September 3, 2021 Edition
As a reminder, registration for the 2021 CHEAC Annual Meeting is now open! This year’s conference theme is “Revitalizing Public Health: Leveraging Lessons Learned from COVID-19.” The conference will be held in an entirely virtual format from October 6 through October 8 and will feature several plenary speakers, as well as multiple breakout sessions.
CHEAC welcomes local health department executives and staff to attend this year’s conference. For additional information and registration, please visit here.
We are pleased to announce that the Nevada County Public Health Department was awarded accreditation status by the Public Health Accreditation Board (PHAB) on August 31, 2021. Nevada County becomes the 21st local health department awarded PHAB recognition in California, in addition to the California Department of Public Health (CDPH).
Please join us in congratulating our colleagues in Nevada County on their accomplishment. Additional information on the announcement can be found here.
Lawmakers in Sacramento this week maintained a steady pace of floor sessions only, working toward next Friday’s legislative deadline for any bill to be passed to the Governor. With only days remaining in this year’s legislative session, legislators continue to secure last-minute amendments and votes to get their remaining bills in play across the finish line.
Legislators are anticipated to hear and act on a number of budget trailer bills next week, cleaning up provisions included in the 2021 Budget Act that was passed by the Legislature earlier this summer. Both the Senate Budget & Fiscal Review Committee and the Assembly Budget Committee are set to convene hearings on Tuesday to review a series of measures that are yet to be in print at the time of this publication.
Given the truncated timeline, several notable measures and topics have been sidelined for the year with many legislators indicating their intent to bring measures for consideration upon the Legislature’s return to Sacramento in January 2022. One such bill is AB 1130 by Assembly Member Jim Wood to create the Office of Health Care Affordability (OHCA) in California to collect and analyze health care cost drivers and trends to inform the development of policies to lower and control high health care costs. Assembly Member Wood issued a statement yesterday indicating the bill has been shelved for the year due to other higher priority issues statewide, including wildfires, COVID-19 vaccination efforts, and the presence of the COVID-19 delta variant.
Many of CHEAC’s tracked measures were advanced to the Governor this week. As a reminder, the Governor has a 12-day period to act on measures in his possession on or before September 9. Bills received by the Governor on or after September 10 are subject to a 30-day period for the Governor to either sign or veto. Any bills not affirmatively signed or vetoed by the Governor during these periods will become law.
Below, we provide updates on several bills of interest to CHEAC Members. For a full update, the latest edition of the CHEAC Weekly Bill Chart is available here.
AB 263 (Arambula) – SUPPORT
Assembly Member Joaquin Arambula’s AB 263 would require private detention facility operator to comply with all local and state public health orders and safety regulations. The measure received approval from the Senate on Monday on a 39-0 vote with one member not voting. The Assembly concurred in the Senate amendments on Wednesday on a 74-0 vote with five members not voting. The bill now heads to the desk of Governor Gavin Newsom.
Drug & Alcohol Services
AB 381 (Davies) – SUPPORT
Assembly Member Laurie Davies’ AB 381 requires licensed adult alcoholism or drug abuse recovery treatment facilities to administer U.S. FDA approved opioid antagonist for treatment of an opioid overdose and have at least one trained staff member to administer the drug on premises. AB 381 received Senate approval on a 39-0 vote with one member not voting on Monday. The Assembly then concurred in the Senate amendments on a 78-0 vote with one member not voting. AB 381 now heads to the desk of Governor Newsom.
Health Coverage/Health Care Reform
AB 369 (Kamlager) – SUPPORT
AB 369, authored by Senator Sydney Kamlager, requires DHCS to implement a program for presumptive Medi-Cal eligibility for homeless individuals to the extent federal financial participation is available. The bill also authorizes a person experiencing homelessness to receive primary care services and referrals for specialty care from any Medi-Cal enrolled provider. AB 369 received final approval from the Senate on a 32-0 vote with eight members not voting on Monday. On Wednesday, the Assembly concurred in the Senate amendments on a 72-0 vote with seven members not voting, and the measure is now on its way to the Governor.
