BILL ANALYSIS
SENATE HEALTH
COMMITTEE ANALYSIS
Senator Elaine K. Alquist, Chair
BILL NO: AB 861
A
AUTHOR: Ruskin
B
AMENDED: May 5, 2009
HEARING DATE: June 17, 2009
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CONSULTANT:
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Orr/
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SUBJECT
Public health services: consolidated contracts
SUMMARY
Requires the Department of Public Health (DPH) to develop
consolidated contracts with local health jurisdictions
(LHJs) administering specified public health programs.
CHANGES TO EXISTING LAW
Existing law:
Establishes the state Department of Public Health, and
transfers the responsibility for certain programs from the
state Department of Health Services to the state Department
of Public Health.
Allows DPH to enter into a single contractual instrument
encompassing services in any number of health service areas
limited to the following: primary care, maternal and child
health, woman, infant, and child care, family planning,
rural health services, migrant and seasonal farmworker
care, child health and disability prevention, genetic
disease, hypertension, grants-in-aid, American Indian
health, adult health care, and dental care, except that
Continued---
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federally funded programs requiring separate accounting and
reporting shall preserve the separate accounting and
reporting for contracts executed pursuant to this article.
States legislative intent to promote efficiency in the
administration of multiple contracts between nonprofit
organizations and the divisions of DPH by requiring uniform
provisions concerning fringe benefits.
Encourages the minimization of duplicative administrative
systems to foster the development of a comprehensive and
collaborative delivery system of services to children and
youths at the state and local level, and to offer fiscal
incentives in the form of waivers and negotiated contracts
to encourage collaboration.
This bill:
Requires DPH to use existing resources to develop and
implement, in consultation with local health jurisdiction
representatives, a model consolidated and streamlined
administration and contracting process with LHJs for DPH's
Center of Infectious Diseases (CID) and the Center for
Family Health (CFH) and for the programs administered by
the respective centers.
Requires prior to July 1, 2011, CID and CFH to develop a
single model allocation contract between DPH and LHJs that
includes consistent budget regulations, a single invoice
format, uniform reporting requirements and outcome
measures, and uniform staff time surveys.
Allows CID and CFH to waive regulations regarding the
method of providing services and the method of reporting
and accountability as required to meet goals of this
proposed statute, with the exception of regulations
regarding privacy and confidentiality of records, civil
service merit systems, or collective bargaining, or
regulations that would reduce the level of services or
benefits to recipients.
Stipulates that nothing in this bill authorizes an LHJ to
discontinue meeting its obligations under existing law to
provide services or reduce its accountability for the
provision of these services.
FISCAL IMPACT
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Assembly Appropriations Committee estimates unknown
one-time General Fund costs of less than $50,000, offset by
reductions in other administrative costs.
BACKGROUND AND DISCUSSION
The author believes this bill will relieve unnecessary
administrative burdens on local county health departments.
The author contends that this bill will allow attention to
be refocused on providing quality healthcare.
The Department of Public Health
Most of DPH's programs are housed within five centers: the
Center for Chronic Disease Prevention and Health Promotion,
Center for Infectious Diseases (CID), Center for Family
Health (CFH), Center for Environmental Health, and the
Center for Health Care Quality (CHCQ).
The Center for Chronic Disease Prevention and Health
Promotion administers programs that address the prevention
and control of chronic diseases including cancer,
cardiovascular diseases, diabetes; the prevention and
control of injuries; and, the prevention and control of
environmental and occupational diseases. The Center
comprises the Division of Chronic Disease and Injury
Control and the Division of Environmental and Occupational
Disease Control.
CID aims to protect the public from the threat of
preventable infectious diseases and assists those living
with an infectious disease in securing prompt and
appropriate access to healthcare, medications and
associated support services. CID does this through an
Office of Infectious Diseases and Emergency Preparedness,
Office of AIDS, and Division of Communicable Disease
Control.
CFH is comprised of four Divisions, including the Genetic
Disease Screening Program, the Office of Family Planning,
the Maternal, Child and Adolescent Health Program and the
Women, Infants and Children Supplemental Nutrition Program.
These divisions oversee a multiplicity of programs that
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impact the health and birth outcomes for Californians and
reduce health disparities.
The Center for Environmental Health comprises the Division
of Food Drug and Radiation Safety and the Division of
Drinking Water and Environmental Management, and is
responsible for administering programs that protect the
public from unsafe drinking water; oversees the disposal of
low-level radioactive waste; regulate the generation,
handling, and disposal of medical waste; and protects and
manages food, drug, medical device, and radiation sources.
