BILL ANALYSIS �
AB 1793
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Date of Hearing: April 17, 2012
ASSEMBLY COMMITTEE ON HEALTH
William W. Monning, Chair
AB 1793 (Yamada) - As Introduced: February 21, 2012
SUBJECT : Public health: federal funding: public health
emergencies.
SUMMARY : Adds long-term care facilities to the list of local
health entities eligible to receive federal funding allocated
for the prevention of, and response to, public health
emergencies. Specifically, this bill :
1)Clarifies that federal funding received by the Department of
Public Health (DPH) for bioterrorism preparedness and
emergency response is subject to appropriation in the annual
Budget Act or other statute.
2)Adds long-term care facilities to the list of local health
entities eligible to receive federal funding when federal
funding is allocated and expended for the prevention of, and
response to, bioterrorist attacks and other public health
emergencies in accordance with a federally approved
collaborative state-local plan.
3)Requires that all applicable procedures and requirements in
existing law related to the allocation and the expenditure of
federal funds for public health emergency preparedness
programs apply to long-term care facilities.
4)Deletes the sunset date of September 2012, making permanent
the sections of law that authorize the expenditures of federal
funds for emergency response and preparedness.
5)Declares that the provisions in this bill take effect
immediately as an urgency statute in order to ensure an
adequate and timely response to public health threats by
preventing the lapse of provisions relating to the allocation
and the expenditure of federal funds for public health
emergency preparedness programs.
EXISTING LAW :
1)Establishes procedures and requirements to govern the
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allocation to, and expenditure by, local health jurisdictions,
hospitals, clinics, emergency medical systems, and poison
control centers, of federal funding received for the
prevention of, and response to, public health emergencies.
2)Provides that these procedures apply only when the specified
entities are designated by a federal or state agency to manage
the funds for public health preparedness and response to
public health emergencies pursuant to a specified
federally-approved plan.
3)Requires funds to be allocated to these entities through the
use of agreements that are exempt from provisions that
establish public contracting standards.
4)Makes the provisions in 1) through 3) above inoperative as of
September 1, 2012, and repeals these provisions as of January
1, 2013.
FISCAL EFFECT : This bill has not yet been heard by a fiscal
committee.
COMMENTS :
1)THE PURPOSE OF THIS BILL . According to the author, during a
bioterrorist attack or other public health emergency, such as
an epidemic or flood, the demand for acute hospital care may
surge beyond hospital capacity or people may not be able to
get to an acute care hospital. The author maintains that
alternative health care facilities and professionals must also
be utilized. The author asserts that long-term care
facilities are numerous, care for some of the State's most
frail and vulnerable residents, have medical professionals and
supplies, and should be considered in emergency planning.
The author argues that federal law deems long-term care
facilities eligible for funding, while state law does not.
Current California law limits participants to local health
jurisdictions, hospitals, clinics, emergency medical systems,
and poison control centers. The author maintains that the
lack of conformity between federal and state law is causing
confusion about the participation of long-term care facilities
and funding for their efforts. The author asserts that this
bill corrects this discrepancy between California law and the
federal guidelines, allowing emergency planners to include
long-term care facilities to preserve public health and
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safety.
2)BACKGROUND . According to the federal Centers for Disease
Control and Prevention (CDC), the events of September 11th and
the devastation caused by Hurricane Katrina demonstrate the
long-term impact of such events to the public health
infrastructure and the importance of emergency preparedness.
CDC maintains that the reality of bioterrorism, as exemplified
by the anthrax cases reported in the United States,
underscores the importance of preparing for possible
bioterrorist attacks. Despite the fact that significant
progress has been made in overall preparedness, according to
CDC, the nation's ability to detect bioterrorist threats,
communicate these in real time to clinical, public health, and
lay communities, and effectively triage and treat afflicted
populations continues to raise concern - especially for
certain vulnerable populations, such as the elderly, whose
unique psychological and medical needs require special
attention.
A 2004 CDC National Nursing Home survey estimates that nearly
1.5 million adults are admitted to the nation's 16,100
long-term care facilities each year. As the United States
population continues to age, long-term care facilities have
become an increasingly important component of the health
system but were not incorporated into larger disaster planning
efforts in September 2001, when Congress initially
appropriated funding to CDC to expand its support nationwide
of state and local public health preparedness. Most health
care preparedness planning efforts were focused on hospital
and first responder preparedness. However, the potential role
and needs of preparedness on the part of long-term care
facilities has emerged in local and national preparedness
discussions and guidelines.
