October 18, 2019 Edition

Newsom Takes Final Actions on Measures, Concludes 2019 Legislative Year

Governor Gavin Newsom on Sunday met the deadline for the governor to sign or veto bills passed by the Legislature on or before September 13, officially concluding the 2019 legislative year. In total, over 2,600 measures were introduced by the Senate and Assembly. Of those introduced, 870 bills were signed into law and 172 bills were vetoed. This year was marked by a number of big-ticket items, including health coverage expansions, homelessness and housing, clean water and environmental protections, labor, and education.

Measures that were not advanced during this year’s legislative session and became two-year bills will be eligible to be taken up for action upon the Legislature’s return in January 2020. Our final CHEAC Bill Chart detailing all tracked measures and final actions is available here. Below, we highlight a number of measures of interest to CHEAC Members.

Access to Health Services

AB 1494 (Aguiar-Curry) – SUPPORT – Chapter 829, Statutes of 2019

Governor Gavin Newsom signed Assembly Member Cecilia Aguiar-Curry’s AB 1494 which will provide Medi-Cal reimbursement for telehealth, telephonic, or off-site services during or up to 90 days after termination of a state of emergency, as deemed appropriate by the Department of Health Care Services (DHCS). Services must be delivered by an enrolled community clinic, including a county or city clinic exempt from licensure, or a fee-for-service (FFS) Medi-Cal provider. The measure also requires DHCS to issue guidance to facilitate reimbursement for these services.


SB 305 (Hueso) – WATCH – Vetoed by Governor

SB 305 by Senator Ben Hueso was vetoed by Governor Newsom. The measure would have prohibited a health care facility from prohibiting a terminally ill patient’s use of medical cannabis within a health care facility. The measure defined health care facilities as licensed general acute care hospitals, special hospitals, skilled nursing facilities, congregate living health facilities, or hospice. SB 305 would have permitted a health care facility to reasonably restrict the way a patient stores and uses medical cannabis. The bill also would have prohibited smoking or vaping as methods to use medical cannabis. The California Department of Public Health (CDPH) and the California Hospital Association were opposed to the measure.

In his veto message, Governor Newsom expressed concerns with the “federal government’s ludicrous stance” on medicinal cannabis and cited the potential for significant conflicts between federal and state law, particularly as it relates to federal reimbursement from the U.S. Centers for Medicare and Medicaid Services (CMS).

Communicable Disease Control

AB 262 (Gloria) – WATCH – Chapter 798, Statutes of 2019

AB 262, authored by Assembly Member Todd Gloria, was signed by Governor Newsom. The measure was prompted by the Hepatitis A outbreak in San Diego in 2017 and requires local health officers (LHOs), during a communicable disease outbreak or imminent threat of an outbreak or an epidemic, to promptly notify and update governmental entities within their jurisdiction about communicable disease outbreaks that may impact them. This notification is required if, in the opinion of the LHO, action or inaction by the governmental entity might affect outbreak response efforts.

AB 283 (Chu) – WATCH – Vetoed by Governor

Assembly Member Kansen Chu’s AB 283 was vetoed by Governor Newsom. The measure would have increased the number of days that CalWORKs applicants and recipients have to provide documentation that all children in the assistance unit who are not required to be enrolled in school have received all age-appropriate immunizations from 30 to 60 days. The measure would have also increased the period for a good-cause extension from 30 to 60 days, as specified.  AB 283 would have allowed the California Department of Social Services (CDSS) to authorize counties to exclude the needs of all parent or caretaker relatives in the assistance unit from the grant after a 60-day grace period until documentation is provided. The measure would have also eliminated current law that allows personal belief exemptions from immunizations for these CalWORKS applicants or recipients. Governor Newsom in his veto message cited the likely increase in General Fund costs by more than $10 million annually as his reason for rejecting the bill.

