March 4, 2022 Edition
CHEAC is proud to issue our February #WeArePublicHealth Newsletter, featuring the critical work of California local health departments. The latest edition of the newsletter features the health departments’ work in health equity activities, workforce innovations, and proposed public health workforce investments.
The February edition can be accessed here.
Policy committees of the California State Senate and Assembly have begun to schedule hearings for new bills introduced in the second half of the 2021-22 Legislative Session. Over the coming weeks, policy committees are anticipated to maintain busy hearing schedules as legislators consider and amend new bill ideas on a wide range of issues and topics.
The CHEAC Legislative Committee will convene next Friday for its second daylong meeting to review nearly 100 new bills of interest to CHEAC Members and local health departments statewide. Recall, the Legislative Committee held its first daylong meeting last week, identifying numerous bills of interest. These bills now appear on the CHEAC Weekly Bill Chart and will continue to be updated as the legislative process gets underway in earnest.
The latest edition of the CHEAC Weekly Bill Chart is available here.
This week, California State Senate and Assembly Budget Subcommittees continued a steady pace of committee hearings, assessing proposed investments offered by the Newsom Administration through the Governor’s January Budget. Below, we highlight a few hearings of most interest to CHEAC Members:
Senate Budget & Fiscal Review Subcommittee No. 3 Hears Stakeholder Proposals, Including California Can’t Wait Coalition HERO Initiative
On Thursday, the Senate Budget & Fiscal Review Subcommittee No. 3 on Health and Human Services convened a hearing to assess a multitude of stakeholder budget proposals, covering a wide array of subjects and departments and agencies. Stakeholder proposals are submitted to the subcommittee for consideration and seek to augment or modify the Governor’s January Budget.
During the hearing, representatives from the Legislative Analyst’s Office (LAO) read into the record the wide range of stakeholder proposals under the authority of all entities within the California Health and Human Services Agency (CalHHS).
Notably, included in the subcommittee’s stakeholder proposals was the California Can’t Wait Coalition’s budget request for the Public Health Equity and Readiness Opportunity (HERO) Initiative which seeks to retain and bolster the state’s public health workforce. The Coalition’s requests total $186.4 million across several initiatives and several fiscal years including:
- Recruitment and Retention
- Public Health Recruitment and Retention Stipends ($120 million one-time, available over three years)
- Waive Public Health Nurse Certification Fees for Three Years ($10 million one-time)
- Public Health Training and Pipeline Investments
- Incumbent Worker Upskill Training ($12.8 million one-time, available over four years)
- California Public Health Pathways Training Corps (CA-PHC) ($24 million one-time, available over three years)
- California Microbiologist Training ($6.5 million, available over three years)
- Public Health Lab Aspire ($6.6 million one-time, available over three years)
- California Epidemiologic Investigation Service (Cal-EIS) Training ($6.5 million one-time, available over three years)
Numerous other stakeholder proposals were also considered, including investments in expanding maternal, child, and adolescent health services, health equity programming, communicable disease control, chronic disease prevention and wellness promotion, and workforce recruitment and retention.
An extensive public comment period was held, allowing stakeholders and interested parties to comment on the slate of proposed investments. Subcommittee No. 3 took no action on stakeholder proposals, leaving open all items for action at a later date. The full hearing agenda is available here. A video recording of the hearing is available here.
Assembly Budget Subcommittees Assess Opioid, Youth Behavioral Health Investments
On Monday, the Assembly Budget Subcommittee No. 1 on Health and Human Services and the Assembly Budget Subcommittee No. 2 on Education Finance, as well as the Assembly Select Committee on Early Childhood Development, convened a hearing to assess budget investment proposals from the Newsom Administration related to youth behavioral health.
The majority of the issues explored by the committees were activities and investments as part of the Administration’s Children and Youth Behavioral Health Initiative (CYBHI). Representatives from the California Health and Human Services (CalHHS) Agency, the Department of Health Care Access and Information (HCAI), the Department of Health Care Services (DHCS), and the California Department of Education (CDE), among others, presented the sweeping proposals to deliver behavioral health services to California’s youngest residents.
Of interest to CHEAC Members, the California Department of Public Health (CDPH) presented its proposal for $55 million in one-time funding to establish: 1) a media and health communications campaign targeted toward youth opioid education and awareness and fentanyl risk education; and 2) syndromic surveillance using the BioSense Platform to collect and analyze data on opioid overdose trends.
CHEAC submitted a letter in support of the CDPH proposal and encouraged the state to leverage best practices and lessons learned from local efforts in combatting opioid misuse.
No action was taken by the committees and items were held open for action at a later date. The full agenda for Monday’s hearing is available here. A video recording of the hearing is available here.