CHCQ is responsible for regulatory oversight of health
facilities, health professionals, and clinical and public
health laboratories, and executes this oversight through
the Center's Licensing and Certification (L&C) program and
Laboratory Field Services (LFS) Program.
According to the Legislative Analysts Office, the state
currently provides a combination of state and federal funds
to LHJs for over 30 categorical programs. These programs
are targeted to specific populations with particular health
needs. Funding for these programs is allocated in a variety
of ways including on a formula basis and via a grant
application process. Each individual DPH division or
program can currently enter into separate contracts with
each individual LHJ . The LHJs receiving these funds must
comply with many and varied administrative requirements,
which can lead to duplicative efforts in contract
negotiations, staff training, and performance reporting,
among other things.
Legislative Analyst's Office recommendations
The LAO noted in their 2008-09 analysis of the budget bill,
that the state's system for funding local health programs
is fragmented, inflexible, and fails to hold local health
jurisdictions accountable to results. The LAO recommended
consolidating certain public health programs into a block
grant, and enacting legislation to direct DPH to "develop a
model consolidated contract for these and other public
health programs (which are not consolidated into the block
grant)." The LAO also recommended establishing outcome
measurements for public health programs.
California Performance Review recommendations
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The governor commissioned the California Performance Review
(CPR) in 2004 in order to reexamine the functions of state
government, and to provide recommendations for improving
efficiency and accountability in its departments. One of
the CPR's general recommendations was to improve services
and productivity through "expand(ing) dramatically
cross-departmental and inter-governmental collaborations in
designing, building and operating smart government services
to make it easier for members of the public to interact
with government?. Local, state and federal governments
must join collaboratively to design a more seamless,
integrated process for delivering routine services to the
public." The report goes on to reiterate the need for
California to replace the duplicative and conflicting
financial, human resources and procurement systems with a
common set of management tools that are interoperable
across state government.
The report determined that the state's burdensome
contracting procedures interfere with the delivery of
public health services for cities and counties. CPR
recommended streamlining administrative processes for
funding local public health programs, reducing processing
times for execution of agreements and consolidating
multiple public health funding sources where appropriate.
Related legislation
SB 162 (Ortiz) Chapter 241, Statutes of 2006, enacted the
California Public Health Act, creating the Department of
Public Health within the Health and Human Services Agency.
AB 1881 (Berg) Chapter 665, Statutes of 2004, extended
authority to the Counties of Humboldt, Mendocino, and
Alameda, to implement a program for the funding and
delivery of services and benefits through an integrated and
comprehensive county health and human services system,
subject to certain limitations, from January 1, 2005 to
January 1, 2009. Extended this authorization to any
additional county or counties, as determined by the
Secretary of the California Health and Human Services
Agency.
SB 1846 (Leslie), Chapter 899, Statutes of 1996 authorized
Placer County and appropriate state departments to jointly
seek federal approval of a pilot project to integrate the
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delivery and funding for a comprehensive county health and
human services system. This statute became inoperative July
1, 2001, and was repealed Jan 1, 2002.
Arguments in support
Supporters claim that local health departments are
currently forced to navigate a labyrinth of contracts and
administrative requirements in order to administer mandated
federal and state public health programs. They contend that
time and energy dedicated to these administrative
requirements would be better spent maximizing outcomes and
services to the people of their respective local health
jurisdictions.
PRIOR ACTIONS
Assembly Floor: 76-0 (on consent)
Assembly Appropriations: 15-0 (on consent)
Assembly Health: 18-0
Assembly Rules: 9-0
COMMENTS
1. General Fund cost pressures
While there are estimated General Fund costs associated
with the implementation of this bill, those costs are
believed to be minor and should be offset by yielding
savings in accounting, reporting, and contracting costs.
It is unknown how soon those savings would materialize,
and whether or not that would affect counties' future
funding requests from the state. It is also difficult to
quantify the savings that could be found from improved
service delivery and improved public health outcomes.
2. Measuring outcomes
The LAO contends that current oversight efforts are
largely focused on the structures of the categorical
programs and on accounting for funds spent within the
programs. This emphasis encourages local administrators
to design programs that ensure compliance, rather than
providing LHJs the freedom to assess the needs of the
community and develop programs that would achieve desired
results. No programs are currently required to routinely
collect good outcome data and measure performance. If
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this bill is passed, it may be useful to evaluate whether
or not the implementation of this measure achieved
improved public health outcomes in participating
jurisdictions.
POSITIONS
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
San Mateo County Health System
Oppose: None.
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