BILL ANALYSIS                                                                                                                                                                                                    



          SENATE COMMITTEE ON HEALTH
                          Senator Ed Hernandez, O.D., Chair

          BILL NO:                    AB 1149             
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          |AUTHOR:        |Wood                                           |
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          |VERSION:       |February 27, 2015                              |
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          |HEARING DATE:  |June 10, 2015  |               |               |
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          |CONSULTANT:    |Vince Marchand                                 |
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           SUBJECT  :  Public health emergencies: funding.

           SUMMARY  :  Adds trade associations to the list of entities that are  
          eligible to receive federal funding, that has been allocated to  
          the Department of Public Health for public health preparedness  
          and response. 

          Existing law:
          1)Establishes provisions of law to govern those instances when  
            federal funding is allocated and expended for public health  
            preparedness and response by local health jurisdictions,  
            hospitals, long-term health care facilities, clinics,  
            emergency medical systems, and poison control centers for the  
            prevention of, and response to, bioterrorist attacks and other  
            public health emergencies. 

          2)Requires federal funding received by the Department of Public  
            Health (DPH) for bioterrorism preparedness and emergency  
            response to be subject to appropriation in the annual Budget  
            Act or other statute.

          3)Exempts federal grant funds appropriated by the Budget Act for  
            public health preparedness and response from being subject to  
            provisions of law governing contracting by state agencies.

          This bill:
          1)Adds trade associations to the list of entities that are  
            eligible to receive federal funding, that has been allocated  
            to the Department of Public Health for public health  
            preparedness and response. 

          2)Contains an urgency clause that will make this bill effective  
            upon enactment.







          AB 1149 (Wood)                                      Page 2 of ?
          
          

           FISCAL  
          EFFECT  :  According to the Assembly Appropriations Committee,  
          this bill has negligible state fiscal effect. This bill  
          clarifies eligibility for an existing federal grant.

           PRIOR  
          VOTES  :  
          
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          |Assembly Floor:                     |78 - 0                      |
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          |Assembly Appropriations Committee:  |17 - 0                      |
          |------------------------------------+----------------------------|
          |Assembly Health Committee:          |18 - 0                      |
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          COMMENTS  :
          1)Author's statement.  According to the author, historically,  
            trade associations have played a major role in the Hospital  
            Preparedness Program (HPP) and have proven to be valuable  
            assets.  The infrastructure and communication channels within  
            associations make them particularly well suited to tackle the  
            education and outreach challenges inherent to the HPP.  In  
            2014, CDPH-EPO rendered a new interpretation of current law  
            and determined that, because associations are not specifically  
            identified within the code, they are not eligible to receive  
            funds and help administer the program.  Fiscal Year 2013/2014  
            marked the first year associations were not eligible since the  
            program originated in 1996. This bill would allow associations  
            to once again become a valuable resource for the HPP.  The  
            familiarity and credibility trade associations bring to the  
            table, when dealing with their membership, creates a training  
            and teaching environment that is uniquely suited to deliver a  
            high quality program.  Finally, by allowing the trade  
            associations to play their role, the CDPH would save valuable  
            resources that otherwise would be expended searching for other  
            entities to execute the program.
          
          2)Background on federal grant programs for emergency  
            preparedness.  According to DPH, it receives funding from two  
            separate federal grant programs for public health emergency  
            preparedness and response: The Public Health Emergency  
            Preparedness (PHEP) program, under the Centers for Disease  








          AB 1149 (Wood)                                      Page 3 of ?
          
          
            Control and Prevention (CDC), and HPP, administered by the  
            U.S. Department of Health and Human Services' Assistant  
            Secretary for Preparedness and Response (ASPR).  In the most  
            recent fiscal year (2014-15), the Budget Act appropriated  
            $74,405,196 from these two federal grant programs.

          DPH states that PHEP funds are restricted to state and local  
            health departments. DPH allocates 70 percent of the PHEP funds  
            to local health departments pursuant to a formula in statute  
            and supports its own preparedness functions with the remaining  
            30 percent of the allocation.

          DPH states that HPP funds are intended for health care facility  
            and emergency medical services preparedness. DPH allocates 63  
            percent of the funds directly to, or on behalf of, the local  
            level.  DPH states that the California Hospital Association,  
            the California Association of Health Facilities, and the  
            California Primary Care Association receive HPP funds to  
            strengthen health care facility preparedness.  HPP funds are  
            allocated to county HPP entities to build health care  
            coalitions.  Coalitions include hospitals, clinics, emergency  
            medical services/systems and long-term care facilities.  DPH  
            states that each county determines the priority for use of HPP  
            funds by health care facilities and emergency medical  
            services.

          3)History of providing HPP funds to trade associations.  
            According to DPH, both the CDC and the ASPR allow states to  
            allocate HPP funds to trade associations, which is a standard  
            practice for many states across the nation. DPH states that  
            while it has not received any complaints regarding allocating  
            emergency preparedness and response funds to trade  
            associations, it is anticipated that if clarification is not  
            provided, health care leaders across the state will raise  
            concerns that emergency preparedness funds are not supporting  
            health care facilities in California.