SB 159 (Wiener) – SUPPORT – Chapter 532, Statutes of 2019

SB 159, authored by Senator Scott Wiener and sponsored by the California Pharmacists Association and the San Francisco AIDS Foundation, allows pharmacists to furnish at least a 30-day supply and up to a 60-day supply of PrEP and PEP to patients without a physician’s prescription. To do so, the pharmacist must complete specified training, screen the patient, provide counseling to the patient, document, to the extent possible, the services provided in the patient’s health record maintained by the pharmacy, and notify the patient’s primary care provider. SB 159 prohibits health plans from placing any prior authorization or step therapy requirements on antiretroviral medications, including PrEP and PEP. Governor Newsom signed the measure into law.

Drug and Alcohol Services

SB 445 (Portantino) – SUPPORT – Vetoed by Governor

SB 445, authored by Senator Anthony Portantino, was vetoed by Governor Newsom. The measure would have placed requirements on DHCS to convene an expert panel to advise the department on the development of youth substance use disorder (SUD) treatment, early intervention, and prevention quality standards for California youth. The bill would have required each county to designate a single public agency be responsible for administering youth SUD treatment services within the county and required the agency to comply with standards adopted by DHCS. Governor Newsom indicated in his veto message that he supported the author’s intent to strengthen SUD treatment services for youth, but the measure’s significant General Fund costs  should instead be considered through the budget process.

Environmental Health

AB 377 (E. Garcia) – SUPPORT – Chapter 536, Statutes of 2019

Governor Newsom signed into law Assembly Member Eduardo Garcia’s AB 377, which is the cleanup measure to AB 626 (Chapter 470, Statutes of 2018) establishing microenterprise home kitchen operations. AB 377 provides clarifying and technical amendments around jurisdictional opt-in procedures, local permitting and inspection activities, and exempted food safety and sanitation provisions. Recall, CHEAC opposed AB 626 last year due to concerns around the potential for increased risks to the public’s health through the operation of microenterprise home kitchens. However, CHEAC supported AB 377 to provide greater clarity on several critical provisions that were enacted through AB 626. AB 377 included an urgency clause and took effect immediately upon Governor Newsom’s signature.

AB 762 (Quirk) –WATCH – Chapter 538, Statutes of 2019

AB 762 by Assembly Member Bill Quirk was signed by Governor Newsom and requires local health officers (LHOs) to conspicuously post and maintain fish and shellfish health warnings at locations where the fish and shellfish may be caught. Posting of the warning is contingent upon an appropriation by the Legislature and an award of grant funding to local agencies, or qualified nonprofit organizations for distribution to local agencies, by the State Water Resources Control Board. LHOs may then request funding to carry out the posting requirement. The Office of Environmental Health Hazard Assessment (OEHHA) is also required to make available to LHOs a digital poster of the health warnings.

Health Coverage/Health Care Reform

AB 414 (Bonta) – SUPPORT – Chapter 801, Statutes of 2019

Governor Newsom signed AB 414 by Assembly Member Rob Bonta which requires the Franchise Tax Board to report to the Legislature specified information on the Minimum Essential Coverage Individual Mandate, Individual Shared Responsibility Penalty, and state financial subsidies paid for health care coverage as were established in the 2019-20 Budget Act earlier this year.

AB 848 (Gray) – SUPPORT – Vetoed by Governor

AB 848, authored by Assembly Member Adam Gray, would have added continuous glucose monitors and related supplies to the schedule of Medi-Cal benefits for diabetes mellitus treatment when medically necessary, subject to utilization controls. AB 848 was vetoed by Governor Newsom due to costs to the General Fund. Governor Newsom acknowledged the importance of the measure but suggested it should instead be considered through the budget process.

