October 2, 2020 Edition
Governor Gavin Newsom met the constitutional deadline to sign or veto bills passed by the Legislature on Wednesday, September 30, officially concluding the 2020 legislative year. During this second year of the 2019-20 legislative session, and despite COVID-19 related interruptions, the Governor signed 457 bills and vetoed 56. This week, the Governor held multiple virtual signing ceremonies for a number of high-profile bills including those addressing racial justice, prescription drugs, and housing.
As this is the second year of the Legislature’s two-year cycle, the Legislature will officially adjourn sine die at midnight on November 30, 2020. The new Legislature, elected in November, will be sworn in and take their seats when Legislative session reconvenes on Monday, December 7.
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 2164 (R.Rivas) – Support – Vetoed by Governor
AB 2164 was vetoed by the Governor. This measure would have authorized Federally Qualified Health Centers (FQHCs) and Rural Health Centers (RHCs) to establish a patient, located within the federal designated service area of the FQHC and RHC, through synchronous interaction or asynchronous store and forward as of the date of service, under specified conditions. And would also sunset 180 days after the termination of the COVID-19 pandemic state of emergency.
In his veto message, the Governor noted his support for telehealth services, he noted that DHCS is currently reviewing their global telehealth policy and any changes should be considered within that context as well as next year’s state budget process.
Animal Care & Control
SB 573 (Chang) – Watch – Chapter 108, Statutes of 2020
SB 573, authored by Senator Ling Ling Chang, was signed by the Governor and will now require animal shelters, including animal control agencies, and rescue groups to microchip dogs or cats prior to releasing the animal back to an owner or to a new owner for adoption, sale, or release. As another version of this bill was vetoed last year due to cost concerns, SB 573 includes an economic hardship exemption for some pet owners.
Communicable Disease Control
AB 685 (Reyes) – Watch with Concerns – Chapter 84, Statutes of 2020
Governor Newsom, in a special ceremony, signed AB 685 on September 17. AB 685 will now require all private and public employers to notify all in writing employees, when notified of a potential COVID-19 exposure in the workplace, that they may have been exposed. Employers will also be required to report names, the number of employees, and occupation, of those infected with COVID-19, to their local health department (LHD). CDPH required to post that information on their public website and requires LHDs to link to that posted information on their local website. AB 685 will take effect on January 1, 2021 and will sunset on December 31, 2022.
AB 1710 (Wood) – Support – Chapter 123, Statutes of 2020
AB 1710, authored by Assembly Member Jim Wood, would now allow pharmacists to administer any FDA approved vaccine in addition to those vaccines they are currently allowed to independently initiate and administer so long as they have completed an immunization training program, be certified in basic life support, and comply with all state and federal recordkeeping and reporting requirements. This measure, sponsored by the California Pharmacists Association, is intended to ensure California is ready to deploy a coronavirus vaccine as quickly and broadly as possible once available.
AB 2077 (Ting) – Support – Chapter 274, Statutes of 2020
This measure, AB 2077 authored by Assembly Member Philip Ting, and signed by Governor Newsom, will extend the sunset, until January 2026, that allows pharmacies to sell and for adults to possess sterile syringes for personal use without a prescription. The bill was sponsored by the Health Officers Association, the San Francisco AIDS Foundation, and the Drug Policy Alliance.
SB 275 (Pan) – Watch – Chapter 301, Statutes of 2020
SB 275, authored by Senator Richard Pan, will require the Department of Public Health (CDPH) to establish a personal protective equipment (PPE) stockpile for health care workers and essential workers in the state and also require health care employers, as specified, to establish a PPE inventory that is sufficient for at least 45 days of surge consumption. The measure will also establish a statewide PPE Advisory Committee to make recommendations for the development of guidelines for the procurement, management, and distribution of PPE.
SB 932 (Wiener) – Watch – Chapter 183, Statutes of 2020
Governor Newsom signed SB 932, by Senator Scott Wiener, over the weekend that will now require any electronic tool that is used by local health officers to report communicable disease information to the California Department of Public Health (CDPH) to now also include the capacity to collect sexual orientation and gender identity data from individuals diagnosed with any reportable communicable disease. Health care providers are also now required to collect this information from patients, if known, to local health officers when reporting any reportable communicable disease.
