May 21, 2021 Edition

CA Can’t Wait Coalition Continues Budget Advocacy for Public Health Infrastructure and Workforce Investment

Governor Gavin Newsom’s May Revise Budget, released last week, did not include any new, ongoing funding for investments in public health infrastructure and workforce, despite the state’s record-breaking surplus of $75.75 billion. The California Can’t Wait Coalition, comprising local health officials, local leaders, frontline workers, and health equity advocates, this week continued its budget advocacy amongst the Legislature urging an ongoing investment of $200 million General Fund.

On Wednesday, the California Can’t Wait Coalition convened a press conference to highlight the urgent need for investing in the state’s local health department infrastructure. Senator Richard Pan, chair of the Senate Health Committee, and Assembly Member Jim Wood, chair of the Assembly Health Committee, appeared during the press conference to push for a $200 million in annual state investment to begin rebuilding California’s battered public health infrastructure and workforce. A video recording of the California Can’t Wait Coalition press conference is available here using password 2!66MTS!

Following the coalition’s press conference, numerous media articles from outlets statewide, including California Healthline, Mercury News, the Sacramento Bee, and KQED, highlighted the coalition’s request. The Sacramento Bee Editorial Board today called on Governor Newsom to adequately fund public health in California.

“Newsom’s reluctance to support public health departments after a deadly and economically catastrophic global health crisis is disturbing. … Nearly 63,000 Californians have died from COVID. We shudder to think how many could have been spared if public health was properly funded.”

The Sacramento Bee Editorial Board, May 21, 2021

Notably, Senate President pro Tempore Toni Atkins, in a press interview, expressed support for the California Can’t Wait Coalition budget request. Assembly Speaker Anthony Rendon similarly expressed strong support for stable funding to local public health.

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Also on Wednesday, the Assembly Budget Subcommittee No. 1 on Health and Human Services convened a hearing to review health-related proposals included in the Governor’s May Revise. Subcommittee members received a presentation from California Health and Human Services (CHHS) Agency Secretary Dr. Mark Ghaly and CDPH Director and State Public Health Officer Dr. Tomás Aragón on the state’s continued pandemic response. Drs. Ghaly and Aragón discussed the Administration’s $3 million one-time investment proposal to conduct a pandemic response assessment to inform future investment proposals to improve California’s public health system.

During the hearing, Assembly Member Jim Wood expressed concern that the Administration did not propose any new funding to support public health and called for an urgent investment to support the work of California’s 61 local health departments. Members of the California Can’t Wait Coalition additionally provided public comment, urging the Legislature to invest $200 million ongoing General Fund to support the state’s public health infrastructure and workforce.

Next week, the Senate Budget & Fiscal Review Subcommittee No. 3 on Health and Human Services will similarly convene a hearing to review health-related investments proposed in the Governor’s May Revise.

The agenda from the Assembly Sub. 1 hearing is available here. A video recording of the hearing is available here.


Legislature Reaches Fiscal Bill Deadline, CHEAC-Sponsored Bill Advances

Today, the California Legislature reached the deadline for fiscal committees to meet and report to the floor bills introduced in their house. Both the Assembly and Senate Appropriations Committees convened suspense file hearings on Thursday to dispense with hundreds of legislative measures by advancing them to the floor or holding them in the committee.

Of particular note, CHEAC’s sponsored measure, AB 240 (Rodriguez) was advanced from the Assembly Appropriations Committee Suspense File to the Assembly Floor without any amendments. CHEAC is joined by the Health Officers Association of California (HOAC), SEIU California, Urban Counties of California (UCC), the Rural County Representatives of California (RCRC), and Public Health Advocates in sponsoring the measure.

In other matters, Senate President pro Tempore Toni Atkins and Assembly Speaker Anthony Rendon on Wednesday announced that legislative leaders have decided to limit members to 12 bills each for the 2021 legislative year. This limit will restrict Senators and Assembly Members from passing more than 12 bills to the opposite house, requiring legislative members to prioritize their proposed legislative measures.

