March 5, 2021 Edition

Legislature Set to Begin Policy Committee Hearings Next Week

The California Legislature is set to begin policy committee hearings in earnest on legislative bills introduced to date beginning next week. Recall, the Legislature has primarily focused its attention on early budget action items, including COVID-19 pandemic response relief and the safe school reopening framework. The Legislature will now begin to shift its focus to legislative bills and policy committee hearings until the release of the May Revise Budget in early May. This year’s scheduling structure is different than years past given the ongoing pandemic and the need to coordinate budget and policy committee hearings in the Capitol’s limited space while maintaining COVID-19 precautions.

The CHEAC Legislative Committee will again meet next week for its day-long bill review meeting to review over 70 measures with an impact on local health departments and public health. The latest CHEAC Weekly Bill Chart is available here.

Below, we highlight several legislative hearings of interest that occurred this week.

Assembly Health Explores Health Information Exchanges

The Assembly Health Committee on Tuesday convened an informational hearing on health information exchange (HIE) priorities in California. The hearing primarily featured Jonah Frohlich, Managing Director with Manatt Health Strategies and author of a recent report on expanding payer and provider participation in data exchange. Tuesday’s hearing built upon recent work of the Assembly Health Committee on HIE priorities in the state and provided an overview of existing HIE arrangements in the state, forthcoming federal requirements, efforts in other states, and policy options to increase the use of HIE in California.

As framed by Assembly Health Committee Chair Jim Wood, the hearing focused on the state’s role in HIE and how best to assist public health entities in emergency response activities, how to establish data exchange across providers that enables population health management and patient care coordination, and to identify and eliminate health disparities.

Assembly Health Committee members received a comprehensive presentation from Mr. Frohlich with Manatt Health on options available to California in designing and implementing a 21st century integrated health system that aligns state purchasing, regulatory, and health and social services entities, addresses clinical data fragmentation, and addresses complex and onerous data exchange rules and regulations.

The hearing agenda is available here. The background paper is available here, and the presentation from Mr. Frohlich is available here. A video recording is available here.

Regulation and Execution of PSPS Events

The Assembly Committee on Utilities and Energy on Wednesday held an oversight hearing on the execution and regulation of public power safety shutoff (PSPS) events. The hearing featured an overview of the regulatory framework that governs PSPS events from the California Public Utilities Commission (CPUC), as well as presentations on the execution of PSPS events from industry representatives from Southern California Edison, Pacific Gas & Electric, and San Diego Gas & Electric.

The hearing detailed the increasing utilization of PSPS events statewide over recent years and the impacts on customers, medical baseline customers, and the public. CPUC discussed the role of their Safety and Enforcement Division (SED) that is tasked with overseeing the safety of electric and communication entities, as well as CPUC’s regulatory and enforcement activities during PSPS events.

The hearing agenda is available here. The background paper is available here, and a video recording of the hearing is available here.

COVID-19 Impacts on Access to Parks and Open Spaces

On Wednesday, the Assembly Committee on Water, Parks, and Wildlife convened an informational hearing entitled, “Access to Parks and Open Spaces in California: COVID-19, Other Challenges, and Future Needs.” The hearing featured a status update on parks and open spaces during the COVID-19 pandemic from representatives from the California Department of Parks and Recreation (CDPR), California Department of Fish and Wildlife, and the University of California, San Francisco (UCSF). Another panel provided a funding overview for parks and open spaces from the Legislative Analyst’s Office (LAO) and CDPR. Lastly, industry representatives outlined future needs of California’s parks and open spaces.

The hearing agenda is available here and a background paper is available here. A video recording of the hearing is available here.

$6.6 Billion Package to Safely Return Students to In-Person Instruction Signed into Law

Today, Governor Gavin Newsom signed into law AB 86, a $6.6 billion budget package that aims to accelerate the safe return to in-person instruction statewide and support schools in expanding academic, mental health, and social-emotional supports. Earlier in the week, the Governor, Senate President pro Tempore Toni Atkins, and Assembly Speaker Anthony Rendon announced at an Elk Grove elementary school their agreement on the budget package to provide $2 billion for safety measures to support in-person learning and $4.6 billion to fund expanded learning opportunities, including through summer school, tutoring, and mental health services.