Emergency Medical Services (EMS)
AB 1544 (Gipson) – Neutral – Chapter 138, Statutes of 2020
AB 1544, authored by Assembly Member Mike Gipson and co-sponsored by the California Professional Firefighters and the California Chapter of the American College of Emergency Physicians, was signed by the Governor. This measure will allow counties to establish community paramedicine and triage to alternate transport programs. AB 1544 will require local emergency medical services agencies (LEMSAs) to provide a first right of refusal to any public agency transport provider when establishing a community paramedicine program. If a LEMSA elects to establish a triage to alternate destination program, they must include all ALS providers that operate within the program jurisdiction; allows for an ALS provider to opt out of the program and includes ability for public agencies to contract with private providers or for private providers to enter into agreements with public agencies to provide these services. These provisions sunset on January 1, 2024.
Health Coverage/Health Care Reform & Vital Statistics
SB 406 (Pan) – Support – Chapter 302, Statutes of 2020
SB 406, authored by Senator Richard Pan, was the health committee omnibus bill and contained several provisions. Governor Newsom signed the measure this week. Of interest to CHEAC members, the bill codifies the Affordable Care Act (ACA) requirement that health insurance cover preventive services and the ACA prohibition on health insurance lifetime or annual limits. SB 406 also extends the sunset provision in statute for one year (January 2022) allowing local registrars to accept an electronic acknowledgement, sworn under penalty of perjury, that the requester of a marriage, birth, or death certificate is an authorized person.
SB 852 (Pan) – Watch – Chapter 207, Statutes of 2020
Governor Newsom signed SB 852, authored by Senator Pan, that is a first in the nation attempt to allow California’s Health and Human Services Agency to form partnerships with drug manufacturers and suppliers that would aid in producing and distributing high cost generic drugs to help lower drug costs and increase market competition in California.
AB 2112 (Ramos) – Support – Chapter 142, Statutes of 2020
AB 2112, authored by Assembly Member James Ramos, was signed by the Governor. This measure allows the California Department of Public Health (DPH) to establish the Office of Suicide Prevention to provide information and technical assistance to statewide and regional partners regarding best practices on suicide prevention policies and programs and conduct and convene experts and stakeholders to encourage collaboration and coordination of resources for suicide prevention.
AB 1788 (Bloom) – Watch – Chapter 250, Statutes of 2020
Governor Newsom signed AB 1788, authored by Assembly Member Richard Bloom. This hotly debated bill the past two years in the Legislature will now prohibits the statewide use of second-generation anticoagulant rodenticides used as pesticides. Exemptions are provided for governmental agencies and for certain circumstances relating to public health need. Proponents argued that the widespread use of these rodenticides were having negative impacts on mountain lions and other California wildlife.
This week, the Assembly convened two oversight hearings of interest to local health departments. Below, we summarize the hearings:
Public Health Guidance and CalREDIE
On Tuesday morning, the Assembly Subcommittee No. 6 on Budget Process Oversigth and Program Evaluation hosted state officials from the California Department of Public Health (CDPH) and the California Department of Technology (CDT), as well as the Legislative Analyst’s Office (LAO) to discuss COVID-19 public health guidance and the CalREDIE system.
In opening comments, Subcommittee Chair Assembly Member Phil Ting and Subcommittee Member Vince Fong briefly discussed the role of public health in navigating the ongoing pandemic, as well as the importance of timely and reliable data. Subcommittee member Joaquin Arambula, who also chairs the Assembly Budget Subcommittee No. 3 on Health and Human Services, also provided opening remarks, discussing health and social services supports that have been made available during the pandemic and the role of the state and local jurisdictions in responding to COVID-19.
Acting State Public Health Officer Dr. Erica Pan provided an overview of the state’s Blueprint for a Safer Economy framework, as well as CDPH’s guidance that has been issued throughout the duration of the COVID-19 pandemic. CDPH Chief Deputy Director Ms. Susan Fanelli discussed the state’s CalREDIE system, the types of data collected on communicable disease cases, and the parties involved in accessing and utilizing CalREDIE data. Ms. Fanelli briefly walked the subcommittee through CalREDIE data reporting issues experienced in July 2020, as well as the standalone California COVID-19 Reporting System (CCRS) that is in the process of being established following the CalREDIE data issues.
