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Health Matters October 2014

October 15th, 2014

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In this issue:
California Plastic Bag Ban
Tensions Rise in Sale of Daughters of Charity Health System to Prime Healthcare
Cap-and-Trade Update
CA to Expand Coverage Options for Immigrants & Pregnant Women
100 Resilient Cities Update
Legislative Updates

California Plastic Bag Ban

On September 30, 2014, Governor Jerry Brown signed SB 270, the nation's first statewide ban on single-use plastic bags at grocery and convenience stores. Large retailers will have to start phasing out plastic bags starting in 2015 and smaller retailers in 2016. Going into effect on July 1, 2015, the bill would prohibit stores from selling or distributing a recycled paper bag at the point of sale unless the store makes that bag available for purchase for no less than $0.10. The bill would also allow stores to distribute compostable bags at the point of sale only in jurisdictions that meet specified requirements and at a cost of no less than $0.10. SB 270 require all funds collected pursuant to these provisions to be retained by the store and be used only for the following:

•Costs associated with complying with the requirements of the bill.
•Actual costs of providing recycled paper bags or reusable grocery bags.
•Costs associated with a store’s educational materials or educational campaign encouraging the use of reusable grocery bags.

Eighty-seven cities and counties in California have already previously adopted ordinances banning plastic bags--including San Francisco, San Jose, Long Beach, Los Angeles County, Santa Clara County, and Alameda County. Many of these local governments also require stores to charge a fee for a paper bag, and a few have banned both single-use plastic and paper carryout bags. This bill does not pre-empt existing ordinances. It does, however, provide uniformity moving forward by pre-empting any local ordinance adopted after September 1, 2014.

For more information, please see: California Legislation Information or contact Community Health Councils’ Policy Analyst, Hector Gutierrez at hector@chc-inc.org.

Tensions Rise in Sale of Daughters of Charity Health System to Prime Healthcare

Since the regional Catholic non-profit Daughters of Charity Health System (DCHS) went on sale earlier this year the health system has been mired in controversy. DCHS operates six hospitals throughout California, one located in South Los Angeles--St. Francis Medical Center in Lynwood, CA--one of the few remaining safety-net hospitals in South Los Angeles. The health system has been experiencing severe financial difficulties, suffering operating losses of $90.7 million two years ago, and $15.6 million in the last fiscal year.

On October 10th, the board of DCHS announced the sale of all six hospitals to Prime Healthcare Services, Inc. Before the decision was even announced labor unions, community advocates, 27 state legislators, and other public officials came out in strong opposition to the possibility of Prime Healthcare Services, Inc. acquiring DCHS. The company has a history of buying struggling health facilities and then aggressively cutting staff and services and canceling insurance contracts--as it did with Centinela Hospital Medical Center in 2007. This is not the first time Prime has faced such strong opposition of its bid to acquire a struggling hospital. In 2011, Prime faced community opposition for similar reasons in its attempt to buy Victor Valley Community Hospital and was ultimately denied by the Attorney General because its “disturbing” business model was not in the best interest of the community.

In September, Lynwood City Council went so far as to pass Resolution Number 2014.162 opposing the sale of DCHS to Prime. Since the closure of Martin Luther King, Jr./Drew Medical Center in 2007, St. Francis has operated the only trauma center left in South Los Angeles. Since trauma centers are notoriously expensive because of the large uncompensated care costs due to seeing a disproportionately uninsured population, the Los Angeles County Board of Supervisors voiced concerns that the St. Francis trauma center could be closed in the sale of DCHS. The new MLK hospital opening in 2015 will not have a trauma center, making the next nearest trauma centers for South Los Angeles residents Harbor-UCLA Medical Center or California Hospital Medical Center, both over ten miles away. Research has shown that the closures of trauma centers resulting in increased travel time for trauma patients are associated with 29% higher odds of inpatient death in California.  Concerned by such a prospect, the Board moved to send a letter to the Attorney General urging her to deny any sale that involved closing the St. Francis trauma center.

