BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SB 1090|
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THIRD READING
Bill No: SB 1090
Author: Mitchell (D)
Amended: 6/1/16
Vote: 21
SENATE HEALTH COMMITTEE: 9-0, 4/6/16
AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen,
Pan, Roth, Wolk
SENATE APPROPRIATIONS COMMITTEE: 7-0, 5/27/16
AYES: Lara, Bates, Beall, Hill, McGuire, Mendoza, Nielsen
SUBJECT: Sexually transmitted diseases: outreach and
screening services
SOURCE: AIDS Healthcare Foundation
DIGEST: This bill requires the Department of Public Health, to
the extent funds are appropriated by the Legislature for these
purposes, to allocate funds to counties for sexually transmitted
disease outreach and screening services.
ANALYSIS:
Existing law:
1)Requires the Department of Public Health (DPH) to develop and
review plans and provide leadership and consultation for, and
participate in, a program for the prevention and control of
"venereal disease." Defines "venereal disease" as syphilis,
gonorrhea, chancroid, lymphopathia venereum, granuloma
inguinale, and chlamydia.
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2)Permits DPH to establish, maintain, and subsidize clinics,
dispensaries, and prophylactic stations for the diagnosis,
treatment, and prevention of venereal disease. Permits DPH to
provide medical, advisory, financial, or other assistance to
the clinics, dispensaries, and stations.
3)Permits DPH to furnish treatment for a case or for a group of
cases in rural counties or cities upon the recommendation of
the local health officer if adequate facilities for the
treatment are not available in the county or city.
This bill:
1)Requires DPH, to the extent funds are appropriated by the
Legislature for these purposes, to allocate funds to counties
for sexually transmitted disease (STD) outreach and screening
services as follows:
a) Counties are targeted and prioritized based on
population and incidence of STDs;
b) Funds are allocated to targeted counties in a manner
that balances the need to spread funding to as many
counties as possible and the need to provide meaningful
services to each funded county; and,
c) Each recipient county demonstrates that it has:
identified priority target populations; satisfactorily
described its outreach protocols; included community-based
partners for outreach and screening; and, allocated
resources for laboratory costs.
2)Requires DPH to develop measures for each county funded to
demonstrate accountability. Requires DPH to monitor activities
in funded counties, based on the accountability measures
required in order to assess the effectiveness of outreach and
screening efforts.
3)Requires DPH to authorize innovative and impactful outreach
and screening services, including, but not limited to:
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a) Voluntary screening for STDs among inmates and wards
of county adult and juvenile correctional facilities;
b) Social media platforms that allow a person to receive
test results, share test results with partners, access
treatment services and reduce administrative costs;
c) State-of-the-art testing modalities that ensure swift
and accurate screening for STDs; and,
d) Community-based testing and disease investigation.
4)Prohibits DPH from spending any more than 10% of any funds
appropriated for purposes of this bill for administrative
costs.
5)Deletes references in existing law to "venereal disease" and
instead uses the term "sexually transmitted diseases," which
is defined under the bill as diseases that are primarily
transmitted through sexual contact.
Comments
1)Author's statement. According to the author, STDs remain a
large and persistent public health challenge for the citizens
of our state. The increasingly large number of cases makes
STDs the most commonly reported communicable disease in
California. Exacerbating the problem is the fact that because
STDs are often asymptomatic, the burden of the disease is far
greater than the number of reported cases. It is astonishing
that infections that have been easily preventable and
treatable for decades are on the rise in dramatic fashion. We
can reverse this deplorable situation through more robust and
systematic prevention and health interventions. There is a
serious lack of funds directed at this epidemic. However,
there is also insufficient statutory direction to DPH in terms
of addressing priorities and defining and implementing
innovative mechanisms for engaging people who are at greatest
risk for exposure to an STD. The consequences of inattention
are varied, expensive and often permanent. Not only can an STD
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lead to infection with HIV, it can lead to infertility, heart
and kidney disease and complicated pregnancies. Inadequate
attention perpetuates a growing epidemic with increasing costs
to society. It is essential that every dollar be spent in
ways that have the greatest impact.
