July 12, 2019 Edition

Just Over Two Weeks Remain for 2019 CHEAC Annual Meeting Early Bird Registration Price

Early bird registration for the 2019 CHEAC Annual Meeting ends in just over two weeks on July 31. This year’s annual meeting will be held from October 9 – October 11 at the Westin Pasadena and will provide local health department professionals representing a wide variety of disciplines throughout California with networking and learning opportunities.

We are pleased to once again offer expanded keynote sessions with guest speakers and a myriad of workshops intended to stimulate best practice sharing and discussions around shared issues in the field. Stay tuned for forthcoming announcements on key speakers!

As a reminder, prices will increase on August 1 and registration will close on September 1. Local health department leadership and staff are strongly encouraged to register as soon as possible. More information on this year’s CHEAC Annual Meeting, including registration and room reservations, is available here.

Legislature Concludes Marathon Week of Hearings, Begins Month-Long Summer Recess

The California Legislature this week undertook an extremely busy schedule, featuring several committee hearings that stretched many hours and the advancement of a number of high-profile measures. Wednesday was the deadline for policy committees to hear and report fiscal measures to fiscal committees, and today was the deadline for policy committees to hear and report non-fiscal measures to the floor of the second house. To meet these deadlines, legislators worked expeditiously to finalize negotiations and amendments to keep their bills on track with the year’s legislative timeline.

With the busy week behind them, legislators yesterday embarked on their month-long summer recess. Lawmakers will return to Sacramento on August 12 to wrap up the first year of the 2019-20 Legislative Session, set to conclude on September 13.

Below, we highlight several items of interest from this week. For a full update, the latest edition of the CHEAC Weekly Bill Chart is available here.

Access to Health Services

AB 1494 (Aguiar-Curry) as amended July 11, 2019 – SUPPORT

AB 1494 by Assembly Member Cecilia Aguiar-Curry was heard in the Senate Health Committee on Wednesday. The measure would require Medi-Cal reimbursement for telehealth, telephonic, or off-site services when delivered by an enrolled community clinic, including city or county clinics exempted from licensure, or fee-for-service Medi-Cal provider during or up to 90 days after an expiration of a state of emergency, as deemed appropriate by the Department of Health Care Services (DHCS). AB 1494 was advanced to the Senate Appropriations Committee on an 8-0 vote with one member not voting.

Chronic Disease Prevention and Wellness Promotion

AB 388 (Limón) as amended June 24, 2019 – SUPPORT

Assembly Member Monique Limón’s AB 388 was set for hearing in the Senate Appropriations Committee on Monday. The measure would require the California Department of Public Health (CDPH) to implement action agenda items from the CDC Healthy Brain Initiative and require CDPH to award one-time competitive grants to up to eight LHDs for local planning and preparation activities consistent with the CDC Healthy Brain Initiative Action Agenda. Assembly Member Limón waived presentation and the measure was placed on the Senate Appropriations Committee Suspense File where it will be acted upon at a later date.

Communicable Disease Control

SB 159 (Wiener) as amended July 1, 2019 – SUPPORT

Senator Scott Wiener’s SB 159 was heard in the Assembly Health Committee on Tuesday. The measure would allow pharmacists to furnish PrEP and PEP to patients without a physician’s prescription if the pharmacist has completed specified training and screens the patient, provides counseling to the patient, documents services in the patient’s health record, and notifies the patient’s primary care provider. Health plans would be prohibited from placing any prior authorizations or step therapy requirements on antiretroviral medications including PrEP and PEP, among other limitations on health plans and insurers. SB 159 was advanced to the Assembly Appropriations Committee on a 13-0 vote with two members not voting.

SB 276 (Pan) as amended July 1, 2019 – SUPPORT

SB 276 by Senator Richard Pan was set for hearing in the Assembly Appropriations Committee on Wednesday. The measure would require physicians and surgeons to utilize a CDPH-developed statewide standardized electronic medical exemption certification form when issuing an immunization exemption for medical purposes. The measure sets forth various requirements for providers when issuing exemptions, including a description of the medical basis for the exemption, whether the exemption is temporary or permanent, and a certification that the provider has physically examined the child. CDPH would be required to create a standardized system to monitor immunization levels in schools and patterns of unusually high exemption form submissions by providers or medical practices. CDPH would also be required to review at least annually immunization reports from all schools to identify exemption forms from schools with an immunization rate of less than 95 percent, from physicians or surgeons who have submitted five or more medical exemptions in a calendar year, and schools that do not provide vaccination rate reports to CDPH. CDPH is permitted to deny or revoke a medical exemption, as well as bar a physician or surgeon from submitting medical exemptions if it is determined that the physician or surgeon is a risk to the public’s health. An appeals process would also be established for parents/guardians of children who have their medical exemption denied or revoked.

