LEGISLATIVE ROUNDUP II: Davis Vetoes More Health Legislation
Gov. Gray Davis (D) vetoed the following health-related legislation this weekend:
- AB 93 by Assembly member Gil Cedillo (D-Los Angeles) would have eliminated DHS' authority to require additional redeterminations of Medi-Cal eligibility and the requirement that Medi-Cal beneficiaries file quarterly status reports, allowing Medi-Cal beneficiaries to maintain continuous eligibility for a minimum of one year. In his veto message, Davis said that the bill "would go beyond" the Medi-Cal expansion that legislators agreed upon as part of the Budget Act of 2000 and might result in allowing individuals no longer in need of Medi-Cal to continue to receive benefits;
- AB 726 by Assembly member Martin Gallegos (D-Baldwin Park) would give all money not- for-profit health plans set aside for "charitable health purposes" when they convert to for-profit status to the Managed Risk Medical Insurance Program, which provides reduced-cost medical insurance for individuals considered "medically uninsurable." Davis said that he vetoed the bill because it is "inconsistent" with the Budget Act of 2000 and because it would be "inappropriate" to direct money that now goes to a variety of health programs to only one program; furthermore, Davis said that a "one-time infusion of funds ... would not be particularly useful" in solving any of the program's "ongoing funding need;"
- AB 945 by Assembly member Abel Maldonado (R-San Luis Obsipo) would have authorized the Marian Medical Center to use an expedited process to restore the license of a closed facility it purchased. In vetoing the bill, Davis said that while it "may have merit," the bill "did not undergo appropriate legislative review and opportunity for public input."
- AB 1722 by Gallegos would have exempted all assets other than income in determining Medi-Cal eligibility, beginning Jan. 1, 2001. Davis said that the bill is "inconsistent" with eligibility regulations passed as part of the Budget Act of 1999 and "related budget trailer bill legislation;"
- AB 1735 by Assembly member Helen Thomson (D-Davis) would require each school district and county superintendent to include information on how to request Medi-Cal Program and Healthy Families Program information in each application for free and reduced-price meals provided to parents. The bill also would also require the governing board of each school district and county superintendent of schools to determine whether the requests for information would be returned to the school and forwarded to DHS or returned directly to the DHS. In vetoing the bill, Davis said that while he supports "the inclusion of schools in Healthy Families and Medi-Cal outreach ... this bill would result in 10 to 15 million dollars in state- mandated and unbudgeted costs to school districts and county offices of education to organize and administer the proposed program."
- AB 1791 by Assembly member Patricia Wiggins (D-Santa Rosa) would authorize school districts to procure and provide epinephrine auto-injectors to school nurses and lay school personnel, allowing them to make the medical judgement to provide emergency medical aid to school children suffering from anaphylactic reaction by administering epinephrine. In his veto message, Davis said, "The administration of epinephrine auto-injectors by medically trained personnel such as school nurses could in certain instances be life saving. However, the shortage of school nurses with the knowledge necessary to administer medications would assure that the bulk of school personnel administering epinephrine in emergencies would be lay personnel. While there are training programs for non-licensed persons that must administer medications conducted by schools of nursing, medical schools, and schools that train physicians assistants, such programs require weeks for matriculation and cannot safely be compressed into a few hours."
- AB 1896 by Assembly member Hannah-Beth Jackson (D-Santa Barbara) would require the California Department of Aging, in cooperation with other state departments and contingent upon a Budget Act appropriation, to establish a Long Term Care Options Pilot Project, under which three general acute care hospitals would be awarded grants to establish long term care options resource centers. In vetoing the bill, Davis said that it would take effect only if funding were provided in future Budget Acts, which would create "pressure for significant General Fund augmentations in 2001-02 and later years." Costs to the General Fund over the program's 42-month duration would exceed $2.5 million.
- AB 1904 by Assembly member George Runner (R-Lancaster) would require the Employment Development Department to publish a semi-annual forecast of the expected deposits to and disbursements from the State Disability Insurance Fund. Davis said, "Because the bill requires two additional reports that are duplicative of reports already prepared by the EDD and, therefore, unnecessary, and because the formula by which the SDI contribution rate is calculated and determined is proscribed by current law, I cannot support AB 1904."
- AB 1974 by Assembly member Carole Migden (D-San Francisco) would require the Managed Risk Medical Insurance Board, in collaboration with the Employment Development Department and DHS, to pursue Healthy Families Program and Medi-Cal outreach activities targeted to all California employees. Employers would be required to distribute, to all employees, information about HFP and Medi-Cal. Davis said he vetoed the legislation because it "mandates a new cost on employers and could lead to 'crowd-out' by encouraging them to replace existing employer-based coverage with publicly funded health coverage."