Under the agreement, all public schools will be required to offer in-person instruction to grades K-2 for all students and for high-needs students in all grades by the end of the month, losing one percent of eligible educational funds every day thereafter if schools do not open. Schools in the jurisdictions in the Blueprint for a Safer Economy Red tier or better will be required to offer in-person instruction to all students in all elementary grades and at least one middle or high school grade or risk the same penalty.

Additionally, the budget measure codifies several school-related activities undertaken by the Newsom Administration, including:

  • Vaccine Prioritization for K-12 School Staff: AB 86 codifies the Governor’s recent announcement that 10 percent of all COVID-19 vaccines will be dedicated to education personnel.
  • Data Reporting: The package additionally codifies reporting requirements, including requirements for schools to report reopening status and COVID-19 safety measures. According to the Administration, these statutory requirements will increase transparency and data will be accessible on the Safe Schools Hub.
  • State Safe Schools Team: AB 86 provides $25 million to the State Safe Schools Team to provide technical assistance, oversight, and accountability to the over 10,000 public schools in the state.

The budget measure was heard by the Senate Budget & Fiscal Review Committee and the Assembly Budget Committee earlier in the week and was voted on by both houses on Thursday. The measure received bipartisan support, with many lawmakers discussing the urgent need to safely return students to schools and address learning losses due to the pandemic. During debate on the measure on the Senate and Assembly floors, several lawmakers who have struggled in instructing their own children during the pandemic expressed relief that their children would soon be returning to the classroom. AB 86 advanced from the Senate on a 36-0 vote with three Senators not voting; the Assembly sent the measure to the Governor on a 72-4 vote with three Members not voting.

Governor Newsom signed into law AB 86 in a virtual ceremony joined by pro Tem Atkins, Speaker Rendon, State Superintended of Public Instruction Tony Thurmond, State Board of Education President Dr. Linda Darling-Hammond, Senators Nancy Skinner, John Laird, and Connie Leyva, and Assembly Members Phil Ting and Kevin McCarty.

Senate Sub. 3 Hears Stakeholder Proposals, Including CHEAC’s Public Health Infrastructure Investments

Today, the Senate Budget & Fiscal Review Subcommittee No. 3 on Health and Human Services convened a hearing to review a series of budget proposals that augment or modify the Governor’s January Budget Proposal. The Subcommittee received a high-level presentation of various budget investments in the California Health and Human Services (CHHS) Agency, Department of Health Care Services (DHCS), California Department of Public Health, Mental Health Services Oversight and Accountability Commission, and Covered California.

Of note, the Subcommittee heard CHEAC’s sponsored budget request for a $200 million General Fund ongoing investment for public health infrastructure and workforce. CHEAC is joined by SEIU California, the California State Association of Counties (CSAC), the Rural County Representatives of California (RCRC), the Urban Counties of California (UCC), and the Health Officers Association of California (HOAC) in sponsoring the request to support local health departments statewide. The Subcommittee additionally heard CHEAC’s sponsored request for $3.2 million General Fund in 2021-22 and $150,000 General Fund annually thereafter to support a public health infrastructure and workforce study. HOAC and SEIU California are additionally sponsoring the public health workforce assessment budget investment with CHEAC.

Both Subcommittee No. 3 Chair Senator Susan Talamantes Eggman and Senator Richard Pan in their brief remarks before public comment highlighted the critical work of local health departments during the ongoing COVID-19 pandemic and the urgent need to invest in the state’s public health infrastructure. The subcommittee heard several hours’ worth of public comment expressing support for various the various health and human services-related investments. All items were held open for action at a future date.

Senate Budget Subcommittees will take a hiatus until around the May Revise Budget release in early May while policy committees begin bill hearings next week. The subcommittee’s hearing agenda is available here. A video recording of the hearing is available here.