Below, we highlight suspense file hearing results of CHEAC-tracked measures. For a full update, the latest edition of the CHEAC Weekly Bill Chart is available here.

Access to Health Services

AB 32 (Aguiar-Curry) – SUPPORT – DO PASS AS AMENDED

Requires Department of Health Care Services (DHCS) to indefinitely continue telehealth flexibilities established during the COVID-19 pandemic. Authorizes providers to enroll Medi-Cal beneficiaries remotely, including Family PACT program. Requires health services provided by an enrolled clinic through telehealth to be reimbursed by Medi-Cal on the same basis, to the same extent, and at the same payment rate as in-person services. Requires DHCS to seek necessary federal approvals, convene an advisory group to includes specified representatives, including designates hospitals and counties, and to consult with stakeholders to develop one or more federally permissible alternative payment methods for FQHCs and RHCs for specified services.

SB 316 (Eggman) – SUPPORT – DO PASS

Authorizes Medi-Cal reimbursement for a maximum of two visits on the same day at a single location if: 1) after the first visit, the patient suffers illness/injury requiring additional diagnosis/treatment; or 2) the patient has a medical visit and a mental health visit or dental visit. Defines medical visit as a face-to-face encounter with a physician, PA, NP, nurse-midwife, visiting nurse, or perinatal practitioner.

Built Environment & Climate Change

AB 585 (L. Rivas) – SUPPORT – DO PASS AS AMENDED

Upon the appropriation by the Legislature, would establish the Extreme Heat and Community Resilience Program within the Office of Planning and Research (OPR) to coordinate state efforts to address extreme heat, facilitate implementation of climate changes projects statewide, and reduce public health risks by establishing community resilience centers. Directs OPR to establish criteria and guidelines for grants and directs OPR to give priority to applicants serving disadvantage communities and vulnerable populations, as determined by local health department, CDPH, or both.

Chronic Disease Prevention & Wellness Promotion

SB 464 (Hurtado) – SUPPORT – DO PASS AS AMENDED

Modernizes the California Food Assistance Program (CFAP) by recasting eligibility criteria to include noncitizens who meet all CalFresh eligibility criteria except requirement related to immigration status beginning January 2023.

Communicable Disease Control

AB 789 (Low) – SUPPORT – DO PASS AS AMENDED

Requires any patient receiving primary care services in an outpatient setting to be offered Hep B or Hep C screening test if their insurances cover the cost. Follow-up care must be provided or referred to health care provider to those who opt out of testing and either test positive for Hep B or Hep C.

SB 306 (Pan) – SUPPORT – DO PASS AS AMENDED

Allows pharmacists to provide expedited partner treatment (EPT) for STDs. Requires both private and public insurance coverage to cover at home STD testing kits. Adds EPT treatment and liability protections when diagnosing and treating STDs. Requires congenital syphilis testing for pregnant women in the third trimester. Allows HIV counselors to perform STD testing and requires counselors to provide appropriate counseling and referrals before performing tests. Reimbursement in the Family PACT program is required, subject to appropriation and draw down of FFP, for STD related services to the uninsured, income eligibility patients, or patients without healthcare coverage with confidentiality concerns who are not at risk for pregnancy or do not need contraceptive services.

SB 742 (Pan) – SUPPORT – DO PASS

Prohibits a person from engaging in physical obstruction, intimidation, or picketing targeted at a vaccination site during the site’s operational hours (and one hour prior and one hour after).

SB 744 (Glazer) – OPPOSE UNLESS AMENDED – DO PASS AS AMENDED

Requires CDPH create a program to provide expedited release, during a declared public health emergency, of specified health care data to researchers of specified institutions of higher education. Requires any electronic tool used by local health officers for reporting communicable disease cases to include capacity to collect and report data including where the patient resides, the number of people the patient resides with, the occupation of the patient, and the cities the patient has traveled to in the past 14 days.

