BILL ANALYSIS
AB 861
Page 1
GOVERNOR'S VETO
AB 861 (Ruskin)
As Amended May 5, 2009
2/3 vote
HEALTH 18-0 APPROPRIATIONS 15-0
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|Ayes:|Jones, Fletcher, Adams, |Ayes:|De Leon, Nielsen, |
| |Ammiano, Block, Carter, | |Ammiano, |
| |Conway, De La Torre, De | |Charles Calderon, Davis, |
| |Leon, Emmerson, Hall, | |Duvall, Fuentes, Hall, |
| |Hayashi, Hernandez, | |Harkey, John A. Perez, |
| |Bonnie Lowenthal, Nava, | |Price, Skinner, Solorio, |
| |V. Manuel Perez, Salas, | |Audra Strickland, |
| |Audra Strickland | |Torlakson |
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|ASSEMBLY: |76-0 |(May 28, 2009) |SENATE: |35-0 |(September 2, |
| | | | | |2009) |
| | | | | | |
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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
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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
regulation, that oversees and administers multiple public
health programs relating to a specified public health subject
area.
FISCAL EFFECT : According to the Senate Appropriations Committee
analysis, special, federal, and General Fund costs of at least
$50,000 in 2009-10, and at least $100,000 annually in 2010-11
and 2011-12.
COMMENTS : 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
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burdens, and notes that DPH and Placer County have developed a
successful consolidated 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.
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.
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
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could not otherwise afford treatment. CID also operates
infectious disease laboratories; administers the Vaccines for
Children Program; conducts sexually transmitted disease
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.
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.
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.
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
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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 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.
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: 1) Create a simplified administrative
framework for managing categorical funding for public health
programs; 2) Maximize the use of public health funds and
staffing by reducing staff administrative duties and deploying
staff more flexibly; 3) Improve administrative efficiencies for
reporting and accountability; and, 4) Track program outcomes
more effectively.
GOVERNOR'S VETO MESSAGE :
"While I strongly support efforts to streamline government, the
provisions of this bill are unnecessary and duplicative of
efforts currently underway at the California Department of
Public Health."
Analysis Prepared by : Allegra Kim / HEALTH / (916) 319-2097
FN: 0003383
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