2)California data. According to DPH, California ranked first
among all states in 2014 for the total number of cases for
chlamydia, gonorrhea, syphilis, and congenital syphilis. In
2014, bacterial STDs (chlamydia, gonorrhea, and syphilis)
significantly increased. Important disparities persist, with
the highest rates found among young people, African-Americans,
and gay and bisexual men. Chlamydia remains the most common
reportable disease in California. The highest rates were among
young women. Rates among African-American teens and young
adult women were the highest of any group, and three to five
times higher than white young women. Gonorrhea rates continued
to increase sharply across all regions of the state. San
Francisco, Shasta, and Kern Counties had the highest rates.
Racial disparities persisted with rates among
African-Americans six times higher than among whites. Early
syphilis cases continued to increase across all regions of
California, with the vast majority of cases among men who have
sex with men. However, the number of cases among females of
reproductive age increased by 56% from 2013. Racial
disparities continued with African-American male rates being
twice as high as among white males.
3)DPH's STD Control Branch. California statute refers to
"venereal disease" and "sexually transmitted diseases" for
purposes of the work that the STD Control Branch conducts.
According to DPH, the STD Control Branch carries out five core
functions to address STD prevention and control in California:
surveillance, health promotion and education, assessment and
assurance of access to and quality of clinical STD services
within the jurisdiction, disease investigation and partner
services, and communication/policy. The STD Control Branch has
developed a contractual scope of work with local health
jurisdictions (LHJs), which includes minimum standards for its
core functions. The STD Control Branch currently has contracts
with 27 counties and one city health jurisdiction (28 of 61
California LHJs); funds are distributed among LHJs according
to a data-driven funding allocation formula. The STD Control
Branch may, and currently does, subcontract with CBOs. The LHJ
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contract process allows for funding of CBOs through a
subcontract. The funding is earmarked to support a
comprehensive scope of work, including STD surveillance and
case reporting (which are legally mandated activities of
LHJs). Funding for local assistance through this program has
remained fairly consistent over the past three years. In
fiscal year (FY) 2014-15, DPH distributed $3.2 million (state
and federal funds) to locals for STD control activities, in
2015-16, the number was $3.5 million, and the Governor's
budget proposes $3.3 million for FY 2016-17.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to the Senate Appropriations Committee:
Unknown costs to provide funding to local health jurisdictions
(General Fund). The bill requires DPH to make funding
available, upon appropriation by the Legislature, to local
health jurisdictions. The amount of funding available under
this bill is unknown at this time and would depend on future
budget appropriations. Staff is not aware of any significant
source of funding that could be used for this new program
other than the General Fund.
Unknown costs to provide program administration, including
developing program guidelines, reviewing applications,
awarding grants, and monitoring accountability requirements on
grantees. If the amount of funding made available in the
future were $10 million per year, DPH would be able to spend
up to $1 million per year to administer the program.
SUPPORT: (Verified5/31/16)
AIDS Healthcare Foundation (source)
American Federation of State, County and Municipal Employees,
AFL-CIO
California Black Health Network
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Planned Parenthood Action Fund of Santa Barbara, Ventura & San
Louis Obispo Counties
Planned Parenthood Advocates Pasadena and San Gabriel Valley
Planned Parenthood Mar Monte
OPPOSITION: (Verified5/31/16)
None received
ARGUMENTS IN SUPPORT: The AIDS Healthcare Foundation (AHF)
writes that the lack of resources to address the continuing
epidemic of STD infection is profoundly troubling and that the
consequences of inattention are varied, expensive, and often
permanent. AHF states that from the larger public health
perspective, inattention also perpetuates a growing epidemic
with increasing costs to society. Other supporters write that
the increasingly large number of cases makes STDs the most
commonly reported communicable disease in California, and it is
unacceptable that a bacterial infection that has been easily
preventable and treatable for decades is on the rise in such
dramatic fashion. SB 1090 will help reverse these trends by
supporting more robust and systematic health interventions and
preventions.
Prepared by:Melanie Moreno / HEALTH /
6/2/16 10:41:28
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