The deal will need to be reviewed by the Attorney General next and either approved or denied which could take approximately three months. In the deal Prime promises to maintain all services for at least five years, however, opponents are skeptical due to the lack of clear enforcement mechanisms in the event a buyer reneges on terms of the deal after the Attorney General has approved the sale. Earlier this year the merger deal between Hoag Hospital in Orange County and St. Joseph Health System promised that there would be no change to reproductive services, yet after receiving approval for the merger from the Attorney General abortion services were cut at Hoag.  At the end of September, Governor Brown vetoed SB 1094, a bill attempting to strengthen the Attorney General’s oversight of the sale of non-profit health facilities, reasoning that the Attorney General’s office was already in the process of revising regulations for  ownership transfers of non-profit hospitals.

For more information, please contact the Attorney General at (213) 897-2000 or Community Health Councils’ Policy Analyst, Ine Collins at ine@chc-inc.org.

Cap-and-Trade Update 

On September 18, the California Air Resource Board (CARB) adopted guidelines for state and local agencies directing the investment of proceeds from the State’s Greenhouse Gas Reductions Fund (GGRF) in the State’s most disadvantaged communities. In our current fiscal year, the proceeds total $832 million, and are expected to grow into the billions in the coming years. Although only 10% will be invested directly into identified disadvantaged communities, SB 535 mandates that 25% of the proceeds be earmarked for their benefit. Interim guidelines can be reviewed here http://bit.ly/VQk4GE.

Disadvantaged communities will be identified by the California Environmental Protection Agency using CalEnviroScreen (California Communities Environmental Health Screening Tool), which calculates both which Census tracts are most burdened by pollution and house the most vulnerable populations. Stakeholders disagree as to whether communities should be prioritized as disadvantaged on a statewide basis or within their respective regions, but a decision on the matter is expected shortly.

The Affordable Housing and Sustainable Communities (AHSC) program within the GGRF will allocate $130 million in funding towards projects intended to reduce greenhouse gas emissions.  These projects focus on efforts to increase affordable housing and alternative transportation options as well as protect agricultural lands from greenhouse gas-intensive development. The public comment period for the AHSC program draft guidelines is open until October 31, 2014. Draft guidelines are available here http://bit.ly/1wA9OPJ.
For more information, please contact Community Health Councils’ Policy Analyst, Naomi Iwasaki at naomi@chc-inc.org.

CA to Expand Coverage Options for Immigrants & Pregnant Women

As a result of the Affordable Care Act (ACA), full-scope Medicaid coverage (Medi-Cal in California) has been expanded to Californians with incomes up to 138% of the federal poverty level (FPL) with a couple of exceptions. Immigrants with less than five years of US residency (newly qualified immigrants or NQIs) are excluded from receiving federally-funded full-scope Medicaid benefits, though states can opt to fund this coverage using their own non-federal funds. California has traditionally used and is currently using state dollars to provide full-scope Medi-Cal to the NQI population.  Pregnancy Medi-Cal, which currently goes up to 213% FPL, offers limited benefits except for those under either 60% FPL (any trimester) or 109% FPL (third trimester).
As a result of recent legislation, the Department of Health Care Services (DHCS) is working in collaboration with Covered California to develop the Full-Scope Medi-Cal Coverage and Affordability and Benefit Program for Low-Income Pregnant Women and NQIs.

Some of the provisions they are looking to implement are as follows:
(1) The income threshold for full-scope Medi-Cal for pregnant women will rise from 60% and 109%, depending on the trimester, to 138% of the FPL regardless of the stage of pregnancy. This coverage expansion would start no sooner than January 1, 2015.
(2) Women enrolled in a qualified health plan (QHP) through Covered California with incomes from 138% to 213% FPL would qualify for a Medi-Cal wraparound benefit that could cover health plan cost-sharing as well as Medi-Cal services not offered under Covered California.  This benefit would be implemented no sooner than January 1, 2016.
(3) NQIs enrolled in a QHP through Covered California with incomes up to 138% of the FPL would also be eligible for a Medi-Cal wraparound benefit that covers costs and Medi-Cal services not covered by the Covered California plan. The wraparound benefit for NQIs would start no sooner than January 1, 2016.

For more information, please see the DHCS website or contact Community Health Councils’ Policy Analyst, Anulkah Thomas at anulkah@chc-inc.org.