          DPH states that historically, it was able to use the existing  
            Health and Safety Code language to allocate funds directly to  
            trade associations, related to the specific itemized list of  
            facilities and response partners, to provide technical  
            assistance and to develop templates, checklists and planning  
            tools that are specific to their members' preparedness and  
            planning needs. DPH states that this early interpretation of  
            the statute was based on the premise that sufficient funds  








          AB 1149 (Wood)                                      Page 4 of ?
          
          
            were not available, nor was it feasible to allocate emergency  
            preparedness funds to over 3,000 health care facilities  
            individually across California. Diluting the funds will not  
            help individual facilities, but funding trade associations to  
            develop planning tools and provide education for their members  
            has advanced and will continue to enhance preparedness for  
            hospitals, clinics, and long-term care facilities.

          In 2012, it was recognized by DPH's Office of Legal Affairs that  
            the existing language did not include long-term care  
            facilities; and the California Association of Healthcare  
            Facilities moved to amend the statute with AB 1793 (Yamada,  
            Chapter 166, Statutes of 2012).  The Governor signed the  
            legislation that provided an amendment to include long-term  
            care facilities with the intent that this amendment would  
            allow DPH to contract directly with the California Association  
            of Health Facilities to provide tools and training to  
            long-term care facilities across California to strengthen  
            their emergency preparedness and response capacity. Since that  
            time, DPH's Office of Legal Services has concluded that the  
            current law is specific and only governs those contracts with  
            local health jurisdictions, hospitals, long-term health care  
            facilities, clinics, emergency medical systems, and poison  
            control centers and not trade associations as was the original  
            interpretation. 

          4)Prior legislation. AB 1793 (Yamada, Chapter 166, Statutes of  
            2012) eliminated the September 1, 2012, sunset date on  
            provisions of law governing how federal funding for emergency  
            preparedness is allocated, and added long-term health  
            facilities to the list of entities that can be designated to  
            receive federal funds for emergency preparedness.
          
            SB 769 (Alquist, Chapter 506, Statutes of 2010), requires  
            federal funding received, pursuant to the Supplemental  
            Appropriations Act of 2009 (HR 2346), for pandemic flu, for  
            purposes of state and local public health and emergency  
            response infrastructure, to be subject to appropriation by the  
            Legislature commencing with the 2009-10 fiscal year.
          
            SB 1103 (Committee on Budget and Fiscal Review, Chapter 228,  
            Statutes of 2004), contained statutory changes that enables  
            the Department of Health Services (now DPH) to allocate  
            federal funds to local health jurisdictions, clinics,  
            hospitals, emergency medical systems, and poison control  








          AB 1149 (Wood)                                      Page 5 of ?
          
          
            centers in an expeditious manner and exempts these  
            expenditures from Public Contract Code requirements.

            SB 406 (Ortiz, Chapter 393, Statutes of 2002), established the  
            procedures by which federal funding may be allocated to, and  
            expended by, local health jurisdictions for the prevention of,  
            and response to, bioterrorism attacks and other public health  
            emergencies, pursuant to the federally approved collaborative  
            state-local plan.

          5)Support.  This bill is sponsored by the California Association  
            of Health Facilities (CAHF), which states that, the  
            infrastructure and communication channels within trade  
            associations make them particularly well suited to tackle the  
            education and outreach challenges inherent in the HPP. CAHF  
            states that through almost eight years of funding, CAHF has  
            developed a nationally recognized, award-winning Disaster  
            Preparedness Program for Long Term Care through the HPP, and  
            were one of the first long term care associations in the  
            country to be funded through the HPP grant program. Recently,  
            however, DPH has stated that current law does not explicitly  
            provide authorization for state associations. CAHF states that  
            this bill will ensure HPP funding continues to be directed at  
            the associations that are suited to provide appropriate  
            training and education to health facilities in California. The  
            California Hospital Association (CHA) states in support that  
            hospitals have many requirements to be prepared for all  
            hazards that pose a threat to their communities. CHA states  
            that through the HPP, it has developed checklists, guidance  
            documents and other planning tools that have assisted  
            hospitals and others. According to CHA, this bill will allow  
            the associations representing hospitals, long term care  
            providers and community health clinics the ability to directly  
            contract with DPH and maintain their established programs that  
            have proven to be effective. The California Primary Care  
            Association states in support that associations have the  
            expertise, and state and local authorities have called on  
            associations for years to assist them in identifying and  
            addressing the issues in disaster preparedness and response.

           SUPPORT AND OPPOSITION  :
          Support:  California Association of Health Facilities (sponsor)
          California Hospital Association
          California Primary Care Association
          








          AB 1149 (Wood)                                      Page 6 of ?
          
          
          Oppose:   None received

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