Under current California law, DPH is required to submit an
annual collaborative state and local plan to the federal
government for approval as a condition of receiving federal
funding. According to DPH, long-term care facilities licensed
as skilled nursing facilities have been recognized as a
critical partner and included in the State's plan to ensure an
integrated response in delivering health care during
emergencies. According to the California Association of
Health Facilities (CAHF), however, while in the past it was
interpreted by DPH's legal counsel that long-term care
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facilities were eligible to receive federal funding related to
emergency preparedness, in 2011 they were informed that new
DPH legal counsel had taken a different interpretation of
existing law and concluded that long-term care facilities are
not included in the eligible group to receive federal
emergency preparedness and response funds.
3)FEDERAL FUNDING FOR BIOTERRORISM AND EMERGENCY PREPAREDNESS .
Under current California law, local health jurisdictions,
hospitals, clinics, emergency medical systems, and poison
control centers are eligible to receive federal funding for
bioterrorism preparedness and public health emergency
response. According to DPH, the department receives the
following three separate funding sources for public health
emergency preparedness and response: a) A federal grant from
the CDC, Public Health Emergency Preparedness (PHEP); b) A
federal grant from the federal Department of Health and Human
Services' Assistant Secretary for Preparedness and Response
(ASPR), Hospital Preparedness Program (HPP); and, c) Funds
from the State General Fund.
DPH explains that Los Angeles County receives its PHEP and HPP
allocations directly from the CDC and ASPR. For the rest of
the state, DPH maintains, that PHEP funds are restricted to
State and local health departments. DPH allocates 70% of the
PHEP funds to 58 local health departments using an allocation
formula that provides each local health department with a base
of $100,000 and distributes the remaining funds on the basis
of each county's population. DPH preparedness functions are
supported with the remaining 30% of the allocation.
HPP funds, according to DPH, are intended for health care
facility and emergency medical services preparedness with 75%
of the funds allocated directly to or on behalf of the local
level. The California Hospital Association, CAHF and the
California Primary Care Association receive HPP funds to
strengthen health care facility preparedness. HPP funds are
allocated to county HPP entities to build health care
coalitions. DPH maintains that each local HPP entity receives
a base of $135,000; the remaining funds are distributed on the
basis of each county's population. Coalitions include
hospitals, clinics, emergency medical services/systems and
long-term care facilities as other partners. Each county
determines the priority for use of HPP funds by health care
facilities and emergency medical services.
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According to the CDC, public health systems and their respective
preparedness programs face many challenges. Federal funds for
preparedness have been declining, causing state and local
planners to express concerns over their ability to sustain the
real and measurable advances made in public health
preparedness. DPH reports that in Fiscal Year (FY) 2009-10
California received $222,982,000 (includes federal H1N1
response funds); in FY 2010-11 $123,088,000; and, in FY
2011-12 $102,062,000.
4)SUPPORT . CAHF writes in support that when the sections of
California law were initially written, long-term care
facilities were not identified as a significant element of
disaster planning and response in the healthcare continuum.
Since then, federal authorities have come to the realization
that long-term care is an important piece of the healthcare
continuum when preparing for, responding to and recovering
from an emergency/disaster. CAHF maintains that the long-term
health care community is now a key player in the planning,
response, and recovery efforts of local jurisdictions and
statewide operations. CAHF argues that it is prudent to
continue, as established in this bill, to include long-term
care facilities as an identified entity in order to continue
to improve California's emergency preparedness, response and
recovery.
The California Commission on Aging writes that by including
long-term care facilities in this law and making the
provisions permanent, this bill brings California into
conformity with federal law regarding public health
preparedness and response helping to ensure the safety of
vulnerable long-term care residents during times of public
health emergencies.
5)PREVIOUS LEGISLATION .
a) SB 1103 (Committee on Budget and Fiscal Review), Chapter
228, Statutes of 2004, contained statutory changes that
enabled the Department of Health Services (now DPH) to
allocate federal funds to local health jurisdictions,
clinics, hospitals, emergency medical systems, and poison
control centers in an expeditious manner and exempted these
expenditures from public contract code requirements.
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b) SB 406 (Ortiz), Chapter 393, Statutes of 2002,
established the procedures by which federal funding may be
allocated to, and expended by, local health jurisdictions
for the prevention of, and response to, bioterrorism
attacks and other public health emergencies, pursuant to
the federally approved collaborative state-local plan.
REGISTERED SUPPORT / OPPOSITION :
Support
California Association of Health Facilities
California Commission on Aging
Crestwood Behavioral Health
Opposition
None on file.
Analysis Prepared by : Tanya Robinson-Taylor / HEALTH / (916)
319-2097