BILL ANALYSIS
AB 861
Page 1
Date of Hearing: April 28, 2009
ASSEMBLY COMMITTEE ON HEALTH
Dave Jones, Chair
AB 861 (Ruskin) - As Amended: March 31, 2009
SUBJECT : Public health services: consolidated contracts.
SUMMARY : Requires the Department of Public Health (DPH) to
implement consolidated and streamlined administration and
contracting processes with counties for DPH's Center for
Infectious Diseases (CID) and Center for Family Health (CFH) and
the programs administered by these centers. Specifically, this
bill :
1)Requires CID and CFH to implement a consolidated and
streamlined administration of its programs by developing, at a
minimum, uniform program requirements and unified contracts
across multiple related program areas.
2)Requires CID and CFH to develop a single allocation contract
between DPH and each county that incorporates the programs
administered by the center. Requires the contract to include
the following elements:
a) Consistent budget regulations, including format,
indirect costs rate, and allowable costs;
b) A single invoice format;
c) Uniform reporting requirements and outcome measures;
and,
d) Uniform staff time surveys.
3)Clarifies that this bill does not authorize a county to
discontinue meeting its obligations to provide services or to
reduce its accountability for the provision of these services.
4)Authorizes CID and CFH to waive regulations regarding the
method of providing services and the method of reporting and
accountability as required to meet the goals of 4) above,
except for regulations pertaining to privacy and
confidentiality of records, civil service merit systems, or
collective bargaining; or, if the waiver results in diminished
services or benefits to an eligible recipient.
5)Defines a program center as an administrative subdivision of
DPH, whether created by statute, or by administrative
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regulation, that oversees and administers multiple public
health programs relating to a specified public health subject
area.
EXISTING LAW :
1)Authorizes DPH to contract with a provider for the provision
of health services, to enter into a single contractual
instrument encompassing services in any number of specified
health subject areas, including primary care, maternal and
child health, family planning, rural health services, migrant
and seasonal farmworker care, genetic disease, among others,
except for federally funded programs that require separate
accounting and reporting.
2)Authorizes the Counties of Humboldt, Mendocino, Alameda, and
any other county as determined by the Secretary of California
Health and Human Services Agency (CHHSA), with the assistance
of the appropriate state departments and within existing
resources of those departments, to implement a program for the
funding and delivery of services and benefits through an
integrated and comprehensive county health and human services
system.
3)Authorizes Placer County, with the assistance of the
appropriate state departments, to implement a pilot program
for funding the delivery of health services through an
integrated and comprehensive county health and human services
system.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
COMMENTS :
1)PURPOSE OF THIS BILL . The author states current reporting
accountability emphasizes costs and services, rather than
children's health outcomes, and requires duplicative efforts
in contract negotiations, staff training, performance
reporting, and other requirements. The author further
contends health workers perform multiple and sometimes
confusing administrative duties because of uncoordinated state
requirements. The author argues counties are desperate for
help in relieving administrative burdens, and notes that DPH
and Placer County have developed a successful consolidated
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contract for all the public health programs Placer County
administers. The author states this bill requires DPH to
develop a narrower consolidated contract for only two of the
program centers it administers, to ease the administrative
process for counties that are interested in participating and
for DPH. The author states this bill is needed to relieve
unnecessary administrative burdens on local county health
departments and refocus attention on quality health care.
2)BACKGROUND . California counties contract with DPH for a
number of programs and services. Each of DPH's five program
centers is divided into various divisions and smaller units
which may enter into separate contracts with an individual
county. According to the Legislative Analyst's Office (LAO),
the principal way in which the state funds public health
programs is through categorical public health programs, which
currently provide $2.4 billion in local assistance. The state
provides state and federal funds to local health jurisdictions
(LHJs), which are 58 counties and three city health
departments, for over 30 categorical programs. The LAO states
these programs are typically targeted to specific populations
with particular health needs, giving LHJs little discretion
over how the categorical funds can be used. The LHJs
receiving these funds must comply with numerous and varied
administrative requirements. For example, some programs
require annual status reports, while others must submit data
on a monthly basis.
