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LEGISLATIVE WRAP UP
Entering 2021, hope abounded that the pandemic would dissipate, allowing to life to return to normal. But the collective longing for normalcy would go unmet. The California State Legislature continued to operate under public health protocols that limited in-person contact and relied upon non-traditional approaches to advocacy. As veteran legislators began settling back into their Capitol offices, 18 new elected legislators were sworn into the Legislature: twelve Democrats and six Republicans. With these additions, the Democrats increased their existing supermajorities in both the Senate and the Assembly. Implementing lessons learned from the prior year on how to better navigate the Capitol’s hybrid-working approach and prohibition on in-person meetings, the California Medical Association (CMA) took an aggressive approach to the year. Specifically, CMA sponsored and cosponsored a larger number of bills than standard practice, entered a greater number of partnerships and coalitions, and maintained an aggressive posture throughout the year, despite calls from legislative leadership to decrease the number of bills under consideration.
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The aggressive positioning of the association allowed CMA to take advantage of abnormalities in the legislative process. For example, during his presentation of the January 10 budget proposal, Governor Newsom called for the Legislature to take early action on specific items designed to either re-open K-12 public schools or boost the economy. This break from the traditional state budget process allowed CMA to lead a multi-industry coalition effort to enact the largest state tax rebate in the history of California, through CMA-sponsored AB 80 (BURKE). This bill provided full state tax conformity with federal tax rules regarding the deductibility of forgiven Paycheck Protection Program loans for physician practices. Thus, by the end of the first quarter of 2021, CMA had already provided approximately $250 million in state tax relief to the physicians of California. With an early victory on state tax conformity, CMA was well positioned for the traditional state budget. Despite programs and efforts to mitigate the economic impacts of the pandemic, many Californians still face severe hardships. Over 4 million Californians remain unemployed and approximately half of the jobs lost during the pandemic have not been recovered. Affordable housing, homelessness and school re-opening remained the top overarching policy areas California’s legislative leadership and the Governor sought to address.
CMA was able to utilize the budget process to make significant progress towards achieving interoperability within the health care delivery system. Specifically, the 2021-22 State Budget establishes the California Data Exchange Framework, which puts California on a path toward making all electronic health data available at the point of care for every patient.
Although pandemic response was also a top priority, it was not among the highest profile matters at the beginning of traditional budget deliberations. However, the COVID-19 pandemic clearly identified rampant inequalities in health care. Whether it was testing, access to physician practices or availability of hospital beds, the case was clear that too many areas of the state did not have sufficient access to health care. CMA refused to concede the point. Though pandemic response was only a portion of what the state needed to address through budgetary allocations, CMA persisted and worked to achieve many victories including: • EXTENDING THE TELEHEALTH
FLEXIBILITIES and expansions from the COVID-19 public health emergency, including payment parity for telehealth (including audio-only) in Medi-Cal, for an additional year. This will provide $179 million in reimbursements for these services and ensure patients continue to have access to care via telehealth. • MAKING PERMANENT THE PROPOSITION 56 TOBACCO TAX FUNDING, ensuring certainty of $1.2 billion in total funds ($413.9 million in general funds) annually to continue the Medi-Cal supplemental payments. This will increase practice stability for Medi-Cal practitioners and access to care for Medi-Cal beneficiaries.
• EXPANDING ELIGIBILITY FOR FULL-SCOPE COVERAGE to individuals 50 and older, regardless of documentation status.
• EXTENDING COVERAGE TO ALL CHILDREN UNDER 5, eliminating the risk of these patients sliding into and out of coverage while a physician is managing their care. • SECURING $50 MILLION, ONE-TIME IN GME FUNDING to support startup costs for new residency programs. • PROVIDING GRANTS OF UP TO $50K TO PHYSICIAN PRACTICES to incentivize participation in the state’s vaccine network for a total of $37 million in one-time support for the community vaccination rollout effort. • FIXING THE STATE AND LOCAL TAX (SALT) DEDUCTION CAP. For an individual with a $200k per year total combined (business and wage) income, this change amounts to an estimated $3,900 per year total tax reduction for those who choose to pursue this option. In addition to these victories, CMA was able to utilize the budget process to make significant progress towards achieving interoperability within the health care delivery system. Specifically, the 2021-22 State Budget establishes the California Data Exchange Framework, which puts California on a path toward making all electronic health data available at the point of care for every patient. Under the framework, the State of California will develop a standard data sharing agreement through which all physicians, hospitals and health plans will exchange health care data. The state will also work with CMA and others to develop a program of technical assistance to support small and safety net practices. With the main budget bill enacted, CMA turned its attention to the passage of the association’s remaining sponsored bills and priority bills of interest. Below are summaries of outcomes in particular issue areas.
