March 15, 2019 Edition

Reminder: CHEAC Annual Meeting Abstract Proposals Due March 29

The 2019 CHEAC Annual Meeting will be held on October 9 – October 11 in Pasadena and will provide local health department leadership and staff throughout the state with networking and learning opportunities. This year’s conference theme is “Strengthening the Public Health Infrastructure” and will once again feature expanded workshops offered to attendees by collaborating with key partners to host innovative and exciting workshop sessions. Approximately 15 workshops will be hosted between 10:00 am and 4:00 pm on Wednesday, October 9 and Thursday, October 10.

Interested parties may submit workshop abstract proposal to CHEAC by COB on Friday, March 29. Additional information on workshop opportunities is available here.

CHEAC Legislative Committee Reviews Additional Bills, Takes Positions

The California Legislature continues to ramp up its hearing activities with a considerable amount of bills set for their first policy committee hearings over the coming weeks. Assembly Speaker Anthony Rendon announced the appointment of Assembly Member Eloise Gómez Reyes as acting chair of the Assembly Budget Subcommittee No. 1 on Health and Human Services in light of the leave of absence taken by Assembly Member Joaquin Arambula.

On Wednesday, the CHEAC Legislative Committee once again met in-person to review over 70 legislative bills impacting local health departments and public health. The Legislative Committee identified and took positions on a number of measures spanning CHEAC’s Legislative Platform areas including Health Coverage/Health Care Reform, Environmental Health, and Maternal, Child, and Adolescent Health Services.

CHEAC’s Weekly Bill Chart is available here. Below, we highlight several new measures of interest to CHEAC Members that also appear on the bill chart.

Access to Health Services

AB 1494 (Aguiar-Curry) as introduced on February 22, 2019 – SUPPORT

Assembly Member Cecilia Aguiar-Curry’s AB 1494 would require Medi-Cal reimbursement for services provided by community clinics or FFS providers via telehealth, telephone, or off-site (such as a shelter or home) during and within 90 days after a state of emergency.

Drug & Alcohol Services

AB 1468 (McCarty) as introduced on February 22, 2019 – SUPPORT

AB 1468 by Assembly Member Kevin McCarty would require opioid manufacturers or wholesalers to submit a report to the California Department of Public Health (CDPH) detailing opioid drug sales in the state and would require CDPH to calculate a stewardship fee to be paid by opioid manufacturers and wholesalers. Revenues generated from fees would then be distributed to counties on an annual basis for opioid prevention and rehabilitation programs.

Environmental Health

AB 1500 (Carrillo) as introduced on February 22, 2019 – SUPPORT

AB 1500 by Assembly Member Wendy Carrillo would strengthen local enforcement authority in instances of hazardous substance release. The bill would authorize the local health officer to issue orders against responsible parties to discontinue or suspend operations, conduct environmental testing, and provide assistance to exposed individuals. The measure would also authorize a unified program agency (UPA) to suspend, revoke, or withhold a facility permit under specified circumstances.

Health Coverage/Health Care Reform

AB 537 (Arambula) as introduced on February 13, 2019 – SUPPORT

AB 537 by Assembly Member Joaquin Arambula would require the Department of Health Care Services (DHCS), in consultation with stakeholders, to establish a quality assessment and performance improvement program for all Medi-Cal managed care plans. The measure would also require all plans to meet minimum performance levels to improve quality of care and reduce health disparities.

AB 1004 (McCarty) as introduced on February 21, 2019 – SUPPORT

Assembly Member Kevin McCarty’s AB 1004 would require screening services under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program to include developmental screening services for individuals zero to three years of age. The measure would also require Medi-Cal managed care plans to put in place mechanisms to ensure timely and consistent development screenings for children.

Maternal, Child and Adolescent Health Services

SB 464 (Mitchell) as introduced on February 21, 2019 – SUPPORT

SB 464 by Senator Holly Mitchell would require specified health facilities providing perinatal care to implement an implicit bias program for all healthcare providers involved in perinatal care within those facilities. The measure would also require death certificates to indicate whether the decedent was pregnant within 42 days of death or within 43 to 365 days of death and would require CDPH to track and publish specified maternal morbidity and mortality data.

Tobacco Control

AB 1625 (R. Rivas) as introduced on February 22, 2019 – SUPPORT

AB 1625 by Assembly Member Robert Rivas would require the California Attorney General to establish and maintain an online list of tobacco products that lack a characterizing flavor. The bill would also authorize the Attorney General to require that all tobacco manufacturers submit a list of all brand styles of tobacco products for enforcement purposes.

Health Committees Convene Joint Hearing on Opioid Crisis

The Senate and Assembly Health Committees convened a joint hearing on Wednesday entitled “Increasing Access to Treatment and Services in Response to the Opioid Crisis.” The hearing featured various panels highlighting the Drug Medi-Cal Organized Delivery System (DMC-ODS) pilots, the California Hub & Spoke System (CA H&SS), and other programmatic efforts underway in California to address the the significant number of opioid-related deaths.