The California Department of Technology (CDT) provided an overview of oversight and technical assistance activities provided to CDPH in response to the backlog of cases in CalREDIE experienced this summer. CDT detailed project management and data monitoring support provided to CDPH, as well as the procurement process for the CCRS.
During member questions, subcommittee members inquired about electronic data reporting, CalREDIE reporting processes, COVID-19 transmission trends, hospital and health system capacity and metrics, testing activities, school reopening processes and child development, vaccine planning, and communications between state and local governments.
The full agenda for the hearing is available here. A video recording of the hearing is available here.
Overview of State Expenditures
The Assembly Subcommittee No. 6 on Budget Process Oversight and Program Evaluation and the Assembly Committee on Accountability and Administrative Review convened a joint informational hearing on state expenditures. Representatives from the Legislative Analyst’s Office (LAO) presented state expenditures and administrative cost trends, as well as trends in the state budget. LAO’s presentation focused on the FY 2020-21 enacted budget and referenced the significant budgetary constraints imposed by the ongoing COVID-19 pandemic.
During member questions, committee members inquired about a wide array of topics and areas, including health care and public health activities, public safety, emergency preparedness and response, education, climate change, and transportation. Notably, Assembly Member Joaquin Arambula queried the LAO and the Department of Finance (DOF) on state and local categorical expenditures of the California Department of Public Health (CDPH), tobacco control funds, and special funds for statewide public health services.
The full agenda for the hearing is available here. A video recording of the hearing is available here.
This week, the Department of Finance (DOF) issued its first quarterly report of the Coronavirus Relief Fund (CRF) provided by the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act. Recall, the CARES Act was signed into law in March and provided state and local governments with federal funds for expenditures incurred between March 1 and December 30, 2020, in response to COVID-19. California received a total of $15.3 billion from the CARES Act with $9.5 billion allocated directly to the state, $5.8 billion allocated to 15 large counties, and five cities with populations over 500,000.
The CARES Act requires states to submit quarterly expenditure reports in 17 categories associated with COVID-19 response and mitigation. The first report issued by DOF covers expenditures and obligations incurred from March 1 through June 30. DOF collected data from counties, cities, local education agencies, community college districts, and state agencies regarding expenditures and obligations to date.
DOF additionally provides data detailing CRF expenditures by recipient and category. Notably, the largest expenditure categories of the $2.5 billion in Q1 expenditures were facilitating distance learning ($468 million), payroll for public health and public safety ($365 million), personal protective equipment ($326 million), public health expenses ($261 million), and budgeted personnel – substantially different use ($259 million). Additionally, during the reporting period, counties reported approximately 38 percent of their funding ($487 million) was spent or obligated; six counties reported funds as fully spent or obligated.
DOF indicates expenditures are expected to increase significantly in the next quarterly report as recipients have more time to identify eligible expenditures and awards will be made for various programs, including Homekey to provide grants to support housing for individuals experiencing or at risk of experiencing homelessness due to COVID-19.
The full DOF first quarter report is available here.
The U.S. House of Representatives on Thursday passed H.R. 8406, a revised version of the HEROES Act, on a 214-207 vote. The sweeping $2.2 trillion measure, narrowed from its original $3 trillion price tag, would provide $436 billion in assistance for state, local, territorial, and tribal governments. The measure would also extend the deadline to use Coronavirus Aid, Relief, and Economic Security (CARES) Act Coronavirus Relief Funds (CRF) for one year until December 31, 2021, provide $75 billion for COVID-19 testing, tracing, and isolation measures, and provide $28 billion for COVID-19-related vaccines, including procurement ($20 billion), distribution ($7 billion, and education campaigns ($1 billion). The measure additionally includes significant investments for education and childcare, small businesses, worker safety, housing assistance, and unemployment benefits.
On Wednesday, prior to the bill’s passage, Governor Gavin Newsom issued a statement on the updated version of the HEROES Act amid bipartisan negotiations on federal COVID-19 relief. Newsom applauded House Speaker Nancy Pelosi for “her dedicated leadership and tireless work” to advance a federal COVID-19 relief package. Newsom urged the White House and Senate to act on the measure without delay, pointing to the state’s dire need for federal funding support.