Health Coverage/Health Care Reform

AB 4 (Arambula) – SUPPORT – DO PASS

Expands Medi-Cal to all undocumented adults 19-25 with income at below 138% FPL, contingent to appropriation by the Legislature in the annual Budget Act or other measure. Expands enrollment eligibility plan to ensure continuity care. Requires DHCS to work with counties and public hospitals to maximize federal financial participation.

SB 56 (Durazo) – SUPPORT – DO PASS AS AMENDED

Expands, effective July 2022, Medi-Cal to all undocumented adults 65 years of age and older with incomes at or below 138% FPL subject to an appropriation in the annual Budget Act approved by the Legislature. Requires DHCS to seek federal approvals to obtain federal participation. If federal funds are unavailable, specifies benefits shall be provided with state-only funds.

Health Equity

SB 17 (Pan) – SUPPORT – DO PASS AS AMENDED

Establishes a statewide Office of Racial Equity to be governed by a Racial Equity Advisory and Accountability Council to coordinate, analyze, develop, evaluate, and recommend strategies for advancing racial equity across state agencies, departments, and the officer of the Governor. Requires a statewide Racial Equity Framework developed by the Office and requires state agencies to develop and implement a Racial Equity Action Plan that aligns to the Racial Equity Framework. Requires annual reporting.

SB 682 (Rubio) – SUPPORT – DO PASS AS AMENDED

Requires the California Health and Human Services (CHHS) Agency, and other specified state entities, to develop and implement a plan that establishes to reduces racial disparities in health outcomes by 50 percent by December 2030. Requires CHHS to develop a plan to combat chronic conditions affecting children, including but not limited to asthma, diabetes, dental caries, depression, and vaping related diseases.

Health Information Technology

SB 371 (Caballero) – SPECIAL INTEREST BILL – DO PASS AS AMENDED

Direct funding to small physician/dental practices, community health centers, critical access hospitals, and other safety net providers to help them implement or expand their use of health information technology (HIT) and connect to health information exchanges.

Injury Prevention

AB 234 (Ramos) – SUPPORT – HELD ON SUSPENSE

Removes provision requiring the California Department of Public Health (CDPH) to utilize existing staff and resources to establish CDPH Office of Suicide Prevention.

Maternal, Child, & Adolescent Health Services (MCAH)

AB 1046 (Rubio) – SUPPORT – DO PASS AS AMENDED

Requires the California Health and Human Services (CHHS) Agency to consult with Stakeholders to improve state and counties’ abilities to draw down Medi-Cal funding for evidence based maternal-infant and early childhood home visiting encounters. Specifies stakeholders to be consulted, including California Home Visiting and CalWORKs Home Visiting programs, LHD divisions, human services, and behavioral health services, among others.

Public Health Infrastructure

AB 240 (Rodriguez) – SUPPORT – DO PASS

Requires California Department of Public Health (CDPH) to contract with appropriate and qualified entity to evaluate the adequacy of the local health department infrastructure to make recommendation for future staffing, workforce, and resources needed to adequately fund local public health. Requires CDPH to convene an advisory group of specified representatives and would require them to report to the Legislature.

Tobacco Control

AB 541 (Berman) – SUPPORT – DO PASS AS AMENDED

Requires licensed recovery and treatment facilities by the Department of Health Care Services (DHCS) to assess each alcoholism and substances use disorder patient/client for tobacco use at the time of initial intake. If tobacco use is identified, requires facility/program to provide information, including an offer for treatment or referral for tobacco use. Requires facility/program to report to DHCS.