SB 260 (Hurtado) – SUPPORT – Chapter 845, Statutes of 2019

Governor Newsom signed SB 260 by Senator Melissa Hurtado which requires, commencing July 1, 2021, Covered California to enroll an individual or individuals using electronic information from Medi-Cal or the Children’s Health Insurance Program in the lowest cost silver Covered California plan. It also requires a health plan or insurer to annually notify an individual that when he or she ceases to be enrolled in coverage, his or her contact information will be provided to Covered California to assist them in obtaining other coverage, or that he or she may opt out of this transfer of information. SB 260 was sponsored by Health Access and Western Center on Law & Poverty.

 Injury Prevention

AB 166 (Gabriel) – SUPPORT – Vetoed by Governor

AB 166 by Assembly Member Jesse Gabriel was vetoed by Governor Newsom. The measure would have required DHCS to establish a violence intervention pilot program at a minimum of nine hospital-based or hospital-linked sites. The measure would have required at least one site in Alameda, Contra Costa, Los Angeles, Monterey, Sacramento, San Bernardino, San Francisco, Santa Clara, and Ventura counties targeted at reducing injury recidivism among Medi-Cal beneficiaries who have been violently injured. The measure specified the violence preventive services to be offered, including care coordination and home and community visitation, to eligible beneficiaries by a qualified violence prevention professional for a minimum of three months and a maximum of 12 months. The measure was sponsored by the Gifford’s Law Center for Prevention of Gun Violence.

In his veto message, Governor Newsom referenced the $30 million in General Fund that was invested into the California Violence Intervention and Prevention (CalVIP) Program this year, as well as his signature on AB 1603 (Wicks) codifying the CalVIP Program into law. Similar to his other veto messages, he recommended the pilot program should be considered through the budget process.

AB 645 (Irwin) – SUPPORT– Chapter 729, Statutes of 2019

Governor Newsom signed into law Assembly Member Jacqui Irwin’s AB 645 that adds language stating, “If you or someone you know is contemplating suicide, please call the National Suicide Prevention Lifeline” with the phone number to existing warning labels on firearms and signage at licensed firearm dealer premises. The measure also requires the Department of Justice (DOJ) firearm safety certificate course and written acknowledgement to cover the topic of suicide prevention.

Jail and Community Corrections

AB 45 (Stone) – WATCH – Chapter 570, Statutes of 2019

AB 45 by Assembly Member Mark Stone was signed into law by Governor Newsom and prohibits a sheriff and other correctional facility administrators from charging a fee for inmate-initiated medical visits or for durable medical equipment (DME) or medical supplies. The measure follows an announcement earlier this year from the California Department of Corrections and Rehabilitation (CDCR) that fees for inmate-initiated medical visits would no longer be charged.

Maternal, Child, & Adolescent Health Services (MCAH)

AB 577 (Eggman) – SUPPORT – Chapter 776, Statutes of 2019

AB 577 by Assembly Member Susan Talamantes Eggman was signed by Governor Newsom. The measure requires health plans and insurers to cover up to 12 months of services associated with the treatment of a maternal mental health condition by a terminated or nonparticipating provider. In an earlier form, the measure sought to extend Medi-Cal eligibility for one year following the last day of an individual’s pregnancy if that individual was diagnosed with a maternal mental health condition. However, the bill was narrowed in its scope as the bill moved through the legislative process. The measure was sponsored by the American College of Obstetricians and Gynecologists (ACOG).

SB 464 (Mitchell) – SUPPORT– Chapter 533, Statutes of 2019

Senator Holly Mitchell’s SB 464 was signed by Governor Newsom and requires specified health facilities providing perinatal care to implement an evidence-based implicit bias program for all healthcare providers involved in perinatal care within those facilities. The measure requires an initial course on the topic and refresher courses at least every two years thereafter. Additionally, the measure requires hospitals to provide patients with information on filing a discrimination complaint.

SB 464 also requires additional information about pregnancy and status of the decedent to be captured in death certificates consistent with data elements on the U.S. Standard Certificate of Death. CDPH would also be required to track and publish specified maternal morbidity and mortality data. The measure includes several recommendations made by CDPH California Pregnancy-Associated Morbidity Review (CA-PAMR), the statewide collaborative tasked with in-depth examinations of pregnancy-related deaths.

