June 8, 2018 Edition

2018 CHEAC Annual Meeting Registration Now Open!

Registration for the 2018 CHEAC Annual Meeting is now open! This year’s annual meeting will be held from October 17 – October 19 at the Hyatt Regency Sacramento and will provide local health department professionals representing a wide variety of disciplines throughout California with networking and learning opportunities.

We are pleased to 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. Keynote session and speakers include:

California’s Health Care Landscape: From Threats of Repeal to Promises of Universal Coverage – Larry Levitt, Senior Vice President, Kaiser Family Foundation
Written Off: A Personal Struggle with Opioids – Molly Hermann and Jane Funk, Written Off Documentary
A Conversation with State Directors – Jennifer Kent, Director, California Department of Health Care Services and Karen Smith, Director, California Department of Public Health
Public Health Approach to Violence: Opportunities for California Local Health Departments – Garen Wintemute, Director, University of California, Davis Violence Prevention Research Program and University of California Firearm Violence Research Center

Early bird registration will be offered through July 13, and 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, is available here.

Governor Brown, Conference Committee Announce Budget Agreement

Today, Governor Brown and Legislative Leaders announced they had reached an agreement on the 2018-19 Budget. Recall, the Budget Conference Committee had convened for just over a week to hear issues and reconcile differences between the two houses. The budget agreement prioritizes investments in education, the Rainy Day Fund, child care and combatting homeless, and poverty. The Budget Conference Committee is expected to meet today to take actions on their close out agenda.

While we await additional detail that is likely to come through the crafting of the trailer bill and budget bill language, please see the agenda for close-out all items. Key areas of the compromise is noted below. As such, the compromise will:

Revenues/Reserves

Adopt the Governor’s May Revision revenues, adjusted to reflect updated property tax growth rates, compared to those proposed by the Legislature which would have resulted in roughly $3 billion in additional revenues than projected in the May Revise.
Fully fund the Rainy Day Fund.
Deposit $200 million into a new Safety Net Reserve with trailer bill language.

Health Care Coverage Expansion and Affordability

Approve $60 million one-time General Fund and trailer bill to implement an all payers claims database to collect costs data and increase transparency.
Approve $5 million one-time General Fund to establish a task force and trailer bill establishing an intent to accomplish universal coverage and a unified publicly financed health care system.
Deny proposals to expand Medi-Cal eligibility, premium assistance, and tax credits.

Public Health

Approve $8 million ongoing, trailer bill, and budget bill language to expand the Black Infant Health Program.
Approve $2 million one-time General Fund and budget bill language for STD prevention, in lieu of the $10 million originally adopted by the Assembly.
Approve $8 million one-time General Fund for Valley Fever outreach and research.
Approve a continuous appropriation for Proposition 56 funds in CDPH.

Homelessness

Adopt $500 million one-time General Fund for local governments to respond to homelessness.

As a reminder, the Legislature must pass the budget by the Constitutional deadline, which is next Friday, June 15. Since bills must be in print at least 72 hours before taking action, we anticipate trailer bill and budget bill language early next week.

Legislature Resumes Committee Hearings, Pro Tem Announces Committee Chair Changes

This week, the California State Legislature resumed committee hearings after last week’s floor-only session and deadline for measures to be advanced out of their house of origin. June is expected to be a very busy month with a significant number of committee hearings prior to the summer recess in July.

Notably this week, Senate President pro Tempore Toni Atkins announced the appointment of Senator Richard Pan as chair of the Senate Health Committee, Senator Anthony Portantino as chair of the Senate Appropriations Committee, and Senator Ricardo Lara as chair of the Senate Labor and Industrial Relations Committee, succeeding Senators Ed Hernandez, Steven Bradford and Ricardo Lara respectively. Senator Hernandez remains a member of the Health Committee.

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

Environmental Health

AB 626 (E. Garcia) as amended on May 9, 2018 – Oppose

The hearing for AB 626 in the Senate Health Committee has been pushed back one week and will now be heard on Wednesday, June 20. This measure would create a new type of food facility defined as a “microenterprise home kitchen” in the California Retail Food Code and allow the sale of potentially hazardous foods directly to consumers in private homes. These entities would be provided a significant number of exemptions related to enforcement, health, and sanitation provisions.