Senate Budget & Fiscal Review Subcommittee No. 5 Examines Jail Oversight
The Senate Budget & Fiscal Review Subcommittee No. 5 on Corrections, Public Safety, Judiciary, Labor, and Transportation on Wednesday convened a hearing to assess a variety of budget proposals related to corrections. A considerable amount of the hearing was dedicated to county jail oversight, local detention facility standards, and inspections.
The Subcommittee explored topics related to incarcerated individuals with behavioral health conditions, whether the Board of State and Community Corrections (BSCC) should have more authority over county jail inspections, and whether changes to the BSCC membership composition is warranted.
No actions were proposed or taken during the examination of local jail oversight. The full agenda, including background information, is available here. A video recording of the hearing is available here.
On Monday, California Governor Gavin Newsom, along with Oregon Governor Kate Brown and Washington Governor Jay Inslee, announced a series of changes to COVID-19 masking guidance. The state leaders, pointing to declining case rates and hospitalizations throughout the West, updated indoor mask policies and mask guidance for K-12 schools.
Specifically, in California, as of March 1, masks are no longer required for unvaccinated individuals. In its place, the state now strongly recommends masking in public indoor settings, regardless of vaccination status. After March 11, masks in schools and childcare settings will no longer be required but will be strongly recommended.
Masks remain required in high transmission and vulnerable settings, including public transit, emergency shelters, health care facilities, correctional facilities, homeless shelters, and long-term care facilities. As always, local jurisdictions may impose additional health-protective measures.
Additional information is available here.
On Monday, Governor Gavin Newsom issued an executive order updating the Division of Occupational Safety and Health (Cal/OSHA) COVID-19 Emergency Temporary Standard (ETS) to align the standard with the state’s new indoor masking guidance.
Executive Order N-5-22 specifies that as of March 1, 2022, masks will no longer be required for unvaccinated employees indoors but will be strongly recommended for all individuals in most indoor settings. Employers must still provide a fact covering upon request of an employee.
The executive order additionally extends the current ETS through May 5, 2022, to ensure the Occupational Safety and Health Standards Board (OSHSB) has time to review new guidance in anticipation of the next readoption of the ETS.
Additional information from the Governor’s Office is available here.
The White House, under the direction of the Biden-Harris Administration, this week issued an updated response and recovery strategy for the COVID-19 pandemic. President Joseph R. Biden, Jr. announced the strategy during his State of the Union Address to U.S. Congress on Tuesday evening, highlighting a series of actions to continue the nation’s response to the pandemic and return to pre-pandemic routines.
The President’s National COVID-19 Preparedness Plan identifies four overarching goals and supporting activities:
- Protect against and treat COVID-19 – Supporting activities include launching an effort to vaccinate the country’s youngest children (upon regulatory authorization); ensuring access to COVID-19 vaccines; increasing U.S. vaccine manufacturing capacity; launching a Test-to-Treat Initiative to receive a COVID-19 test and, if positive, treatment medications at no cost; helping Americans with long-term impacts of COVID-19; and ensuring equitable access to COVID-19 health care and public health resources, among others.
- Prepare for new variants – Supporting activities include improving data collection, sequencing, and surveillance capabilities; leveraging a COVID-19 Variant Playbook to determine the impact of new variants on existing tests and treatments; leveraging a COVID-19 Surge Response Playbook to deploy mass vaccination and testing sites and expedite deployment of critical supplies and resources to areas experiencing a surge in cases; and adding at-home tests, antiviral pills, and masks to the Strategic National Stockpile, among others.
- Prevent economic and educational shutdowns – Supporting activities include giving schools and businesses guidance, tests, and supplies to stay open; working with Congress to provide paid sick leave to workers who need to miss work due to COVID-19; engaging early care and education providers to ensure safe operation; and expanding levels of services at public-facing federal offices, among others.
- Continue to lead the effort to vaccinate the world and save lives – Supporting activities include leveraging the vaccine donation model established by the U.S. to deliver vaccines; increasing efforts to expand global vaccination efforts; and ensuring availability of oxygen and emergency supplies.
The Biden-Harris Administration notes it will work with the U.S. Congress to secure additional resources and funding to support the continued response to COVID-19. Per the Administration, equity will remain at the center of all COVID-19 actions included in its plan.
The full updated National Preparedness Plan is available here.
This week, President Joseph R. Biden, Jr. directed the Federal Emergency Management Agency (FEMA) to continue its emergency and disaster assistance available to state and local governments due to the COVID-19 pandemic through June 30, 2022.
Under the directive, FEMA will continue its 100 percent federal cost share for all work eligible for assistance, including utilization of the National Guard, through June. The extension of federal assistance is critical to supporting the capacity and capability of state and local government responses to the pandemic.
