March 13, 2020 Edition

President Trump Declares National Emergency Due to COVID-19

Earlier today, President Donald Trump declared a National Emergency to combat coronavirus, indicating the declaration allows access to $50 billion in emergency funding. President Trump also announced a number of actions the federal Administration would be taking, which include but are not limited to:

  • Directing every state to set up emergency operation centers
  • Directing every hospital in the country to activate their emergency preparedness plan
  • Providing new authority to the United States Health and Human Services Secretary to waive laws to allow for maximum flexibility to providers to respond and care for patients
  • Waiving requirements restricting when patient can be moved to a nursing home
  • Waiving requirements limiting where hospitals can conduct activities
  • Providing greater flexibility for physicians
  • Waiving interest on student loans
  • Purchasing large quantities of oil

Joined by executives representing private labs and companies such as CVS, Walgreens, and Walmart, President Trump announced efforts to expand testing capacity across the country. The President commended Google’s partnership and efforts underway to develop a website that would be available to the public to determine if testing is warranted and provide testing locations. He also announced partnerships with the private sector labs to accelerate testing capacity and lastly, announced partnerships with major stores to set up drive thru testing sites.

Vice President Pence slightly changed his messaging, moving away from “the risk to the American people is low” to now saying the “the risk of Americans becoming seriously ill is low.”

While the text of the declaration is limited to allowing the United States Secretary of Health and Human Services the authority to waive or modify requirements for Medicare, Medicaid, State Children’s Health Insurance programs, and HIPAA rules throughout the duration of the emergency declaration, the President alluded to a “paper” that would be forthcoming addressing the aforementioned actions. The emergency declaration dates back to March 1.


Newsom Issues Executive Orders Around COVID-19 Response Activities, School Flexibility

On Thursday, the Governor issued Executive Order N-25-20 to further support COVID-19 response activities. The Governor’s executive order:

  • Waives the one-week waiting period for people to apply for unemployment or disability insurance as a result of COVID-19.
  • Delays the deadline for filing state taxes for individuals and business by 60 days for those unable to comply due compliance with public health requirements for COVID-19.
  • Directs residents to follow public health directives and guidance related to non-essential mass gatherings.
  • Allows the state to commandeer property to be used as temporary residences and/or medical facilities to treat, isolate or quarantine individuals.
  • Waives requirements related to open meetings to allow for meetings to be held via virtually or telephonically.
  • Allows the Director of the Emergency Medical Services Authority to implement additional local optional scopes of practice as needed.

On Friday afternoon, Governor Newsom issued Executive Order N-26-20 to set forth guidelines around local educational agencies (LEAs) that choose to close temporarily due to COVID-19. For LEAs that close temporarily to retain state funding, LEAs must:

  • Continue delivering high-quality educational opportunities to students through other options, distance learning, and independent study.
  • Safely provide school meals through the Summer Food Service Program and Seamless Summer Option.
  • Arrange for the supervision of students during ordinary school hours to the extent practicable.
  • Continue to pay employees.

CHEAC Legislative Committee Reviews Bills, Includes CHEAC-Sponsored STD Navigation Services Measure

Last Friday, March 6, 2020, the CHEAC Legislative Committee met for its second in-person meeting in Sacramento to review and discuss the remaining batch of newly introduced bills in the second part of the 2019-20 Legislative Session. During the meeting, the CHEAC Legislative Committee identified an additional 35 legislative bills of interest to local health departments and public health. These measures have now been added to the CHEAC Weekly Bill Chart, which is available here. Below, we detail several of those measures.

Communicable Disease Control

AB 3224 (Rodriguez) as introduced February 21, 2020 – SUPPORT

AB 3224 by Assembly Member Freddie Rodriguez is CHEAC’s sponsored measure to establish a statewide program, to be administered by the California Department of Public Health (CDPH), to support local health departments in providing STD navigation services to individuals experiencing reinfections of syphilis, chlamydia, and gonorrhea or complex cases of STDs. Navigation services include, but are not limited to, assessing the health and social needs of clients, identifying and resolving risk factors and obstacles to care, and coordinating referrals and connections to health and social services including behavioral health services, housing, homeless assistance, and harm reduction counseling and services.

CHEAC’s bill is associated with our sponsored budget ask for $20 million General Fund ongoing to support these services at the local level. CHEAC’s budget request was heard this week in the Senate Budget & Fiscal Review Subcommittee No. 3 on Health and Human Services.

Chronic Disease Prevention and Wellness Promotion

AB 3118 (Bonta) as introduced February 21, 2020 – SUPPORT

AB 3118 by Assembly Member Rob Bonta would add medically supportive food and nutrition services, including health food boxes or groceries, nutrition education, and linkages to community-based food services and application assistance to CalFresh and WIC, as a covered benefit to the Medi-Cal program. These services would be added to the extent funds are made available in the annual budget act. Recall, the Department of Health Care Services (DHCS) is currently operating the Medically Tailored Meals (MTM) Pilot Program in 10 counties for individuals with specified chronic disease conditions which provides individuals with similar nutrition related services. Additionally, the Newsom Administration’s CalAIM proposal also includes medically tailored meals in its in lieu-of services (ILOS) component.

Health Coverage/Health Care Reform

AB 2817 (Wood) as amended March 2, 2020 – WATCH

Assembly Member Jim Wood’s AB 2817 would establish the Office of Health Care Quality and Affordability, an independent state agency charged with analyzing the health care market for cost trends and drivers of spending. The Office would also develop data-informed policies for lowering health care costs for consumers, create a statewide strategy for controlling the cost of health care, and ensure affordability for consumers. Assembly Member Wood’s proposal differs from that proposed by Governor Gavin Newsom in his January Budget to establish an Office of Health Care Affordability.


