October 6, 2017 Edition

CHEAC Health Realignment Training Registration Now Open

CHEAC will be hosting a Health Realignment Training on Wednesday, December 6, 2017, from 10:00 am to 3:15 pm at The California Endowment in Sacramento (1414 K Street, First Floor – Adelante Room). The training will include the following sessions:

  • Realignment Historical Overview
  • Realignment Basics
  • Significant Policy Changes Impacting 1991 Realignment
  • CHEAC Realignment Tracking
  • County Realignment Budgeting and Projecting

The cost to attend is $100 and includes all session materials, light breakfast/coffee, and lunch. Seating is very limited; members are encouraged to register as soon as possible.

Registration is now open until Friday, November 3 and may be accessed here. For any questions, please contact CHEAC Staff at admin@cheac.org or 916-327-7540.

Threats to Affordable Care Act Continue

Despite failing to legislatively repeal and replace the Affordable Care Act (ACA) last month, Congressional Republicans and Trump Administration officials are expected to continue attempts to undermine the ACA through what’s being characterized as a “synthetic repeal” through a series of administrative and budgetary actions. It is rumored that President Trump may soon sign an executive order to allow for new association health plans and/or to allow for the sale of insurance plans across state lines. Association health plans allow small employers to join associations – based on certain types of professional, trade, or interest groups – that offer insurance to their members. Proponents argue these would allow for more affordable coverage options.  However, these plans would also likely be exempt from many of the ACA protections such as covering people with pre-existing conditions or providing the ten essential health benefits.  As for selling insurance across state lines, insurers from lightly regulated states where policies may offer fewer benefits and lower premiums would be able to sell plans in highly regulated states. Some experts argue these actions could lead to financially unsustainable markets where healthier individuals flock to skinnier plans and less healthy individuals stay in comprehensive plans.

Another option to destabilize the ACA being considered by Congressional Republicans is to gut Medicaid and ACA provisions as part of their ongoing discussions to reform the country’s tax code. Proposed cuts to Medicaid and Medicare have been reported to be at least $1 trillion, in addition to significant reductions to ACA subsidies.

Senate, House Committees Pass CHIP Reauthorization Measures

This week, the Senate Finance Committee and the House Energy and Commerce Committee advanced measures to reauthorize and fund the Children’s Health Insurance Program (CHIP). Recall earlier this week, Congress allowed CHIP funding to lapse. The Senate Finance Committee quickly advanced a bipartisan measure which would extend CHIP funding for five years and provide additional protections for low-income children.

The House Energy and Commerce Committee, however, spent over six hours debating their measure, ultimately resulting in the advancement of the bill on a partisan vote. The House measure includes a series of provisions that would make significant changes and utilize funds from Medicare and the Affordable Care Act, including the Prevention and Public Health Fund (PPHF). This week, CHEAC, along with the California State Association of Counties (CSAC), submitted a letter to the House Energy and Commerce Committee expressing opposition to the use of PPHF funds to reauthorize CHIP.

While the Senate CHIP reauthorization measure now heads to the floor where a funding source will have to be identified, the House version is expected to be mired in a partisan fight on the floor over its changes to broader health care programs and funding sources. With limited funds remaining, time is running short for Congress to take action. California, along with a handful of other states, is expected to run out of funds for the CHIP program at the end of 2017, forcing the state to make difficult decisions around its coverage of more than two million low-income children and pregnant women.

Governor Brown Signs Notable Legislation with Deadline Nearing

With just under 10 days remaining to take action on bills, Governor Brown has steadily been making his way through the hundreds of bills sent to his desk by the Senate and Assembly. Recently, Governor Brown signed into law a comprehensive legislative package to increase the state’s housing supply and affordability. The measures, including SB 2 (Atkins), SB 3 (Beall), and SB 35 (Wiener), are expected to lead to the development of approximately 70,000 housing units throughout the state.

Additionally, Governor Brown signed into law this week SB 54 (de León), the sanctuary state bill, which would modify ways in which law enforcement agencies cooperate with federal immigration authorities.

As a reminder, CHEAC will issue a final bill chart following the October 15 deadline for Governor Brown to take action on bills. Below, we highlight a handful of CHEAC bills that were either signed into law or vetoed this week.

Maternal and Child Health

AB 1316 (Quirk) – Support

Chapter 507, Statutes of 2017

Assembly Member Bill Quirk’s AB 1316 was signed into law this week. The measure requires CDPH, in consultation with medical and environmental experts, to consider other significant environmental risk factors that could expose a child to lead contamination. CDPH is also required to use an electronic database to support electronic laboratory reporting of blood tests, management of lead-exposed children, and assessment of sources of lead exposure. AB 1316 goes into effect January 1, 2018, and requires regulations to be completed by July 1, 2018.

Communicable Disease Control

AB 1279 (Salas) – Watch

Vetoed by Governor

Assembly Member Rudy Salas’ AB 1279 was vetoed by the Governor this week. The measure was significantly watered down during the legislative process and would have required CDPH to develop outreach programs to educate the public about Valley Fever. In his veto message, Governor Brown cited existing Valley Fever public awareness outreach by CDPH and the need for additional resources to be allocated during the budget process for the expansion of CDPH’s work.

