Bill Text: CA AB2424 | 2015-2016 | Regular Session | Amended

NOTE: There are more recent revisions of this legislation. Read Latest Draft

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Bill Title: Community-based Health Improvement and Innovation Fund.

Spectrum: Partisan Bill (Democrat 1-0)

Status: (Failed) 2016-11-30 - From Senate committee without further action. [AB2424 Detail]

Download: California-2015-AB2424-Amended.html

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BILL NUMBER: AB 2424	AMENDED
	BILL TEXT

	AMENDED IN ASSEMBLY  APRIL 6, 2016

INTRODUCED BY   Assembly Member Gomez

                        FEBRUARY 19, 2016

   An act to add Part 8 (commencing with Section  106100)
  106050)  to Division 103 of the Health and Safety
Code, relating to public health.



	LEGISLATIVE COUNSEL'S DIGEST


   AB 2424, as amended, Gomez.  Health  
Community-based Health  Improvement and Innovation Fund.
   Existing law establishes the State Department of Public Health,
within the California Health and Human Services Agency, vested with
certain duties, powers, functions, jurisdiction, and responsibilities
over specified public health programs.
   This  bill   bill, among other things, 
would create the  Community-based  Health Improvement and
Innovation Fund in the State Treasury and the moneys in the fund
would be available, upon appropriation by the Legislature, for
certain purposes, including, but not limited to, reducing 
the rates of preventable health conditions and addressing health
disparities.   health inequity and disparities in the
rates and outcomes of priority chronic health conditions, as defined,
preventing the onset of priority chronic health conditions using
community-based strategies in communities statewide and with
particular focus on health equity priority populations, as defined,
and strengthening local and regional collaborations between local
public health jurisdictions and health care providers, and across
government agencies and community partners to create healthier
communities, using a health in all policies approach.  The
department would be required  to use a specified percentage of
moneys from the fund f   or certain public health and
administrative activities and would be required  to award  a
specified percentage of  moneys from the fund to eligible
 applicants, as described.   applicants to be
used to improve health and health equity, as provided.  
   This bill would create an advisory committee, with the members
serving terms not to exceed 4 years, and would require the advisory
committee to provide expert input and offer guidance to the
department on the development, implementation, and evaluation of the
fund. The bill would require the advisory committee to produce, and
periodically revise, a comprehensive master plan for advancing
chronic disease and injury prevention throughout the state and would
require the advisory committee to submit the master plan and its
revisions to the Legislature triennially. 
   Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: no.


THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:

   SECTION 1.    Part 8 (commencing with Section 106050)
is added to Division 103 of the   Health and Safety Code
  , to read:  