Panelists included representatives from the University of California, Los Angeles (UCLA), substance use disorder (SUD) treatment centers, and the California Department of Health Care Services (DHCS) and the California Department of Public Health (CDPH). Presentations covered implementation activities and preliminary outcomes of the DMC-ODS pilots and H&SS model and discussed ongoing evaluation efforts from a local perspective.

DHCS Director Jennifer Kent discussed the state’s approaches to addressing the opioid crisis, including the medication assisted treatment (MAT) expansion project and naloxone distribution efforts. CDPH representatives discussed the department’s role in preventing overdoses and the importance of public health surveillance and data collection.

Assembly Health Committee Chair Jim Wood discussed at length the challenges experienced by jurisdictions within his district given the disproportionate number opioid use disorders and difficulties in accessing to care. Committee members further discussed the future of SUD treatment and prevention efforts, particularly as the DMC-ODS waiver expires in 2020 and it is unclear if the federal government will provide additional funding for the H&SS model.

The hearing agenda is available here. Additional materials, presentations, and a background paper are available here.

Trump Administration Releases 2020 Budget, Proposes Significant Cuts to Health, Social Program Spending

On Monday, President Donald Trump released his Administration’s proposed FY 2020 budget, amounting to a record $4.75 trillion plan that increases military and defense spending while significantly cutting health, environmental, and education spending. Notably, spending on the U.S. Department of Health and Human Services is slated for a 12 percent cut, which includes a $750 million decrease to the U.S. Centers for Disease Control and Prevention (CDC), a $5.4 billion decrease to the National Institutes of Health (NIH), a $1 billion decrease to the Health Resources and Services Administration (HRSA), a $200 million decrease to the Agency for Healthcare Research and Quality (AHRQ), and a $62 million decrease to the Substance Abuse and Mental Health Services Administration (SAMHSA).

The budget proposes to cut $845 billion from Medicare over the next 10 years, largely by modifying payments to hospitals and providers and strengthening fraud and abuse enforcement activities. The budget also proposes to cut $1.5 trillion for Medicaid over the next 10 years and instead provide $1.2 trillion for block grants or per-person caps starting in 2021. Under this arrangement, states would be granted far greater authority to determine coverage for low-income residents. Further, the budget proposes to eliminate funding for Medicaid expansion provided under the Affordable Care Act (ACA).

In other areas, the Trump Administration proposes to cut $220 billion from the Supplemental Nutrition Assistance Program (SNAP) over the next 10 years, implement mandatory work requirements for able-bodied adults receiving SNAP benefits, and provide SNAP beneficiaries with food box deliveries in lieu of cash benefits. The Office of National Drug Control Policy (ONDCP) is proposed to be cut by more than 95 percent, shifting the bulk of duties and responsibilities into other federal agencies. The budget proposes to cut the U.S. Environmental Protection Agency (EPA) budget by 31 percent, largely eliminating climate change-related programs and research.

The Trump Administration does propose several areas of new spending in areas related to health and social programs. For example, the budget proposes to set aside $750 million to establish a paid parental leave program and a $1 billion one-time fund for underserved populations and company investments in childcare. A $643 million increase is proposed for the U.S. Food and Drug Administration (FDA) and includes a proposal for a new user fee to help evaluate electronic cigarettes. The Administration also proposes to spend $291 million in ending the spread of HIV in the United States within a decade. However, the budget also calls for significant cuts to global HIV investments, including a $1 billion decrease in spending on the President’s Emergency Plan for AIDS Relief (PEPFAR) and reductions to the Global Fund to Fight AIDS, Tuberculosis, and Malaria.

The budget proposal largely mirrors the same increases in military and defense spending and decreases in domestic spending as presented to Congress by President Trump last fiscal year. With a divided Congress, the Trump Administration’s budget proposal is certain to face significant scrutiny and largely serves as a symbolic blueprint to the Administration’s campaign promises.

The full FY 2020 budget proposal, along with fact sheets and other materials, is available from the White House here.

FDA Issues Electronic Cigarette Guidance and Regulations

This week, U.S. Food and Drug Administration (FDA) Commissioner Scott Gottlieb announced the release of draft guidance entitled “Modifications to Compliance Policy for Certain Deemed Tobacco Products.” The draft guidance proposes to restrict flavored electronic cigarette sales and ban new flavored cigars from the market. FDA expects manufacturers of electronic nicotine delivery systems (ENDS) that remain on the market under new regulatory conditions set forth by the draft guidance to submit premarket applications to the agency by August 2021, which is one year earlier than previously proposed. FDA Commissioner Gottlieb also indicated the agency will prioritize enforcement efforts of products that pose a greater risk for access by minors.