AB 1407 (Burke) – SUPPORT
AB 1407 by Assembly Member Autumn Burke requires nursing programs and schools of nursing to include implicit bias training as a requirement for graduation. The measure also requires for nurse licensees, beginning January 2023, within the first two years of holding their license to complete an implicit bias course. AB 1407 received final approval from the Senate on Monday on a 32-1 vote with seven members not voting. The Assembly concurred in the Senate amendments on Wednesday on a 68-0 vote with 11 members not voting. The measure now moves to the Governor’s desk.
SB 395 (Caballero) – SUPPORT
Senator Anna Caballero’s SB 395 was heard on the Senate Floor this week. SB 395 imposes a 12.5 percent tax on retail sale of electronic cigarettes in California. Requires tax revenues to be allocated to Proposition 99, Proposition 10, and Proposition 56 tobacco programs, and others. The measure received final approval by the Assembly on Wednesday on a 61-14 vote with four members not voting. The Senate concurred in the Assembly amendments on Thursday on a 29-9 vote with two members not voting. The measure now heads to the desk of Governor Newsom.
AB 751 (Irwin) – SUPPORT
AB 751, authored by Assembly Member Jacqui Irwin, received final legislative approval this week. The measure requires requests made for these documents electronically to accept electronic verification authenticating the identity of the applicant using a process that meets the National Institute of Standards and Technology Digital Identity Guidelines and other requirements. AB 751 is now on its way to the Governor.
This week, Governor Gavin Newsom announced during a visit to a vaccination clinic in Alameda County that more than 80 percent of eligible residents ages 12 and older have received at least one dose of the COVID-19 vaccine. During his visit to the clinic on Tuesday, Governor Newsom urged unvaccinated residents to receive their vaccine to protect themselves and their communities from the COVID-19 and the delta variant.
Governor Newsom also this week issued an “On the Record” column highlighting the safety and effectiveness of available COVID-19 vaccines and encouraging residents to do their part to end the COVID-19 pandemic.
Additional information on the Governor’s announcement is available here.
The California Department of Public Health (CDPH) today announced jurisdictions in the San Joaquin Valley Region have met the established threshold to enter COVID-19 surge protocols, pursuant to the State Public Health Officer Order issued on August 16. The San Joaquin Valley Region becomes the first region in the state to trigger the state’s order and applies to the following counties: Calaveras, Fresno, Kern, Kings, Madera, Mariposa, Merced, San Benito, San Joaquin, Stanislaus, Tulare, and Tuolumne.
The regional threshold is triggered when a region has less than 10 percent of staffed adult ICU beds available for a period of three consecutive days. For at least the next seven days, hospitals in the San Joaquin Valley Region must adhere to the following:
- All general acute care hospitals in the county who do have ICU bed capacity must accept transfer patients when clinically appropriate and directed by the Medical and Health Operational Area Coordinator (MHOAC).
- All general acute care hospitals in the region who do have ICU bed capacity must accept transfer patients when clinically appropriate and directed by the Regional Disaster Medical Health Specialist (RDMHS).
- If there is no ICU bed capacity within the region, then all general acute care hospitals in the State of California must accept transfer patients when clinically appropriate and directed by the California Emergency Services Authority (EMSA) director or designee.
The San Joaquin Valley Region will be reevaluated on September 9. Additional information from CDPH is available here. Regional ICU capacities for all regions is available here.
The Milton Marks “Little Hoover” Commission on California State Government Organization and Economy, an independent state oversight agency, recently issued a report entitled, “COVID-19 and Children’s Mental Health: Addressing the Impact.” The report discusses the implications of the COVID-19 pandemic on child and adolescent mental health, as well as highlights challenges in student mental health and school-based service delivery.
To address the COVID-19 pandemic’s impacts on child and adolescent mental health, the Little Hoover Commission calls for a larger, more diverse mental health workforce, a “genuine continuum of care for children,” prevention and early intervention services, and school-based activities to transform schools as “hubs of mental well-being.”
The Little Hoover Commission features the California Advancing and Innovating Medi-Cal (CalAIM) Initiative, as well as the Children and Youth Behavioral Health Initiative, as significant reforms that have potential to address child mental health needs as a result of the COVID-19 pandemic. Specifically, the Little Hoover Commission sets forth the following recommendations:
- The State of California should identify a central point of leadership for children’s mental health; the Governor and Legislature should also initiate a review process to examine the potential creation of a Department of Behavioral and Mental Health to exercise statewide leadership over mental health care and services.
