May 3, 2019 Edition

Assembly Budget Subcommittee No. 1 hears STD, CHVP and BIH Proposals

On Monday, the Assembly Budget Subcommittee No. 1 on Health and Human Services continued to hear the Governor’s January budget proposals. This hearing focused on issues under the purview of the California Department of Public Health (CDPH) and included three key proposals of interest to local health departments. Highlights are provided below.  

STD Funding. Dr. Gil Chavez, Deputy Director for the Center for Infectious Diseases at CDPH presented the Administration’s request for $2 million ongoing General Fund beginning FY 2019-20. Recall, this builds upon the one-time funding that was included in the FY 2018-19 enacted budget. Dr. Chavez highlighted the increased rates of STDs in California and the related health disparities that exist. He further underscored the need for ongoing funding and the great work local health departments have done to date.

The Legislative Analyst’s Office (LAO) noted that the amount of $2 million does not have an analytic basis, but instead is simply a continuation of the funding passed in last year’s budget and mentioned their interest in working with the Department of Finance and others to determine the appropriate level of STD funding needed in our State.

CHEAC expressed support for the Governor’s proposal while also noting that the amount of investment local health departments need to address communicable diseases, including STDs, is much greater.

California Home Visiting Program (CHVP). CDPH representatives from the Center for Family Health at CDPH provided members with a brief overview of the Administration’s proposal to provide $23 million ongoing  General Fund to increase participation in CHVP, expand to additional jurisdictions and utilize additional evidence-based home visiting models. During their presentation, CDPH provided a three-year timeline for the funding. In year one, CDPH would provide additional funding to existing sites. In year two, CDPH would expand into new counties. In year three, CDPH would expand the number of evidence-based models that could be utilized. The budget subcommittee asked CDPH to comment on whether these activities could overlap in year 1. CDPH indicated that preparation activities would overlap in year 1 but did not express a reconsideration of the timeline.

Acting Chair Reyes also expressed considerable concern with her county not being one of the counties that receive CHVP funding currently and further expressed an interest in understanding the criteria to be used to expand to additional counties. Members continued to question CDPH’s approach in both selecting counties to expand to and with selecting additional models. CDPH referenced their ongoing discussions with local MCAH directors in informing CDPH’s process.

CHEAC shared our support for the ongoing investment in CHVP and expressed an interest in engaging in discussions around the State’s approach.

Black Infant Health (BIH). CDPH representatives presented the Governor’s proposal to provide $7 million to local health departments to expand the BIH program. CHEAC expressed support for the Governor’s additional investment into the BIH program, but also shared concerns around the current prescriptive nature of the program and the need for additional flexibility in implementing interventions. Acting Chair Reyes voiced her appreciation for the comment around flexibility and asked CDPH about whether that could be incorporated. CDPH discussed the work of the Perinatal Equity Initiative (PEI) and indicated their desire to use the PEI data to potentially inform new strategies.

All items were held open.

Meeting materials can be found here.
link to the hearing can be viewed here.

Governor’s Healthy California For All Commission Heard in Senate Sub. 3

On Thursday, the Governor’s proposal to rename and refocus the Council on Health Care Delivery Systems (Council), established by the 2018 Budget Act, to the Healthy California For All Commission (Commission) was heard in the Senate Budget and Fiscal Review Subcommittee No. 3 on Health and Human Services.  

The California Health and Human Services Agency (CHHSA) provided a brief overview of the proposal, including reverting the $5 million expenditure authority for the current Council and providing it instead to the Commission. Commission membership would be expanded to 13 members and would include the  Secretary of CHHSA, six members appointed by the Governor, three members appointed by the Senate Rules Committee, three members appointed by the Speaker of the Assembly and three ex-officio members (the Executive Director of Covered California, Director of the Department of Health Care Services, and the Chief Executive Officer of the Public Employees’ Retirement System).

