June 21, 2019 Edition

PHAB Awards Merced County National Accreditation Status

We are pleased to announce that the Merced County Public Health Department was awarded accreditation status by the Public Health Accreditation Board (PHAB) this week. Merced County becomes the 15th local health department awarded PHAB recognition in California, in addition to the California Department of Public Health (CDPH).

Please join us in congratulating all of the hard work of our colleagues in Merced County. Additional information on PHAB, as well as the press release, is available here.

Committee Hearings Ramp Up, SB 276 Clears Major Hurdle in Assembly

This week, the California Legislature maintained a steady pace of committee hearings, bill negotiations, and amendments. Agendas for committee hearings over the next several weeks are becoming quite lengthy as legislators approach the next round of deadlines in early July prior to their month-long summer recess set to begin on July 12.

Below, we highlight significant actions of interest on legislative bills this week. For a full update, the CHEAC Weekly Bill Chart is available here.

Communicable Disease Control

SB 276 (Pan) as amended June 18, 2019 – SUPPORT

In a tense hearing on Thursday, the Assembly Health Committee convened solely to hear SB 276 by Senator Richard Pan, which tightens current law governing medical exemptions for immunizations. Senator Pan gave an impassioned opening during the hearing about how his bill was intended to protect the safety of California’s children, particularly infants and those that are medically fragile. Dr. Pan thanked both Governor Newsom and California Health and Human Services Secretary, Dr. Mark Ghaly, for their assistance in crafting a “California solution” that would ensure the safety of children who truly require a medical exemption to enroll in school (a summary of the new amendments negotiated with the Administration are outlined below). He also noted that schools that have large medical exemptions on file or where their immunization rate has fallen below the disease immunity threshold represent “the tinder for a disease wildfire that could harm the broader community.”

Senator Pan touted the support of the California Medical Association (CMA), the American Academy of Pediatrics and Vaccinate California, the sponsors of the bill, as well as the California State PTA, Children Now, the March of Dimes, CSAC, CHEAC and HOAC among others. Testifying in support of the bill were Jenni Balck, a mother of a child who had received a heart transplant and cannot receive immunizations, Dr. Margaret Parsons, a CMA Board of Trustees member, and Dr. Erica Pan, Alameda County’s interim health officer. Opposition testimony included Dr. Bob Sears, a prominent pediatrician from Southern California, and Stephanie Fetzer, representing a grassroots organization, Parents United for Kids. Robert F. Kennedy, Jr, was also present as an opponent, but the time allotted for testimony ran out before he could state his concerns. Opposition testimony was then followed by a nearly two-hour stream of hundreds of individuals and families from throughout the state.

Once public testimony concluded, the discussion moved back to the members of the Assembly Health Committee. Members focused on a variety of issues that the bill addressed with the new amendments, either to their satisfaction or not enough. Provisions discussed were the inclusion of consideration of a child’s family medical history and the expansion of factors considered for exemptions, the California Medical Board’s current practice regarding physicians who have complaints lodged against them for approving an excess of medical exemptions, and the bill’s impact on exemptions issued prior to the new requirements.

On a 9-2 vote, with four members of the committee abstaining, SB 276 passed out of committee with amendments (pending) and now heads to the Assembly Appropriations Committee.

As noted above, amendments were negotiated with the Newsom Administration and significantly restructure the process of medical exemptions. With these amendments, Governor Newsom has indicated a willingness to now sign the bill, should it reach his desk. Amendments include:

  • California Department of Public Health (CDPH) remains the designated state agency responsible for reviewing medical exemptions.
  • Standardized electronic forms, created by CDPH, would now be submitted by physicians through the California Immunization Registry (CAIR) beginning January 1, 2021.
  • Exemption forms must also be printed, signed, and submitted directly to a child’s school or governing authority.
  • Forms must include information from the physician including the name of the primary care physician of the child if different from the physician issuing the exemption. Physicians must certify they have physically examined the child, describe the medical basis for the exemption, whether the exemption is permanent or temporary (not to exceed one year). Physicians must authorize CDPH to contact them directly with questions on the exemption as well as authorize the release of relevant medical records to both CDPH and the Medical Board of California.
  • CDPH is tasked with creating a standardized system to monitor immunization levels in schools and to monitor patterns of unusually high exemption form submissions by physicians, surgeons, or medical practices.
  • Requires CDPH to annually review immunization reports from all schools to identify medical exemption forms from schools with an immunization rate of less than 95% and for physicians/surgeons who have submitted five or more medical exemptions in a calendar year.
  • Allows CDPH, on the discretion of clinically trained immunization branch staff, to accept a medical exemption that is based on other contraindications or precautions, including consideration of family medical history, if the physician provides written documentation supporting the exemption consistent with the relevant standard of care. Expands the criteria used to evaluate medical exemptions to include applicable CDC, ACIP, or American Academy of Pediatrics criteria for appropriate medical exemptions.
  • CDPH required to notify an issuing physician, the school, and the local health officer with jurisdiction over the school of a denial or revocation of an exemption.
  • Includes provisions on suspending a physician’s ability to issue medical exemptions and notifying the California Medical Board and the Osteopathic Board when exemptions from physicians are denied or revoked.
  • Allows a parent or guardian of a child denied a medical exemption the opportunity to appeal to the Secretary of the California Health and Human Services Agency (CHHS). CHHS Secretary directed to establish an independent expert review panel, consisting of three licensed physicians, who are primary care providers or immunization experts to review all exemption appeals. CHHS Secretary must issue a final decision, consistent with the findings of the expert panel, and that decision is not subject to further administrative review.

Chronic Disease Prevention & Wellness Promotion

AB 388 (Limón) as amended June 12, 2019 – SUPPORT

AB 388 by Assembly Member Monique Limón was heard in the Senate Health Committee on Wednesday. The measure would require the California Department of Public Health (CDPH) to implement action agenda items from the U.S. Centers for Disease Control and Prevention (CDC) Healthy Brain Initiative, as well as award one-time competitive grants up to eight local health jurisdictions for local planning and preparation activities consistent with the CDC Healthy Brain Initiative Action Agenda. Recall, funding for these grants was included in the 2019-20 Budget Act which was passed by the Legislature last week. AB 388 was unanimously approved by the Senate Health Committee on a 9-0 vote. The measure now heads to the Senate Appropriations Committee.

Drug & Alcohol Services

AB 1031 (Nazarian) as amended May 17, 2019 – SUPPORT

Assembly Member Adrin Nazarian’s AB 1031 would establish the Youth Substance Use Disorder Treatment and Recovery Program Act and direct the Department of Health Care Services (DHCS), in collaboration with counties and SUD services providers, to establish regulations of community-based nonresidential and residential treatment and recovery programs for youth under 21 years of age. DHCS is also directed to seek funding for this purpose for all services covered by Medi-Cal and to use additional funding from cannabis tax revenues available to DHCS. AB 1031 was heard in the Senate Health Committee on Wednesday and was unanimously advanced to the Senate Appropriations Committee on a 9-0 vote.

SB 445 (Portantino) as amended June 11, 2019 – SUPPORT

Similarly, SB 445 by Senator Anthony Portantino would require DHSC to convene an expert panel and adopt regulations based on the expert panel’s recommendations to establish youth SUD treatment, early intervention, and prevention quality standards for California youth. The measure would also require each county to designate a single public agency responsible for administering youth SUD treatment services within the county and require that agency to comply with standards adopted by DHCS. SB 445 was heard in the Assembly Health Committee on Tuesday and was advanced to the Assembly Appropriations Committee on a 14-0 vote with one member not voting.