The full federal directive is available here.
The Public Policy Institute of California (PPIC) recently issued a report examining the demographic trends of who remains unvaccinated against COVID-19 throughout the state. In PPIC’s February statewide survey, more than eight in 10 California adults have received at least one dose of the COVID-19 vaccine with three in four receiving either both doses of a two-dose vaccine or a single-dose vaccine.
While most California adults are vaccinated, more than one in 10 indicate they will definitely not (12 percent) or probably not (2 percent) receive the COVID-19 vaccine. The overwhelming majority of unvaccinated adults (86 percent) further indicate that the omicron variant does not make them more likely to get vaccinated. Although majorities across demographic, political, and regional groups are vaccinated, wide disparities remain.
PPIC finds that older adults are more likely to indicate they have been vaccinated, and younger adults make up a larger share of the unvaccinated population compared to their shares of the adult population. Men, compared to women, make up a disproportionate share of the unvaccinated (59 percent of unvaccinated vs. 49 percent of the adult population).
Further, large partisan differences exist in vaccination rates with Democrats (94 percent) much more likely to be vaccinated than independents (75 percent) and Republicans (65 percent). Compared to their shares of registered voters, Republicans and independents make up larger shares of the unvaccinated registered voters.
As the state approaches its two-year anniversary of the COVID-19 state of emergency in California, PPIC notes the importance of continuing to monitor vaccination rates and trends statewide. Additional information is available here.
On Thursday during a visit to a mental health treatment center in Santa Clara County, Governor Gavin Newsom unveiled a new policy framework to assist people living with untreated mental health and substance use disorders. The framework, entitled the Community Assistance, Recovery, and Empowerment (CARE) Court, would require counties to provide comprehensive treatment to the most severely impaired and untreated residents and hold patients accountable to their treatment plan.
CARE Court, which must gain approval by the California Legislature, seeks to offer court-ordered individualized interventions and services, stabilization medication, advanced mental health directives, and housing assistance. Plans may be up to 12 to 24 months and involves a full clinical team, a public defender, and a supporter to assist individuals in making self-directed care decisions.
Per the Newsom Administration, if an individual is unable to successfully complete a CARE Plan, the individual may be referred to conservatorship, consistent with current law, with a presumption that no suitable alternatives to conservatorship are available. Under the proposal, all counties will participate in CARE Court. If local governments do not meet their specified duties under court-ordered CARE Plans, the court will have the ability to order sanctions and, in extreme cases, appoint an agent to ensure services are provided.
Additional details on the Newsom Administration proposal, including potential impacts on counties, are anticipated to be forthcoming. More information from the Governor’s Office is available here.
This week, the California Department of Health Care Services (DHCS) released additional details regarding its proposal to sunset the Child Health and Disability Prevention (CHDP) Program, as set forth in the Governor’s January Budget. DHCS proposes to sunset the CHDP Program by July 1, 2023, to simplify and streamline the delivery of services to children and youth under age 21.
The CHDP Program provides screening and follow-up services, care coordination, presumptive eligibility, and coordination of the Health Care Program for Children in Foster Care (HCPCFC) and the Childhood Lead Poisoning Prevention (CLPP) Program. DHCS’ proposal to sunset CHDP will not impact EPSDT services as currently required under Medi-Cal fee for service (FFS) and managed care delivery systems.
DHCS further notes that presumptive eligibility will continue under a new Children’s Presumptive Eligibility Program that expands to include all applicable Medi-Cal providers and permits more providers to make presumptive eligibility determinations. DHCS additionally proposes to preserve the HCPCFC as a standalone program and transition the CLPP program responsibilities to Medi-Cal managed care plans.
Recall, this proposal must be considered any acted upon by the Legislature. CHEAC, in submissions to appropriate budget subcommittees, expressed opposition to the sunset of the CHDP program out of concerns with impacts to children and local program operations.
Additional information from DHCS is available here.
This week, the California Department of Health Care Services (DHCS) unveiled Medi-Cal’s Strategy to Support Health and Opportunity for Children and Families. Noting that DHCS is responsible for the health care of more than 50 percent of California’s children, the department is launching a strategy for families enrolled in Medi-Cal to unify threads of existing and newly proposed child and family health initiatives and to strengthen DHCS’ accountability and oversight of children’s services.
The strategy includes eight action areas with key initiatives illustrating where DHCS is strengthening its focus on children and families. These initiatives include improved preventive care; the Early and Periodic Screening, Diagnostic, and Treatment Medi-Cal benefit; addressing health disparities in children’s care and outcomes; engaging with families to better include their voices in decision-making; and addressing youth behavioral health.
DHCS will host a webinar on March 14 to discuss these action areas and initiatives. Advanced registration is required and available here.