      PART 8.  Community-based Health Improvement and Innovation Fund



   106050.  The Legislature finds and declares all of the following:
   (a) Over the past century, chronic diseases have emerged as a
predominant challenge to public health. Chronic disease and injury
account for eight of every 10 deaths and affects the quality of life
of 14 million Californians.
   (b) Obesity and diabetes in particular have grown rapidly, posing
a grave threat to health. Today over one-half of California adults
are estimated to have either diabetes or prediabetes. Thirteen
million adults in California, 46 percent of the adult population, are
estimated to have prediabetes or undiagnosed diabetes, while another
2.5 million adults, 9 percent of the adult population, have already
been diagnosed with diabetes.
   (c) The health inequities in this state are stark:
   (1) Ethnic minorities and individuals who have low incomes have
higher rates of diabetes. Nearly one-in-five African-Americans and
Latinos in California have diabetes, more than double the rate of
Whites.
   (2) Nearly 12 years of life separate the life expectancy at the
top and at the bottom of neighborhood clusters in California, from a
life expectancy of 87 years in parts of northwest Santa Clara County
to 75.3 years in the City of Twenty-Nine Palms and the City of
Barstow in the County of San Bernardino.
   (3) Economically disadvantaged children are far less likely to
complete the fitness requirements of the physical fitness test
offered to students in grade school.
   (4) Adolescents covered by Medi-Cal reported significantly higher
rates of drinking sugar-sweetened beverages and less daily
consumption of vegetables than the general California adolescent
population and were significantly more likely to be obese.
   (d) The following short list of risk factors is responsible for
much of the burden of chronic disease: tobacco use, physical
inactivity, unhealthful diet, excessive consumption of alcohol,
hyperlipidemia, and uncontrolled high blood pressure. These risk
factors and chronic conditions are largely preventable and
inequitably distributed.
   (e) The State Department of Public Health estimates that as much
as 80 percent of heart disease, stroke, and type II diabetes and more
than 30 percent of cancers can be prevented by eliminating the
underlying risk factors.
   (f) The economic burden of chronic disease in California weighs
heavily on families, employers, and all levels of government.
Approximately $98 billion, or 42 percent of all health care
expenditures in the state, was spent on treating just six common
chronic health conditions (arthritis, asthma, cardiovascular disease,
diabetes, cancer, and depression) in 2010.
   (g) The indirect costs associated with chronic disease in
California are also high. According to the Economic Burden of Chronic
Disease (EBCD) Index, the projected impact of lower productivity and
lost workdays for individuals with chronic conditions and their
caregiving family members in California was estimated to be $51
billion in 2010.
   (h) The cost of health care continues to surpass the rate of
inflation, causing increasing strain on the budgets of families,
employers, and the government.
   (i) Despite the fact that chronic disease results in decreased
quality of life, premature death, and exorbitant medical costs,
investments in measures that prevent chronic disease have been
minimal.
   (j) The United States spends only 2.6 percent of health care
dollars on all public health, yet 75 percent of health care costs are
attributable to preventable health conditions.
   (k) Paying for prevention works and upstream strategies have a
remarkable history of success, measured in both cost avoidance and
health improvement. In the County of Los Angeles, smoking amongst
high school students fell from 27 percent to 7 percent between 1997
and 2013, thanks to investment in policy and environmental changes as
well as education.
   (l) Childhood obesity amongst Los Angeles Unified School District
5th graders decreased by 10.6 percent (from 31.2 percent to 27.9
percent) between 2010 and 2013, and leveled off among 7th and 9th
graders, after nine years of steady increases, reflecting investments
to reduce the consumption of sugar sweetened beverages, promote
healthier eating, and increase physical activity.
   (m) The California Health and Human Services Agency, in
partnership with the State Department of Public Health, has defined
ambitious health improvement goals for the state through the "Let's
Get Healthy California" initiative, including making California the
healthiest state in the nation by 2022, reducing health disparities,
and achieving better health at lower cost. These goals cannot be met
by improvements in health care or on an individual basis alone.
Meeting these goals requires urgent and substantial investment in
community-based prevention of chronic disease.
   (n) The existing limited resources of funding for chronic disease
prevention are threatened, declining from past levels, and subject to
significant restrictions.
   (o) Strategic investment in upstream prevention will protect, not
deplete, the coffers of government. Investment in prevention has a
strong evidence base of positive return on investment through
reducing health care costs on a long-term basis.
   106051.  For purposes of this part, the following terms have the
following definitions:
   (a) "Department" means the State Department of Public Health.
   (b) "Fund" means the Community-based Health Improvement and
Innovation Fund.
   (c) "Health equity priority population" means, for each condition,
populations that exhibit significant disparities with respect to
prevalence of a priority chronic health condition or injury or worse
outcomes such as higher hospitalization or death rates. Priority
populations may be defined based on race, ethnicity, geography,
socioeconomic status including income or education, other factors as
defined by the department, or current findings and recommendations of
research, including assessments of innovations funded by the fund.
   (d)  "Local health jurisdiction" means county health department or
combined health department in the case of counties acting jointly or
city health department within the meaning of Section 101185.
   (e) "Priority chronic health conditions" means asthma, type II
diabetes, cardiovascular and cerebrovascular disease, cancer, dental
disease, obesity, and other chronic conditions and injuries that are
prevalent, largely preventable, and associated with high health care
