June 5, 2020 Edition
Today, the County Health Executives Association of California (CHEAC) issued a statement declaring racism a public health crisis, particularly amid recent acts of racially motivated violence throughout the country. The statement details the impacts of systemic racism on California’s black communities and communities of color and urges governing bodies at all levels to implement specific actions to address racism as a public health crisis.
The full statement is available here.
This afternoon, the California Department of Public Health (CDPH) issued a series of guidance and informational materials related to the ongoing COVID-19 pandemic. The CDPH guidance issued today provides sectors with information on public health modifications that should be implemented prior to reopening only upon local public health official approval and review of local data related to COVID-19 spread and county preparedness. Local health officials will make final decisions regarding the timing for opening a sector within their jurisdiction.
CDPH published the County Monitoring List to provide residents insight into how their county is performing and provide early indication of developing areas of concern. According to CDPH, the state will work closely with county health officials to target public health response activities more effectively to local outbreaks. This process will include identifying drivers of increased transmission, reviewing strategies, discussing gaps in resources, and reviewing local containment measures.
CDPH also today issued guidance documents for 12 sectors in areas including schools, day camps, and casinos operated by sovereign tribal nations. Guidance for music, film, and television production and professional sports without live audiences was also issued with a recommended implementation date of no sooner than June 12, 2020, and subject to county public health official approval.
Guidance for counties with attestations was issued in the areas of: campgrounds, RV parks, and outdoor recreation; hotels; cardrooms, satellite wagering facilities and racetracks; family entertainment centers; restaurants, bars, and wineries; fitness facilities; and museums, galleries, zoos, and aquariums. Notably, guidance in these areas is effective as of June 12, 2020, and is only implementable with local health official approval after review of local conditions.
The full CDPH press announcement is available here. Guidance documents from the state are available here.
On Wednesday, Senate and Assembly leaders reached an agreement on the 2020 Budget Act, largely adopting the Senate’s budget framework that was adopted last week. The deal reached by legislative leaders diverges in a series of areas, notably by rejecting numerous proposed funding reductions and/or eliminations in areas of health and human services and education. The budget package reached by legislative leaders allows the Legislature to forego the traditional Budget Conference Committee process in which legislators reconcile differences between the two houses’ budgets.
The legislature’s version of the budget utilizes the Newsom Administration’s budgetary framework, including major revenue assumptions and revenue proposals. However, the legislative package utilizes the Legislative Analyst’s Office (LAO) caseload estimates for Medi-Cal and CalWORKs, providing an estimated $3.6 billion in savings. Further, the legislative package includes provisions around the receipt of federal financial assistance, but unlike the Governor’s May Revision, the legislative package assumes federal financial assistance would be received to offset baseline General Fund costs. If federal financial assistance is not received, the legislative package includes “trigger reductions” which would take effect on October 1, 2020, allowing Congress more time to act on assistance for state and local governments.
If federal financial assistance is received by California, the legislative package would end with $1 billion more in reserves compared to the Governor’s May Revision, reject numerous May Revision proposals, and increase funding in several areas not included in the Governor’s May Revision. Among the augmentations included in the legislative package are $1 billion in county realignment backfill ($600 million would be withdrawn if no federal financial assistance is received), $350 million for local homelessness programs, and $65 million for an Earned Income Tax Credit (EITC) expansion.
If no federal financial assistance is received by California, the legislature proposes to take a substantially different approach in solving the state’s budget problem. In this case, the legislative package would withdraw less reserves from the Budget Stabilization Account (BSA) and designate up to $716 million in the Special Fund for Economic Uncertainties (SFEU) for COVID-19-related expenses as opposed to establishing a $2.9 billion COVID-19 contingency fund. The legislative package also relies more heavily on special fund loans and transfers and defers payments in other areas, including education. Other notable differences in the legislative package compared to the Governor’s May Revision include rejections of the Governor’s proposals to use Proposition 56 to fund Medi-Cal growth instead of supplemental provider payments, reduce rates of state preschool program and child care programs, eliminate housing and homelessness infill infrastructure funds, and implement a 10 percent reduction to state employee pay.
Of particular note to local health departments, the legislative package:
- Rejects the Newsom Administration proposals to eliminate funding for CHDP county case management activities;
- Rejects reduction of funding to the Black Infant Health (BIH) program;
- Defers the Governor’s proposed e-cigarette nicotine-content-based tax to allow for further discussion and deliberation;
- Provides $26.3 million General Fund for supplemental payments to non-hospital based clinics, as proposed in the Governor’s January Budget, to offset losses from changes to the 340B program;
- Maintains the Governor’s January proposal to expand full-scope Medi-Cal coverage to all seniors age 65 and over regardless of immigration status, but delays the implementation date to January 1, 2022, with the ability for the governor to further delay implementation based on the budget at the time;
- Rejects the Governor’s proposed elimination of Medi-Cal optional benefits;
- Rejects the Governor’s proposed elimination of the multipurpose senior services program (MSSP) benefit and community-based adult services (CBAS); and
- Rejects the Governor’s proposed elimination of rate carve-outs for FQHCs and RHCs.