SCOPE OF PRACTICE A primary focus of CMA’s Government Relations team was to ensure that the singular occurrence of the passing of a major scope bill did not turn into a harmful pattern. Despite many attempts, CMA was able to stop bills that sought to further erode important patient protections. Most notably, AB 1328 (IRWIN) if enacted, would have increased pharmacists’ scope by authorizing them to order and interpret all CLIA-approved tests, as opposed to only monitoring and managing the efficacy and toxicity of drug therapies. In partnership with the American College of Obstetricians and Gynecologists, CMA was successful in defeating this legislation. In addition, AB 407 (SALAS) would have allowed optometrists to treat more severe eye diseases with the use of pharmaceutical agents and therapeutic pharmaceutical agents without increased education and training. Recognizing the detrimental impact this bill would have, CMA teamed up with the California Academy of Eye Physicians and Surgeons and successfully limited the optometrists’ expansion to include treatable areas, such as the front of the eye, eyelids and adjacent tissue, as well as shortened the list of approved drugs for the conditions they may treat.
ADMINISTRATIVE BURDENS CMA-sponsored SB 510, authored by Senator Richard Pan, M.D., requires the health plans and insurers to cover COVID-19 testing and vaccinations during the pandemic without barriers like patient cost-sharing or prior authorizations. At a time when health inequities have been laid bare in the health care system, SB 510 ensures that all Californians, regardless of race, income or geographic region are able to receive vaccination and testing, which will remain necessary until the conclusion of the pandemic. This bill implements valuable lessons learned over the course of the pandemic, setting up a framework in preparation for future public health crises.
CMA also sponsored SB 242 by Senator Josh Newman, which requires health care plans and insurers to reimburse provider costs related to the procurement of critical safety supplies, such as personal protective equipment. These increased costs have impacted physician practices of all sizes. Protecting practices from future sudden dramatic cost increases is necessary to increase the resiliency of physician practices during significant public health crises. The passage of SB 242 will ensure health plans meet their obligation to protect provider networks and ensure access to care for all Californians.
TELEHEALTH AB 457 by Miguel Santiago ensures that patients are notified of their rights to have a telehealth visit with their own physician. It would further guarantee that, when patients do access services through a third-party corporate telehealth provider, they receive high quality, integrated care including the sharing of medical records. Essentially, AB 457 stops health insurers from steering patients away from their treating physicians to third-party,
direct to consumer companies utilizing a “next doc up” model of care. Thus, it ensures that patients have the right to turn to their treating physicians to continue receiving coordinated, fully integrated care.
MENTAL HEALTH COVERAGE The COVID-19 pandemic has increased the spotlight on the importance of identifying and treating mental health conditions across the board. CMA-sponsored SB 428, authored by Melissa Hurtado, requires commercial health care service plan contracts or health insurance policies to provide coverage for adverse childhood experiences (ACEs) screenings. This bill makes commercial plan coverage consistent with the screening coverage currently provided for Medi-Cal beneficiaries to assist the California Surgeon General’s goal of providing universal screening for all Californians.
IMPROVING PUBLIC HEALTH, INCREASING ACCESS TO CARE CMA has worked tirelessly for decades to decrease the harmful impacts of tobacco. With the successful passage of Proposition 56 in 2016, the state increased the taxation on traditional cigarettes, but inadvertently created a financial incentive for traditional smokers to switch to vaping products that where taxed at a lower level. Authored by Senator Ann Caballero, SB 395 imposes a 12.5% tax on e-cigarettes to reduce their use and generate revenue for important health care workforce initiatives. Most significantly, the majority of the ongoing funding— an estimated $30 MILLION each year—will be used to support the Medi-Cal Loan Repayment Programs for Physicians and Dentists. FIGHT ON! Though the pandemic persists and the changing dynamics of state legislature continue to create chaos, the voice of the physician community is breaking through. The accomplishments, achievements and acclaim of this year showcased CMA’s ability to move forward an agenda to protect physician practices, increase access to care and build a prosperous future for the medical profession. Our fight is not finished. Next year, we will continue to push for additional relief from onerous administrative burdens, to protect physician autonomy and to preserve an economic environment that allows physician practices to keep their doors open to the communities they serve. In unity,
Janus L. Norman
CMA Senior Vice President Centers for Government Relations and Political Operations
For more details on the major bills that CMA followed this year, visit cmadocs.org/legwrap2021. Subscribe to CMA’s free biweekly Newswire and stay informed on CMA’s legislative efforts and other issues critical to the practice of medicine at cmadocs.org/subscribe.