Newsom Administration Rolls out Vaccine Equity Framework, Ties Equitable Vaccine Distribution to Blueprint for a Safer Economy

This week, Governor Gavin Newsom announced a significant policy change relative to COVID-19 vaccine allocation and administration aimed at increasing vaccine distribution to the most severely impacted communities. Under the new approach, the state will dedicate 40 percent of all COVID-19 vaccine doses to disadvantaged communities, as determined by the lowest quartile of the Healthy Places Index (HPI). The 40 percent carve-out of the vaccines will exist within the state’s existing approach of allocating 70 percent of vaccines based on age and 30 percent of vaccines based on employment sectors.

As part of this approach, the state will be modifying the Blueprint for a Safer Economy to incorporate the vaccine equity metric. Once the state delivers two million doses to the lowest HPI quartile, the Blueprint will be updated to allow slightly higher case rates per 100,000, allowing counties to move to less restrictive tiers. To date, the state has administered approximately 1.6 million doses to the lowest HPI quartile. It is estimated the state will reach two million doses to this quartile within the next two weeks. Once four million doses have been administered to this quartile, the Blueprint will again be updated, loosening restrictions on allowable activities based on Blueprint tiers.

The Governor’s Office released a press statement from leaders and advocates statewide, including CSAC President and Sonoma County Supervisor James Gore, applauding the Newsom Administration’s move to prioritize equitable distribution of vaccines. A fact sheet on the announcement from the Governor’s Office is available here and a press release on the new approach is also available here.

To support the Newsom Administration’s new vaccine equity approach, the California Department of Finance (DOF) released a memorandum detailing two efforts which will have fiscal implications for the state. First, the Administration intends to expend up to $60 million to make available funding to onboard and support providers using the MyTurn vaccination system. The expenditure is anticipated to improve accuracy and timeliness of data reporting, as well as provide for appointment reservations to eligible individuals living in the lowest HPI quartile. Additionally, the Administration anticipates expending up to $30 million for vaccine navigators and trusted messengers to increase vaccine take-up among communities most significantly impacted by the pandemic. The investment will build upon the recently awarded community outreach grants supported by the California Department of Social Services (CDSS).

CDPH Issues Updated Guidance on Face Coverings, Youth Sports

This week, the California Department of Public Health (CDPH) issued updated COVID-19 guidance relative to face coverings and youth sports. These items are detailed below:

Masking Guidance Highlights Importance of Proper Fit and Filtration

Updated guidance from CDPH this week underscores the importance of wearing a mask during the COVID-19 pandemic, particularly with an increasing presence of COVID-19 virus variants statewide. The updated guidance discusses fit and filtration of masks and indicates “double masking” serves as an effective way to improve fit and filtration. The guidance details situations in which individuals require a higher level of protection through the use of masking, such as being in indoor spaces with people from outside one’s household, and provides guidance on use of cloth masks, medical masks, and KN95 and N95 masks.

The updated masking guidance from CDPH is available here.

Youth Sports Guidance Updated Following Legal Case

CDPH additionally updated on Thursday an update to its outdoor and indoor youth and recreational adult sports guidance which specifies conditions under which youth and adult recreational sports may resume practice with contact and competition under the Blueprint for a Safer Economy. The guidance has been updated to authorize any youth or adult recreational sports team, including indoor sports, to begin practice with contact and competition at any time if they adhere to the specific requirements applicable to college sports under the COVID-19 industry guidance for Institutions of Higher Education.

The updated guidance specifies that teams can return to competition earlier than otherwise authorized under the previous guidance which was issued on February 19, 2021, but only if teams adhere to the stricter requirements in place for college sports teams. The guidance resolves uncertainty created by a recently issued court order in response to a lawsuit filed in San Diego County.

A press announcement on the updated youth sports guidance is available here.

State Updates Blueprint to Allow for More Outdoor Activities with Consistent Masking

The California Department of Public Health (CDPH) this afternoon announced additional updates to the Blueprint for a Safer Economy to allow outdoor ballparks, stadiums, and theme parks to open with significantly reduced capacity, mandatory masking, and other public health precautions. The announced changes do not take effect until April 1, 2021.