Emergency Medical Services (EMS)

SB 438 (Hertzberg) as amended June 18, 2019 – OPPOSE

SB 438, by Senator Robert Hertzberg, which would undermine local EMS agency medical control and place restrictions on contracting EMS 9-1-1 dispatch services, was amended this week. CHEAC, along with a coalition of county organizations including CSAC, UCC, RCRC, EMSAAC, and EMDAC are all opposed to the measure.

Briefly, this bill would:

  • Restrict a county’s ability to contract with a private entity for 9-1-1 dispatch services unless the contract was with a JPA that existed prior to January 1, 2019, or would allow a private contract, established prior to 1/1/19, to continue if the public safety agencies that provide EMS consent to renegotiate and adopt a new contract.
  • Allows public safety agency EMS dispatch to recover costs from EMS providers for providing connections to their dispatch center, including defining connections to that dispatch center to include ring down lines, intercoms, radio or other means of notifications.
  • Allows a public safety agency to implement Emergency Medical Dispatch (EMD) or advanced life support programs within 60 days unless LEMSA’s take an action to the contrary.
  • Defines in statute that a public safety agency’s adherence to a LEMSA’s policies, procedures, and protocols does not constitute a transfer of the public safety agency’s authorities regarding the administration of EMS. Also eliminates LEMSA medical authority over the processing and administration of 9-1-1 dispatch calls for public safety agencies.

We strongly encourage counties to review provisions in this bill, consult with your EMS Administrators and EMS Medical Directors regarding the impact to your jurisdictions, and provide any additional feedback to Betsy Armstrong at barmstrong@cheac.org.  

Injury Prevention

AB 166 (Gabriel) as amended April 30, 2019 – SUPPORT

Assembly Member Jesse Gabriel’s AB 166 would direct DHCS to develop and implement services targeted at reducing injury recidivism among Medi-Cal beneficiaries who have been violently injured. The measure would also create a covered benefit within Medi-Cal fee-for-service and managed care for a beneficiary who has received treatment for a violent injury and those who have been determined to be at an elevated risk of violent reinjury or retaliation and referred by a health care provider to participate in a violence preventive services program. AB 166 was advanced in the Senate Health Committee to the Senate Appropriations Committee on Wednesday on a 7-2 vote.

AB 645 (Irwin) as amended March 6, 2019 – SUPPORT

AB 645 by Assembly Member Jacqui Irwin was heard in the Senate Public Safety Committee on Tuesday. The measure would add to existing warning labels on firearms and signage at licensed firearm dealer premises to include language stating, “If you or someone you know is contemplating suicide, please call the National Suicide Prevention Lifeline,” with the phone number. The measure would also require the Department of Justice (DOJ) firearm safety certificate course and written acknowledgement to cover the topic of suicide prevention. AB 645 was advanced from the Senate Public Safety Committee to the Senate Appropriations Committee on a 5-1 vote with one member not voting.

Environmental Health

AB 377 (E. Garcia) as amended May 20, 2019 – SUPPORT

Assembly Member Eduardo Garcia’s AB 377 was advanced from the Senate Health Committee to the Senate Appropriations Committee on Wednesday on a 7-2 vote. AB 377 is the cleanup measure to AB 626 (Chapter 470, Statutes of 2018) which established microenterprise home kitchen operations. The measure provides clarifying and technical amendments around jurisdictional opt-in procedures, local permitting and inspection activities, and exempted food safety and sanitation provisions. CHEAC remains concerned with the potential for increased risk to the public’s health and safety through the operation of microenterprise home kitchens; however, CHEAC supports AB 377 as the measure provides greater clarity of critical provisions enacted through AB 626.

Tobacco Control

SB 8 (Glazer) as introduced December 3, 2018 – SUPPORT

SB 8 by Senator Steven Glazer would ban the smoking and disposal of all cigar and cigarette waste at al state coastal beaches and state parks. SB 8 was heard in the Assembly Water, Parks, and Wildlife Committee on Tuesday and advanced to the Assembly Appropriations Committee on a 10-3 vote.