- The California Health and Human Services (CHHS) Secretary, in consultation with stakeholders, should set statewide goals for child mental health based on key metrics related to overall mental well-being, access to care, and quality of services.
- The Governor and Legislature should reserve a portion of Behavioral Health Initiative funding to competitively award counties and health plans for effectively and efficiently implementing successful reforms and programs.
- The Department of Health Care Services (DHCS) should work with stakeholders to identify ways to increase the support and technical assistance to counties, health plans, and other providers.
- The Governor and Legislature should leverage the Behavioral Health Initiative to encourage local educational agencies and partners to develop comprehensive approaches to student mental wellness.
- The Governor should establish a clear timeline for the development, testing, and piloting of the behavioral health services virtual platform.
The full Little Hoover Commission is available here.
The U.S. Centers for Disease Control and Prevention (CDC) awarded more than $116 million in the first year of a three-year, $348 million program to support community health worker (CHW) services related to COVID-19 prevention and control. The CDC also awarded more than $6 million of a four-year $32 million program for training, technical assistance, and evaluation.
These awards, funded through the Coronavirus Aid, Relief, and Economic Security (CARES) Act and the American Rescue Plan Act (ARPA) of 2021, will provide critical support to states, localities, territories, tribes, tribal organizations, urban Indian health organizations, and health services providers for tribes. Award amounts were determined by population size, poverty rates, and COVID-19 statistics.
The funded is intended for recipients to address:
- Disparities in access to COVID-19-related services included testing, contact tracing, and immunization
- Factors that increase risk of severe COVID-19 illness such as chronic diseases, smoking, and pregnancy
- Community needs that have been exacerbated by COVID-19, including health and mental health care access and food insecurity
Recipients of the CHW awards include Alameda, San Diego, San Joaquin, Sonoma, and Tulare counties in California. Two tribal organizations were also funded in California.
Additional information about the awards is available here.
The U.S. Centers for Disease Control and Prevention (CDC) on Wednesday issued a COVID-19 toolkit with communication resources to support people with intellectual and developmental disabilities (IDD) and their caregivers protect themselves against the SARS-CoV-2 virus. CDC hosted multiple discussions with adults with IDD and their caregivers in forming the guidance.
The toolkit contains social stories, videos, posters, and interactive activities that focus on the following five topics:
- Receiving a COVID-19 vaccine
- Wearing a mask
- Physical distancing
- Hand washing
- Receiving a COVID-19 test
A tip sheet is also available to caregivers offering suggestions for easing loved one’s worries about the COVID-19 virus. The CDC additionally developed videos and web resources in American Sign Language (ASL) providing important COVID-19 information and safety tips.
The full suite of CDC IDD resources is available here.
The Biden-Harris Administration this week issued guidance to states on available options to advance COVID-19 vaccination and testing, as well as Medicaid insurance enrollment, as part of its implementation of the American Rescue Plan Act of 2021 (ARPA). The Centers for Medicare & Medicaid Services (CMS) will provide guidance to states about additional ARPA funds for states to promote the importance of COVID-19 vaccination in eligible children and adults enrolled in Medicaid.
Under the guidance issued by the federal government, the Biden-Harris Administration reiterates the availability of Medicaid coverage for diagnostic and screening testing for COVID-19 consistent with CDC recommendations in school settings. The guidance additionally addresses the coverage of habilitation services for children with disabilities, access to COVID-19 vaccinations, and incentives to expand Medicaid coverage to specified populations.
Additional information on the federal government’s guidance is available here.
President Joseph R. Biden Jr. this week proclaimed September 2021 as National Preparedness Month and urged all Americans to recognize the importance of preparedness and work together to enhance resilience and readiness. President Biden indicates the theme of this year’s preparedness month is “Prepare to Protect” and reiterates steps available to Americans to prevent and prepare for disasters and emergencies.
The full presidential proclamation is available here.