costs, as defined by the department. High-burden conditions whose
prevention is not adequately supported by other funding streams shall
be prioritized.
   106052.  (a) (1) There is hereby created in the State Treasury the
Community-based Health Improvement and Innovation Fund. The fund
shall consist of any revenues deposited therein, including any fine
or penalty revenue allocated to the fund, any revenue from
appropriations specifically designated to be credited to the fund,
any funds from public or private gifts, grants, or donations, any
interest earned on that revenue, and any funds provided from any
other source.
   (2) A target level of annual statewide investment from the fund
shall be established as a set dollar amount per capita, to be
allocated for the purposes described in subdivision (b) and as
described in subdivision (c).
   (b) (1) Moneys in the fund shall be available, upon appropriation
by the Legislature, for any of the following purposes:
   (A) Reducing health inequity and disparities in the rates and
outcomes of priority chronic health conditions.
   (B) Preventing the onset of priority chronic health conditions
using community-based strategies in communities statewide and with
particular focus on health equity priority populations.
   (C) Strengthening local and regional collaborations between local
public health jurisdictions and health care providers, and across
government agencies and community partners to create healthier
communities, using a health in all policies approach.
   (D) Contributing to a stronger evidence base of effective
community-based prevention strategies for priority chronic health
conditions.
   (E) Evaluating effectiveness and cost-effectiveness of innovative
community-based prevention strategies for priority chronic health
conditions, as a basis for future decisions about investment in those
strategies in order to reduce the costs of providing health care
services and to improve population health status.
   (2) Moneys in the fund shall be used to address social,
environmental, and behavioral determinants of chronic disease and
injury at any phase of the life cycle, including, but not limited to,
all of the following:
   (A) Promotion of healthy diets and food environments.
   (B) Promotion of physical activity and of a safe, physical
activity-promoting environment.
   (C) Prevention of unintentional and intentional injury.
   (3) In expending moneys from the fund, policy, systems, and
environmental change approaches are to be emphasized, although funds
can support implementation of community-based programs.
   (4) Moneys in the fund shall not be used for clinical services.
   (c) Revenues deposited in the fund that are unexpended at the end
of a fiscal year shall remain in the fund and not revert to the
General Fund.
   106053.  (a) The department shall be allocated an amount not
greater than 20 percent of the annual appropriation from the fund for
all of the following activities:
   (1) Mandatory activities for which the funds shall be used are as
follows:
   (A) Statewide media and communications campaigns, which shall be
allocated 9 percent of those funds.
   (B) Evaluation of program activities, which shall be allocated at
least 5 percent of those funds.
   (C) Other activities, which shall be allocated no more than 6
percent of those funds, as follows:
   (i) Mandatory activities, including all of the following:
   (I) Overall program implementation and oversight.
   (II) Review and approval of local health improvement plans.
   (III) Granting of and monitoring the implementation of local
health jurisdiction awards and competitive grant awards.
   (ii) The definition of criteria for evidence-based and innovative
approaches to improving health and health equity, with evaluation
criteria appropriate to each type of approach.
   (iii) The definition of priority chronic health conditions and
health equity priority populations based on public health data.
   (iv) The definition of criteria for participation of community
partners in local health jurisdiction funding.
   (v) The development of tools that can be used by the state and by
grantees to monitor progress towards improving health and health
equity, including establishment of a health equity index.
   (2) Discretionary activities, as may be appropriate to support
community-based prevention of priority chronic health conditions
throughout the state, for which the funds may be used, include, but
are not limited to, any of the following:
   (A) Research, development, and dissemination of best practices,
including training and technical assistance for grantees.
   (B) Development of infrastructure, including, but not limited to,
data resources or information technology resources to be shared
statewide.
   (C) Coordination of local efforts.
   (D) Development and promotion of statewide initiatives.
   (b) The department shall award at least 80 percent of total moneys
made available in the annual appropriation from the fund to eligible
applicants to be used consistent with the purposes described in
subdivision (b) of Section 106052. Moneys from the fund shall be
distributed and awarded according to the following criteria:
   (1) (A) At least 50 percent of those funds shall be awarded to
local health jurisdictions and shall be allocated on a formula basis
to local health jurisdictions, or their nonprofit designee, with
approved applications for three-year funding cycles.
   (B) Each local health jurisdiction shall submit an application for
a three-year funding cycle, to be reviewed and approved by the
department, that includes all of the following information:
   (i) A detailed assessment of community health needs within the
local health jurisdiction with respect to priority chronic health
conditions and health equity priority populations.
   (ii) A health improvement and evaluation plan that includes
initiatives focused on health equity priority populations.
   (iii) The level of local funds, including in-kind resources, for
community-based prevention activities that was provided in the most
recently completed fiscal year.
   (iv) Documentation of the existence and activities of a community
health partnership, which includes leading health care providers,
local health jurisdictions, community partners, including those
serving health equity priority populations, businesses, and other
relevant local government agencies and community leaders.
   (C) Each local health jurisdiction with an approved application
shall receive a base award of two hundred fifty thousand dollars
($250,000) for a three-year funding cycle. The balance of the funds