- AB 2102 by Assembly member Virginia Strom-Martin (D-Duncans Mills) would appropriate $500,000 from the General Fund for a program of supplemental Medi-Cal payments to critical access hospitals. While the program "has merit," Davis said that "it should not compete with the many other good proposals that will be suggested next year."
- AB 2326 by Assembly member Kerry Mazzoni (D-Novato) would require DHS to seek federal waivers to provide supportive and rehabilitative Medi-Cal services to eligible functionally impaired adult survivors, and makes implementation subject to approval of the waivers. Davis said that the proposal "should not compete with other priorities during the annual budget process next year."
- AB 2338 by Assembly member Richard Floyd (D-Wilmington) would have provided a new, higher, optional retirement formula for local miscellaneous members of one CalPERS covered agency. In vetoing the bill, Davis said, "I am not aware of any business or policy basis that would justify providing retirement benefits for miscellaneous members that is equivalent to those of local safety members."
- AB 2531 by Assembly member Jack Scott (D-Pasadena) would establish under DHS a program to train and certify "developmental assistants" for intermediate care facilities. In vetoing the bill, Davis noted that the Budget Act of 2000 already includes increases to assist facilities in retaining, training and recruiting workers.
- AB 2477 by Wiggins would change California's unemployment insurance program to permit unemployed individuals to use an alternate base period to meet certain eligibility requirements for collecting unemployment insurance benefits. In his veto message, Davis said that the bill would impose "additional and substantial" administrative costs and would provide only a "relatively small benefit increase to a limited number of workers."
- SB 147 by Sen. Dede Alpert (D-Coronado) would have amended a section of the Welfare and Institutions Code to direct DHS to seek a State Plan Amendment to continue Medi-Cal eligibility up to 21 years of age for foster children who must leave the program at age 18. Davis said the bill "does not appear necessary."
- SB 500 by Sen. Hilda Solis (D-El Monte) would expand the eligible population of the Family PACT (Planning, Access, Care and Treatment) program by including all uninsured women under 65 years of age. Stating that he has already provided increases for the program, Davis vetoed the bill, adding, "This proposal should compete with the many other good proposals that will be suggested next year for adoption in the Budget Act of 2001."
- SB 1320 by Sen. Martha Escutia (D-Montebello) would require schools that have at least one student with diabetes to have a school nurse or individual trained in testing blood glucose levels, recognizing and treating hypoglycemia and hyperglycemia, and administering glucagons available at all times. In his veto message, Davis said, "Currently, the governing boards of local educational agencies have a clear statutory responsibility to give diligent care to the health and physical development of pupils and have the authority to determine their staffing needs consistent with fulfilling this obligation. School health staffing needs are determined at the local level based on local priorities and should remain so."
- SB 1630 by Sen. Tom Hayden (D-Los Angeles) would have required the medical director of tissue banks performing assisted reproductive technology procedures to be certified, the bank to provide a standardized, written summary of ART procedures to patients and the bank to establish a one-time special assessment to fund the bill's provisions. In his veto message, Davis said, "The Department of Health Services is in the process of developing guidelines for assisted reproductive technology procedures including informing the patient of the potential risks and provisions contained in this measure."
- SB 1770 by Sen. Wesley Chesbro (D-Arcata) would establish a new program in the Department of Mental Health to provide grants to county mental health departments for mental health client and family member empowerment programs. Noting that the 2000-01 budget includes $1.8 million for the mental health department and that counties now must provide mental health services, Davis said the 2000-01 budget did not include funds for the bill's purpose.
- SB 1780 by Chesbro would require the California Health and Human Services Agency to establish a Medicare Payment Task Force to develop and submit recommendations to the Governor and the Legislature on alternative methods for development Medicare payment areas. In his veto message, Davis said, "While I am supportive of efforts to ensure that Medicare reimbursement rates encourage provider participation in the Medicare+Choice program, the Health Care Financing Administration requires that any adjustments to payment methodology be cost neutral. Under this constraint any upward rate adjustment in one part of California comes at the expense of a reduction elsewhere in the state. Any reduction in rates would greatly exacerbate the existing problem of HMO's leaving the Medicare+Choice program."
- SB 1880 by Sen. Byron Sher (D-Palo Alto) would appropriate $730,000 to the California Public Employees' Retirement System to conduct a study to determine the feasibility of aggregating the purchase and distribution of prescription drugs for various groups. This bill would require CalPERS to submit the results of the study to the Legislature and the governor within 18 months after securing full funding for the study. Davis said, "I support the goal of reducing prescription drug costs and last year signed Senate Bill 393 to provide persons on Medicare the discount the state receives for persons in the Medi-Cal program. Several other states are currently exploring alternative methods of reducing prescription drug costs including the approach suggested by this bill. The experience in those other states will ultimately show if a separate study in California is meritorious."