The legislative package also includes modifications to the Newsom Administration’s proposed plan to distribute federal funds received from the Coronavirus Relief Fund. The legislature’s version approves $550 million for acquisition and/or rehabilitation of motels, hotels, or hostels, as well as other sites and assets for sheltering and housing. $500 million would be provided to cities and $1.289 billion, allocated based on population, would be provided to counties to be used for homelessness, public health, public safety, and other services to combat the COVID-19 pandemic.
To review the final legislative budget package, the Assembly Budget Subcommittee No. 6 on Budget Process, Oversight, and Program Evaluation met on Thursday to review the two-house budget package, receive presentations from the LAO and Department of Finance (DOF), and take public comment. A handout from the LAO detailing key differences between the legislative package and the Governor’s May Revision is available here and a video recording from the hearing is available here.
With the legislative package now finalized, negotiations between legislative leaders and the Newsom Administration are now underway and are expected to continue through the weekend. Recall, the Legislature must past a budget by the June 15 constitutional deadline. However, given the 72-hour in-print rule, the legislature’s budget bill must be in print by next Friday, June 12. An overview of the legislative budget package is available here.
On Wednesday, the Assembly Appropriations Committee convened its suspense file hearing, determining the fate of numerous bills amid limited budget resources due to the ongoing COVID-19 pandemic. Assembly Appropriations Committee Chair Lorena Gonzalez opened Wednesday’s hearing noting that the committee had referred 188 out of 307 bills to the suspense file on Tuesday, representing over $8 billion in potential one-time and ongoing General Fund expenses.
Wednesday’s hearing lasted about 30 minutes with the majority of measures advancing with amendments to trim down potential General Fund costs. Below, we highlight several bills of interest to CHEAC Members and their outcome in the Assembly Appropriations Committee.
For a full update, the CHEAC Weekly Bill Chart is available here.
Public Health Workforce
AB 3224 (Rodriguez) – SUPPORT – DO PASS
This measure is sponsored by CHEAC, HOAC, and SEIU California and requires CDPH to contract with an entity to conduct an evaluation of the adequacy of local health department infrastructure and to make recommendations for future staffing, workforce needs, and resources.
Access to Health Services
AB 2164 (R. Rivas) – SUPPORT – DO PASS AS AMENDED
Specifies that an FQHC and/or RHC “visit” includes an encounter between a provider and patient using telehealth in synchronous real-time or asynchronous store-and-forward. Specifies that FQHCs/RHCs would not have to establish an individual as a patient via face-to-face encounter prior to providing telehealth services. The measure was amended on the Assembly Appropriations Suspense File to remove provisions around the E-Consult Services and Telehealth Assistance grant program.
Communicable Disease Control
AB 2077 (Ting) – SUPPORT – DO PASS
Extends the sunset that authorizes physicians or pharmacists, without a prescription, to furnish hypodermic needles and syringes to those 18 years or older, passed out of the Assembly Appropriations Committee on a 12-5 vote. This measure is co-sponsored by the Drug Policy Alliance, the Health Officers Association of California (HOAC), and the San Francisco AIDS Foundation.
AB 2276 (Reyes) – WATCH – DO PASS
Requires DHCS to ensure all children enrolled in Medi-Cal receive blood lead screening tests consistent with California regulations. Requires DHCS to establish a monitoring system to ensure children receive blood tests. Requires DHCS to require Medi-Cal providers test each child in Medi-Cal pursuant to state and federal laws, regulations, and guidelines. Requires DHCS to notify parents/guardians of children up to six years of age enrolled in Medi-Cal of risks of lead poisoning, requirement to receive tests, and recommendation of test if at risk of exposure. Requires DHCS to annually report on progress toward ensuring blood lead testing.
AB 2277 (Salas) – WATCH – DO PASS
Requires DHCS to notify parents/guardians of children enrolled in Medi-Cal when a child misses a required blood lead screening test and specifies the notification shall be included in an annual notice to each family who has not utilized preventive services over the course of a year. Requires contract between DHCS and Medi-Cal managed care plans to require plans to identify on a quarterly basis every child enrolled in Medi-Cal without record of a blood lead test and remind responsible providers of the need to perform a blood lead test.