shall be awarded to local health jurisdictions proportional to the
number of residents living below the federal poverty level.
   (D) Health improvement and evaluation plans shall emphasize
sustainable policy, systems, and environmental change approaches to
creating healthier communities.
   (E) Local health jurisdictions may come together if they so desire
to submit combined regional applications.
   (F) No single recipient may receive more than 30 percent of the
funding allocated to local health jurisdictions on a formula basis.
   (G) Recipients of funds pursuant to this paragraph shall maintain
the level of local funds, including in-kind resources, for
community-based prevention activities that were provided in the most
recent completed fiscal year prior to July 2016. Funds provided
pursuant to this paragraph shall supplement and not supplant existing
funding for community-based prevention activities of priority
chronic health conditions.
   (H) Local health jurisdiction investments shall prioritize
communities in the third and fourth quartiles of the California
Health Disadvantage Index or other criteria of health equity priority
populations subsequently adopted by the department.
   (I) The initial year of funding may be used for needs assessment,
planning, and development.
   (2) At least 30 percent of those funds shall be allocated for
competitive grants as follows:
   (A) (i) Competitive grants shall be awarded to local or regional
level entities or statewide nonprofit organizations.
   (ii) Local or regional level entities include community-based
organizations or local public agencies, in partnership with other
entities, including, but not limited to, other community-based
organizations, other local public agencies, schools, religious
organizations, businesses, labor unions, health care plans,
hospitals, clinics, other health care providers, or other
community-based entities.
   (iii) Each participating health care plan or hospital shall
identify monetary, in-kind, or both, contributions to projects.
   (iv) Local or regional projects shall prioritize investments that
serve communities in the third and fourth quartiles of the California
Health Disadvantage Index or other criteria of health equity
priority populations subsequently adopted by the department.
   (v) At least 10 percent of the funds awarded as competitive grants
shall be used for statewide nonprofit organizations.
   (vi) Organizations receiving competitive grants shall coordinate
efforts with any local health jurisdictions where they are carrying
out activities.
   (B) (i) Competitive grant applicants shall identify projects as
either an evidence-based or an innovative project.
   (ii) At least 10 percent of the funding for competitive grants
shall be set aside for innovative projects that test previously
untested strategies in order to improve the evidence base of
effective community-based prevention strategies for priority chronic
health conditions.
   (iii) Applications for innovative projects shall provide a
rationale for the defined approach and any evidence that suggests the
innovative project will be effective, as well as a plan and resource
allocation for the evaluation.
   (iv) Competitive grants may be used by organizations for policy
systems or environmental change efforts, direct program delivery, or
for technical assistance to other grantees.
   106054.  (a) (1) An advisory committee, with the members serving
terms not to exceed four years, shall provide expert input and offer
guidance to the department on the development, implementation, and
evaluation of the fund.
   (2) The advisory committee shall include, at a minimum, experts on
priority chronic health conditions, effective nonclinical prevention
strategies, policy strategies for chronic disease prevention, and
the unique needs of health equity priority populations.
   (3) The advisory committee shall include representatives from the
State Department of Health Care Services, the Health in All Policies
Task Force, the California Health and Human Services Agency, the
California Conference of Local Health Officers, and the California
Public Employees' Retirement System.
   (b) The department shall develop a robust evaluation framework for
all activities funded through the fund.
   (c) The department may define state priorities and require
activities funded by the fund to align with those priorities in a
manner that is consistent with the intent of this part. The
department may narrow the list of priority chronic health conditions
if necessary to ensure an effective program.
   (d) (1) Based on the results of programs supported by this part
and any other proven methodologies available to the advisory
committee, the advisory committee shall produce a comprehensive
master plan for advancing chronic disease and injury prevention
throughout the state.
   (2) The master plan shall include recommended implementation
strategies for each priority chronic health condition throughout the
state and identify areas where innovative solutions are especially
needed.
   (3) The advisory committee shall submit the master plan, and
revisions to the master plan, to the Legislature triennially.
   (4) The master plan and its revisions shall include
recommendations on specific goals for reduction of the burden of
preventable chronic conditions and injuries by 2030, administrative
arrangements, funding priorities, integration and coordination of
approaches by the department, the University of California, the
Health in All Policies Task Force, and their support systems, and
progress reports relating to each health equity priority population.
   (5) A report submitted pursuant to paragraph (3) shall be
submitted in compliance with Section 9795 of the Government Code.
 
  SECTION 1.    Part 8 (commencing with Section
106100) is added to Division 103 of the Health and Safety Code, to
read:

      PART 8.  Health Improvement and Innovation Fund


   106100.  (a) There is hereby created in the State Treasury the
Health Improvement and Innovation Fund.
   (b) Moneys in the fund shall be available, upon appropriation by
the Legislature, for the following purposes:
   (1) Reduce the rates of preventable health conditions.
   (2) Address health disparities.
   (3) Reduce state health care costs.
   (4) Build evidence of effective prevention programs.
   (c) (1) The State Department of Public Health shall award moneys
from the fund to eligible applicants.
   (2) Eligible applicants shall include, but not be limited to,
community-based organizations and local governments.