CHEAC, along with our county colleagues HOAC, CCDEH, CSAC, UCC, and RCRC, is opposed to the measure due to concerns about increased risk of foodborne illness and inspections and enforcement. We strongly encourage LHDs to secure an official oppose position to AB 626, send in letters of opposition, and contact Senate Health Committee members and staff. CHEAC will continue to provide updates to members as the hearing date nears.

Chronic Disease Prevention and Wellness Promotion

AB 3043 (Berman) as amended April 11, 2018 – Support

AB 3043 by Assembly Member Marc Berman was advanced from the Senate Education Committee to the Senate Appropriations Committee this week. The measure would authorize any educational entity that participates in the federal School Breakfast Program to provide a universal breakfast program through which a nutritionally adequate breakfast is provided to every pupil at no charge. AB 3043 would also increase the award amount of California Department of Education grants to initiate or expand a school breakfast program or federal summer meals program upon budgetary appropriation.

CDC Report Indicates Rising Rates of Suicide Throughout U.S.

This month’s Vital Signs report from the U.S. Centers for Disease Control and Prevention (CDC) reveals that suicide rates have been increasing in nearly every state between 1999 and 2016. Suicide is the 10^th leading cause of death in the U.S. and is one of three leading causes that are on the rise. In 2016 alone, nearly 45,000 Americans age 10 and older died by suicide. The national average rate of suicide increased 25.4 percent during the study period. In California, the rate increased 14.8 percent.

According to CDC researchers, more than half of people who died by suicide did not have a known diagnosed mental health condition at the time of death. Relationship problems or loss, substance misuse, physical health problems, and job, money, legal, or housing stress most commonly contributed to the risk of suicide. Firearms were the most common method of suicide used by those with and without a known diagnosed mental health condition.

The CDC strongly recommends a comprehensive public health approach to suicide prevention and a coordinated strategy to address the range of factors contributing to suicide. The CDC report suggests a number of interventions to address the increasing rates of suicide, including teaching coping and problem-solving skills early in life, working to ease housing and unemployment stress, and reducing access to lethal means that may be used in a suicide.

In 2017, the CDC issued a technical package of policies, programs, and practices to prevent suicide. This month’s Vital Signs report also details the warning signs of suicide and prevention resources available to individuals and entities. The most recent edition of Vital Signs is available here.

California Cannabis Emergency Regulations Readopted, Cannabis Product Transition Period Ends

California’s emergency cannabis regulations for each of the three state-level regulatory agencies were officially readopted on June 4, 2018, and are now in effect as of June 6, 2018. These readopted emergency regulations will be in effect for 180 days. During that time, the Bureau of Cannabis Control (BCC), the California Department of Public Health (CDPH), and the California Department of Food and Agriculture (CDFA), will engage in the regular rule making process to adopt their final nonemergency regulations. Draft permanent regulations are anticipated to be released sometime this summer.

The final text of readopted regulations and department summaries of key changes for all three state regulatory agencies are listed below.

CDPH – Manufacturing – Readopted Emergency Regulations

CDPH – Manufacturing – Emergency Regulations Summary

BCC – Distribution, Transportation, Retailers, and Laboratories – Readopted Emergency Regulations

BCC – Distribution, Transportation, Retailers, and Labs – Emergency Regulations Summary

CDFA – Cultivation – Readopted Emergency Regulations

CDFA – Cultivation – Emergency Regulations Summary

For a more thorough summary of these emergency regulations and other cannabis information, please visit CHEAC’s Cannabis webpage here.

Yesterday, the Bureau of Cannabis Control also announced that the transition period for cannabis licensees from specific regulatory provisions will end on June 30, 2018. Beginning on July 1, 2018, all cannabis goods must meet all statutory and regulatory requirements. Cannabis goods that do not meet all statutory and regulatory requirements must be destroyed in accordance with the rules pertaining to destruction. Below is a listing of all the regulatory requirements that will be in effect as of July 1.