Legislature Acts on Several Budget Trailer Bills, Health Trailer Bills in Print

This week, the Legislature acted on several budget trailer bills that followed last week’s passage of AB 74, the 2019-20 Budget Act. A chart reflecting the status of all budget trailer bills is available here.

Notably, two health omnibus budget trailer bills are now in print, detailing implementation actions of health- and public health-related funding appropriated through the 2019-20 Budget Act. CHEAC has developed a detailed summary of items included in the two health omnibus bills that can be found below.

Health Omnibus I (AB 78/SB 78)

Health Omnibus II (AB 103/SB 104)

Budget Trailer Bills of Interest (as of June 21, 2019)

With the requirement for bills to be in print for a minimum of 72 hours prior to being acted upon, the Legislature is expected to act on the additional trailer bills next week.

Federal Appeals Court Lifts Nationwide Injunction on Trump Administration Title X Rule

On Thursday, the Ninth U.S. Circuit Court of Appeals invalidated nationwide injunctions previously put into place by lower court judges in Oregon, Washington, and California, clearing the way for the Trump Administration to enforce its new rules governing the Title X family planning program. Recall, the Trump Administration issued a final rule in March prohibiting Title X providers from referring patients to certain reproductive health services and limiting sites that are eligible to receive Title X funds. The rule further specified that clinics that refer patients to other facilities for abortion services would no longer qualify for Title X funds to provide low-income women with comprehensive family planning and preventive health services.

Following the issuance of the final Title X rule by the Trump Administration, several states, including California, and reproductive health and medical organizations filed lawsuits challenging the overhaul of Title X, resulting in the issuance of the nationwide injunction.

Thursday’s ruling by the three-judge appeals court panel granted the Trump Administration’s request to remove the nationwide injunction while those lawsuits continue. In its 3-0 ruling, the judges indicated, “Absent a stay, HHS will be forced to allow taxpayer dollars to be spend in a manner that is has concluded violates the law, as well as the Government’s important policy interest in ensuring that taxpayer dollars do not go to fund or subsidize abortions.” The judges also determined the Trump Administration’s new approach to Title X was a “reasonable interpretation” of the federal family planning program and was likely to succeed in the ongoing legal challenges.

California Attorney General Xavier Becerra has indicated as a result of the removal of the injunctions, some provisions of the Trump Administration’s final rule, including the ban on abortion services referrals, will take effect immediately, while others, including the requirement for Title X grant recipients to physically and financially separate abortion services and Title X-funded services, will take effect next year. In a statement, Governor Gavin Newsom expressed his disappointment in the Ninth Circuit ruling, stating, “The Trump Administration’s Title X rule was never about protecting women’s health – it is designed to promote a backwards agenda at the expense of women and their doctors. Title X is a critical lifeline for nearly four million low-income women around the country – one million here in California – who trust the program for quality care and life-saving screenings and now face immediate harm.”

In California, eight LHDs are Title X subgrantees, delivering reproductive health services to residents at 46 sites in those jurisdictions. LHDs that are not subgrantees work closely with community-based Title X providers to ensure access to essential health services.

Parties who brought the lawsuit against the Trump Administration on Thursday reiterated their commitment to challenging the new Title X rules, though their next steps were unclear. A different panel of Ninth Circuit judges will soon hear arguments on the merits of cases brought by states and organizations, and other ongoing legal challenges are expected to continue while the Trump Administration may now enforce its new rules governing the program.

BCC Launches Cannabis Informational Campaign

The California Bureau of Cannabis Control (BCC) launched a public information campaign, “Get #weedwise”, this week to educate cannabis consumers about the dangers of purchasing cannabis from unlicensed businesses. Some of the messages include information on the dangers of using or ingesting cannabis that has not been tested which may include dangerous foreign material such as chemicals, mold, or fecal matter. The campaign is multilingual and will use a variety of advertising methods. The campaign will also include alerts to illegal businesses informing them that they could face confiscation of cash or cannabis by engaging in unlicensed activity.

More information on the campaign can be found here.