Senate Budget & Fiscal Review Subcommittee No. 3 Discusses COVID-19 and STDs

Yesterday, the Senate Budget Subcommittee No. 3 on Health and Human Services heard items under various state agencies. Of particular interest were items related to the California Department of Public Health (CDPH), which included hearing from State Public Health Director and Health Officer Sonia Angell on COVID-19 response activities as well as hearing a comprehensive array of stakeholder requests for resources to address the rising tide of sexually transmitted diseases, HIV and HCV.

Dr. Angell first presented a State of the State’s Public Health, mirroring her address provided to the Assembly Budget Subcommittee No. 1. Dr. Angell then provided Senators with the most case numbers and an overview of the Administration’s efforts. Following her presentation, Senator Pan began to question California’s public health infrastructure both at the state and local level. While Dr. Angell’s comments focused on California’s preparedness efforts, Senator Pan continued to push, raising questions about public health funding declines both at the state and federal levels. Dr. Angell later indicated that public health could always use more resources; but coupled with saying resources are not the issue with the current response.

The hearing also featured a panel discussion consisting of associations representing public health, hospitals, and other health care facilities engaged in COVID-19 response activities. Kat Deburgh from the Health Officers Association of California provided the local health department perspective, raising the need for messaging from CDPH regarding testing priorities, state staff for any alternate care sites, a statewide call center to field the influx of calls, facilities for isolation and quarantine for people without housing, and guidance on jails and casinos, among other areas. She also elevated ongoing needs, such as continued investment in communicable disease infrastructure, workforce development and training, creating pipelines for future public health workforce through loan forgiveness programs or lower certification fees for public health nurses, and lastly, public health labs.

Other panelists included representatives from the California Primary Care Association (CPCA), the California Hospital Association (CHA), the California Association of Public Hospitals (CAPH) and the California Association of Health Facilities (CAHF). A number of challenges were raised, including the lack of testing availability and personal protective equipment, limited staffing due to exposures, and limited bed space.  Senator Pan also echoed concerns around the availability of testing and need to expand testing capacity across the state.

STDs/HIV/HCV

CHEAC’s sponsored budget request for $20 million ongoing General Fund for STD navigation services is now being co-sponsored by SEIU and was jointly presented before the budget subcommittee. Pan expressed appreciation for bringing the budget proposal forward.

The End the Epidemic’s Coalition presented their budget requests for:

  • $3 million ongoing General Fund for STD prevention;
  • $5 million ongoing General Fund for the Office of AIDS Syringe Exchange Supply Clearinghouse;
  • $2 million one-time General Fund for the development of a Master Plan on HIV, HCV and STDs;
  • $15 million General Fund to address HIV health inequities;
  • Increasing ADAP and PrEP-AP eligibility from 500 percent FPL to 600 percent FPL to align with new Covered California subsidies; and
  • $15 million ongoing General fund for HCV prevention, linkage to and retention in care.

All items were held open.

For additional information, please see the hearing agenda and recording.


Senate, Assembly Convene Joint Oversight Hearing on Childhood Lead Levels

On Tuesday, the Assembly Environmental Safety and Toxic Materials Committee, Joint Legislative Audit Committee, Assembly Health Committee, Senate Environmental Quality Committee, and the Senate Health Committee convened a joint legislative oversight hearing on childhood lead levels following a report from the California State Auditor. Recall, the State Auditor’s report, “Childhood Lead Levels: Millions of Children in Medi-Cal Have Not Received Testing for Lead Poisoning,” was released in January and examined childhood lead exposure and screening activities of the Department of Health Care Services (DHCS) and the California Department of Public Health (CDPH). Among the findings of the report, the State Auditor determined that from fiscal years 2009-10 through 2017-18, more than 1.4 million of the 2.9 million one- and two-year old children enrolled in Medi-Cal did not receive any of the required lead level tests and another 740,000 children missed one of the two tests.

Tuesday’s oversight hearing featured an overview of the report from State Auditor Elaine Howle and her staff, as well as responses to the report from DHCS Director Dr. Bradley Gilbert, State Medicaid Director Jacey Cooper, and CDPH Deputy Director Monica Morales. In providing responses to the report, DHCS representatives discuss their plans and timelines for implementing the State Auditor’s recommendations around requiring managed care plans to identify children who missed a required test, remind the responsible health care providers of the existing requirement to test children, and implementing performance standards for lead testing. Monica Morales from CDPH discussed the department’s approach and timelines to the Auditor’s recommendations around high-risk lead exposure areas of the state, lead exposure prevention programs and activities, and healthcare provider guidance around lead exposure factors.

Both DHCS and CDPH indicated the seriousness of the topic and their commitment to addressing the issues identified in the State Auditor’s report. Many lawmakers, including Senator Richard Pan, Senator Connie Leyva, Assembly Member Jim Wood, and Assembly Member Eloise Gomez Reyes, during the question and answer session of departmental representatives expressed frustration with the number of children that did not receive required blood lead level testing throughout the state and the need for urgency by DHCS and CDPH to address the report’s findings.

The hearing also featured Dr. Robert Byrd with UC Davis Health to discuss blood lead level screening protocols and activities from a healthcare provider perspective. Public comment during the hearing largely featured representatives from children’s health, public health, and environmental health related entities.

The joint oversight hearing agenda is available here. A background memo is available here. A State Auditor’s Office handout is available here. A video recording of the hearing is available here.