June 12, 2020 Edition

2020 CHEAC Annual Meeting Cancelled Due to COVID-19

CHEAC announced this week that the 2020 Annual Meeting, originally scheduled for September 30-October 2 in Santa Rosa, has been cancelled. The decision to cancel the meeting was not made lightly and was done with consideration for the ongoing concerns with the COVID-19 pandemic, group size restrictions, and significant LHD workload associated with the pandemic. A virtual CHEAC General Membership Meeting will instead occur on Thursday, October 1.

CHEAC kindly requests that members complete a brief attendance planning survey (sent via email) as CHEAC Staff works to plan the 2021 CHEAC Annual Meeting. We greatly appreciate the tireless work of LHDs during these challenging times.

Facing Monday Deadline, Legislature Continues Budget Negotiations with Administration

The California State Legislature faces a Monday constitutional deadline to pass a state budget for FY 2020-21. Although negotiations continue between legislative leaders and the Newsom Administration, the Legislature’s budget bills, SB 74 and SB 808, are in print and is expected to be taken up for a final vote on Monday, June 15. The two measures are largely seen as “placeholder” measures, allowing legislators to meet the constitutional deadline and continue negotiations with the Newsom Administration.

On Wednesday, Senate President pro Tempore Toni Atkins and Assembly Speaker Anthony Rendon released a statement on the budget, indicating, “In order to meet the Constitutional deadline for passing the budget by June 15 and to comply with the 72-hour in-print rule, we must pass the updated Legislative version of the budget while our productive negotiations continue with the Governor. We will approve any amendments to the Legislature’s version of the budget as soon as they are eligible for floor action.”

Detailed provisions of the budget are implemented through budget trailer bills (TBLs); these measures typically follow the main budget measure and represent finalized negotiations between the Legislature and the Administration. As such, negotiations on key budget provisions, are expected to continue through the weekend and additional TBLs are anticipated.

The Senate Budget & Fiscal Review Committee this morning convened a hearing to examine TBLs on 2019 augmentations, education finance, and revenues. The committee also received a presentation from the Legislative Analyst’s Office (LAO) on the differences between the Senate’s version of the budget and the finalized legislative budget agreement. Legislative Analyst Gabe Petek walked members through the primary differences between the two versions of the budget, including an additional $400 million in Realignment backfill, an additional $100 million in homelessness funds, and additional educational funds. Mr. Petek also indicated the final legislative budget package does not include provisions from the Senate’s budget around the managed care organization (MCO) tax and differs in the Administration’s proposed COVID-19 contingency fund.

Committee members had the opportunity to comment on the legislative budget package and raise questions of the LAO and Department of Finance (DOF). Notably, during the hearing, Senator Richard Pan expressed support for the Legislative proposal to provide county realignment backfill to maintain critical local services, including public health services, during the ongoing public health crisis. Further, Senator Pan expressed support and gratitude for local and state public employees in responding to the COVID-19 pandemic, particularly those who have been reassigned to assist in contact tracing activities statewide.

Today’s Senate Budget & Fiscal Review Committee concluded with the advancement of the three trailer bills that are expected to be taken up by the Assembly Budget Committee on Monday. A video recording of today’s Senate Budget & Fiscal Review Committee hearing is available here.

With negotiations between legislative leaders and the Newsom Administration continuing over the coming days, CHEAC will continue to update members of relevant budget actions as information becomes available.

Legislature Continues on Accelerated Pace, CHEAC Measure Passes to Senate

This week, the Senate Appropriations Committee assembled for their house of origin hearing this year. Members of the committee met to hear over 90 bills, with the majority of measures placed on the Suspense File. The Committee will meet next week to dispense with these suspense file bills including SB 793, Senator Jerry Hill’s measure to ban flavored tobacco products statewide.

Meanwhile, the Assembly convened two fairly lengthy floor sessionsthis week. Of note, the Assembly passed CHEAC’s sponsored bill, along with co-sponsors HOAC and SEIU, AB 3224 (Rodriguez) with a 76-0 vote. The measure nowmoves over to the Senate. Wednesday’s session also included an over two-hour debate on ACA 5, which would place an initiative on the ballot to overturn Proposition 209, the 1996 ballot initiative that prohibited the consideration of race and sex in public education, employment, and contracting. The measure, authored by Assembly Member Shirley Weber, passed the Assembly on a 60-14 vote. Thursday’s Assembly session considered measures on high-speed rail, a task force on reparations, a measure to allow elections to be conducted vote-by-mail, and a clean-up measure for Assembly Member Lorena Gonzalez’s landmark AB 5 (Statutes of 2019), which rewrote California employment law, that was signed into law last year.  