Health Coverage/Health Care Reform
AB 2100 (Wood) – WATCH – DO PASS AS AMENDED
Requires DHCS, as part of their annual Medi-Cal assumptions and estimates, to include a variety of data elements related to drugs dispensed in Medi-Cal, pharmacies billing Medi-Cal, drug rebates, DHCS administrative costs, and any contracting costs for a vendor that administers the Medi-Cal prescription drug benefit. Requires DHCS to establish the independent Prescription Drug Medical Review System. Modifies existing statute to ensure DHCS’ cost reimbursement methodology for specialty drugs is sufficient to provide access to covered drugs.
AB 2347 (Wood) – WATCH – HELD IN COMMITTEE
Expands Covered California affordability subsidies included in the 2019 Budget Act, including additional premium support.
AB 2830 (Wood) – WATCH – DO PASS AS AMENDED
Expands requirements for the Health Care Payments Data Program overseen by the Office of Statewide Health Planning and Development (OSHPD), including requiring OSHPD to convene a health care data policy advisory committee, require data be collected on all California residents, require OSHPD to develop guidance to require data submission from specific entities, define what data should be collected, and the data that should be used.
AB 2112 (Ramos) – SUPPORT – DO PASS AS AMENDED
Authorizes CDPH to create the Office of Suicide Prevention and specifies various activities that the office may undertake, including providing strategic guidance to statewide and regional partners on suicide prevention best practices, conducting state level evaluation of suicide prevention policies and practices, and disseminating information to advance statewide progress in reaching populations with high rates of suicide.
Public Health Emergency Preparedness
AB 2178 (Levine) – SUPPORT – DO PASS
Adds in statute a deenergization event as a condition qualifying as a state or local emergency.
AB 2376 (Flora) – SUPPORT – DO PASS
Removes the sunset provision in statute allowing local registrars to accept an electronic acknowledgement, sworn under penalty of perjury, that the requester of a marriage, birth, or death certificate is an authorized person. This measure is sponsored by the County Recorders Association.
This week, Department of Health Care Services (DHCS) Director Dr. Bradley Gilbert announced his resignation, effective June 12, 2020. Dr. Gilbert has served as director or the past four months and previously retired as chief executive officer from the Inland Empire Health Plan.
Dr. Gilbert indicated in a statement to DHCS employees, “After much thought, I have decided to really retire and rejoin my family in Southern California.” Neither DHCS nor the Newsom Administration has announced plans for a successor.
Governor Gavin Newsom on Wednesday issued Executive Order N-67-20 related to the November 3, 2020, General Election. The executive order ensure in-person voting opportunities are available in sufficient numbers to maintain physical distancing amid the COVID-19 pandemic and requires counties that are unable to comply with current law to provide three days of early voting starting the Saturday before election day and requires ballot drop-box locations be available between October 6 and November 3. The order further allows counties to consolidate voting locations with at least one voting location per 10,000 registered voters.
In issuing the order, the Newsom Administration further indicated it continues to work with the Legislature, the Secretary of State, and county elections officials on voter education and outreach and other topics to preserve public health and provide counties needed flexibility.
This week, the National Association of County and City Health Officials (NACCHO) announced two funding opportunities available for local health departments. These include:
Demonstration Site Project on COVID-19 Local Infection Prevention & Control
NACCHO, in conjunction with the U.S. Centers for Disease Control and Prevention (CDC) Division of Healthcare Quality and Promotion, announced the Building Local Operations Capacity for COVID-19 (BLOC COVID-19) demonstration site project to strengthen local infection prevention and control (IPC) capacity. NACCHO anticipates issuing awards in the form of fixed-price contracts up to $100,000 to local health department demonstration sites with the goals of increasing capacity for LHDs to prevent and respond to COVID-19 in health care facilities, strengthening IPC practices in high-risk facilities, increasing coordination among local IPC partners, and enhancing coordination with state and local IPC partners. Applications due July 1. Additional information is available here.
Innovations in Congenital Syphilis Prevention Project
NACCHO also announced the launch of “Innovations in Congenital Syphilis Prevention” to support LHDs in addressing the alarming rise of congenital syphilis cases. The launch of the new funding opportunity coincides with the release of a new analysis from the CDC that finds that one in two newborn syphilis cases in the U.S. occurs due to gaps in testing and treatment during prenatal care.
NACCHO, in partnership with CDC’s Division of STD Prevention, will support a diverse set of LHDs to galvanize local efforts to address rising rates of congenital syphilis and syphilis among pregnant individuals and individuals of child-bearing capacity. Funded LHDs will implement and evaluate their innovation or improvement, including addressing pregnancy testing, pregnancy intention ascertainment, STI testing and treatment, partner services, case management, and referral to care over approximately 12 months. More information is available here.