CHHSA noted two reports that would be required of the Commission. The first report would be due July 2020 and would be an analysis of California’s existing health care delivery system and options for preparing to transition to a single-payer system. The second report would be due in 2021 and would detail options for key design considerations. Key components of that report would include eligibility and enrollment, benefits, provider participation and payments, cost containment, governance and administration, information technology investments, and the integration of federal spending on health care in California.

The Legislative Analyst’s Office (LAO) noted the proposal represents a shift in the focus for the Commission and that previously activities were broader in understanding health care delivery systems and exploring various alternatives. The LAO indicated this proposal recasts and focuses the work on now bringing California into a single-payer system.

The Legislature raised questions around how the $5 expenditure authority would be utilized; however, a detailed plan was not presented at this time.

A link to hearing materials can be found here.

Trailer bill language can be found here.

Legislature Continues Bill Hearings, Reaches Deadline for Non-Fiscal Bills

This week, the California Legislature continued a steady pace of committee hearings as it begins to shift its focus toward floor sessions and budget deliberations which will occur throughout the month of May. Today marks the deadline for bills without a fiscal impact to be heard in policy committees and advanced to the floor of their house of origin. Recall, bills with a fiscal impact had to be acted upon by last Friday’s deadline. While the bulk of measures proposed by lawmakers have a fiscal impact, a number of non-fiscal measures made their way through committees this week.

Below, we highlight several actions on bills of interest to CHEAC Members. The latest edition of the CHEAC Weekly Bill Chart is available here.

Access to Health Services

AB 1494 (Aguiar-Curry) as amended April 11, 2019 – SUPPORT

AB 1494 by Assembly Member Cecilia Aguiar-Curry would require Medi-Cal reimbursement for services provided by community clinics or fee-for-service providers via telehealth, telephone, or off-site (such as a shelter or home) during or within 90 days after expiration of a state of emergency. The measure was set for hearing in the Assembly Appropriations Committee on Wednesday. Assembly Member Aguiar-Curry waived presentation, and the measure was placed on the Suspense File.

Emergency Medical Services (EMS)

AB 1544 (Gipson) as amended April 22, 2019 – OPPOSE UNLESS AMENDED

Assembly Member Mike Gipson’s AB 1544 would enact the Community Paramedicine or Triage to Alternate Destination Act to allow local emergency medical services agencies (LEMSAs) to develop local community paramedicine programs. The measure requires LEMSAs to use or establish local emergency medical care committees (EMCCs) and establishes the Community Paramedicine Medical Oversight Committee to advise the EMS Authority on and to approve minimum medical protocols for all community paramedicine programs, among other activities. The measure was scheduled for hearing in the Assembly Appropriations Committee on Wednesday. Assembly Member Gipson waived presentation, and the measure was placed on the Suspense File.

SB 438 (Hertzberg) as amended May 2, 2019 – OPPOSE

SB 438 by Senator Robert Hertzberg was heard in the Senate Health Committee on Wednesday. The measure would restrict the use of non-governmental-operated public safety answering points (PSAPs), including 9-1-1 EMS dispatching centers. The measure would allow municipal agencies providing EMS services in their jurisdictions to circumvent existing medical control oversight responsibilities of LEMSA medical directors. Witnesses from CSAC, EMSAAC, and EMDAC provided lead testimony in opposition to the bill. CSAC, RCRC, UCC, CHEAC, EMSAAC, and EMDAC are all opposed to the measure. The measure was advanced to the Senate Floor on a unanimous 9-0 vote.

Health Coverage/Health Care Reform

AB 4 (Bonta) as amended March 28, 2019 – SUPPORT

Assembly Member Rob Bonta’s AB 4 would expand Medi-Cal coverage to all undocumented adults with income at or below 138 percent of the federal poverty level (FPL). The measure was scheduled for hearing in the Assembly Appropriations Committee on Wednesday. Assembly Member Bonta waived presentation, and the measure was placed on the Suspense File.