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

Communicable Disease Control

AB 2077 (Ting) as amended May 20, 2020 – SUPPORT

AB 2077, sponsored by HOAC, the San Francisco AIDS Foundation, and the Drug Policy Alliance, would extend 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 passed off the Assembly floor 50-18 and now advances to the Senate.

Senate, Assembly Convene Hearings on COVID-19 and SNFs

This week, the Senate and Assembly convened separate hearings on COVID-19 outbreaks in skilled nursing facilities (SNFs) throughout the state. Below, we detail the two hearings:

Assembly Health and Assembly Aging & Long-Term Care Committees Assess the State’s Response

On Tuesday, the Assembly Health Committee and the Assembly Aging & Long-Term Care Committee convened a joint hearing on the COVID-19 outbreak in skilled nursing facilities (SNFs) and the state’s response to the outbreaks. The hearing featured a discussion of what has worked, what has not, and what the state’s plans are for mitigating the impacts of the ongoing COVID-19 pandemic in SNFs and other similar care facilities.

In opening the hearing, Assembly Health Chair Jim Wood acknowledged the Newsom Administration’s activities in responding to the pandemic but expressed concerns that the state has let down our most vulnerable residents in skilled nursing and long-term care facilities. Wood discussed the most recent data on infections in SNFs, indicating significant challenges in stopping and preventing the transmission of COVID-19 persist. Assembly Aging & Long-Term Care Committee Chair Adrin Nazarian also provided opening comments, calling for the need to protect older and disabled Californians in congregate living facilities, urging improvements in SNF management and oversight, and decrying the Governor’s May Revision proposals cutting back on senior services as an example of “ageism.”

The hearing consisted of two panels featuring state regulators and skilled nursing facilities, as well as skilled nursing facility residents and advocates. CDPH Center for Health Care Quality Deputy Director Heidi Steinecker discussed the role of CDPH in implementing oversight and response activities of SNFs throughout the state, including deploying infection strike teams, conducting daily outreach to SNFs, and providing technical assistance to facilities. Steinecker detailed CDPH’s six-step COVID-19 mitigation plan for SNFs, indicating progress made in strengthening SNF infection prevention and control practices. California Department of Aging (CDA) Director Kim McCoy Wade discussed the role of CDA in serving California’s seniors during COVID-19, including through establishing a friendship phone line and expanding other supportive services for seniors and their families.

Other panelists included representatives from the California Association of Health Facilities, California Association of Long-Term Care Medicine, California Advocates for Nursing Care Reform, and California Long-Term Care Ombudsman Association. Testimony largely expressed concerns around state and facility response to COVID-19 outbreaks in SNFs and identified a number of areas for improvement, such as personal protective equipment (PPE), SNF staff training and turnover, staff compensation, stakeholder engagement, and inspection and enforcement activities.

Committee members queried panelists on a range of topics, including PPE procurement, SNF facility oversight, and the state’s role in providing technical assistance to at-risk SNFs. Assembly Health Chair Jim Wood, in closing comments, suggested the committees convene an additional hearing at a later date to further review the ongoing response activities statewide. Hearing materials, including an agenda and background paper, are available here. A video recording of the hearing is available here.

Senate Special Committee Convenes State, Local Officials to Examine COVID-19 SNF Response

On Wednesday, the Senate Special Committee on Pandemic Emergency Response held a similar hearing to examine state and local response activities to COVID-19 outbreaks in SNFs. Special Committee Chair Senator Lena Gonzalez opened the hearing by remarking on the ongoing COVID-19 cases and outbreaks amongst SNFs statewide and expressing concerns with SNF management and operations, staff turnover, and state oversight and accountability. Notably, committee member Senator Richard Pan, in opening comments, similarly expressed concerns with COVID-19 case increases statewide and SNF outbreaks. Senator Pan referenced recent health official retirements and resignations amid the COVID-19 pandemic, framing the issue as a “crisis” for local health officials and reiterating his support of the work of local health departments throughout the state.

Wednesday’s hearing featured CDPH’s Heidi Steinecker, as well as Santa Clara County Public Health Director/Health Officer Dr. Sara Cody and Los Angeles County Department of Public Health Chief Medical Officer Dr. Jeffrey Gunzenhauser. Representatives from the California Association of Health Facilities and the California Association for Nursing Home Reform also appeared as panelists during Wednesday’s hearing.