SB 395 (Caballero) – SUPPORT – DO PASS

Imposes a 12.5 percent tax on the retail sale of electronic cigarettes in California. Specifies allocation of tax revenues, consisting of 23 percent to Proposition 99, 13 percent to Proposition 10, and 52 percent to Proposition 56, and 12 percent to the Health Careers Opportunity Grant Program. Creates the Health Careers Opportunity Grant Program to improve access by underrepresented students from disadvantaged backgrounds to postsecondary health professions programs, including schools of public health.


LAO Issues Report on Governor’s May Revise

This week, the California Legislative Analyst’s Office (LAO) issued a report following the Governor’s release of his Administration’s May Revise Budget last week. The LAO provides the Legislature initial takeaways from the Governor’s budget and details considerations for the Legislature as they assess investment proposals over the coming weeks.

Of particular note, the LAO estimates the state’s budget surplus at $38 billion in FY 2021-22. This figure is markedly less than the Governor’s surplus figure of $76 billion which stems from different definitions between the LAO and the Administration. According to the LAO, the Governor’s estimate includes constitutionally required spending on schools and community colleges, reserves, and debt payments. The LAO does not consider these spending amounts as part of the budgetary surplus because they must be allocated for specific purposes.

The LAO recommends the Legislature not take a step back from its track record of prudent budget management by restoring budget resilience. The LAO details the state appropriations limit (SAL) which is estimated to be exceeded by $16 billion; the Legislature will play a key role in determining how to meet the constitutional requirement imposed by the SAL. Further, the LAO suggests the Legislature may be able to make more progress in several key policy areas by allocating the surplus in a more targeted manner as opposed to the Governor’s May Revision which proposes roughly 400 new investments.

Last, the LAO recommends the Legislature delay some of its investment decisions given the surplus and significant amount of federal fiscal recovery funds. State agency and department capacity to allocate this significant amount of funding in a timely and effective manner, according to the LAO, will likely be significantly constrained, and the Legislature is likely to need more time to deliberate proposed investments.

The full LAO report on the Governor’s May Revise is available here. Other LAO analyses on the Governor’s May Revise are available here.


CDPH Releases Beyond the Blueprint Guidance

Today, the California Department of Public Health (CDPH) published its Beyond the Blueprint Framework for Industry and Business Sectors ahead of the state’s anticipated June 15 retirement of the Blueprint for a Safer Economy. Under the Beyond the Blueprint framework, all sectors listed in the current Blueprint Activities and Business Tiers Chart may return to normal operations with no capacity limitations or physical distancing.

Limited exceptions are in place for mega events, defined as large crowds greater than 5,000 individuals indoors or 10,000 individuals outdoors. Mega events may either have assigned or unassigned seating and may be either general admission or gated, ticketed and permitted events. Vaccine verification or negative testing is required for indoor mega events and recommended for outdoor mega events.

Further, under the state’s Beyond the Blueprint Framework, individuals are instructed to follow current CDPH Guidance for Face Coverings and travelers are instructed to follow CDC travel recommendations and CDPH’s travel advisory

The Beyond the Blueprint Framework for Industry and Business Sectors will become effective June 15. The latest guidance is available here. A Q&A about the Beyond the Blueprint guidance is available here.


CDPH to Maintain Masking Guidance Until June 15

Earlier this week, the California Department of Public Health (CDPH) announced it would maintain its existing COVID-19 guidance related to the use of face coverings until June 15 when the state aims to retire the Blueprint for a Safer Economy. The move comes as the CDC last week announced it had updated its masking guidance for fully vaccinated persons, allowing individuals to resume activities without wearing a mask or physically distancing when not otherwise required by federal, state, local, tribal, or territorial laws, rules, and regulations, including business and workplace guidance.

After June 15, according to CDPH, California plans to implement the CDC’s guidelines around masking to allow fully vaccinated persons to go without a mask in most indoor settings. The four-week period is anticipated to provide residents more time to prepare for this change while vaccines continue to be administered statewide.

A statement on the decision from California Health and Human Services (CHHS) Secretary Dr. Mark Ghaly is available here.