Tobacco Control

SB 8 (Glazer) – SUPPORT– Chapter 761, Statutes of 2019

Governor Newsom signed into law Senator Steven Glazer’s SB 8 which prohibits the smoking and disposal of cigar and cigarette waste at all state beaches and state parks. The prohibition includes the use of electronic cigarette products. The measure was amended during the last week of the legislative session at the request of the Newsom Administration to exempt paved roadways and parking facilities and clarify the definition of state beaches. With SB 8 being signed into law, Governor Newsom vetoed the identical AB 1718 (Levine). Recall, both Assembly Member Levine and Senator Glazer carried similar measures over the past several years, all of which either failed to pass the Legislature or were vetoed by then-Governor Jerry Brown.

SB 538 (Rubio) – SUPPORT – Vetoed by Governor

Governor Newsom vetoed SB 538 by Senator Susan Rubio, which would have required electronic cigarette manufacturers to submit to CDPH a written physical description and a photograph of each electronic cigarette sold in California. The California Department of Tax and Fee Administration (CDTFA) would have been required to share with CDPH a list of manufacturers licensed to sell electronic cigarettes in California, and CDPH would have been required to verify all manufacturers are in compliance with the bill’s provisions and post the written product descriptions and photographs online. CDPH would have also been required to coordinate with the California Department of Education (CDE) to notify local educational agencies of the online listing availability.

Governor Newsom in his veto message underscored his Administration’s commitment to confronting the public health crisis from the increasing use and dangers associated with electronic cigarettes, including activities set forth through his recent executive order. Governor Newsom again reiterated his request for a bill from the Legislature banning the flavored vaping products in the coming year. Ultimately, Newsom vetoed SB 538, citing the fees collected from electronic cigarette manufacturers “may not be sufficient to fund the program,” creating General Fund pressures.

Assembly Holds Joint Informational Hearing on Vaping Tobacco and Cannabis Products

On Wednesday, the Assembly Health, Governmental Organization, Business and Professions Committees convened a joint informational hearing titled, “Vaping Tobacco and Cannabis Products: Health Effects and Deficiencies in Regulation and Current Law.” The nearly four-hour hearing was convened amid increasing youth and young adult use of vaping products, ongoing reports of vaping-related illnesses and injuries nationwide, and recent actions at the federal and state levels. Wednesday’s hearing was the first of two hearings that will examine the issues related to tobacco and cannabis vaping, including the health effects and regulatory landscape, featuring expert testimony from medical providers, tobacco and vaping experts, and state government regulators.

The hearing was opened by Assembly Governmental Organization Committee Chair Adam Gray who provided an overview of the current statistics related to vaping, including that vaping has increased from approximately seven million users worldwide in 2012 to over 30 million users worldwide today. Gray referenced the dramatic increase in vaping among youth and young adults, largely fueled by the wide variety of flavored vaping products that have been made available on the market, as well as the number of legislative measures aiming to ensure greater health and safety that were ultimately unsuccessful in passing the Legislature.

Assembly Business and Professions Committee Chair Evan Low discussed the importance of working to protect consumers and enforce current regulations in the tobacco and cannabis industries. Assembly Health Committee Chair Jim Wood further discussed the concerning rise in use of vaping products in California and the U.S. and the emerging public health crisis that must be addressed by the Legislature and Administration.

The hearing featured three expert panels, beginning with Dr. Elisa Tong from the University of California, Davis and Kimberlee Homer Vagadori from the California Youth Advocacy Network to provide an overview of the vaping and electronic cigarette industry, its rapid rise in popularity, and the current regulatory landscape related to the products. The panelists discussed extensively data related to youth tobacco and cannabis use, industry advertising and marketing tactics, youth appeal to vaping products, and sources of access for such products. The panelists also detailed California city and county ordinances related to tobacco products; currently, 44 local ordinances prohibit the sale of flavored tobacco products, three city ordinances prohibit the sale of electronic smoking devices, and one city ordinance prohibits the sale of all tobacco products.