Under the updates to the Blueprint, the following will be allowed:

  • Outdoor Sports and Live Performances: These activities with fans and attendees will be eligible to begin April 1. In the Purple tier, capacity will be limited to 100 people of fewer and attendance will be limited to regional visitors. Advanced registrations will be required, and no concession or concourse sales will be allowed. In the Red tier, capacity will be limited to 20 percent and concession sales will be primarily in-seat. The Orange tier will allow capacity of 33 percent and the Yellow tier will increase to 67 percent. Attendance will be limited to in-state visitors in the Red, Orange, and Yellow tiers.
  • Amusement Parks in the Red Tier: Amusement parks will be eligible to open in the Red tier beginning April 1. Capacity will be limited to 15 percent in the Red tier, 25 percent in the Orange tier, and 35 percent in the Yellow tier. Attendance will be limited to in-state visitors only.

The press announcement from CDPH is available here.

Biden Expects to Vaccinate All Adults by End of May, Announces Vaccine Manufacturing Partnership

This week, President Joseph R. Biden, Jr. announced several updates related to the federal government’s ongoing response to the COVID-19 pandemic. Below, we highlight these activities:

  • Vaccines by End of May: President Biden announced on Tuesday the U.S. will have enough COVID-19 vaccine supply for every adult in America to be inoculated by the end of May. The Biden Administration had previously indicated it anticipated having enough supply to vaccinate all adults by the end of July, representing a two-month improvement on previous projections. The President’s remarks are available here.
  • Merck and J&J to Partner: President Biden indicated his Administration invoked the Defense Production Act to help forge a manufacturing partnership between Merck and Johnson & Johnson to expand production of Johnson & Johnson’s single-dose COVID-19 vaccine. The collaboration will increase manufacturing capacity of the COVID-19 vaccine as Merck repurposes its existing facilities to produce drug substance, formulate, and fill vials of Johnson & Johnson vaccine. Merck previously abandoned development of its own COVID-19 vaccine following unfavorable Phase 1 clinical trial results. Additional information from the U.S. Department of Health and Human Services is available here.
  • Health Insurers Partner to Vaccinate Older Adults: The Biden-Harris Administration additionally announced the creation of the Vaccine Community Connectors Pilot Initiative to support the vaccination of two million seniors age 65 and older in the country’s most at-risk, vulnerable, and undeserved communities. Members of America’s Health Insurance Plans (AHIP) and Blue Cross Blue Shield Association (BCBSA) extended their commitment to identifying vulnerable older adults, working with partners to educate seniors on the vaccine, and working with governmental partners to deliver vaccines to underserved communities. Additional information on the initiative is available here.

Western States Workgroup Recommends Johnson & Johnson COVID-19 Vaccine, Distribution Begins Statewide

Following the U.S. Food & Drug Administration’s (FDA) issuance of an emergency use authorization (EUA) of the Janssen Biotech, Inc. single-dose Johnson & Johnson COVID-19 vaccine last Saturday, the Western States Scientific Safety Review Workgroup met early this week to review the vaccine’s safety and efficacy data. The Workgroup completed its review of the available data and notified the governors of California, Nevada, Oregon, and Washington on Tuesday evening of its unanimous recommendation that the Johnson & Johnson vaccine is safe and effective against COVID-19.

Following the Workgroup’s review, the Johnson & Johnson vaccine became the third COVID-19 vaccine supported for use in the western states. Initial shipments of the single-dose vaccine were distributed throughout the state this week.

Additional information, including statements from western states governors, is available here.

LAO Issues Report on Legislative Oversight of Governor’s Emergency Spending Authorities

This week, the California Legislative Analyst’s Office (LAO) issued a report providing an overview and recommendations to improve the Legislature’s oversight of the Governor’s emergency spending authorities. The report details the existing authorities available to the Administration in incurring emergency costs in light of the Governor’s proposals for COVID-19 emergency spending and authority.

Namely, the Governor proposes to extend the use of the Disaster Response-Emergency Operations Account (DREOA) for COVID-19 response activities through fiscal year 2021-22. The Governor has additionally proposed budget control section 11.91 that allows the California Department of Finance (DOF) to shift between various departments $1.4 billion in funds proposed in the 2021-22 budget for COVID-19 response activities and spend federal and private funds on pandemic response activities.

