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COUNTY OF SAN MATEO
Inter-Departmental Correspondence
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County Manager’s Office
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DATE:
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June 15, 2005
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BOARD MEETING DATE:
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June 22, 2005
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SPECIAL NOTICE/HEARING:
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None
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VOTE REQUIRED:
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Majority
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TO:
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Honorable Board of Supervisors
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FROM:
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John Maltbie, County Manager
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SUBJECT:
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County Manager’s Report #10
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A.
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Resolution in support of H.R. 1441 (Schakowsky), Inclusive Home Design Act
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RECOMMENDATION:
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Adopt a resolution in support of H.R. 1441 (Schakowsky), Inclusive Home Design Act
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VISION ALIGNMENT:
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Commitment: Offer a full range of housing choices
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Goal(s): Goal #9—Housings exists for people of all income levels and for all generations of families.
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BACKGROUND:
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The limited availability of affordable and accessible housing in San Mateo County remains a major challenge for people with disabilities and seniors to live independently in the community. To address this challenge, the Commission on Aging/Commission on Disabilities Joint Housing Committee has been promoting the concept of “visitability” for newly constructed single-family dwellings. The primary elements of visitability are an accessible path of travel to a no-step entry, minimum width doorway of 32 inches and same-level access to a bathroom with the same minimum door width.
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DISCUSSION:
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H.R. 1441, the Inclusive Home Design Act of 2005, would require all newly constructed, federally assisted, single-family houses and townhouses to meet minimum standards of visitability for persons with disabilities. Federal financial assistance includes any assistance that is provided or otherwise made available by the Secretary of Housing and Urban Development (HUD) or the Secretary of Veterans Affairs (VA), or any other federal agency though any grant, subsidies, loan, or contract. Housing and Community Development Act funds would also be included. In order to meet the minimum standards of visitability, the dwelling unit would need to contain at least one level that would have an accessibly route to an accessible, no-step entry and accessible interior doors, accessibly environmental controls, and accessible habitable space and bathroom. Exceptions to these requirements would be granted to those dwellings where the finished grade of the site is too steep to provide an accessibly route, or where there is no driveway serving the unit, or no alley or other roadway that would provide vehicular access to the rear of the unit. Minimum standards would be in effect beginning a year after enactment of H.R. 1441.
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Enforcement of this act requires each applicant for Federal financial assistance to submit an assurance to the Federal agency responsible for such assistance that all of its programs and activities will be in compliance with the Act. In addition, architectural and construction plans for such units must be submitted to the appropriate state or local department or agency responsible under law for the review and approval of those plans for compliance of generally applicable building codes or requirements. H.R. 1441 also allows for civil action and relief for private persons aggrieved by an act or omission that is unlawful under the Act. Relief in a civil action may include actual and punitive damages and reasonable attorney fees and costs.
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The Legislative Committee and Commission on Aging recommend support.
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FISCAL IMPACT:
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No fiscal impact.
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B.
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Resolution in support of AB 866 (Yee), Code of Fair Campaign Practices
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RECOMMENDATION:
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Adopt a resolution in support of AB 866 (Yee), Code of Fair Campaign Practices
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VISION ALIGNMENT:
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Commitment: Realize the potential of our diverse population
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Goal(s): Goal #1—Our diverse population works well together to build strong communities, effective government and a prosperous economy.
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BACKGROUND:
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AB 866 would add to the existing Code of Fair Campaign Practices (Code), to which candidates voluntarily subscribe, a provision that a candidate will not use or permit any appeal to negative prejudice based on sexual orientation or gender identity.
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Elections Code Section 20440 requires elections officials to provide the Code and a copy of Section 20440 to each person (and campaign) that is issued papers evidencing their campaign intentions. Elections officials must also inform them that subscription to the form is voluntary.
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The Code is a pledge seemingly intended to promote “principles of decency, honesty, and fair play which every candidate for public office in the State of California has a moral obligation to observe and uphold”. While voluntary, the Code requires those who sign it to refrain from activities including using or permitting an appeal to negative prejudice based on race, sex, religion, national origin, physical health status, or age.
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DISCUSSION:
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According to supporters there have been instances of candidates and campaigns using anti-gay rhetoric and appealing to negative prejudice, especially in issues surrounding the rights of lesbian, gay, bisexual and transgender (LGBT) people. In addition to coloring the campaign itself, supporters argue that such negative appeals can be dangerous to LGBT people by creating atmospheres of fear and intimidation and, occasionally, physical violence.
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Opponents argue that many voters disagree with the “homosexual lifestyle” for religious and other reasons and that these voters (and presumably all voters) have a right to such information as a basis to decide whether they should support a candidate. As a result, they oppose AB 866 arguing that it could keep information about a candidate (i.e. the candidate’s sexual orientation) from the public.
