Veto messages provide tremendous insight as to how governors think, and also what they will entertain in legislative proposals going forward. This week, the Newsletter focuses on a handful of bills the Governor vetoed that were of interest to CSAP in 2023. With the exception of AB 616 (Rodriguez), which CSAP opposed, the remainder of the bills listed were supported by CSAP.
AB 616 vetoed (Rodriguez) Medical Group Financial Transparency Act – The Governor’s veto message stated that this bill…”proposed to require the Office of Health Care Affordability (OHCAJ and the Department of Managed Health Care (DMHC) to publicly disclose audited financial reports and comprehensive financial statements of provider and physician organizations. Just last year, the OHCA was established within the Department of Health Care Access and Information (HCAIJ to develop data-informed policies and to create a state strategy for controlling the costs of health care while ensuring affordability. The OHCA is authorized to receive financial information from the DMHC, with specific provisions regarding confidentiality and use. While I support transparency, this policy is premature. Given the OHCA is in its initial stages of implementation, any additional requirements and associated impacts should be evaluated following full implementation of existing law.”
AB 912 (Jones-Sawyer) Strategic Anti-Violence Funding Efforts Act – The Governor’s veto message stated that this bill “would establish the Violence Reduction Grant Program to be administered by the Department of Justice, re-establish the Youth Reinvestment Grant Program to be administered by the Office of Youth and Community Restoration, and create additional grant programs designed to improve the health and well-being of youths in the State. While I appreciate the author’s commitment to early interdiction and violence reduction efforts, this bill creates new additional cost pressures and must be considered in the annual budget in the context of all state funding priorities. In partnership with the Legislature, we enacted a budget that closed a shortfall of more than $30 billion through balanced solutions that avoided deep program cuts and protected education, health care, climate, public safety, and social service programs that are relied on by millions of Californians. This year, however, the Legislature sent me bills outside of this budget process that, if all enacted, would add nearly $19 billion of unaccounted costs in the budget, of which $11 billion would be ongoing. With our state facing continuing economic risk and revenue uncertainty, it is important to remain disciplined when considering bills with significant fiscal implications, such as this measure.”
AB 1085 (Maienschein) Medi-Cal: housing support services – The Governor’s veto message stated this bill “would require the Department of Health Care Services (DHCS) to establish a Medi-Cal benefit to cover housing support services for individuals experiencing or at risk of homelessness, subject to an appropriation and federal approval. My Administration has made significant investments to combat homelessness and provide housing supports. While I appreciate and share the author’s goal to support those who are experiencing homelessness, new Medi-Cal benefits must be considered as part of the annual budget process. This year, however, the Legislature sent me bills outside of this budget process that, if all enacted, would add nearly $19 billion of unaccounted costs in the budget, of which $11 billion would be ongoing. With our state facing continuing economic risk and revenue uncertainty, it is important to remain disciplined when considering bills with significant fiscal implications, such as this measure.”
AB 1288 (Rendon) Health care coverage: Medication-assisted treatment – The Governor’s veto message stated this bill “would prohibit health plans from requiring prior authorization or step therapy for a naloxone product or other opioid antagonist approved by the United States Food and Drug Administration (FDA), buprenorphine product, methadone, or long-acting injectable naltrexone for detoxification or treatment of a substance use disorder. I appreciate the author’s intent to increase access to medication for opioid use disorder. My Administration takes the opioid crisis seriously, as evidenced by the over $1 billion invested to combat overdoses, support those with opioid use disorder, raise awareness, and crack down on trafficking. However, utilization review is an important tool to contain health care costs, protect patients from unanticipated billing, and ensure medically necessary care. While immediacy of treatment is important, prior authorization also helps avoid fraudulent requests or abuse of the drugs addressed in this bill, such as methadone.”