Despite Senator Pan waiving presentation of his measure in the Assembly Appropriations Committee, a significant number of individuals and families were present to express opposition to the measure. SB 276 was placed on the Assembly Appropriations Committee Suspense File where it will be acted upon at a later date.

Emergency Medical Services (EMS)

AB 1544 (Gipson) as amended on July 11, 2019 – OPPOSE UNLESS AMENDED

After being heard in the Senate Health Committee last week and passing out on a 6-0 vote, AB 1544 by Assembly Member Mike Gipson, the Community Paramedicine/Triage to Alternate Destination bill, was heard in the Senate Judiciary Committee this week. CHEAC, along with CSAC, UCC, RCRC, EMSAAC, and EMDAC, remain in an oppose unless amended position and continue to negotiate amendments with the sponsors to mitigate our remaining concerns with the bill. One of those concerns around the treatment of hospice patients was clarified in amendments today that counties that elect to not adopt a triage to alternate destination program may continue to treat and keep hospice patients in the patient’s home without requiring transportation. AB 1544 passed out of the Senate Judiciary Committee by a vote of 7-1 and now moves on to the Assembly Appropriations Committee.

SB 438 (Hertzberg) as amended July 11, 2019 – OPPOSE

SB 438, by Senator Robert Hertzberg, which places restrictions on local EMS agency medical control and limits private contracting for EMS 9-1-1 dispatch services, was heard in the Assembly Health Committee this week and passed out on a 13-0 vote, and now moves to the Assembly Floor. CHEAC, along with a coalition of county organizations including CSAC, UCC, RCRC, EMSAAC, and EMDAC, are all opposed to the measure; however, our coalition continues to negotiate amendments with the sponsors to ameliorate county concerns. Amendments in print today clarify contracting provisions for those jurisdictions currently operating privately contracted 911 dispatch centers, delineate a process for public safety agency EMD or advanced life support program applications, and further clarify local EMS agency medical control responsibilities.

Environmental Health

AB 1500 (Carrillo) as amended June 21, 2019 – SUPPORT

Assembly Member Wendy Carrillo’s AB 1500 was heard in the Senate Judiciary Committee on Tuesday. The measure would authorize a local health officer (LHO) to issue an order to the responsible party of a hazardous waste release to suspend or discontinue operations, conduct specified environmental testing, and/or assist exposed individuals. Additionally, the authority of a unified program agency (UPA) would be expanded to suspend, revoke, or withhold unified program facility permit under specified circumstances in which public health, safety, or the environment is imminently and substantially endangered. The measure is sponsored by CCDEH and Los Angeles County. AB 1500 was advanced to the Senate Appropriations Committee on an 8-0 vote with one member not voting.

Health Coverage/Health Care Reform

SB 29 (Durazo) as amended July 2, 2019 – SUPPORT

SB 29 by Senator Maria Elena Durazo would expand Medi-Cal coverage to all undocumented adults 65 years of age and older with incomes at or below 138 percent of the federal poverty level (FPL). The measure was recently amended to expand coverage to those older than 65 years old after the 2019-20 Budget Act included coverage expansion for undocumented adults ages 19-25. SB 29 was advanced from the Assembly Health Committee to the Assembly Appropriations Committee on Tuesday on a 10-3 vote with two members not voting.

Health Equity

AB 241 (Kamlager-Dove) as amended July 1, 2019 – SUPPORT

AB 241 by Assembly Member Sydney Kamlager-Dove would require continuing education for physician or surgeon, nurse, and physician assistant licensure on understanding implicit bias and how biases may contribute to healthcare disparities. The measure was heard in the Senate Business, Professions, and Economic Development Committee on Monday and was unanimously advanced to the Senate Appropriations Committee on a 9-0 vote.

Maternal, Child, and Adolescent Health Services (MCAH)

AB 577 (Eggman) as amended July 11, 2019 – SUPPORT

Assembly Member Susan Talamantes Eggman’s AB 577 was heard in the Senate Health Committee on Wednesday. The measure was recently amended to pare back some of its provisions and now permits the completion of covered services associated with a maternal mental health condition for up to 12 months for an individual by a terminated or nonparticipating provider. The individual is required to provide written documentation of a maternal mental health condition diagnosis to the health plan or insurer. AB 577 was advanced to the Senate Appropriations Committee on an 8-0 vote with one member not voting.

