May 25, 2018 Edition

CHEAC Office Closed on Monday, May 28

The CHEAC Office will be closed on Monday, May 28 in observance of the Memorial Day holiday. We will resume normal operations on Tuesday, May 29.

Monterey County Awarded Accreditation Status

We are pleased to announce that the Monterey County Health Department was awarded national public health accreditation status by the Public Health Accreditation Board (PHAB) last week.  Monterey County becomes the 12th local health department awarded PHAB recognition in California, in addition to CDPH.

Please join us in congratulating all of the hard work and success of our colleagues in Monterey County. Additional information on PHAB, as well as the press release, is available here.

Fiscal Committees Hold Suspense File Hearings

Fiscal Committees Hold Suspense File Hearings

Today marks the deadline for fiscal committees to hear and report bills in their house of origin. Both the Senate and Assembly Appropriations Committees reviewed a number of bills in Suspense File hearings this week. Below, we highlight actions of interest to CHEAC Members.

An updated version of the CHEAC Weekly Bill Chart is available here.

Environmental Health

AB 1964 (Maienschein) – Oppose Unless Amended – Held on Suspense

AB 1964, by Assembly Member Brian Maienschein, originally sought to add day camps to the existing definition of organized camps, thereby creating an additional mandate on local enforcement agencies. CHEAC took an ‘oppose unless amended’ with a county coalition consisting of HOAC, CSAC, UCC and RCRC, and specifically sought amendments to limit the role of the local enforcement agency to solely the health and sanitation aspects of a day camp. The bill was subsequently amended in the Senate Health Committee to create a new definition for organized day camps in statute and would require local enforcement agencies to issue a health and sanitation permit to day camps with food service.

Though the amendments were a step in the right direction, CHEAC and our county colleagues continued to maintain our ‘oppose unless amended’ position and sought additional provisions to: 1) clarify the definition of organized day camps; and 2) to clarify the role of the local enforcement agency in overseeing a day camp without a facility and/or fixed location. No new amendments were offered by the author’s office. The bill was held on suspense in the Assembly Appropriations Committee and will not move forward in the legislative process.

CHEAC would like thank our members and county colleagues for sending letters, engaging with members of the legislature, and supporting our advocacy efforts on this bill.

Health Care Coverage/Health Care Reform

AB 2430 (Arambula) – Support – Passed

Would expand Medi-Cal eligibility for seniors or disabled individuals from 100% FPL up to 138% FPL.

AB 2965 (Arambula) – Support – Passed with amendments

Would expand Medi-Cal eligibility to all undocumented adults with income at or below 138% FPL. Amendments would narrow the eligibility to adults ages 19-25, conforming to the actions taken by the Assembly budget subcommittee.

AB 2275 (Arambula) – Support – Passed

Requires DHCS to establish a quality assessment and performance improvement program for all Medi-Cal managed care plans to improve quality and reduce health disparities beginning in January 2021.

SB 945 (Atkins) – Support –Passed

Eliminates caps on the period of coverage for the Breast and Cervical Cancer Treatment program and allows coverage for the duration of treatment.

SB 1023 (Hernandez) – Support – Passed with amendments

Clarifies that health care service plans, health insurers and Medi-Cal managed care plans may cover sexual and reproductive health services provided through telehealth services. Amendments would make it contingent upon federal approval.

SB 1264 (Stone) – Support– Passed

Requires specified hypertension medication management services to be included as a Medi-Cal covered pharmacist benefit.

SB 974 (Lara) – Support – Passed with amendments

Expands Medi-Cal eligibility to all undocumented adults with income at or below 138% FPL. Amendments would make the bill conform to the senate budget proposal, which narrows the expansion to individuals over age 65. Amendments also make the bill contingent upon appropriation.

Drug and Alcohol Services

AB 1751 (Low) – Support – Passed

Allows the CA Department of Justice to enter into an agreement to participate in an interstate data-sharing hub for prescription drug monitoring program information sharing.

AB 2328 (Nazarian) – Support – Held on Suspense

Establishes the Youth Substance Use Disorder Treatment and Recovery Program Act. Directs   DHCS, in collaboration with counties and substance use disorder services providers, to establish regulations regarding community-based nonresidential and residential treatment and recovery programs for youth under 21 years of age.

AB 2384 (Arambula) – Support – Passed with amendments

Requires all health plans in CA, including Medi-Cal managed care, to include all FDA-approved medication assisted treatment (MAT) drugs and drugs for the reversal of overdose in their formularies. The bill would also presume MAT to be medically necessary and not subject to prior authorization or limitations. Amendments include a sunset after five years and removing the presumption of being medically necessary.

Injury Prevention

AB 1798 (Chu) – Support – Passed

Requires all school buses to be equipped with a passenger restraint system by 07/2035.

AB 2034 (Kalra)  – Support – Passed with amendments

Requires transit operations entities (bus, train, or light rail) to train employees in recognizing and reporting signs of human trafficking to law enforcement.