AB 1437 (Irwin) Medi-Cal: serious mental illness -The Governor’s veto message stated this bill “would require the Medi-Cal program to automatically approve any prescription refill for serious mental illness (SMI) for a period of 365 days after the initial prescription is dispensed for a beneficiary 18 years or older. I appreciate the author’s intent to increase Medi-Cal beneficiaries’ access and adherence to SMI drugs. However, this approach does not address the underlying obstacles with medication adherence and would remove clinical safeguards. Currently most medications used for an SMI are covered without prior authorization, and if prior authorization is needed, DHCS provides a response within 24 hours and allows emergency coverage of a drug up to 14 days. In instances where prior authorization is required, it is in place for patient safety. Maintaining utilization control is important to contain health care costs, protect patients, and ensure medically necessary care.”
AB 1451 (Jackson) Urgent and emergency mental health and substance use disorder treatment -The Governor’s veto message stated this bill “would require health plans to cover treatment for urgent and emergency mental health and substance use disorders without prior authorization, upon appropriation by the Legislature for administrative costs. …Existing law already prohibits prior authorization for emergency care, and requires mental health and substance use disorder services to meet timely access standards. The requirements in this bill would result in significant costs in the tens of millions of dollars, to the state General Fund and to consumers through health plan premium increases. With our state facing continuing economic risk and revenue uncertainty, it is important to remain disciplined when considering bills with significant fiscal implications, such as this measure.”
SB 373 (Menjivar) Board of Behavioral Sciences, Board of Psychology, and Veterinary Medical Board: licensees’ and registrants’ addresses – The Governor’s veto message stated this bill “would prohibit the Board of Behavioral Sciences, the Board of Psychology, and the Veterinary Medical Board from disclosing on the internet the public address of record of a licensee or registrant. I appreciate the author’s goal to provide additional safety to these providers; however, this bill would serve as an impediment for patients seeking access to their medical records, as a patient would need their provider’s address to make a request. Absent access to addresses on board websites or other publicly accessible sources, patients may need to submit a public records act request to obtain the address needed to request access to their medical records. This could result in a significant delay for patients seeking to obtain their medical records. There are already protections in existing law for providers that work from their homes and seek to maintain their privacy, including the use of a post office box that avoids the need to disclose their home address. The safety of healthcare providers is paramount, but I cannot support a measure that would restrict patient access when effective alternatives exist to protect the safety and privacy of providers.”
SB 509 (Portantino) School employee and pupil training: youth mental and behavioral health: mental health education – The Governor’s veto message stated this bill “would require local educational agencies to certify to the California Department of Education by July l, 2027, that l 00 percent of its certificated staff and at least 40 percent of its classified staff who have direct contact with students in grades 7-12 have received youth behavioral health training as specified. I share the author’s goal of ensuring that school staff are equipped with the tools to recognize and offer appropriate support to students experiencing mental health challenges. However, I have concerns with some aspects of the bill as written, including the appropriate scope of the required, one-time training and the lack of an appropriate mechanism to fund the bill via the Gun Violence Prevention and School Safety Fund (AB 28, Chapter 231, Statutes of 2023) . To address these issues, and to ensure alignment with other state investments in this area, I am directing the Department of Finance to propose language for the Legislature’s consideration as part of next January’s state budget proposal.” (Emphasis added).
SB 582 (Becker) Health Information – The Governor’s veto message stated this bill “would require the California Health and Human Services Agency’s (CHHS) Data Exchange Framework (DxF) stakeholder advisory group to consider new standards for including Electronic Health Records (EHR) vendors in the DxF, establish standards for EHR vendors’ fees, and authorize CHHS to oversee and enforce EHR vendors for noncompliance with federal standards. My Administration spearheaded the creation of the DxF to accelerate and expand the exchange of health information to provide safe, effective, whole person care to Californians in real time. Given the ongoing efforts by CHHS and the Center for Data Insights and Innovation to stand up the DxF, this bill is premature. The state should prioritize implementation of this important work before we consider modifications.”
Next week, the Newsletter will return to exploring bill signings to ensure members are as aware as possible of what lies ahead effective January 1, 2024.