the overdose crisis with approximately 1,000 additional unanticipated deaths in 2020.
  • Drug-related fatal overdose is a top 10 cause of death in California and kills more people than influenza and pneumonia and over twice as many people killed in traffic accidents.
  • Synthetic opioids and stimulants are the drugs most frequently involved in the increased number of fatal overdoses. Approximately 90 percent of all fatal overdoses now involve one or both these drug classes.
  • Overdose deaths disproportionately impact some age groups and race/ethnicities and the pandemic made the overdose epidemic worse among many of the most disadvantaged groups. Blacks are the most overrepresented amongst overdose fatalities and they experienced the largest increase in overdose mortality.

The report is a product of the joint effort of the California Department of Health Care Services (DHCS) Medication Assisted Treatment (MAT) Expansion Project, Health Management Associates (HMA), and CalHPS.

The full report is available here.

Governor Issues Emergency Due to Winter Storms

Amid record snowfall along the Sierras and significant rain events statewide, Governor Gavin Newsom last week issued a statement and emergency proclamation in support of the disaster recovery.

Newsom’s statement highlighted the state government’s response activities to the storm and associated impacts. The emergency proclamation issued by the Governor expands access to state resources for counties under the California Disaster Assistance Act and applies to the following counties: Alameda, Amador, Calaveras, El Dorado, Humboldt, Lake, Los Angeles, Marin, Monterey, Napa, Nevada, Orange, Placer, Sacramento, San Bernardino, San Luis Obispo, San Mateo, Santa Cruz, Sierra, and Yuba.

The full emergency proclamation is available here.