Tobacco Control

AB 1639 (Gray) as amended July 2, 2019 – WATCH

Assembly Member Adam Gray, chair of the Assembly Governmental Organization Committee, recently significantly amended AB 1639, a sweeping measure to set forth stricter requirements and penalties related to tobacco products. Specifically, the measure prohibits, until January 2022, licensed tobacco retailers and online retailers from selling flavored electronic cigarettes except those that are tobacco, mint, or menthol flavored, if a tobacco retailer does not permit anyone under 21 years old from accessing the premises, or if online retailers use age verification processes to ensure purchasers are at least 21 years old. Persons under 21 years old would be prohibited from entering a tobacco store, and retailers would be required to use age verification software or devices for purchasers who appear under 27 years old. Further, CDPH would be required to conduct random, onsite sting operations of at least 20 percent of the total number of licensed tobacco retailers in California and conduct follow-up sting operations on retailers who are found to be in violation of selling tobacco products to underage purchasers.

The measure would also strengthen penalties both against specified retailers and individuals who furnish, purchase, or possess tobacco products. Specifically, civil penalty amounts on retailers would be increased and suspension or revocation of a retail license would be required upon specified underage sale violations. The measure would also prohibit various advertising, promoting, or packaging of electronic cigarette products in a manner that is attractive to or intended to encourage the use by those under 21 years old, among other conditions. In its current form, the measure would levy penalties against individuals under 21 years old who purchase or possess tobacco by requiring specified drug or tobacco education or counseling and community service. Individuals between ages 18 and 21 who purchase or possess tobacco would be subject to a fine of not more than $100. Additionally, individuals between 13 and 18 who are found guilty of purchasing or possessing tobacco products would have their driving privileges suspended by one year.

The measure was presented in the Assembly Governmental Organization Committee on Wednesday during a full, and, at times contentious, hearing. The measure is opposed by the American Cancer Society Cancer Action Network, the American Heart Association, the American Lung Association, and the Tobacco-Free Kids Action Fund due to a number of provisions included in the measure such as penalties against youth for purchasing or possessing tobacco and exemptions around flavored tobacco products. AB 1639 was advanced to the Assembly Health Committee on a 16-0 vote with five members not voting.

AB 1718 (Levine) as revised May 16, 2019 – SUPPORT

AB 1718 by Assembly Member Marc Levine was heard in the Senate Natural Resources and Water Committee on Tuesday. The measure would prohibit smoking and disposal of cigar or cigarette waste at all state coastal beaches and in state parks. Recall, this measure is identical to measures passed by the Legislature in previous years; however, all measures were vetoed by then-Governor Jerry Brown. AB 1718 was advanced to the Senate Appropriations Committee on a 7-1 vote with one member not voting.

SB 39 (Hill) as amended April 10, 2019 – SUPPORT

Senator Jerry Hill’s SB 39 was heard in the Assembly Governmental Organization Committee on Wednesday. The measure would require mail-order and online tobacco products to be packed in a container with specified conspicuous labeling and require the signature of a person 21 years of age or older upon or before completing the delivery of the tobacco products. SB 39 was unanimously advanced to the Assembly Health Committee on a 21-0 vote.

Legislature, Governor Finalize $26 Billion Wildfire Liability Measure

This week, the California Legislature and Governor Gavin Newsom finalized a sweeping $26 billion wildfire liability measure aimed at protecting wildfire victims, creating additional safety and oversight processes for public utilities, and holding public utility companies accountable for safety of their infrastructure systems. After extensive negotiations between the Legislature, Administration, and relevant utility and wildfire victim stakeholders, AB 1054 (Holden) was passed by the Legislature this week and signed into law this morning by Governor Newsom.

Under the measure, a new safety and oversight division within the California Public Utilities Commission (CPUC) will be created to set forth safety regulations and ensure compliance with wildfire mitigation plans. Additionally, investor-owned utility companies will be required to pay $5 billion into a wildfire mitigation and safety fund over five years and meet new safety standards in order to access up to $21 billion in funds to pay out claims from damages in future catastrophic fire events caused by the equipment of participating electric utilities. Existing charges on consumer utility bills will be extended 15 years to raise $10.5 billion for the fund, and the state’s three largest investor-owned utilities could elect to contribute an additional $10.5 billion. The sweeping measure also includes rate payer protections and cost recovery by allowing recovery from ratepayers only if the utility’s conduct was reasonable and in accordance with specified safety standards.