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The bill analysis of the Assembly Committee on Elections and Redistricting discussed possible First Amendment concerns, but noted that, “to the extent that a candidate's decision to sign or to refuse to sign the Code is voluntary, the Code likely does not impermissibly restrict a candidate's freedom of speech. However, when a law coerces candidates to subscribe to the Code, and thus to restrict their speech, that law may be unconstitutional. Because this bill simply adds a provision to the Code, it does not coerce a candidate to subscribe to the Code beyond any inherent coercive effect that the Code already has.“
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AB 866 has been referred to the Senate Elections, Reapportionment and Constitutional Amendment Committee and is scheduled for a hearing June 15. The bill passed from the Appropriations (13:5 Ruskin, Yee in support), and Assembly Floor (47:27 Mullin, Ruskin, Yee in support).
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At the request of Assemblymember Yee, Supervisor Gordon recommended the Legislative Committee consider this bill. The Legislative Committee recommends support.
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FISCAL IMPACT:
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No fiscal impact.
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C.
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Resolution in support of SB 798 (Simitian), Prescription drug collection and distribution program
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RECOMMENDATION:
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Adopt a resolution in support of SB 798 (Simitian), Prescription drug collection and distribution program
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VISION ALIGNMENT:
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Commitment: Ensure Basic Health and Safety for All
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Goal(s): Goal #5—Residents have access to healthcare and preventative care
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BACKGROUND:
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This bill would authorize a county to establish, by local ordinance, a repository and distribution program for the purposes of distributing surplus unused medications, donated by specified entities, to persons in need of financial assistance.
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Under the authority created in SB 798, defined health facilities (such as general acute care hospitals, skilled nursing facilities and assisted living centers) and drug manufacturers would be permitted to donate excess or surplus unused prescription medications. SB 798 allows counties to establish local ordinances creating repository and distribution programs for such donated medications. However, the county must establish procedures that, in part, limit participation to medically indigent patients, prohibit charging for such medications and ensure proper safety and management of the medications.
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DISCUSSION:
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According to Senator Simitian, California wastes hundreds of millions of dollars through the disposal of unused medications, despite the fact that medication costs continue to rise making access to medications more difficult. SB 798 is intended to help bridge the contradiction of disposing of needed medications.
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Several states including Indiana, Oklahoma, South Dakota and Wisconsin have already enacted similar legislation. According to the Senate Health Committee analysis, Oklahoma reported on the performance of their program and recommended the program be made permanent noting minimal operating costs and no adverse clinical, operational or administrative problems.
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The San Mateo Medical Center (SMMC) has reviewed SB 687. Staff raises some questions regarding administration (cost) and liability. The bill requires the county, in creating a distribution program, to establish safety procedures. Many (if not all) of the requirements appear sensible. For example the bill requires medications to be dispensed before the expiration date and that pharmacists adhere to standard pharmacy practices when dispensing such medications. However, some of the requirements may prove challenging for a county to ensure. For example, the bill requires a county to establish policies to ensure that donated drugs have not been stored under conditions contrary to pharmacological or manufacturer standards. While the purpose of having such assurance is clear, how (possibly through contracts between the County and donors?) counties will be able to have assurance of a medication’s treatment before it receives possession of the medication is unclear.
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As currently drafted, SB 798 provides no liability protections for counties. In contrast, the Oklahoma legislation provides liability protections. Senator Simitian’s staff expects to address this concern, but perhaps not as robustly as the Oklahoma model.
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Regardless of these concerns, SMMC staff recommends a support position. SB 798 does not require counties to implement such programs, but rather provides counties with the flexibility to offer such services. In determining whether to participate, San Mateo County might consider factors including the benefit to patients, the cost of providing such a service (versus the reduced pharmaceutical costs) and the potential liability risks.
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SB 798 has been referred to the Assembly Health Committee for a hearing on June 14, 2005. The bill passed from the Senate Health Committee (10:0) and Senate Floor (30:6) Simitian in support; Speier absent/not voting). The Legislative Committee recommends support.
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FISCAL IMPACT:
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Unknown. SMMC has yet to conduct a cost analysis. According to Senator Simitian’s office, (Santa Clara) Valley Medical Center anticipates cost savings of at least $250,000 per year.
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D.
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Resolution in support of AB 1125 (Pavley), Household battery recycling act
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RECOMMENDATION:
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Adopt a resolution in support of AB 1125 (Pavley), Household battery recycling act
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VISION ALIGNMENT:
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Commitment: Ensure basic health and safety for all
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Goal(s): Goal #7—Maintain and enhance the public safety of all residents and visitors.
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BACKGROUND:
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Requires most retailers of household batteries to take back used batteries for reuse, recycling, or proper disposal, at no cost to the customer.
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The Household Battery Recycling Act of 2006 would require, by July 2006, retailers to create a system for the acceptance and collection of used household batteries for reuse, recycling, or proper disposal. Household batteries would include many batteries excluding lead-acid batteries (i.e. car batteries) and those not normally handled by consumers at the time of purchase (i.e. batteries sold in watches). AB 1125 would require that each system allow for the return of used batteries at no cost to the consumer. For example, consumers would be able to deliver used batteries to the retailer from which they purchased the battery.
