BILL ANALYSIS Ó SB 1090 Page 1 Date of Hearing: June 28, 2016 ASSEMBLY COMMITTEE ON HEALTH Jim Wood, Chair SB 1090 (Mitchell) - As Amended June 1, 2016 SENATE VOTE: 39-0 SUBJECT: Sexually transmitted diseases: outreach and screening services. SUMMARY: Requires the Department of Public Health (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. Specifically, this bill: 1)Requires DPH, to the extent funds are appropriated by the Legislature, to allocate funds to local health jurisdictions for STD outreach and screening services in accordance with the following: a) Requires counties to be targeted and prioritized based on population and incidence of STDs; b) Requires funds to be 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; SB 1090 Page 2 c) Requires each recipient county to demonstrate to DPH that the county has done all of the following: i) Identified priority target populations; ii) Satisfactorily described its outreach protocols; iii) Included community-based partners for outreach and screening; and, iv) Allocated resources for laboratory costs. d) Requires DPH to develop measures for each county to demonstrate accountability. 2)Requires DPH to authorize innovative and impactful outreach and screening services, including, but not limited to, the following: 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; SB 1090 Page 3 c) State-of-the-art testing modalities that ensure swift and accurate screening for STDs; and, d) Community-based testing and disease investigation. 3)Requires DPH to monitor activities in funded counties, based on the accountability measures required under 1) d) above in order to assess the effectiveness of outreach and screening efforts. 4)Prohibits DPH from spending more than 10% of any funds appropriated by the Legislature for administrative costs. 5)Deletes references in existing law to "venereal disease" and instead uses the term "sexually transmitted diseases," which is defined as diseases that are primarily transmitted through sexual contact. EXISTING LAW: 1)Requires 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. 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 SB 1090 Page 4 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. FISCAL EFFECT: According to the Senate Appropriations Committee: 1)Unknown costs to provide funding to local health jurisdictions (General Fund). This bill requires DPH to make funding available, upon appropriation by the Legislature, to local health jurisdictions. The amount of funding available under the 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. 2)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. COMMENTS: 1)PURPOSE OF THIS BILL. According to the author, this bill is necessary because 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 SB 1090 Page 5 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 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)BACKGROUND. 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, the last year for which full data is available, bacterial STDs (chlamydia, gonorrhea, and syphilis) significantly increased over 2013 and even more dramatically for the five year period from 2010 to 2014. During that time chlamydia rose by 12%, gonorrhea by 68%, and primary and secondary syphilis by 86%. 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 SB 1090 Page 6 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. The number of infants born with congenital syphilis nearly doubled for the second consecutive year. 3)STD CONTROL BRANCH. According to DPH, the STD Control Branch (STDCB) carries out five core functions to address STD prevention and control: surveillance; health promotion and education; assessment and assurance of access to quality clinical STD services within the jurisdiction; disease investigation and partner services; and, communication/policy. STDCB has developed a contractual scope of work with local health jurisdictions (LHJs), which includes minimum standards for its core functions. STDCB 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. STDCB may, and currently does, subcontract with community based organizations (CBOs). The LHJ 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 FY 2015-16, the number was $3.5 million, and the Governor's budget proposed $3.3 million for FY 2016-17. 4)SUPPORT. The AIDS Healthcare Foundation (AHF) writes that the lack of resources to address the continuing epidemic of STD SB 1090 Page 7 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. This bill will help reverse these trends by supporting more robust and systematic health interventions and preventions. REGISTERED SUPPORT / OPPOSITION: Support AIDS Healthcare Foundation (sponsor) California Black Health Network California Chapter of the American College of Emergency Physicians Community Action Fund of Planned Parenthood of Orange and San Bernardino Counties SB 1090 Page 8 Planned Parenthood Action Fund of Santa Barbara, Ventura & San Luis Obispo Counties Planned Parenthood Action Fund of the Pacific Southwest Planned Parenthood Advocacy Project Los Angeles County Planned Parenthood Advocates Pasadena and San Gabriel Valley Planned Parenthood Affiliates of California Planned Parenthood Mar Monte Planned Parenthood Northern California Action Fund Opposition None on file. Analysis Prepared by:John Gilman / HEALTH / (916) 319-2097 SB 1090 Page 9