Cal/OSHA Delays Action on Relaxing COVID-19 Workplace Restrictions

On Thursday, the California Occupational Safety and Health Standards Board (OSHSB) postponed a scheduled vote on the Cal/OSHA Emergency Temporary Standard (ETS) proposal that would have allowed individuals to return to workplaces without physical distancing or face coverings if all individuals in the workplace are vaccinated. The delay came at the request of Cal/OSHA leadership that OSHSB not vote to approve the current proposed standards following this week’s earlier announcement from the California Department of Public Health (CDPH) indicating that guidance for the use of face coverings would be relaxed in nonworkplace settings on June 15.

With the delay, Cal/OSHA requested OSHSB to allow Cal/OSHA to present a new proposal at a future meeting, which is anticipated to occur on June 3. A revised Cal/OSHA proposal is anticipated to be made public by May 28.

Additional information from Cal/OSHA is available here.


Newsom Administration Unveils Employer COVID-19 Vaccination Toolkit

This week, the Newsom Administration announced the state’s new Employer Vaccination Toolkit, which is intended to improve the process for employers to request a local provider partner or workplace COVID-19 vaccination clinic. The Employer Vaccination Toolkit provides employers with vaccine education materials, information on COVID-19 Supplemental Paid Sick Leave and other employee guidance, and an online form to request vaccination support. There will be no financial cost to employers.

Employers requesting a vaccination clinic or provider partner will have their request reviewed by the state within three business days; if approved, CDPH will provide the employer a list of local vaccination partners able to support their request. Before the state approves the employer request, CDPH intends to contact the applicable local health department to first determine if local public health can support the employer request.

Additional information on the Employer Vaccination Toolkit is available here.


CAPH Issues Report on Equitable Distribution of COVID-19 Vaccines

The California Association of Public Hospitals and Health Systems (CAPH) and the California Health Care Safety Net Institute (SNI) recently released a report detailing recommended practices for equitable distribution of the COVID-19 vaccine.

California’s public health systems have been undertaking efforts to vaccinate community members of color, low-wage essential workers, and other most at-risk populations impacted by the COVID-19 pandemic. To further these efforts, the California Health Care Safety Net Institute (SNI) conducted interviews with California’s public health care systems to better understand their successful outcomes.

The report shares three key strategies, including tips and real-world examples of how counties can reach higher numbers to vaccinate our most at-risk communities. The first key strategy included public health care systems partnering up with community and faith leaders, organization, unions, and employers which constituents and community members often have trusted relationships with. Second, public health systems would need to employ a mix of approaches to ensure consistent geographic coverage deep within communities and to target subpopulations. Lastly, blanketing counties and health systems with multimedia and multilingual communications and engagement would increase the community’s volume in vaccine acceptance.

For further strategies and examples, you can find more information here.


San Joaquin County Public Health Services Awarded PHAB Accreditation

We are pleased to announce that the San Joaquin County Public Health Services was awarded accreditation status by the Public Health Accreditation Board (PHAB) on May 19, 2021. San Joaquin County becomes the 19th local health department awarded PHAB recognition in California, in addition to the California Department of Public Health (CDPH).

Please join us in congratulating our colleagues in San Joaquin County on their accomplishment. Additional information on the announcement can be found here.


ITUP Issues 2021 Regional Health Coverage Fact Sheets

The Insure the Uninsured Project (ITUP) recently issued its 2021 Regional Health Coverage Fact Sheets. Each year, ITUP releases “Coverage at a Glance” regional health coverage fact sheets for its 11 ITUP Regional Workgroup locations.

This year, the ITUP Regional Health Coverage Fact Sheets included race/ethnicity data for each county including the county’s uninsured population. These publications provide data, facts, and graphics, as well as a breakdown of state/county enrollment in Medi-Cal and Covered California, including enrollment by health plan.

The ITUP Coverage at a Glance Fact Sheets are available here.