Committee members queried panelists about a number of issues, including tobacco enforcement activities and taxation, whether vaping products are a legitimate alternative to traditional combustible cigarettes, public education initiatives, nicotine content and concentrations, and whether lawmakers should implement more restrictive regulations and laws related to the products or prohibit them outright.

The hearing’s second panel focused on state regulatory actions and necessary improvements, with appearances from the California Department of Public Health (CDPH) Acting Director Susan Fanelli, Bureau of Cannabis Control (BCC) Chief Lori Ajax, California Department of Tax and Fee Administration (CDTFA) Director Nicolas Maduros, and two representatives from the California Office of the Attorney General (OAG). Panelists discussed the role of their respective departments in educating the public about tobacco and cannabis use, regulating industry entities, and enforcing current regulations in retail settings. CDPH Acting Director Susan Fanelli discussed CDPH’s surveillance data related to tobacco and cannabis use, particularly among youth, as well as CDPH’s approach to tobacco education, including the new public awareness campaign related to vaping which was established by Governor Gavin Newsom’s recent executive order and is set to begin next week.

BCC’s Lori Ajax discussed her bureau’s regulatory and enforcement actions, including laboratory testing of cannabis products, seizure of products and operations of unlicensed cannabis retailers, manufacturers, and distributors, and public awareness initiatives related to the purchase of cannabis products from licensed entities. CDTFA’s Nicolas Maduro discussed his department’s activities related to licensure, fees, and taxation of tobacco products, enforcement around counterfeit tobacco and vaping products, and recent directives set forth for CDTFA through Governor Newsom’s executive order. Representatives from the Attorney General’s Office further discussed its enforcement and investigatory actions related to tobacco and cannabis sales, taxation and licensure. Committee members discussed extensively local enforcement activities, strategies for ceasing operations of unlicensed tobacco and cannabis entities, and industry accountability.

Rounding out the hearing was CDPH Acting State Health Officer Charity Dean who provided an update on current vaping-associated pulmonary injury (VAPI) cases statewide. According to CDPH’s most recent data, as of October 15, there have been 78 confirmed and 55 probable VAPI cases; 14 cases are still under investigation. Dr. Dean provided committee members with the health impacts and conditions associated with the VAPI cases, as well as ongoing investigatory actions by CDPH, the U.S. Centers for Disease Control and Prevention (CDC), and the U.S. Food and Drug Administration (FDA).

Public comment largely featured witnesses from the cannabis industry, medical providers and public health-related stakeholders, and business and retailer representatives. With California grappling with the sharp increase in youth vaping, activities by unlicensed cannabis manufacturers and retailers, and recent cases of vaping-associated illnesses and injuries, this issue is all but certain to be a significant issue to be further considered by lawmakers upon their return to Sacramento in January 2020.

The hearing agenda, background paper, and presentations from Wednesday’s hearing is available here. A video recording of the full hearing is available here.

CDPH Releases Healthy Brain Initiative Funding Opportunity for LHDs

Yesterday, the California Department of Public Health (CDPH) Alzheimer’s Disease Program released the new California Healthy Brain Initiative Funding Opportunity Request for Applications (RFA). The RFA process opened October 17 and will close on January 6, 2020. $4.5 million is available to six local health jurisdictions, including up to two rural counties and at least one coastal county, to assist in the following local planning and preparation activities consistent with the U.S. Centers for Disease Control and Prevention (CDC) Healthy Brain Initiative:

  • Monitoring data and evaluating programs to contribute to evidence-based practice.
  • Education and empowerment of the public with regard to brain health and cognitive aging.
  • Mobilizing public and private partnerships to engage local stakeholders in effective community-based interventions and best practices.
  • Ensuring a competent workforce by strengthening the knowledge, skills, and abilities of health care professionals who deliver care and services to people with Alzheimer’s disease and other dementias and their family caregivers.