100 Resilient Cities Update

An initiative pioneered by the Rockefeller Foundation, 100 Resilient Cities (100RC) will work to redefine the way cities respond to challenges. 100RC focuses on acute challenges such as earthquake, floods and fires, as well as chronic stresses such as high unemployment, inefficient public transportation systems, or an overburdened tax base that can make cities especially vulnerable to those challenges. By addressing both, the initiative hopes to enable cities to become more capable of responding to adverse events and delivering basic functions in both good times and bad, to all.

With both the Earth’s population and the frequency, scale, and impact of natural episodes projected to increase in the coming years, urban resiliency will be crucial to human development and well-being.

Through this initiative, 100RC will select cities each year to receive assistance and necessary resources to transform into resilient cities. Each selected city will receive:
•    Financial and logistical guidance for establishing a Chief Resilience Officer
•    Support for development of a resilience strategy;
•    Access to solutions, service providers, and private and public partners who can help develop and implement resilience strategies; and
•    Membership to a global network of resilient cities.

100RC is a global initiative, and earlier in 2014 the first round of cities were selected totaling thirty-two. Four California cities – Los Angeles, San Francisco, Oakland and Berkeley -- were a part of the selection. Following selection, cities are tasked with establishing a city position for their Chief Resilience Officer who will develop a long-term resilience strategy.

To learn more about the initiative and to see how other cities are responding please visit the 100RC webpage at 100resilientcities.org.

For more information, please contact Community Health Councils’ Policy Analyst, Heather Davis at heather@chc-inc.org.

Legislative Updates

Environmental Health
AB 330- With the passage of California State Assembly Bill 380 (Dickinson), emergency responders will soon be better equipped for accidents involving trains carrying oil. Shipments of oil by rail in California increased from 45,491 barrels in 2009 to over six million barrels in 2013 and are projected to jump to as much as 150 million barrels by 2016.  The nature of this particular method of oil transport makes it vulnerable to spills, explosions, and fires. Last year, the amount of oil spilled from trains was more than the amount spilled over the last 40 years combined. Leaked oil can cause fires and contamination and in extreme cases, crude by rail has caused explosions like the 2013 Quebec train derailment and explosion that killed 47 people. Companies transporting oil by rail will now be required, thanks to AB 380, to inform local and state agencies when oil will be shipped and disclose the characteristics of the oil and other hazardous materials. The bill passed out of the Assembly with broad bipartisan support and was requested by safety officials.  Visit http://bit.ly/1sMXmx8 for a map of oil by rail routes.

SB 1281- (Pavley) requires oil companies to report the amount of water they use and the source of that water. According to the bill’s author, California companies used over 80 billion gallons of water in oil recovery activities in 2014—enough to supply half a million households. Oil companies will also be required to track water recovered and reused in oil and gas operations. This measure was prompted by concern over California’s ongoing drought.

SB 605- (Lara and Pavley) addresses the effects that short-lived climate pollutants have on global warming, air quality, and the health of those exposed to the emissions. California will create a strategy for cutting down on short-lived climate pollutants like methane and black carbon. The bill requires the California Air Resources Board complete an inventory on the sources of these pollutants; identify and address any gaps in research or data; and develop pollution reduction measures that prioritize overburdened communities. You can learn more about the topic by visiting http://bit.ly/1D9IhIZ.

For more information, please contact Community Health Councils’ Policy Analyst, Erin Steva at erin@chc-inc.org.

Urban Agriculture and Gardens
AB 2561: Personal agriculture: restrictions- This bill, also known as the Neighborhood Food Act intends to remove obstacles to the practice of growing edible fruits and vegetables in urban and suburban residential neighborhoods for personal and community use or consumption.  It requires a landlord to permit a tenant to participate in personal agriculture in portable containers approved by the landlord on the premises. The bill seeks to ensure the ability of residents in common interest developments (CID) and tenants in one- or two-unit rental properties to grow edible fruits and vegetables at home for personal consumption. Signed by the Governor

AB-551 Urban Agriculture Incentive Zone Act-Authorizes, under specified conditions up until January 1, 2019, a city, county, or city and county and a landowner to enter into a 5-year contract to enforceably restrict the use of vacant, unimproved, or otherwise blighted lands for small-scale production of agricultural crops and animal husbandry. Private property owners would receive a tax-reassessment at the annual agricultural rate of $12,000 per acre to reduce their property tax.  San Francisco is the only jurisdiction to take advantage of the law since it went into effect earlier this year and the San Francisco Board of Supervisors approved the ordinance language in September. Efforts are underway in Los Angeles to do the same and catalyze urban agriculture throughout the region. A land use petition to support urban agriculture and AB-551 efforts in LA has been circulating. Signed by the Governor

For more information, please see Los Angeles urban agriculture land use petition or contact Community Health Councils’ Policy Analyst, Hector Gutierrez at hector@chc-inc.org.