3)DPH PROGRAM CENTERS . In 2007, SB 162 (Ortiz) Chapter 241,
Statutes of 2006, divided the Department of Health Services
into DPH and the Department of Health Care Services. After
the division, the State Public Health Officer re-organized DPH
and established five centers for related programmatic
activities. The five centers are CID, CFH, the Center for
Healthcare Quality, the Center for Environmental Health, and
the Center for Chronic Disease Prevention and Health
Promotion.
CID includes the Office of AIDS, which monitors the human
immunodeficiency virus (HIV) epidemic, administers HIV
counseling and testing programs, and provides, with federal
funds, drugs for the treatment of HIV disease to individuals
who could not otherwise afford treatment. CID also operates
infectious disease laboratories; administers the Vaccines for
Children Program; conducts sexually transmitted disease
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prevention, surveillance, and control; and, conducts
tuberculosis surveillance and control, among other
responsibilities.
CFH operates the California Women, Infants and Children (WIC)
nutrition program, which distributes over $1 billion annually
in federal funds for nutrition programs, a breastfeeding peer
counseling program, and evaluations of nutrition education
methodologies. The WIC program serves 1.4 million individuals
per month and contracts with 82 local agencies, including
cities, counties, and community-based organizations. CFH also
includes the comprehensive Family Planning Access Care and
Treatment (Family PACT) program; domestic violence prevention;
the Genetic Disease Screening Program, which conducts over
560,000 screening tests of newborns annually and nearly
400,000 prenatal screening tests per year; and, numerous
programs related to maternal and child health.
4)LAO RECOMMENDATION . The LAO's Analysis of the 2008-09 Budget
Bill recommended the consolidation of certain public health
programs into a block grant and legislation directing DPH to
develop a model consolidated contract for public health
programs.
5)California performance review . Governor Schwarzenegger
established the California Performance Review (CPR) with the
ultimate goal of restructuring, reorganizing, and reforming
state government to make it more responsive to the needs of
its citizens and business community. In 2004, the CPR, which
was composed of 21 leaders from state and local government,
the business and labor communities, and public policy experts,
found that health and human services agencies operate under
over 1,000 administratively burdensome contracts and
recommended that CHHSA reduce the number of public health
agreements by combining multiple programs and reporting
requirements.
6)SAN MATEO COUNTY CONTRACTS . San Mateo County, the sponsor of
this bill, reports that it currently has six contracts or
allocations with CFH, including programs to enhance the
health, social, economic, and educational well-being of
pregnant and parenting adolescents and their children; the
Black Infant Health Program; the Comprehensive Perinatal
Services Program, which provides a wide range of services to
pregnant women, including services in nutrition, psychosocial
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and health education; WIC; and, a breastfeeding program. San
Mateo County also has six contracts or allocations with CID,
for the following public health services: education,
prevention, and treatment of HIV and acquired immune
deficiency syndrome (AIDS) clients; viral load testing for HIV
and AIDS clients; sexually transmitted disease control;
tuberculosis control (two contracts); and, hepatitis B
control.
7)PLACER COUNTY CONSOLIDATED CONTRACT . Placer County is
piloting a program that integrates health and human services
programs and allows the county to have an integrated contract
with the state that consolidates the administrative
requirements for 16 state and federally funded health
programs. Placer County's consolidated health contract pilot
program has been operational for six years. DPH reports that
it took three years of concentrated efforts on the part of
both DPH and Placer County to develop the contract. According
to the LAO, the Placer County contract consolidates the
administrative requirements for 16 state and federally funded
health programs. The goals of the Placer County consolidated
contract were to: a) Create a simplified administrative
framework for managing categorical funding for public health
programs; b) Maximize the use of public health funds and
staffing by reducing staff administrative duties and deploying
staff more flexibly; c) Improve administrative efficiencies
for reporting and accountability; and, d) Track program
outcomes more effectively.