SB 1397 (Hill) – Support – Passed

Requires an AED to be provided in existing structures whenever a building permit is obtained for modifications or renovations if the construction meets specified conditions. Exempts facilities owned/operated by local government entities.

Chronic Disease Prevention & Wellness Promotion

AB 1871 (Bonta) – Support – Passed with amendments

Requires charter schools to provide needy pupils with one nutritionally adequate free or reduced-price meal per school day. Amendments would delay implementation and limit the bill to charter schools with classroom-based education.

AB 2434 (Bloom) – Support – Passed

Establishes the Health in All Policies Program within the Strategic Growth Council.

SB 1275 (Stern) – Support – Held on Suspense

Establishes the Plan Against Hunger Program within the Student Aid Commission and would require the Commission to provide awards to eligible Cal Grant B students equal to the amount of the cost of a meal plan providing 10 meals per week.

Maternal, Child and Adolescent Health

AB 2289 (Weber) – Support – Passed

Sets forth accommodation rights of pregnant and parenting pupils.

AB 2785 (Rubio) – Support – Passed with amendments

Requires by 01/2020 all California Community Colleges and the California State University to provide reasonable accommodations on all campuses for a lactating student to express breastmilk, breastfeed an infant, or address other breastfeeding needs.

Communicable Disease Control

AB 2601 (Weber) – Support – Passed

Requires charter schools to ensure all enrolled students in grades 7-12 receive comprehensive sexual health and HIV prevention education.

AB 2892 (Quirk) – Support –– Passed with amendments

Establishes the CA Mosquito Surveillance & Research program within CDPH. Amendments would limit funding to private funds.

Health Equity

AB 3085 (Calderon) – Support if Amended – Passed with amendments

Establishes the New Beginnings California Program within the Department of Community Services and Development to provide matching funds to cities, counties, and continuum of care programs to implement, expand, and continue employment programs for homeless individuals.

SB 900 (Wiener) – Support – Passed with amendments

Requires DSS to establish a minimum of three grants to pilot a supplemental benefits mechanism for the purchase of California-grown fresh fruits and vegetables using CalFresh EBT in authorized retail settings, including at least one farmers market. Amendments would authorize the creation of a new fund, delay reporting and create a sunset date.


SB 835 (Glazer) – Support – Passed

Bans smoking and disposal of cigar/cigarette waste at all state parks.

SB 836 (Glazer) – Support – Passed

Bans smoking and disposal of cigar/cigarette waste at all state coastal beaches.

Access to Health Services

SB 1125 (Atkins) – Support – Passed with amendments

Authorizes Medi-Cal reimbursement to FQHCs and RHCs for two visits in the same day if the visit includes a medical visit and a mental health or dental visit. Amendments would make the bill contingent upon appropriation.


Assembly Sub. 1 Votes on Remaining Issues

This week, Assembly Budget Subcommittee No. 1 on Health and Human Services concluded their work with a final vote-only hearing to close-out all remaining open issues. Key actions of interest to CHEAC members are provided below.

Proposition 56 – Local Tobacco Program and Oral Health Program Rollover.  The Administration’s May Revision proposed converting specific accounts under Proposition 56 to a continuous appropriation, which would allow rollover for both local oral health and tobacco programs. The Senate approved the transfer of the accounts related to oral health and local tobacco programs to continuous appropriations with the requirement to adopt placeholder language directing the California Department of Public Health to grant rollover for up to three years. However, the Assembly denied the Administration’s proposal for a continuous appropriation and instead adopted placeholder trailer bill to ensure counties could rollover Proposition 56 funds that flow through the California Department of Public Health for three years. This issue will move to the Budget Conference Committee.

Elimination of 340B Drug Purchasing in Medi-Cal. The Administration’s May Revision maintained their proposal to eliminate 340B Drug Purchasing in Medi-Cal. The Administration estimated the savings to be merely $16.6 million in annual General Fund savings beginning in 2021. The Assembly Subcommittee rejected the Administration’s proposal. This conforms with Senate action.

SubjectItemAssembly Sub. 1 Actions and Comments
Continuous Glucose Monitors in Medi-Cal$13 million ($6.5 m GF) ongoing and placeholder trailer bill to establish continuous glucose monitors as a covered benefit in Medi-Cal. Approved
Dental Benefit$12 million ($6 m GF) ongoing and placeholder trailer bill language to add silver diamine fluoride as a Medi-Cal covered benefit.Approved
Asthma Home Visiting$1 million General fund annually and placeholder language to clarify/ensure medically necessary asthma education and home assessments for poorly controlled asthma are a covered Medi-Cal benefit. Approved

Senate approved a similar proposal.
BCCTP Treatment Limitations$8.4 million General Fund in 2018-19, $10.5 million in FY 2019-20, $8.5 million in FY 2020-21, $7.6 million in 2021-22 and $6.9 million ongoing to remove the limitations and expand coverage for the duration of the illness. Compliments SB 945 (Atkins) – CHEAC SupportedApproved.