AB 414 (Bonta) as introduced on February 7, 2019 – SUPPORT

AB 414 by Assembly Member Rob Bonta was set for hearing in the Assembly Appropriations Committee on Wednesday. The measure would establish a state-level individual health insurance coverage mandate in California and would require Covered California to determine a penalty for not obtaining health insurance. Revenues generated from fines would be directed toward improving the affordability of coverage in California. Assembly Member Bonta waived presentation, and the measure was placed on the Suspense File.

Maternal, Child, and Adolescent Health Services (MCAH)

SB 464 (Mitchell) as amended April 11, 2019 – SUPPORT

SB 464 by Senator Holly Mitchell would require specified health facilities providing perinatal care to implement an implicit bias program for all health care providers involved in perinatal care within those facilities. Hospitals would be required to provide patients with information on filing a discrimination complaint, and CDPH would be required to track and publish specified maternal morbidity and mortality data, among other activities. SB 464 was set for hearing in the Senate Appropriations Committee on Monday. Senator Mitchell waived presentation, and the measure was placed on the Suspense File.

JLAC, Assembly Health Committee Convene Joint Informational Hearing on State Auditor Report on Preventive Health Services for Medi-Cal Children

On Tuesday, the Joint Legislative Audit Committee (JLAC) and the Assembly Health Committee convened an informational hearing related to California State Auditor Elaine Howle’s recent report, “Department of Health Care Services: Millions of Children in Medi-Cal Are Not Receiving Preventive Health Services.” Recall, the audit report, released in March, determined that an average 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 further examined other screening rates, including immunization goals, and options available to DHCS to compel Medi-Cal health plans to meet established performance levels.

Tuesday’s joint JLAC and Assembly Health Committee hearing featured an overview of the report and findings by State Auditor Elaine Howle and a key member of her staff. Ms. Howle detailed key recommendations for consideration by legislators and DHCS around access standards, reimbursement rates, contracting, performance standards, and internal audit procedures.

DHCS Director Jennifer Kent also appeared as a witness in the hearing, providing an overview of DHCS activities undertaken as a result of the Auditor’s findings and other initiatives related to preventive services and screenings as part of the Governor’s proposed budget. Director Kent further detailed key modifications to DHCS practices and procedures in an attempt to increase Medi-Cal preventive service utilization, screening, and health plan compliance. Committee members questioned Director Kent on a broad array of topics, including provider reimbursement rates and incentives, performance metric oversight, and regional disparities in preventive health services access and utilization, and informational technology challenges.

A stakeholder panel rounded out the hearing, featuring representatives from health plans and insurers, health care providers, and patient organizations. The hearing agenda may be accessed here. A recording of the hearing is available here.

CAPF Wellness Trust Proposal to be Featured on Webinar Next Week

The California Alliance for Prevention Funding (CAPF) Wellness Trust Proposal will be featured on a Dialogue4Health Web Forum next Tuesday, May 7 from 11:00 am-12:00 pm. CAPF is a coalition of 20 statewide organizations, including CHEAC, advocating for the creation of a California Wellness Trust to provide sustained funding for public health prevention activities. Next week’s webinar will provide an overview of CAPF’s draft proposal to create a wellness trust, detail community successes and challenges in prevention activities, and actions needed to make the California Wellness Trust a reality. Registration for the webinar is available here.

National Opioid Leadership Summit Registration Now Open

Registration for the National Opioid Leadership Summit, hosted by the Public Health Institute (PHI), is now open. The summit will be held on Tuesday, June 25 in Sacramento and will provide opportunities for attendees to learn about, share, and collaborate on solutions to the opioid crisis that bridge criminal justice, health care, and public health sectors. The event will feature a keynote address by U.S. Surgeon General Jerome Adams, as well as a number of other speakers from the U.S. Centers for Disease Control and Prevention (CDC), the Trust for America’s Health (TFAH), and the California Health Care Foundation (CHCF).

Additional information and registration details are available here.