Drs. Cody and Gunzenhauser discussed local health department (LHD) activities in COVID-19 surveillance and monitoring, SNF infection prevention and control, and technical assistance and support provided to SNFs in their jurisdictions. Panelists also identified areas for improvement, including testing, PPE procurement, SNF infection control practices and training, and SNF management and staffing.

Committee members raised questions around the state’s role in working with SNFs, the impact of implementation of nonpharmaceutical interventions, SNF management and operations, testing strategies, PPE procurement and stockpiling, and SNF resident wellbeing, among other topics. An agenda from the hearing is available here and a background paper is available here. A video recording of the hearing is available here.

State Issues Variance County Guidance on Personal Care Services

Today, the state issued guidance for expanded personal care services, including personal care that requires touching a client’s face (e.g. facials, electrolysis, and waxing). The guidance also applies to esthetician, skin care, and cosmetology services; electrology; nail salons; body art professionals; tattoo parlors and piercing shops; and massage therapy (in non-healthcare settings). The guidance applies to variance counties only with local health official approval and with a recommended implementation date of no sooner than next Friday, June 19.

The guidance is available here.

NIOSH Certifies California’s N95 Masks, Shipments Begin

On Monday, Governor Gavin Newsom’s Office announced that the National Institute for Occupational Safety and Health (NIOSH) certified California-based BYD North America’s production of N95 respirators for the state. Recall, the Newsom Administration in April entered into a $990 million contract with BYD North America to supply N95 respirators and other personal protective equipment (PPE).

After several delays, BYD North America secured NIOSH certification allowing the company to begin shipping 150 million N95 masks to the state for distribution to health care providers. According to the Newsom Administration, the first shipment of masks were anticipated to arrive this week. The full announcement from the Administration is available here.

Newsom Administration Augments COVID-19 Emergency Food Assistance Program

On Monday, the Department of Finance (DOF) notified the California Legislature of a $5 million augmentation to the California Department of Social Services (CDSS) for the Emergency Food Assistance Program, intended to support low-income and food-insecure populations during the COVID-19 pandemic. To augment the program, the Newsom Administration is using part of the $1 billion in emergency funds appropriated by the Legislature in March prior to their historic joint recess to mitigate the risks of the pandemic.

The full DOF letter is available here.

DHCS Announces Stakeholder Meetings for Potential New Long-Term Care at Home Benefit

This week, the Department of Health Care Services (DHCS) announced upcoming stakeholder meetings for its potential new “Long-Term Care at Home” benefit in the Medi-Cal program for managed care and fee-for-service beneficiaries. The new model of care is intended to help address the ongoing COVID-19 pandemic by decompressing skilled nursing facilities (SNFs) and provide eligible consumers with a coordinated and bundled set of medical and home and community services.

The benefit is envisioned to support home care for individuals transferring from hospitals to home, from SNFs to home, or to prevent a SNF stay. DHCS and the California Department of Aging (CDA) are anticipated to develop the new benefit in coordination with the Master Plan for Aging Long-Term Services and Supports Subcommittee, other stakeholders, and partner departments, including the Department of Social Services (CDSS), Department of Public Health (CDPH), Developmental Services, and Rehabilitation.

DHCS and CDA will convene three public stakeholder meetings to discuss the proposal on Thursday, June 25 from 2:00 pm to 3:30 pm, Friday, July 17, 3:30 pm to 5:00 pm, and Friday, July 31 from 1:00 pm to 2:30 pm. All meetings will be available via telephone and webinar.

Additional information on the potential new benefit and the upcoming stakeholder meetings is available here.

DHCS Announces Additional Funding Opportunities for Medicaid/CHIP Providers, Safety Net Hospitals

This week, the Department of Health Care Services (DHCS) announced additional federal funding opportunities available from the Health Resources and Services Administration (HRSA) to support Medicaid/CHIP providers and safety net hospitals amid the COVID-19 pandemic. The U.S. Department of Health and Human Services (HHS) indicated $15 billion from the Provider Relief Fund would be available to eligible Medicaid and CHIP providers and $10 billion in Provider Relief Funds would be available to safety net hospitals serving a disproportionate number of Medicaid patients or providing large amounts of uncompensated care.

Additional information on provider payments, including eligibility and application processes is available here. Safety net hospitals must submit required information to HHS by June 15, 2020, to determine eligibility for this additional funding. Additional information on the Provider Relief Fund is available here.