Conforms with Senate Action
Substance Use Screening Tool Expansion$2.6 million General Fund ongoing to placeholder language to expand the SBIRT to authorize screening for misuse of opioids and other drugs.Approved
Homeless Mentally Ill Outreach and TreatmentThe Governor’s May Revision proposed $50 million in one-time General Fund for the California Department of Public Health to provide counties with targeted funding for multi-disciplinary teams to support intensive outreach, treatment and related services for homeless individuals with mental illness.Approved with modification to allow cities with Whole Person Care Pilots to be eligible.

Senate took similar action.
Valley Fever$1 million for an outreach and awareness campaign for Valley FeverApproved

Senate approved $1 million for the awareness campaign and additional funding for the Valley Fever Institute.
STD Prevention$10 million to support the work of local health jurisdictions to prevent the spread of STDs. Approved
Hepatitis C Prevention$6.6 million ongoing and placeholder trailer bill to implement Hepatitis C prevention efforts. Approved
HIV/AIDS Prevention• $10 million General Fund ongoing for HIV prevention services.
• $2 million General Fund for three years for a demonstration project specific to HIV and transgender women
• $3 million General Fund over three years for a demonstration project specific to HIV and older adults
• $1million General Fund ongoing for provider education
• $2 million and trailer bill to modify PrEP to provide more comprehensive coverage.
Assembly approved all actions.

Senate approved similar proposals.
Opioid Treatment Navigation$11 million General Fund ongoing as follows:
• $7.7m grants to harm reduction programs for treatment navigation
• $1.5m for staff training and capacity building for harm reduction programs
• $1.76 million for state administration
Approved with placeholder trailer bill.
Adverse Childhood Experiences$15 million MHSA funds to establish a three-year pilot in 12 cities and counties to test public health approaches to preventing childhood trauma and countering the effects.Approved
Diabetes Awareness$10 million one-time General Fund for a 24-month diabetes awareness campaign Approved
CalWORKs Home Visiting$158. million over three years to implement a home visiting program in CalWORKs. Approved placeholder language and funding.
Fruits and Vegetables EBT PilotStakeholder request for $9 million one-time General Funds for the CalFresh Fruit and Vegetable EBT Pilot to increase consumption of fresh fruits and vegetables for low income residents in seven community-based pilots.Approved

Conforms to Senate action.

Senate Budget and Fiscal Review Committee Adopts Budget

This week, the Senate Budget and Fiscal Review Committee, chaired by Senator Holly Mitchell met to close out final items not addressed by the Subcommittees and to adopt the Senate’s budget package. Senator Mitchell commended the work of the subcommittees which convened a total of 61 hearing. She emphasized that the Senate budget reflects a balanced approach and is responsible, honest and continues to make progress. She also noted the investments reflect the Senate’s commitment to ensuring the budget addresses the critical needs of California.

The Senate utilized the General Fund and property tax revenue estimates put forward by the Legislative Analyst’s Office, which results in a greater revenue than the Administration’s estimates.

Subcommittee chairs provided highlights from their work, which included a $483.9 million investment for wildfire prevention and mitigation, increased child care rates, expanded Medi-Cal eligibility for special persons with disabilities and undocumented seniors. Senator Pan noted benefit restorations, increased reimbursement rates and the rejection of the Administration’s proposal to eliminate the 340B drug purchasing program within Medi-Cal, among other investments.

Once the Assembly adopts their full budget, the Budget Conference Committee will begin to reconcile the differences between the two houses.

2018-19 Budget Conference Committee Members Announced

The 2018-19 Budget Conference Committee will be co-chaired by respective budget committee chairs Senator Holly Mitchell and Assembly Member Philip Ting. Conference Committee members include Senators Nancy Skinner, Richard Roth, Jim Nielsen, and John Moorlach and Assembly Members Joaquin Arambula, Richard Bloom, Rocky Chávez, and Jay Obernolte.

The Assembly is expected to adopt their full budget next Tuesday. Budget Conference Committee hearings are expected to begin soon after to reconcile differences between the two houses.

Feds Clarify Hemp Policy for Alcohol Beverage Products

Earlier this week the federal Alcohol and Tobacco Tax and Trade Bureau (TTB) released an FAQ clarifying that the Bureau will not approve any formulas or labels for alcoholic beverages that contain a controlled substance including cannabis.  TTB notes that tetrahydrocannabinols (THC), cannabidiols (CBD), or terpenes that are derived from cannabis plants but are not specifically excluded from the Controlled Substances Act (CSA) are considered controlled substances.  They also note that the definition of cannabis in the CSA specifically excludes specific substances considered “hemp” ingredients such as hemp seed oil, sterilized hemp seeds, and non-resinous, mature hemp stalks.  Any product that contains one of these hemp ingredients must be clearly labeled in a way that the ingredient is not a controlled substance nor may it create the misleading impression that the product contains a controlled substance or has effects similar to those of a controlled substance.  The TTB also makes clear that any alcoholic beverage formula containing hemp ingredients requires formal approval from the TTB prior to use in the production of the product.