Recall, this funding was allocated in the 2019-20 Budget Act. The anticipated award term is June 1, 2020, to June 30, 2022. An informational webinar regarding the funding opportunity will be held on Thursday, December 5, 2019 from 10:00 am to 12:00 pm. Additional information and the application for funding is available here.

DHCS Issues Guidance on $20m Funding Opportunity for Non-WPC Counties

The California Department of Health Care Services (DHCS) today issued guidance related to the 2019-20 Governor’s Budget investment of $20 million from the Mental Health Services Fund to encourage additional counties to initiate Whole Person Care-like pilot capacity at the local level. California has successfully established 25 Whole Person Care (WPC) Pilot programs throughout the state to provide target populations with a range of comprehensive services and supports to address unmet needs and improve the quality and outcomes of high-risk populations.

This new one-time funding opportunity provides jurisdictions beyond the current 25 WPC Pilot counties the ability to establish similar programming, care coordination, and services for targeted populations. The funding allocation methodology considers the prevalence of homelessness, geographical cost of living using Fair Market Rent (FMR), and individuals who are mentally ill and are experiencing homelessness using the Point in Time Count (PIT). Funded jurisdictions may perform a series of administrative and programmatic activities such as core program development, planning, and support, IT infrastructure, intensive case management, housing services and supports, non-traditional housing solutions, and purchase of mobile units for mobile health and behavioral health services.

DHCS requests that interested counties submit a letter of interest/application describing how the county intends to use the funding, letters of support from community partners, and a signed Board of Supervisors resolution upon approval of the funding request. Applications are due to DHCS by December 2, 2019, with an expected funding release date of March 31, 2020. Funds will be available for encumbrance or expenditure until June 30, 2025.

Additional information, including an overview, methodology, and application, from DHCS is available here.

UCLA Issues Policy Brief on WPC Care Coordination

Researchers from the University of California, Los Angeles (UCLA) Center for Health Policy Research recently completed an evaluation of the state’s Whole Person Care (WPC) Pilot program, finding that the collaboration among medical, behavioral, and social service providers improves the lives of patients with complex needs. Recall, WPC Pilots are part of the Department of Health Care Services’ (DHCS) 1115 federal waiver and aim to provide quality, comprehensive care to certain Medi-Cal enrollees.

Using data from the first three years of WPC, UCLA found that pilots successfully shared data across providers in different sectors, conducted needs assessments, developed comprehensive care plans, and linked patients to various services. Evaluators further developed a framework that identifies key elements of a successful care coordination model and assessed pilots’ efforts to align with this framework. Elements of success in WPC Pilots include:

  • Developing agreements and protocols for sharing relevant medical, behavioral health, and social services data with partners to facilitate care coordination
  • Including community health workers and/or peers with lived experience to build trust with patients
  • Using in-person, field-based outreach to engage and retail hard-to-reach patients, particularly those experiencing homelessness
  • Accompanying patients to appointments and/or using other active referral strategies to facilitate patient access to care
  • Utilizing multidisciplinary team meetings and/or case conferences to promote communication, learning, and shared accountability for outcomes

The full UCLA evaluation and policy brief is available here.

Alzheimer’s Association to Hold Webinar on Public Health and Aging

The Alzheimer’s Association will host a national webinar on Thursday, October 31 from 11:00 am to 12:00 pm titled, “Addressing Healthy Aging Across the Whole Public Health Agency: A Washington State Case Study.” Webinar participants will learn how the Washington State Department of Health is engaging the agency to create a unified response to healthy aging, what the implementation process has been, and next steps for success. Participants will also hear about new data analysis from the Alzheimer’s Disease and Healthy Aging Program at the U.S. Centers for Disease Control and Prevention. More information and registration for the webinar are available here.