BILL ANALYSIS                                                                                                                                                                                                    Ó

          |SENATE RULES COMMITTEE            |                       AB 1149|
          |Office of Senate Floor Analyses   |                              |
          |(916) 651-1520    Fax: (916)      |                              |
          |327-4478                          |                              |

                                   THIRD READING 

          Bill No:  AB 1149
          Author:   Wood (D)
          Vote:     27  - Urgency

           SENATE HEALTH COMMITTEE:  9-0, 6/10/15
           AYES:  Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,  
            Pan, Roth, Wolk

           AYES:  Lara, Bates, Beall, Hill, Leyva, Mendoza
           NO VOTE RECORDED:  Nielsen

           ASSEMBLY FLOOR:  78-0, 5/14/15 (Consent) - See last page for  

           SUBJECT:   Public health emergencies: funding

          SOURCE:    California Association of Health Facilities

          DIGEST:   This bill 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,  


                                                                    AB 1149  
                                                                    Page  2

            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 DPH for public health preparedness and response. 

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

          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, the Emergency Preparedness Office of DPH rendered a new  
            interpretation of existing law and determined that, because  
            associations are not specifically identified in the statute,  
            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 allows 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 DPH would save valuable resources that  


                                                                    AB 1149  
                                                                    Page  3

            otherwise would be expended searching for other entities to  
            execute the program.

          2)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 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% of the PHEP funds to  
            local health departments pursuant to a formula in statute and  
            supports its own preparedness functions with the remaining 30%  
            of the allocation.

          DPH states that HPP funds are intended for health care facility  
            and emergency medical services preparedness. DPH allocates 63%  
            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  

          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.


                                                                    AB 1149  
                                                                    Page  4

          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  
            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  
            existing 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  

          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  


                                                                    AB 1149  
                                                                    Page  5

          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 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.

          FISCAL EFFECT:   Appropriation:    No          Fiscal  
          Com.:YesLocal:   No

          According to the Senate Appropriations Committee, minor cost  
          pressures to provide funding to trade associations, rather than  
          to facilities directly (federal funds). By authorizing trade  
          associations to receive federal funding (via DPH), individual  
          health facilities may not receive funding directly. However,  
          given the very large number of health facilities in the state,  
          it is not practical for DPH to grant enough funds to individual  
          facilities to have a practical benefit. Using trade associations  
          can be a cost-effective way to disseminate information and best  
          practices to individual facilities.

          SUPPORT:   (Verified6/24/15)

          California Association of Health Facilities (source)
          California Hospital Association
          California Primary Care Association


                                                                    AB 1149  
                                                                    Page  6

          OPPOSITION:   (Verified6/24/15)

          None received

          ARGUMENTS IN 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 existing 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.


          ASSEMBLY FLOOR:  78-0, 5/14/15
          AYES:  Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom,  
            Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang,  
            Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle,  


                                                                    AB 1149  
                                                                    Page  7

            Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina  
            Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez,  
            Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden,  
            Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Lopez, Low,  
            Maienschein, Mathis, Mayes, McCarty, Melendez, Mullin,  
            Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea,  
            Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago,  
            Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber,  
            Wilk, Williams, Wood, Atkins
          NO VOTE RECORDED:  Linder, Medina

          Prepared by:Vince Marchand / HEALTH / 
          6/24/15 15:30:02

                                   ****  END  ****