An evaluation of the Placer County pilot found that having a
consolidated contract increased staff's flexibility to provide
services to their clients. One Placer County executive stated
that the consolidated contract "liberated" his staff of health
educators. For example, a health educator can now work with a
high-risk teenager on HIV prevention, nutrition, tobacco,
dental health, and other concerns, whereas, prior to the
pilot, multiple health educators would have to see this
teenager even though the educators were teaching the same
prevention strategies. Placer County officials report that
the consolidated contract will significantly simplify
administrative, contracting, and claiming processes for public
health programs, and permit greater county flexibility in
meeting state and federal requirements. Placer County
officials believe the consolidated contract will shift the
focus from being accountable for carrying out a series of
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individual categorical programs to being accountable for the
overall health of the community. The LAO reports that Placer
County has also reduced its accounting, reporting, and
contracting workload by 1,600 hours annually.
8)PREVIOUS LEGISLATION .
a) AB 1859 (Leslie) Chapter 268, Statutes of 2006, extends,
from July 1, 2006 to July 1, 2011, the sunset of the Placer
County health and human services pilot project pursuant to
SB 1846 (Leslie) Chapter 899, Statutes of 1996.
b) AB 392 (Chan) of 2005 would have permitted any county,
with the assistance and participation of the appropriate
state departments, to implement a program for the funding
and delivery of services and benefits through an integrated
and comprehensive county health and human services system,
as specified. AB 392 was amended on the Senate Floor to
address toxic chemicals.
c) AB 1881 (Berg), Chapter 665, Statues of 2004, authorized
Humboldt, Mendocino, and Alameda counties, and any
additional county, as determined by CHHSA, with the
assistance and participation of the appropriate state
departments, to implement a pilot program for the funding
and delivery of services and benefits through an integrated
and comprehensive county health and human services system
until January 1, 2009.
d) SB 1846 authorizes Placer County, with the assistance of
the appropriate state departments, to implement a pilot
program for funding the delivery of health services through
an integrated and comprehensive county health and human
services system.
9)SUPPORT . The California State Association of Counties and the
County Health Executives Association of California write in
support of this bill that local health departments must
navigate a labyrinth of contracts and administrative
requirements and that the process in this bill would be an
important step toward simplifying and standardizing the
contracting process for categorical public health programs,
resulting in more effective utilization of local health
department resources. The California Conference of Local
Health Department Nursing Directors writes in support that
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California needs a comprehensive approach to administering
public health programs and reducing the arbitrary complexities
in invoicing and reporting, and that this bill will reduce
costs and allow savings to be passed on to services for
residents. The San Bernardino County Board of Supervisors
writes in support that the San Bernardino County Public Health
Department has long been concerned about slow, cumbersome, and
inefficient contracting process with DPH.
10)POLICY QUESTIONS .
a) Model contract . Should this bill require DPH to develop
a model single allocation contract, rather than a single
allocation contract between DPH and each county?
b) LHJs . In California, in addition to the 58 county (or
city and county) health departments, there are three city
health departments. Should this bill require DPH to
implement consolidated and streamlined administration and
contracting processes for LHJs, which would include the
cities that operate their own health departments, rather
than only counties?
c) Stakeholder input . Should this bill require DPH to work
closely with representatives of counties or LHJs, or, at a
minimum, solicit input from LHJs, as it develops a
consolidated contract?
d) Deadline . Should this bill specify a date by which DPH
must implement a consolidated contract?
11)TECHNICAL AMENDMENT . On page 3, lines 11 and 12, capitalize
references to CID and CFH.
REGISTERED SUPPORT / OPPOSITION :
Support
California Conference of Local Health Department Nursing
Directors
California State Association of Counties
County Health Executives Association of California
San Bernardino County Board of Supervisors
Opposition
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None on file.
Analysis Prepared by : Allegra Kim / HEALTH / (916) 319-2097