Health Coverage

AB 617 California Health Benefit Exchange: appeals - Establishes an appeals process for Covered California eligibility and enrollment determinations and requires Covered California to appoint the Department of Social Services as the entity to hear these appeals. AB 617 outlines various requirements, including that applicants must be notified of their right to appeal upon eligibility determination and that appeal hearings occur under specified timelines. Signed by the Governor

AB 2706 Schools: health care coverage: enrollment assistance - Requires that public school enrollment forms provide information on affordable health insurance options and enrollment assistance referrals. Signed by the Governor

SB 18 Medi-Cal renewal - Provides $6 million in funding from The California Endowment (TCE) [http://calendow.org/] which was originally eliminated from the Governor’s final 2014-2015 budget. The grant will fund Medi-Cal renewal processing work and triggers a federal match which ensures $12 million to process the more than eight million renewals due by the end of the 2014 calendar year.  Signed by the Governor

SB 1052 Prescription drug formularies- Requires health plans and insurers to provide up-to-date drug formularies on their websites. Signed by the Governor

SB 1124 Medi-Cal: estate recovery- Federal law currently requires states to file for estate recovery to recoup funds used for Medicaid long-term care services after a beneficiary has passed. California takes it one step further and uses estate recovery for all Medi-Cal services, including basic health care services. The intent of SB 1124 was to exclude basic health care services from the estate recovery requirement in California and bring it back down to the federal minimum. Vetoed by the Governor

For more information, contact Community Health Councils’ Policy Analyst, Anulkah Thomas at anulkah@chc-inc.org.

Healthcare Systems
SB 964 Ensuring Access to Care-Requires insurance plans to submit annual reports to the Department of Managed Health Care on the adequacy of their provider networks and timely access to care for beneficiaries. It requires separate reviews if the provider network for individual market plans differs from networks offered through employer plans, and a separate review for Medi-Cal plans if the network differs from those offered through commercial coverage. Signed by the Governor

AB 2629 Monitoring Mental Health Care Delivery Performance-Current law requires counties to annually report mental health care performance data on client outcomes and cost-effectiveness to the Director of Health Care Services. Additionally, there is a California Mental Health Planning Council that reviews performance data and makes recommendations. AB2629 requires that the director and the council make all these reports publicly available via their website. Signed by the Governor

SB 1053 Improving Access to Contraceptive Care-The Affordable care Act required that health plans provide all forms of FDA-approved birth control at no-cost for women, but vaguely allowed for “reasonable medical management techniques” which led to delays, outright denials of certain methods, and out-of-pocket costs for contraception. SB 1053 clarifies the requirement to provide the full range of FDA-approved contraceptive “drugs, devices, and products, as well as voluntary sterilization procedures, contraceptive education and counseling, and related follow-up services” for women and men.  It explicitly prohibits delays, restrictions, and any cost-sharing beginning January 1, 2016. Signed by the Governor

SB 1094 Increasing the Attorney General’s Oversight of Non-Profit Health Facility Sales-The Attorney General oversees the sale of non-profit hospitals and has the authority to approve or deny such sales and issue conditions for the transaction to take place. SB 1094 sought to strengthen the Attorney General’s ability to enforce conditions of transactions and amend conditions after an agreement has been made. The governor vetoed it because the Attorney General’s office is in the process of updating related regulations. Vetoed by the Governor

AB 2325 Improving Language Access for Medi-Cal-
Sought to create the Medi-Cal Patient-Centered Communication program (Communi-Cal) that would require DHCS to provide and reimburse for medical interpreter services for limited English proficient enrollees. This is the second time the governor has vetoed such a bill, explaining that it would create additional complexity during California’s implementation of health reform. Vetoed by the Governor

For more information, contact Community Health Councils’ Policy Analyst, Ine Collins at ine@chc-inc.org.


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