The U.S. Department of Health and Human Services (HHS) this week announced the formation of the Office of Climate Change and Health Equity (OCCHE) in response to President Joseph R. Biden, Jr.’s executive order earlier this year directing specified federal agencies to undertake activities related to climate change. The HHS office is the first of its kind at the national level to address health equity and climate change issues.
OCCHE’s mission is to protect vulnerable communities who disproportionately bear the brunt of pollution and climate-related disasters, such as drought and wildfires, at the expense of public health. Specifically, OCCHE will be tasked with:
- Identifying communities with disproportionate exposures to climate hazards and vulnerable populations
- Addressing health disparities exacerbated by climate impacts to enhance community health resilience
- Promoting and translating research on public health benefits of multisectoral climate actions
- Assisting with regulatory efforts to reduce greenhouse gas emissions and criteria air pollution throughout the health care sector, including participating suppliers and providers
- Fostering innovation in climate adaptation and resilience for disadvantaged communities and vulnerable populations
- Providing expertise and coordination with the White House, HHS, and other federal agencies.
- Promoting training opportunities to build climate and health workforce
- Exploring opportunities to partner with philanthropic and private sectors to support innovative programming to address disparities and health sector transformation
Additional information on the newly formed office is available here.
The California Department of Health Care Services (DHCS) today made available the recording and materials from the August 25 webinar for providers and interested parties on the California Advancing and Innovating Medi-Cal (CalAIM) initiative Enhanced Care Management (ECM) and In Lieu of Services (ILOS) components.
The August 25 webinar covers the following:
- What are ECM and ILOS and what is the implementation timeline?
- What are the roles and responsibilities of ECM and ILOS providers?
- How will payment work?
- Where can I find DHCS guidance and resources?
- How can providers prepare for CalAIM?
DHCS previously held a webinar to learn about forthcoming changes to the state’s Medi-Cal managed care system and CalAIM. The materials from the first of the two-part webinar series are available here.
The California Department of Public Health (CDPH) recently issued its 2019-20 Kindergarten Immunization Assessment, detailing immunization rates for California children. According to CDPH, immunization rates reported for kindergarteners in California have remained at high levels (94.3 percent in 2019-20) but have decreased slightly over recent years.
A modest decrease in the combined vaccination rate in 2019-20 reflects enactment of the new requirement for a second dose of Varicella vaccine. In both 2018-19 and 2019-20, 17 counties reported fewer than 95 percent of their kindergarteners receiving two doses of MMR, compared to 14 counties in 2016-17 and 31 counties in 2015-16. The proportion of kindergarteners with a permanent medical exemption increased slightly from 0.9 percent to 1.0 percent in 2019-20.
Additional information from CDPH is available here.
California Health Policy Strategies (CHPS) recently issued a report highlighting funding opportunities for housing and behavioral health services for reentry and justice-involved populations included in the state’s 2021 Budget Act. In its resource, CHPS provides a high-level overview of over $12 billion in new program initiatives and investments, including as part of the state’s sweeping California Advancing and Innovating Medi-Cal (CalAIM) and Home and Community-Based Services (HCBS) waiver.
The full CHPS resource is available here.
Governor Gavin Newsom on Wednesday announced that, within hours of the state’s request, the White House approved a Presidential Emergency Declaration for direct federal assistance to support the response to the Caldor Fire burning in El Dorado, Amador, Alpine, and Placer counties.
The declaration will supplement state, local, and tribal government emergency services for the protection of lives, property, public health, and safety. The move by the federal government follows a state of emergency proclaimed by Governor Newsom for Alpine, Amador, and Placer counties earlier this week due to the Caldor Fire. The Governor in late August issued a state of emergency for El Dorado County for the same fire.
Additional information on the presidential emergency declaration is available here.
California’s ACEs Aware, the joint initiative between the Office of the California Surgeon General and the California Department of Health Care Services (DHCS), will convene a webinar on Wednesday, September 22 from 12:00 pm to 1:00 pm. The webinar will be the third and final in the multipart series and will explore the science of adverse childhood experiences (ACEs) and toxic stress.
The webinar will feature Dr. Rachel Gilgoff from the Stanford University School of Medicine and will cover how providers can develop their clinical response to ACEs and toxic stress, including treatment and follow-up plans.
Additional information, including registration, is available here.