- SB 1886 by Escutia would require general acute care hospitals to submit data regarding the cost of compliance with the seismic retrofit standards of the Hospital Seismic Safety Act to a national accounting firm and would exempt this data from disclosure. The Office of Statewide Health Planning and Development would select and contract with the firm and would adopt regulations to determine fees to be paid by rural and non-rural hospitals to recover the costs resulting from this bill. In vetoing the bill, Davis said, "This bill appears to be unnecessary. If hospitals wish to compile aggregate data on the cost of complying with seismic safety requirements through a national accounting firm, they may do so without the benefit of legislation."
- SB 1969 by Solis would reduce the Medi-Cal share-of-cost paid by some beneficiaries with end-stage renal disease by up to $400 per month, subject to federal approval and the availability of federal financial participation. In his veto message, Davis said, "This bill would also establish a different income eligibility standard solely for one disease, thereby violating the federal Medicaid comparability standard by providing preferential treatment for one segment of the Medi-Cal population."
- SB 2050 by Sen. Jackie Speier (D-Hillsborough) would require DHS to revise its California Children's Services application to allow applicants to also apply for the Healthy Families Program or Medi-Cal.In his veto message, Davis said, "Combining the Medi-Cal and HFP programs could risk losing many children currently enrolled in HFP whose families do not wish to be associated with Medi-Cal."
- SB 2193 by Sen. Nell Soto (D-Pomona) would require DHS to create a Medi- Cal public inquiry unit. The public inquiry unit would be required to respond to Medi-Cal eligibility rule inquiries and to correct eligibility interpretations, determinations and beneficiary computer files. In his veto message, Davis said, "Traditionally, the counties have administered the Medi-Cal program. Whenever individuals are dissatisfied with any action or inaction on the part of the county they have the right to request a fair hearing. This process is established to be an unbiased, appeal process to ensure that Medi-Cal eligibility is equitably determined under federal and state laws and regulations" (Office of the Governor release, 9/29).
- SB 996 by Sen. Patrick Johnston (D-Stockton) would require the General Fund to contribute the entire administrative cost of the workers' compensation program and would omit the current provision that employers contribute 20% of the program's cost. The bill includes some improvements over the provisions of its predecessor, SB 320, which Davis vetoed last year, but would increase costs to employers statewide by more than $2.6 billion, Davis said in his veto message.
- SB 546 by Solis would provide a 65% increase in unemployment insurance benefits for most California workers phased in over three years. This bill would increase the wage replacement rate, increase the weekly minimum and maximum benefit amounts, and provide a statutory formula for adjusting the maximum weekly benefit each year in accordance with the state's average weekly wage. In his veto message, Davis said, "The proposed increases in this bill would result in costs to the UI Fund of $236.6 million in 2000- 01, $641.6 million in 2001-02, and $864.9 million in 2002-03. Without raising the taxable wage base or tax rates, this increase in benefit costs could place the solvency of the UI Fund at risk" (Office of the Governor release, 9/29).
- AB 678 by Assembly member John Dutra (D-Fremont) would allow the Alameda County Emergency Services agency to authorize an immunization program overseen by the Alameda County Health Care Services Agency, using emergency medical services technicians to provide immunizations. It would also authorize up to three similar programs as pilot projects elsewhere in the state. Davis stated in his veto message that the "complex technical aspects of immunization practice, and as a result the AB 678 language, require substantial and continuing training for EMTs, as well as registered nurse supervisors on-site at the clinics. Thus, the available empirical evidence indicates that the programs proposed by this bill represent an ineffective and cost-inefficient use of taxpayer's dollars."
- AB 688 by Assembly member Darrell Steinberg (D-Sacramento) would establish the Health Care Quality and Cost Protection Committee to explore and develop innovative health benefit cost containment concepts. It would require the committee to report and recommend specific cost containment findings to the Legislature and the Board of Administration of the Public Employees' Retirement System by Jan. 1, 2002. In his veto message, Davis said, "I share the concern of state employee unions that rapidly escalating health care costs must be contained. I also agree that the state should bear a large share of the burden of the premium increases in the CalPERS health plans. This bill, however, does not accomplish these goals in a responsible manner."
- AB 2136 by Assembly member Abel Maldonado (R-Santa Maria) would require the Long Term Care Council to establish a uniform definition of respite care for future legislative change; develop a minimum data set of information on family caregiver programs that provide caregiver support; and improve service coordination between existing programs. Davis stated, "While I support the intent of this legislation, I believe this issue should be considered along with other worthy projects during the fiscal year 2001-2002 budget process."
- SB 1839 by Speier would require health care service plans and certain disability insurers to provide coverage for routine patient care costs associated with participation in a clinical trial to treat life-threatening prostate cancer. Davis said in his veto message that "under this bill, thousands of Californians suffering from breast cancer and other cancers would continue to be denied coverage. I favor a more comprehensive approach, one which would cover other cancer trials in addition to prostate" (Office of the Governor release, 10/1).