Governor Newsom, in a statement on Thursday, expressed his gratitude for the Legislature and underscored the importance of the action, stating, “The rise in catastrophic wildfires fueled by climate change is a direct threat to Californians. Strengthening our state’s wildfire prevention, preparedness, and mitigation efforts will continue to be a top priority for my administration and our work with the Legislature.”

Citing Recent State Affordability Initiatives, Covered California Announces 2020 Premium Increase to be Lowest in Program’s History

This week, Covered California announced rates for health plan coverage in 2020, indicating the individual market will see a preliminary rate change of 0.8 percent – the lowest increase in rates since Covered California’s launch in 2014. For context, the five-year actual average increase over previous six years was 7.9 percent. According to Covered California, the significantly lower rate change was driven by two new state affordability initiatives: the establishment of the state-level individual insurance coverage mandate and expanded state premium assistance subsidies.

Through actions included in the 2019-20 Budget Act, an estimated 922,000 consumers will be eligible to receive to receive the expanded state subsidies, and, together with the individual mandate, the number of Californians accessing health insurance is estimated to increase by 229,000 consumers. Covered California Executive Director Peter Lee indicated in a statement, “The bold moves by Governor Newsom and the Legislature will save Californians hundreds of millions of dollars in premiums and provide new financial assistance to middle-income Californians, which will help people get covered and stay covered. California is building on the success of the Affordable Care Act and bringing quality care and coverage within reach for more people.”

The individual mandate and expanded subsidies will result in premium decreases between two and five percent per carrier after health plans rolled back increases added to premiums in 2019 resulting from Congress’ removal of the Affordable Care Act’s (ACA) financial penalty for not maintaining coverage pursuant to the federal individual mandate. These reduced rates are estimated to save Californians an average of $14 per month or $167 per year on their health care premiums in 2020.

Further, Covered California detailed the benefits to the estimated 922,000 Californian consumers as a result of the expanded state subsidy program:

  • 235,000 middle-income Californians who previously did not qualify for financial assistance due to their income are expected to be eligible to receive an average of $172 per household per month which will help them save an average of 23 percent off their current premiums.
  • 663,000 Covered California enrollees who currently receive federal financial help are estimated to be eligible to receive an average of an additional $15 per household per month which will help them save an average of five percent off their current premiums.
  • 23,000 Covered California enrollees whose annual household income falls below 138 percent of the federal poverty level (FPL) will see their premiums or the benchmark plan lowered to $1 per member per month.

The proposed rates, negotiated with Covered California, announced this week will be filed with regulators and are subject to final review. Preliminary rates for California’s 19 rating regions will be released on July 17. A fact sheet on the expanded subsidy program and individual mandate, including income thresholds for subsidies, from Covered California is available here. The full Covered California statement is available here.

CDPH CHC Announces Quarterly Leadership Calls

The California Department of Public Health (CDPH) Center for Health Communities (CHC) will be launching quarterly leadership calls with all local health department leaders as a follow up to the Healthy and Resilient Communities: California’s Shared Vision planning convening held in June. The leadership calls are intended to offer regular communication opportunities between state and local leadership staff to share federal and state-level updates and priorities, strengthen the public health capacity to address current and emerging needs, and discuss alignment priorities and opportunities.

The intended audience for the calls is local and state public health leadership that provide cross-cutting strategic direction and decision-making (e.g. local health officers, public health directors, program directors, public health strategists, and branch and office chiefs). The calls will be held during the following dates and times; registration is available by clicking the links:

Additionally, for information on activities, actions, and accomplishments of CDPH CHC, interested parties may view The Stakeholder Brief, which is a quarterly publication of the department.

2019 Advancing Health Equity Award Applications Now Available, Due August 4

The Committee for California’s Health (formerly the Health Equity Awards Planning Committee) recently announced its third cycle of the California Advancing Health Equity Awards and accompanying workshop. These awards are designed to honor innovative local health departments and uplift strategies that build power to advance health equity for all Californians.

All California local health departments are encouraged to apply. Applications are now open and are due no later than Sunday, August 4, 2019. An informational applicant webinar will be held on Monday, June 17 from 2:00 pm to 3:00 pm and will detail the award purpose, guidelines, and application process; webinar registration is available here.

An awards ceremony will be held on December 3, 2019, in Oakland, and a special invitation will be extended to California LHDs to join the accompanying Advancing Health Equity Workshop that will be held December 3 and 4.