BILL ANALYSIS Ó ----------------------------------------------------------------- |SENATE RULES COMMITTEE | AB 1149| |Office of Senate Floor Analyses | | |(916) 651-1520 Fax: (916) | | |327-4478 | | ----------------------------------------------------------------- THIRD READING Bill No: AB 1149 Author: Wood (D) Introduced:2/27/15 Vote: 27 - Urgency SENATE HEALTH COMMITTEE: 9-0, 6/10/15 AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen, Pan, Roth, Wolk SENATE APPROPRIATIONS COMMITTEE: 6-0, 6/22/15 AYES: Lara, Bates, Beall, Hill, Leyva, Mendoza NO VOTE RECORDED: Nielsen ASSEMBLY FLOOR: 78-0, 5/14/15 (Consent) - See last page for vote SUBJECT: Public health emergencies: funding SOURCE: California Association of Health Facilities DIGEST: This bill adds trade associations to the list of entities that are eligible to receive federal funding, that has been allocated to the Department of Public Health for public health preparedness and response. ANALYSIS: Existing law: 1)Establishes provisions of law to govern those instances when federal funding is allocated and expended for public health preparedness and response by local health jurisdictions, AB 1149 Page 2 hospitals, long-term health care facilities, clinics, emergency medical systems, and poison control centers for the prevention of, and response to, bioterrorist attacks and other public health emergencies. 2)Requires federal funding received by the Department of Public Health (DPH) for bioterrorism preparedness and emergency response to be subject to appropriation in the annual Budget Act or other statute. 3)Exempts federal grant funds appropriated by the Budget Act for public health preparedness and response from being subject to provisions of law governing contracting by state agencies. This bill: 1)Adds trade associations to the list of entities that are eligible to receive federal funding, that has been allocated to DPH for public health preparedness and response. 2)Contains an urgency clause that will make this bill effective upon enactment. Comments 1)Author's statement. According to the author, historically, trade associations have played a major role in the Hospital Preparedness Program (HPP) and have proven to be valuable assets. The infrastructure and communication channels within associations make them particularly well suited to tackle the education and outreach challenges inherent to the HPP. In 2014, the Emergency Preparedness Office of DPH rendered a new interpretation of existing law and determined that, because associations are not specifically identified in the statute, they are not eligible to receive funds and help administer the program. Fiscal year 2013/2014 marked the first year associations were not eligible since the program originated in 1996. This bill allows associations to once again become a valuable resource for the HPP. The familiarity and credibility trade associations bring to the table, when dealing with their membership, creates a training and teaching environment that is uniquely suited to deliver a high quality program. Finally, by allowing the trade associations to play their role, the DPH would save valuable resources that AB 1149 Page 3 otherwise would be expended searching for other entities to execute the program. 2)Federal grant programs for emergency preparedness. According to DPH, it receives funding from two separate federal grant programs for public health emergency preparedness and response: the Public Health Emergency Preparedness (PHEP) program, under the Centers for Disease Control and Prevention (CDC), and HPP, administered by the U.S. Department of Health and Human Services' Assistant Secretary for Preparedness and Response (ASPR). In the most recent fiscal year (2014-15), the Budget Act appropriated $74,405,196 from these two federal grant programs. DPH states that PHEP funds are restricted to state and local health departments. DPH allocates 70% of the PHEP funds to local health departments pursuant to a formula in statute and supports its own preparedness functions with the remaining 30% of the allocation. DPH states that HPP funds are intended for health care facility and emergency medical services preparedness. DPH allocates 63% of the funds directly to, or on behalf of, the local level. DPH states that the California Hospital Association, the California Association of Health Facilities, 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. Coalitions include hospitals, clinics, emergency medical services/systems and long-term care facilities. DPH states that each county determines the priority for use of HPP funds by health care facilities and emergency medical services. 3)History of providing HPP funds to trade associations. According to DPH, both the CDC and the ASPR allow states to allocate HPP funds to trade associations, which is a standard practice for many states across the nation. DPH states that while it has not received any complaints regarding allocating emergency preparedness and response funds to trade associations, it is anticipated that if clarification is not provided, health care leaders across the state will raise concerns that emergency preparedness funds are not supporting health care facilities in California. AB 1149 Page 4 DPH states that historically, it was able to use the existing Health and Safety Code language to allocate funds directly to trade associations, related to the specific itemized list of facilities and response partners, to provide technical assistance and to develop templates, checklists