Health Equity

AB 1520 (Burke) – Watch

Chapter 415, Statutes of 2017

AB 1520 by Assembly Member Autumn Burke was signed into law this week. The measure creates the Lifting Children and Families Out of Poverty Task Force to study and annually report on how the Governor’s budget will impact the child poverty rate in California. Task force members will include representatives from county health and social services agencies, community agencies, and CDPH, DHCS, and DSS.

Select Committee on Health Care Delivery Systems and Universal Coverage Announces First Hearing Dates

This week, Assembly Members Jim Wood and Joaquin Arambula announced the first hearing dates for the Assembly Select Committee on Health Care Delivery Systems and Universal Coverage. The hearings will be held on Monday, October 23 and Tuesday, October 24 at the State Capitol in Sacramento. The first hearing day convene experts to discuss California’s current health care system, including:

  • Who is and is not currently covered
  • Current coverage systems, including public programs, safety net providers and employer-based and individual market coverage
  • How current systems are financed

The second hearing day will explore versions of universal health coverage around the world and will include an opportunity for public comment.

Additional hearings for later this year and early next year are still being planned. Topics for future hearings will include health care systems within U.S. cities and states, input from stakeholders on proposed universal coverage systems, and identified challenges to achieving health care for all in California.

CDPH to Continue ICR Standardization

The California Department of Public Health (CDPH) recently announced it will continue with the program to standardize the indirect cost rates (ICR) for contracts, allocations, and grants with local health departments (LHD). As in previous years, each LHD will be requested to submit documentation used to calculate their ICR as a percentage of personnel services costs and a percentage of total allowable direct costs.

More information from CDPH regarding ICRs is expected in the coming days and weeks. CDPH has proposed the following timeline for the FY 2018-19 ICR Program:

  • October 18, 2017 – Webinar training on ICR reporting process
  • November 30, 2017 – LHDs to submit ICR documentation to CDPH
  • November-December, 2017 – CDPH to review submissions and issue LHD result letters
  • January 19, 2018 – CDPH programs to be notified of approved LHD ICRs
  • July 1, 2018 – CDPH to apply approved ICR to FY 2018-19 agreements

For more information, please contact Duane Cissna at 916-552-8442 or email the CDPH LHD ICR mailbox at CDPH-ICR-mailbox@cdph.ca.gov.

Statewide Cannabis Implementation Activities are Heating Up

Last week, the Bureau of Cannabis Control released a couple of announcements.  The first was the official launch of their upgraded website and rebranding efforts.  The site, www.bcc.ca.gov, was redesigned to reflect changes to statute made over the past few months, updated information on upcoming regulations, and licensing applications.

The Bureau also announced, along with CDPH and the Department of Food and Agriculture, that they were officially withdrawing the medical cannabis regulations proposed earlier this year.  The effective date of the withdrawal is today, October 6.  The three licensing authorities are currently working on emergency regulations with an expected publish date sometime in November.

This month, the Bureau will be conducting three public cannabis licensing workshops throughout the state.  These will be structured like an open house to allow attendees to obtain information from various state and local agencies about what licensing information is needed and what resources are available to those looking to apply for state commercial cannabis licenses.  The workshops are scheduled for October 12 in Los Angeles, October 13 in Riverside, and October 17 in Sacramento.  More information on these workshops can be found here.

Finally, the Bureau also announced the members of their 22-member Cannabis Advisory Committee.  They will be tasked with assisting the three State regulatory agencies develop regulations on cultivation, transport, testing and sale of both medical and adult use cannabis.  A full list of committee members can be found here.

Covered California Rate Decisions Expected Next Week

With uncertainty around the continuation of cost-sharing reductions to subsidize health exchanges by the federal government, Covered California has been delaying its decision on setting its premium rate increases. Covered California enrollees will be able to view coverage options and plans beginning on October 11. If Congress does not take action on cost-sharing reductions by next week, Covered California will assume federal contributions have ended and add a surcharge to silver tier plans.  As a result, silver tier plan premium rates for next year could increase an additional 12.4 percent on top of a previously-announced 12.5 percent average increase for all Covered California plans. Silver tier plans are the only Covered California plans that benefit from federal cost-sharing reductions. With the delay in setting rate increases, time is running short for enrollees to receive notices and decide between plans in a timely manner when open enrollment begins on November 1.

Tobacco Use and Oral Health Webinar to be Held This Month

The California Smokers’ Helpline and the Center for Tobacco Cessation will be holding a webinar on Thursday, October 26 from 12:00 pm to 1:00 pm on Tobacco Use and Oral Health: The Critical Role of Dental Professionals. The webinar will provide information on oral conditions affected by tobacco use, oral health implications of new and alternative tobacco products, and discuss the role of dental professionals in tobacco prevention and cessation. Registration is available here.