CA Budget and Policy Center Releases Brief on Improving Maternal Mental Health in California

On Wednesday, the California Budget and Policy Center (CBPC) released a brief, “Strategies to Improve Maternal Mental Health in California.” The brief examines the impact of untreated maternal mental health conditions on short- and long-term maternal and child health outcomes, including significant medical and economic costs. CBPC finds mothers of color and mothers with lower incomes in California are more likely to experience prenatal and postpartum depressive disorders. To improve upon rates of adverse maternal mental health conditions, the brief discusses a number of strategies, including home visiting programs, anti-poverty initiatives, and other support services. The report is rounded out by an overview of current legislative and budget proposals under consideration in California. The CBPC brief is available here.

Health Affairs Issues Two Policy Briefs on Early Child Health Initiatives

Health Affairs this week published two health policy briefs as part of its ongoing series, funded by the Robert Wood Johnson Foundation, on the social determinants of health. The briefs are intended to provide readers with a comprehensive examination of evidence, research, and potential policy interventions that are fundamental to advancing a culture of health. This week’s briefs include:

  • Early Childhood Home Visiting Programs and HealthThis brief examines childhood home visiting programs and their role in connecting new and expectant parents with support services, screenings, case management, and caregiver skills training. Researchers have found that various home visiting programs have resulted in fewer preterm and low-birthweight babies, more children adequately immunized and completing well-child visits, greater achievement of developmental milestones, fewer child emergency department visits, and better maternal physical and mental health outcomes. The brief also indicates that current federal funding for such programming is insufficient to meet the need and calls for an innovative and sustainable approach to delivering these critical services.
  • The Effects of Early Care and Education on Children’s HealthThis brief examines the landscape of nonparental early care and education (ECE) services, including center-based care, public and private preschool, and Head Start. The brief acknowledges that the outcomes of ECE on children’s educational and behavioral outcomes are well-studied, but research on the impacts of children’s health is a nascent subject. While ECE programs are not necessarily designed to improve child health, a growing body of research indicates that such programming may lead to short- and long-term improvements in health-related outcomes for participants. An extended summary of key studies in the area of health impacts of ECE is included as part of the brief.

Additional information on Health Affairs, including additional health policy briefs, is available here

NASEM to Host Workshop on California Wildfires and Health Impacts

The National Academies of Sciences, Engineering, and Medicine (NASEM) has announced it will host a two-day in-person workshop, “Implications of the California Wildfires for Health, Communities, and Preparedness.” The collaborative public workshop will be held on June 4 and 5 in Sacramento and will convene experts to address a series of topics related to public and environmental health, emergency preparedness, and public initiatives and services.

Objectives of the workshop include:

1) Assist in the identification of the current scale and probability of subsequent wildfires in high risk regions in the West, including but not exclusively in the state of California

2) Describe and define potential disproportionate deleterious outcomes on vulnerable populations in the geographic areas identified

3) Explore the residual and chronic health consequences resulting from wild fires, including respiratory and cardiovascular disease caused by released atmospheric particulate matter, housing displacement, and post traumatic psychological distress

4) Identify challenges resulting from the increased scale and population of the urban-wildland interface, and explore opportunities to increase community and individual preparedness in the face of the wildfire threat

5) Suggest opportunities for improved institutional and government actions and steps to mitigate the adverse and disproportionate impact of wildfires on vulnerable populations, including community preparedness, resilience and capacity building before, during, and after wildfires.

Additional information on the workshop, including registration, resources, and a forthcoming agenda, is available here.

NASEM Publishes Resources on Health System Interventions to Prevent Firearm Injuries and Deaths

This week, the National Academies of Science, Engineering, and Medicine (NASEM) published proceedings and an infographic on its recent workshop, “Health Interventions to Prevent Firearm Injuries and Death.” NASEM indicates that firearm injuries and death remain a serious public health concern throughout the U.S., burdening individuals, communities, and health care systems. The materials examine possible roles of health entities and health systems in addressing the ongoing epidemic of firearm injury and death in the U.S.

The Proceedings of a Workshop detail speakers’ presentations on research and programs to prevent firearm injury and death, as well as discussion of the potential role of health systems. A digital overview and infographic of the workshop is available here. Additional information on NASEM’s work on firearm injuries and death is also available here.