and planning tools that are specific to their members' preparedness and planning needs. DPH states that this early interpretation of the statute was based on the premise that sufficient funds were not available, nor was it feasible to allocate emergency preparedness funds to over 3,000 health care facilities individually across California. Diluting the funds will not help individual facilities, but funding trade associations to develop planning tools and provide education for their members has advanced and will continue to enhance preparedness for hospitals, clinics, and long-term care facilities. In 2012, it was recognized by DPH's Office of Legal Affairs that the existing language did not include long-term care facilities; and the California Association of Healthcare Facilities moved to amend the statute with AB 1793 (Yamada, Chapter 166, Statutes of 2012). The Governor signed the legislation that provided an amendment to include long-term care facilities with the intent that this amendment would allow DPH to contract directly with the California Association of Health Facilities to provide tools and training to long-term care facilities across California to strengthen their emergency preparedness and response capacity. Since that time, DPH's Office of Legal Services has concluded that the existing law is specific and only governs those contracts with local health jurisdictions, hospitals, long-term health care facilities, clinics, emergency medical systems, and poison control centers and not trade associations as was the original interpretation. Prior Legislation AB 1793 (Yamada, Chapter 166, Statutes of 2012) eliminated the September 1, 2012, sunset date on provisions of law governing how federal funding for emergency preparedness is allocated, and added long-term health facilities to the list of entities that can be designated to receive federal funds for emergency preparedness. AB 1149 Page 5 SB 769 (Alquist, Chapter 506, Statutes of 2010) requires federal funding received, pursuant to the Supplemental Appropriations Act of 2009 (HR 2346), for pandemic flu, for purposes of state and local public health and emergency response infrastructure, to be subject to appropriation by the Legislature commencing with the 2009-10 fiscal year. SB 1103 (Committee on Budget and Fiscal Review, Chapter 228, Statutes of 2004) contained statutory changes that enables 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 exempts these expenditures from Public Contract Code requirements. 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. FISCAL EFFECT: Appropriation: No Fiscal Com.:YesLocal: No According to the Senate Appropriations Committee, minor cost pressures to provide funding to trade associations, rather than to facilities directly (federal funds). By authorizing trade associations to receive federal funding (via DPH), individual health facilities may not receive funding directly. However, given the very large number of health facilities in the state, it is not practical for DPH to grant enough funds to individual facilities to have a practical benefit. Using trade associations can be a cost-effective way to disseminate information and best practices to individual facilities. SUPPORT: (Verified6/24/15) California Association of Health Facilities (source) California Hospital Association California Primary Care Association AB 1149 Page 6 OPPOSITION: (Verified6/24/15) None received ARGUMENTS IN SUPPORT: This bill is sponsored by the California Association of Health Facilities (CAHF), which states that, the infrastructure and communication channels within trade associations make them particularly well suited to tackle the education and outreach challenges inherent in the HPP. CAHF states that through almost eight years of funding, CAHF has developed a nationally recognized, award-winning Disaster Preparedness Program for Long Term Care through the HPP, and were one of the first long term care associations in the country to be funded through the HPP grant program. Recently, however, DPH has stated that existing law does not explicitly provide authorization for state associations. CAHF states that this bill will ensure HPP funding continues to be directed at the associations that are suited to provide appropriate training and education to health facilities in California. The California Hospital Association (CHA) states in support that hospitals have many requirements to be prepared for all hazards that pose a threat to their communities. CHA states that through the HPP, it has developed checklists, guidance documents and other planning tools that have assisted hospitals and others. According to CHA, this bill will allow the associations representing hospitals, long term care providers and community health clinics the ability to directly contract with DPH and maintain their established programs that have proven to be effective. The California Primary Care Association states in support that associations have the expertise, and state and local authorities have called on associations for years to assist them in identifying and addressing the issues in disaster preparedness and response. ASSEMBLY FLOOR: 78-0, 5/14/15 AYES: Achadjian, Alejo, Travis Allen, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, AB 1149 Page 7 Daly, Dodd, Eggman, Frazier, Beth Gaines, Gallagher, Cristina Garcia, Eduardo Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Atkins NO VOTE RECORDED: Linder, Medina Prepared by:Vince Marchand / HEALTH / 6/24/15 15:30:02 **** END ****