Laboratory Testing Requirements

Beginning July 1, 2018, a licensee may only sell cannabis goods that have been tested and passed all testing requirements in effect at the time of testing.

Untested cannabis goods cannot be sold by a retailer and must be destroyed. A retailer may not send cannabis goods to a distributor for testing.
Untested cannabis goods manufactured or harvested before January 1, 2018, in possession of a distributor that are owned by the distributor must be destroyed.
Untested cannabis goods manufactured or harvested before January 1, 2018, in the possession of a distributor owned by a manufacturer or cultivator may be returned to the licensee who owns the cannabis goods. If a cultivator or manufacturer chooses to sell the returned cannabis goods, the cannabis goods must be sent to a distributor for testing and must meet all of the testing requirements in effect at the time of testing before transported to a retailer for sale.

Packaging and Labeling Requirements

Beginning July 1, 2018, all packaging and labeling must be performed prior to cannabis goods being transported to a retailer.

A retailer shall not accept cannabis goods that are not properly packaged and labeled. A retailer shall not package or label cannabis goods, even if the cannabis goods were in inventory before July 1, 2018. However, for medicinal sales, retailers will place a sticker on cannabis goods stating, “FOR MEDICAL USE ONLY” upon sale to a qualified medicinal consumer, unless the statement is already printed on the package.
A retailer may not send unpackaged cannabis goods to another licensee for packaging or labeling. Cannabis goods in possession of a retailer that do not meet packaging and labeling requirements must be destroyed.
Exit packaging is not required to be child-resistant and can no longer be used to satisfy the child-resistant packaging requirements. All cannabis goods must be in child-resistant packaging prior to delivery to a retailer.

THC Limits for Edible Cannabis Products

Beginning July 1, 2018, edible cannabis goods may not exceed 10 milligrams of THC per serving and may not exceed 100 milligrams of THC per package.

THC Limits for Non-Edible Cannabis Products

Beginning July 1, 2018, non-edible cannabis products must meet package THC restrictions.

Non-edible cannabis products shall not contain more than 1,000 milligrams of THC per package if intended for sale only in the adult-use market.
Non-edible cannabis products shall not contain more than 2,000 milligrams of THC per package if intended for sale only in the medicinal market.

Ingredients and Appearance of Cannabis Products

Beginning July 1, 2018, a retailer may only sell cannabis products that meet the requirements set by the California Department of Public Health for ingredients or appearance.

CDPH Let’s Talk Cannabis Webinar to be Held June 21

The California Department of Public Health (CDPH) will be hosting its next Let’s Talk Cannabis health information initiative webinar on Thursday, June 21 from 9:30 am to 10:30 am. The webinar will feature a presentation from the Los Angeles County Department of Public Health Office of Communications and Public Affairs. The webinar will be available here on June 21.

CDPH Issues Statewide Standing Order for Naloxone

This week, California Department of Public Health (CDPH) Director and State Health Officer Dr. Karen Smith issued a standing order for naloxone. The standing order expands access to naloxone for California residents and allows organizations that cannot prescribe naloxone to distribute it to those who are at risk of experiencing an opioid-related overdose and those in a position to assist during an opioid-related overdose.

The order also authorizes the administration of naloxone to assist a person experiencing or suspected of experiencing an opioid overdose by a family member, friend, or other person who have been trained by an opioid overdose prevention and treatment training program. Entities may apply for the standing order online and must agree to all terms and conditions.

More information, including the standing order application, are available on CDPH’s website here.

Insure the Uninsured Project (ITUP) Regional Workshops Continue

Insure the Uninsured Project (ITUP) continue their series of regional workshops throughout California focusing on health care reform and behavioral health integration and management. The remaining workshops scheduled for this year are listed below. Registration information can be found here.

North Central

Workgroup Agenda

Tuesday, June 19 – 11:30 a.m. – 2:00 p.m.

The California Endowment (Adelante Room)

1414 K Street, Sacramento, CA 95814

Bay Area

Workgroup Agenda

Wednesday, June 20 – 11:30 a.m. – 2:00 p.m.

The California Endowment (Eastmont Room)

2000 Franklin Street, Oakland, CA 94612

Central Coast

Workgroup Agenda