March 13, 2020 Edition
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
- 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.
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.
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
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.
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.
Coverage/Health Care Reform
AB 2817 (Wood) as amended March 2, 2020 – WATCH
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
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.
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
- $3 million ongoing General Fund for STD
- $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
- 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
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.
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.
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.
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.