The LAO raises a series of concerns with the Governor’s proposals on emergency spending without reasonable legislative checks and balances on the Governor’s COVID-19 spending authority. According to the LAO, concerns with the Governor’s proposal are reflective of larger problems associated with the state’s existing emergency spending authorities that allow the Governor to spend an essentially unlimited amount of funds on emergency-related activities with very little opportunity for legislative oversight.

Given this arrangement, the LAO recommends to the Legislature a series of improvements to ensure additional checks and balances on the Governor’s authority while still allowing for some flexibility in spending funds for emergency response activities. The LAO recommends the Legislature adopts legislation to make fundamental changes to the Governor’s overall emergency spending powers. The Legislature is additionally urged to consider a new budget control section process specific for COVID-19-related augmentations for the upcoming fiscal year, as well as to modify the Governor’s proposed authority to transfer funds budgeted for COVID-19-related activities to require legislative notification. Ultimately, the LAO recommends the Legislature reject the Governor’s proposed flexibility to expend federal and private funds.

The full LAO report is available here.

CMS Grants Approval for Medi-Cal Reimbursement for COVID-19 Testing for Low-Income Students

On Wednesday, Governor Gavin Newsom announced the Biden-Harris Administration approved California’s request to use Medicaid (Medi-Cal) funding to provide voluntary COVID-19 testing for low-income students covered by Medi-Cal. The California Department of Health Care Services (DHCS) late last year requested permission to provide COVID-19 testing in schools for Medi-Cal children in grades transitional kindergarten through 12.

The request to the U.S. Centers for Medicare and Medicaid Services (CMS) was approved retroactively to February 1, 2021, and will continue for 60 days after the end of the federal public health emergency. The CMS approval letter is available here. A statement from the Governor’s Office is available here.

Newsom Signs Order on COVID-19 Evictions and Price Gouging

On Thursday, Governor Gavin Newsom issued Executive Order N-03-21 extending authorization for local governments to prohibit evictions for commercial renters impacted by the COVID-19 pandemic through June 30, 2021. The order additionally extends protections against price gouging for emergency and medical supplies amid the ongoing emergency response to the pandemic.

EMS Commission Appointment Announced

Last week, Governor Gavin Newsom announceda new appointment to the Emergency Medical Services Commission. As a bit of background, the EMS Commission provides regulatory oversight for emergency medical services in California and is comprised of eighteen members representing a variety of EMS disciplines including physicians, a local health officer, paramedics, EMTs, fire representatives, and local EMS agency representatives.

Kristin Weivoda, the local EMS Administrator for Yolo County, was appointed to fill the local EMS administrator seat. Ms. Weivoda has been the Yolo County EMS administrator since 2013, and previously served as a Flight Paramedic at REACH Air Medical Service and was a firefighter and paramedic at the North Tahoe Fire District. Kristin is the immediate past president of the Emergency Medical Services Administrators Association of California (EMSAAC) and serves as the EMSAAC legislative committee chair. CHEAC congratulates Ms. Weivoda on her appointment.

Governor Newsom also reappointed Nancy Gordon, a public safety expert, and Speaker Rendon reappointed Todd Valeri, an ambulance representative, to the Commission.

CDPH Issues Health Alert on Travelers Returning from DRC or Guinea After Ebola Outbreaks

The California Department of Public Health (CDPH) today issued a health alert regarding the monitoring of travelers returning to California from the Democratic Republic of Congo (DRC) and Guinea following Ebola Virus Disease (EVD) outbreaks in those countries. Both countries have declared EVD outbreaks with nearly 30 combined cases and four deaths.

As part of the health alert, CDPH identifies recommendations for healthcare providers and facilities, as well as local health departments (LHDs). LHDs are instructed to immediately notify CDPH of any patients suspected of having EVD or other highly infectious illnesses due to special pathogens. If a traveler has returned from affected regions of the DRC or Guinea, the LHD is instructed to interview the traveler and conduct a risk assessment. Based on the risk assessment, LHDs should develop a plan with the traveler as to whom to notify should the person become ill, and if the LHD decides to implement active monitoring, the LHD should provide a daily contact for the traveler.

Additional information on the health alert, including guidance for LHDs, is available here.