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For those retailers that deliver (i.e. mail) subject batteries to California consumers, the bill would require that the retailer provide the consumer a return mechanism at the time of delivery.
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AB 1125 would also require retailers to make recycling information available to consumers about household battery recycling opportunities provided by the retailer and to encourage consumers to utilize those opportunities.
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The bill would exempt those retailers that have annual sales less than $1 million and/or primarily sell food and are listed in the Progressive Grocers Guide.
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DISCUSSION:
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While there is an existing free retailer based recycling programs already in place at several thousand retail locations throughout California, the author notes that less than 5% of rechargeable batteries and less than 1% of other batteries are being recycled each year. As a result, AB 1125 is intended to build on the existing recycling opportunities and improve the reuse, recycling and proper disposal of household batteries.
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Opponents argue that existing voluntary programs can adequately accommodate those consumers who wish to recycle batteries. In addition, opponents express concern about the costs associated with collecting, recycling and, in particular, disposing of those batteries that are not recyclable.
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AB 1125 passed from the Assembly floor (43:34 Mullin, Ruskin, Yee in support) on June 1. The Legislative Committee recommends support.
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FISCAL IMPACT:
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No fiscal impact. Possible cost savings.
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E.
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Authorize the County Manager to communicate the position of the Board of Supervisors regarding California’s Medi-Cal Hospital Finance Waiver.
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RECOMMENDATION:
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Authorize the County Manager to communicate the position of the Board of Supervisors regarding California’s Medi-Cal Hospital Finance Waiver.
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VISION ALIGNMENT:
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Commitment: Ensure basic health and safety for all
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Goal 5: Residents have access to healthcare and preventative care
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BACKGROUND:
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In response to the June 30th expiration of the current Section 1115 Federal waiver, the Schwarzenegger Administration has been in negotiations with the Centers for Medicare & Medicaid Services (CMS) and the Office of Management and Budgets (OMB) in the development of a Section 1115 waiver and hospital finance redesign.
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Following a May 6th letter by the California Congressional Delegation urging “full Federal funding” for California’s Medicaid hospital finance waiver, the California Hospital Association, the California Health and Human Services Agency and representatives of the Governor’s office met on May 26 to discuss the most recent (May 19th) version of California’s proposed five-year 1115 Medicaid waiver, which will restructure safety net hospital financing. While state representatives argue that the proposal is the best they are able to secure, many of the service providers have expressed significant concerns about the proposal.
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DISCUSSION:
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The May 19th version of the hospital finance waiver has fueled ongoing frustration with the process and the negotiations. In reviewing the existing proposal, staff has identified several areas of concern:
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Allocation of Federal funds among local governments and hospitals.
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Most federal funds will be allocated to the state through a Federal-local government match called the certified public expenditure (CPE) process. While San Mateo County likely has a high level of CPE, the allocation of funding from muich of the waiver has not been determined. As a result, San Mateo County may not realize a proportionate share of Federal funding in relation to its CPE. That is, San Mateo County may “subsidize” other jurisdictions that do not generate enough CPE to access their needed level of federal funds.
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Statewide adequacy of funding
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The May 19th version contains several changes that do not meet the California Congressional Delegations position of “full Federal funding.” The May 19th proposed Safety Net Care Pool would be a flat funding source. This is problematic when the cost of health care continues to rise. Of perhaps greater concern is the condition that Pool funds ($180 million in each of the first two years) be contingent on reaching managed-care “milestones.” While San Mateo County currently participates in managed care and may (as an individual jurisdiction) meet the requirements, the Legislature rejected the Administration’s efforts to expand managed care. According to CSAC, neither the Senate nor Assembly budget committees included the proposal in their respective budgets. While the Budget Conference Committee is an “open” conference permitting all issues to be discussed regardless of whether they are contested, the message from the Legislature rejecting managed care is clear. Should the Administration approve such a condition for federal funding and should the Legislature sustain its rejection of managed care, California would fail to realize $360 million.
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3.
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Elimination of “hold harmless” provisions for moving to managed care
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CSAC also asserts, although not clear in the May 19th proposal, that a “hold harmless” provision for reduced revenue associated with patients moving from fee-for-service (FFS) to managed care has been eliminated. Presumably, hospitals would use the Safety Net Care Pool to make up such losses, but that funding as proposed in the May 19th version would be fixed. While this may not impact San Mateo County significantly
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due to our existing managed care system, it highlights the importance of the certified public expenditure (CPE) process through which both FFS and Pool funds would be accessed.
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4.
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Private versus public hospitals.
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The May 19th proposal would also separate public and private safety net hospitals. Initial analysis by CSAC and CAPH suggests that private hospitals would receive funding growth while public hospitals would not.
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FISCAL IMPACT:
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Unknown—likely significant—Possibly negative
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