Additional information from DHCS on this strategy is available here.
The California Department of Public Health (CDPH) Climate Change and Health Equity Section (CCHES) this week issued its monthly update summary for March 2022. In its update, CCHES highlights funding opportunities through the CDPH Office of Health Equity (OHE), state government updates, public comment opportunities on climate programming, and toolkit resources to support local work.
The March 2022 CCHES Update is available here.
This week, California Attorney General Rob Bonta announced a $6 billion settlement with Purdue Pharma and the Sackler Family over their role in the opioid epidemic. Under the agreement, if Purdue’s bankruptcy reorganization plan is approved, the Sackler Family will pay up to an additional $1.675 billion to help abate the opioid crisis nationwide, bringing total plan relief to as much as $6 billion.
If the plan is ultimately approved, California is estimated to receive approximately $486 million from the settlement to fund opioid addiction treatment and prevention. Further, the Sackler Family must allow removal of the Sackler name from all buildings and institutions. Also, as part of the settlement plan with Purdue, the Sackler Family is no longer provided with nonconsensual releases from state law enforcement claims. The plan still, however, provides nonconsensual releases from private claims against the Sackler Family by individuals directly harmed by their misconduct. Attorney General Bonta notes that this practice is not consistent with law and urges the U.S. Court of Appeals for the Second Circuit to block the Purdue plan confirmation until it is addressed.
If the settlement plan is approved, provisions of Purdue’s bankruptcy plan will be kept intact, including those that require the company to be dissolved or sold by 2024 and prohibiting the Sackler Family from the opioid business.
The Attorney General’s Office filed a lawsuit against Purdue Pharma and the Sackler Family in 2019 for unlawful practices in the promotion and sale of opioids. After Purdue Pharma filed for bankruptcy in September 2019, bankruptcy court approved a plan blocking states from pursuing claims against the Sackler Family. A series of states, including California, objected to and ultimately appealed the plan. Then, in December 2021, the U.S. District Court vacated the bankruptcy order, siding with states and their ability to seek claims against the Sackler Family.
The settlement announced this week is subject to court approval and creation of a final settlement documentation. Additional information from the Attorney General’s Office is available here.
The U.S. Centers for Disease Control and Prevention’s (CDC) Tips From Former Smokers, now celebrating its 10th anniversary, this week unveiled a series of new advertisements encouraging people who smoke to quit. The campaign has had significant and sustained impact over the past decade, helping more than one million U.S. adults quit smoking.
The Tips campaign continues to elevate powerful stories about real people experiencing smoking-related diseases and disabilities and the toll these conditions have taken on them and their loved ones. Further, the Tips campaign addresses tobacco-related health disparities to advance health equity by increasing the reach, representation, receptivity, and accessibility of quit smoking messages. The campaign additionally increases awareness of free quit-smoking resources among all adults.
Additional information, including the new advertisements, is available here.
On Thursday, the U.S. Food and Drug Administration (FDA) finalized guidance to help companies prepare to remove violative products quickly and effectively from the market. The guidance describes steps companies should take before a recall is necessary to develop recall policies and procedures that include training, planning, and record-keeping to reduce the time a recalled product is on the market, thus limiting the public’s exposure to risk.
A voluntary recall is an action taken by a company to correct a violative product or remove it from the market. A recalling company may act on its own initiative, or the FDA may informed the company that a distributed product violates the law and recommend the company recall the product. The FDA retains its authority to require recalls of certain products in particular circumstances, including controlled substances, medical devices, and food.
Under the final guidance, the FDA explains how companies should have adequate product coding and maintain distribution records to facilitate faster, more accurate recall actions. It encourages recalling companies to use electronic communications to quickly identify and provide certain product information when alerting the public about a voluntary recall.
The guidance additionally urges companies to act quickly to initiate a recall when public health is at risk and to do so prior to completing an investigation into the cause of a problem. The FDA recommends companies develop recall procedures to quickly inform their entire distribution chain, allowing individuals to rapidly identify affected products and recall downstream products when necessary.
Additional information is available here.
Today, Governor Gavin Newsom issued an executive order directing all state agencies and departments to ensure their contractors are complying with economic sanctions imposed in response to Russia’s attacks on Ukraine. The order requires state agencies and departments within the Governor’s Administration to review their contracts for commodities, services, and technology and to terminate any contracts with entities that are subject to economic sanctions imposed by the U.S. government.
The order further requires state agencies and departments to direct all grantees and contractors with agreements valued at $5 million or more to report their compliance with economic sanctions and on steps they are taking in response to the matter, such as halting financial transactions with Russian entities, not transferring technology to Russian entities, and supporting the Ukrainian government and people.
Executive Order N-6-22 is available here. Additional information is available here.