Recall, as part of the 2020-21 Budget Act, California needs at least $14 billion of flexible federal funding by October 15 to restore sweeping budget items referred to as “trigger” restorations. If California does indeed receive the $14 billion by October 15, an additional $250 million would supplement the $750 million General Fund allocated to “backfill” County Realignment services, including health and indigent health services. Other “trigger” items include funding for housing, child support, education expenses and more. If federal funding is more than $2 billion but less than $14 billion, the amount above $2 billion would be proportionately allocated among the “trigger” items.
Despite the bill’s passage in the House, the measure faces an exceedingly difficult path forward in the U.S. Senate and with the White House. Further, amid recent announcements of COVID-19 diagnoses among key political figures, including President Donald Trump, and the upcoming General Election, it is unclear how the measure might fare moving forward, even as California’s October 15 deadline for federal funding quickly approaches.
Today, U.S. Health and Human Services Secretary Alex Azar announced that he renewed the COVID-19 national public health emergency for an additional 90 days, effective October 23.
Recall, HHS Secretary Azar initially declared COVID-19 a national public health emergency on January 31, 2020. According to Secretary Azar, the renewal of the national emergency will allow the federal government to continue its “whole-of-America response to the virus” and continue its work to “ensure Americans have access to the care they need.”
The Trust for America’s Health (TFAH) will host a webinar on October 21 from 10:00 am to 11:30 am titled, “Ensuring COVID-19 Vaccine Access, Safety, and Utilization: Building Vaccination Confidence in Communities of Color.”
The webinar will feature expert panelists to educate policymakers and stakeholders on the historical reasons for vaccine hesitancy in communities of color, highlight ongoing vaccination disparities, and discuss policy recommendations to build vaccine confidence and access in communities of color. Attendees will have the opportunity to ask panelists questions.
Additional information and registration for the webinar are available here.
On Wednesday, the California Department of Public Health (CDPH) released details of the state’s new health equity metric which is part of the Blueprint for a Safer Economy framework. According to the state, the equity metric is intended to help guide counties in their continuing efforts to more effectively fight COVID-19, including through more intensive efforts to prevent and mitigate the spread of COVID-19 among Californians who have been disproportionately impacted by the pandemic.
Under the state’s Blueprint for a Safer Economy, a county must meet the equity metric and/or demonstrate targeted investments to eliminate disparities in COVID-19 transmission to advance to the next, less restrictive tier. Notably, counties with a population greater than 106,000 residents must ensure the test positivity rates in its most disadvantaged neighborhoods do not significantly fall behind its overall county test positivity rate and submit a plan outlining plans to invest funding to interrupt disease transmission in disproportionately impacted communities. Additionally, counties with demonstrated declining case rates and test positivity rates for both the countywide and most disadvantaged neighborhoods that fall into two tiers below the current tier may advance to the next, less restrictive tier.
Given data limitations in small and rural jurisdictions, counties with a population of fewer than or equal to 106,000 must submit a plan that defines its disproportionately impacted populations, specifies the percent of COVID-19 cases in these populations, and outlines plans to invest funding to decrease disease transmission in these communities.
To assist all counties in developing best practices in achieving this metric, CDPH is launching a Health Equity Technical Assistance Team to provide additional support and resources to jurisdictions.
Additional information on the equity metric is available here. A press statement from CDPH is available here.
This week, the California Department of Public Health (CDPH) launched its seasonal influenza vaccination campaign, “Let’s Fight Flu Together.” The campaign includes materials available to assist partners in communicating the importance of a seasonal influenza vaccination, including communications messaging and social media images. Additional campaign materials and resources, including infographics and public service announcements, are forthcoming.
The CDPH communications toolkit is available here.
Earlier this week, the Governor’s Office of Business and Economic Development (GO-Biz) released the application for the next round of the California Community Reinvestment Grants (CalCRG). Recall, these funds from Proposition 64 (Adult Use of Marijuana Act) are directed to local health departments and community-based organizations to provide grants to support activities such as job placement, system navigation services, and linkages to medical care, for communities disproportionately affected by past federal and state drug policies.
A total of $20.8 million is available for FY 2020-21, and awardees will have three years (May 2021-April 2024) to expend funds. 2020-21 CalCRG program priorities include proposals from organizations led by individuals directly impacted by the WoD, organizations that serve formerly incarcerated individuals, and organizations placing individuals in jobs with Preference Points allocated to proposals that match current CalCRG program priorities.