Under the proposed guidance, the FDA expects that some flavored electronic cigarette and cigar products will no longer be sold and that other flavored electronic cigarette products that continue to be sold will be sold in a manner that prevents youth access. The FDA is soliciting comments on the draft guidance via the Federal Register by April 15, 2019. The full announcement from the FDA is available here.

WHO Announces New Global Influenza Strategy, Details Pandemic Preparedness and Response

On Monday, the World Health Organization (WHO) announced the 2019-2030 Global Influenza Strategy which seeks to prevent seasonal influenza, control the spread of influenza from animals to humans, and prepare for the next influenza pandemic. The strategy outlines a path to protect populations and prepare for pandemic through the strengthening of core public health programs; the two overarching goals include:

  1. Build stronger capacity for disease surveillance and response, prevention and control, and preparedness. To this end, the WHO calls on every country to have a tailored influenza program that contributes to national and global preparedness and health security.
  2. Develop better tools to prevent, detect, control, and treat influenza, such as more effective vaccines, antivirals, and treatments, and make these tools available to all countries.

The WHO committed to expanding partnerships to increase research, innovation, and availability of new and improved global influenza tools while working closely with countries to improve capacities to prevent and control influenza. This work builds upon the Global Influenza Surveillance and Response System (GISRS), which monitors seasonal influenza trends and potentially pandemic viruses, and the Pandemic Influenza Preparedness Framework, which provides access to vaccines and treatments and strengthens preparedness capacities of countries.

The full WHO Global Influenza Strategy is available here.

State Auditor Releases Report on Preventive Services for Medi-Cal Children

On Thursday, California State Auditor Elaine Howle released a report, “Department of Health Care Services: Millions of Children in Medi-Cal Are Not Receiving Preventive Health Services.” The audit report determined that an average of 2.4 million children in Medi-Cal per year did not receive all required preventive health services between FY 2013-14 and FY 2017-18. The report indicated that California’s utilization rate for preventive services has remained below 50 percent and ranked 40th among all U.S. states. For example, childhood immunization goals, set at 80 percent, have not been met in the past five years with rates ranging from 70 to 75 percent.

Further, the audit report indicated that although DHCS may impose financial sanctions or penalties against Medi-Cal health plans not meeting established performance levels, plans very rarely faced such penalties. According to State Auditor Howle, DHCS has not provided adequate guidance and oversight of Medi-Cal managed care plans, particularly in areas of contract management, follow-up on plan outreach to beneficiaries, and maintenance of accurate provider information.

State Auditor Howle makes a series of recommendations to improve upon the delivery of Medi-Cal preventive services to children. Recommendations suggest the Legislature direct DHCS to ensure plans assist members in locating out-of-network providers when travel times and distances to in-network providers are unreasonable and implement a pay-for-performance program to ensure plans are more consistently delivering preventive services. DHCS is urged establish performance measures for all relevant age groups and require plans to report utilization rates on those measures, modify processes for ensuring health plans and providers adequately deliver preventive services, and ensure plans are effectively mitigating child health disparities related to cultural and linguistic needs.

The full State Auditor report is available here.

CDPH Publishes Violence Prevention Data Brief

The California Department of Public Health (CDPH) recently published “Preventing Violence in California Data Brief 1: Overview of Homicide and Suicide Deaths in California” which presents information on violent deaths in the state through a broad overview of the prevalence and burden of homicides and suicides. The resource was developed to inform and support continuing dialogue around opportunities for preventing violence in California through a comprehensive public health approach.

According to the data brief, over the last decade, more than 60,000 Californians died from either homicide or suicide. In 2017, over 6,500 violent deaths occurred, including 4,323 suicides and 2,113 homicides. Non-fatal violence-related injuries also resulted in over 20,000 hospitalizations and over 171,000 emergency department visits. Violent deaths also account for an estimated $8.0 billion medical and work-loss costs per year.

This data brief comes on the heels of the recent establishment of the CDPH Violence Prevention Initiative (VPI) which aims to elevate violence as a departmental priority, integrate and align efforts across multiple CDPH programs, and frame the public health governmental role in addressing violence. More information on the data brief, the CDPH VPI, and the CDPH Safe and Active Communities Branch is available here.

WPC Webinar to be Hosted on Tuesday, March 19

The Whole Person Care (WPC) Learning Collaborative will host a webinar on Tuesday, March 19 from 12:00pm to 1:00 pm entitled “Psychiatric Respite, Medical Respite, and Sobering Centers: Lessons from WPC.” The webinar will feature presentations from Santa Clara and San Francisco on their experiences launching or expanding psychiatric and medical respite, as well as sobering centers, as part of WPC. Presenters will describe how their programs are structured, share lessons from implementation, and discuss plans for sustainability. WPC Pilots are encouraged to invite team members involved in respite or sobering care. Registration for the webinar is available here.