Phase One applications are due to GO-Biz on Monday, November 2, 2020. Applicants that pass through the Phase One process will be invited to participate in the Phase Two application process, anticipated to be released on January 11, 2021. More information on the grant solicitation can be found here.
This week, the Office of Governor Gavin Newsom announced an additional $137 million in awards to 15 applicants for 19 projects totaling 938 units as part of the state’s $600 million Homekey initiative to purchase and rehabilitate housing – including hotels, motels, vacant apartment buildings, and other properties – to convert them into permanent, long-term housing for people experiencing or at-risk of experiencing homelessness.
This week’s announcements include awards to Lake County, Tulare County Health and Human Services Agency, Tehama County, Mariposa County Health and Human Services Agency, Del Norte County, City of Long Beach, Alameda County, Sutter County, Humboldt County, and Los Angeles County. The awards bring the state total awarded under Homekey to $449.9 million for 33 applicants and 49 awards totaling 3,351 units. The statewide average cost to Homekey thus far is approximately $134,000 per unit.
Governor Newsom additionally requested of the Joint Legislative Budget Committee (JLBC) to approve an additional $200 million in Coronavirus Relief Funding (CRF) for Homekey. According to the Administration, the additional funding would provide for approximately 20 more Homekey projects now on a waitlist pending additional funds. If JLBC approves of the request, the Administration will have provided local governments with a total of $800 million for acquisition, rehabilitation, and operating support under Homekey.
A press announcement from the Newsom Administration is available here.
On Monday, Governor Gavin Newsom issued an emergency proclamation for Napa, Sonoma, and Shasta counties due to the Glass and Zogg fires. The Governor additionally requested a Presidential Major Disaster Declaration to assist state and local wildfire response and recovery efforts in Fresno, Los Angeles, Madera, Mendocino, San Bernardino, San Diego, and Siskiyou counties.
A copy of the emergency declaration is available here. The request for a major disaster declaration is available here.
This week, California State Auditor Elaine Howle released an audit report on youth suicide prevention efforts at a selection of school districts and chart schools, as well as the role of state agencies in youth suicide prevention. As indicated by the state auditor, from 2009 through 2018, the annual number of youth suicides (ages 12-19) increased 15 percent and incidents of self-harm increased 50 percent. The report describes how school personnel are well-positioned to recognize warning signs of suicide and self-harm risks and make appropriate referrals for assistance.
The auditor recommends local education agencies implement appropriate suicide prevention policies, train faculty and staff to recognize and respond to youth who are at risk of suicide or self-harm, and employ an adequate number of professionals, such as school counselors, who can provide mental health services. The auditor determined the schools reviewed in the report failed to adopt policies and provide training that meet requirements of state statute relative to suicide prevention activities. Further, it was determined that none of the 1,034 local education agencies that submitted personnel information to the California Department of Education (CDE) did not employ an adequate number of mental health professionals in schools, failing to meet CDE staffing ratio recommendations.
The report additionally reviews the availability of school-based health centers throughout the state, determining only four percent of California’s kindergarten through 12th grade students attended a school with a school health center. The auditor concludes the state has done little to foster broader implementation of school health centers which could improve access to youth mental health services.
Further, the auditor discusses a 2007 statutory requirement for the California Department of Public Health (CDPH) to establish a program to support the development of school health centers. As of July 2020, however, CDPH had not established the support program, determining that the $1.2 million across two fiscal years (FY 2016-17 and 2017-18) provided to CDPH by the Legislature was insufficient to establish a full program. The auditor determined CDPH has not requested additional funding for the program and that a robust support program could assist local education agencies in creating school health centers and enabling them to better leverage available funding to improve student access to mental health services. In responding to the auditor’s findings, CDPH indicated the department will evaluate resources necessary to establish and implement the support program as required by statute.
The Department of Health Care Services (DHCS) is recommended to work with the California Department of Education to inform local education agencies of their ability to partner with county offices of education to centralize administrative responsibilities necessary to obtain reimbursement through the billing option program for certain mental health services provided by schools. DHCS indicated their intent to implement the auditor’s recommendations.
The full state auditor report is available here.