Government and Public Affairs California End-of-Session Briefing

1. Government and Public AffairsCalifornia End-of-Session Briefing Oct. 9, 2018

2. California government affairs team Michael Tou Director, Government Relations California Region michael.tou@providence.org • Rochelle Silsbee • Director, Public Affairs • California Region • rochelle.silsbee@providence.org

3. Overview of briefing • Understand our advocacy work at the state and local level • Overview of California legislative session and how key policy issues will impact our family of organizations • Understand our priorities and what we can expect • Identify opportunities for caregivers to engage in advocacy

4. Why we advocate

5. Our enduring commitment to advocacy Catholic heritage calls us to influence policy and promote a culture of social justice Bringing voice to the poor and vulnerable by focusing the strength of our experts and caregivers to influence public policy at the local, state and federal levels. Advancingthe organization’s strategic objectives by aligning proactive and defensive advocacy and public policy goals with strategy and operations. Collaborationwith external stakeholder groups and associations to strengthen our voice on policy priorities. Engagingour system and regional leadership teams and subject experts to position PSJH as a national thought leader on health care delivery, reform and innovation.

6. Government and public affairs team Ali Santore vice president Montana Washington Oregon Jamie Luna executive assistant Jessica Adamson, director, government affairs Kristen Federici, director, government affairs Kristen Downey, program manager, state advocacy Lauren Platt, program manager, state advocacy New Mexico Michael Tou, director, government affairs Alaska Rochelle Silsbee, director, public affairs Texas Washington, D.C. California Jacquelyn Bombard, director, federal relations Emily Ford, program manager, state advocacy Steve Beck, regional SVP, TX and NM Sarabeth Zemel, manager, federal regulatory affairs and engagement

7. How we engage in policymaking Relationship building Develop relationships with policy makers and identify external stakeholders with shared goals. Identify new solutions Serve as resource to identify potential policy issues and brainstorm possible solutions. Legislative process Work with executive and clinical leadership to define our priorities carry out advocacy strategy. Regulatory process Work across ministries to determine impact, inform participation and submit public comments. Implementation and compliance Work with teams and project managers to inform implementation and compliance.

8. Our 2018 Advocacy AgendaAdvancing innovative, compassionate care for all • Advocacy priorities for a better future • Ensure affordable coverage for all • Enhance patient-centered care • Pioneer new paths in health care • Answer the call for more mental health care • Respond to the needs of our communities Available online at www.psjhealth.org/advocacy

9. 2018 legislative session An overview

10. California session snapshot During the 2018 session, government affairs tracked nearly 200 bills that aligned with our advocacy agenda. Priority issue areas included: • 340B • Medi-Cal home health payment rates • Commercial payment rates • Opioid use • Health care contracting • Heath facility licensing and closures • Mental health services • Emergency medical services • Nursing education and staffing ratios • Pharmacy staffing and licensing • Medication management services • Coverage expansion • Homelessness • Social determinants of health

11. Financial and operational stability Top outcome

12. Prevented massive cuts to provider payments The proposal: Created the California Health Care Cost, Quality and Equity Commission to set commercial payments to hospitals, doctors and other health care providers. Establishes provider payments by using Medicare rates as a floor for determining base amounts. • PSJH advocacy: • PSJH core leaders, physicians and board members joined our grassroots campaign and sent 1,050 emails to state legislators to express opposition. The bill did not advance after failing passage in a key committee due to concerns about the bill from our legislators. • Advocacy protected more than $1 billion in reimbursement for providing needed care to our vulnerable patients.

13. Enable the best care Top outcomes

14. Nurse-to-patient ratio penalties vetoed by governor The proposal: Requires periodic inspections of hospitals by CDPH to include review of compliance with nurse staffing ratios. Establishes a separate penalty structure for citations issued by CDPH for violations of nurse-to-patient ratio regulations: $15,000 for a first violation, and $30,000 for subsequent violations. New strict liability standard failed to take into account the realities of hospital operations. • PSJH advocacy: • Gov. Brown vetoed the bill at the direct urging of our regional and ministry CNOs. • In his veto message, Gov. Brown stated that “California hospitals are regularly inspected to assure patient safety and quality of care” and “penalties are imposed based on the overall assessment of the severity and duration of the violations…”

15. Advocacy prevents unfunded pharmacy mandates The proposals: New requirements for the operation and licensing of an automated drug delivery system. Prohibits a community pharmacy from requiring a pharmacist employee to work alone or being redirected to retail functions and not pharmacy duties. Requires a pharmacist at a hospital pharmacy to obtain an accurate medication profile or list for each high-risk patient. • PSJH advocacy: • Government affairs helped amend key pharmacy bills to: • Eliminate requirements to license hospital-based ADDS units, saving PSJH at least $200,000 in annual licensing fees. • Exempt hospital retail pharmacies from new retail pharmacy staffing requirements. • Better align medication profile requirements for high-risk patients with current policies.

16. Enhance patient-centered care Top outcomes

17. Preserved 340B savings within Medi-Cal • PSJH advocacy: • PSJH helped convince legislators to reject the governor’s budget proposal through direct advocacy by California caregivers who joined our online grassroots campaign, and lobbying by government affairs. • Advocacy preserved $15.4 million in 340B cost savings across 14 ministries in California, so that we can continue providing free or discounted medications to our patients. • The proposal: • Requires covered entities to purchase drugs at wholesale acquisition cost. • State wants to prevent hospitals and clinics from purchasing 340B drugs to avoid duplicate discounts and state paying funds back to drug manufacturers. • State claims hospitals are using cost savings to support margins and savings should go directly to state, which administers the Medi-Cal program.

18. Refine homeless patient discharge policies The proposal: Require hospitals to adopt a homeless patient discharge planning policy. Ensure hospitals follow specified protocols prior to and upon discharge of a homeless patient. Require hospitals to maintain a log of homeless patients discharged and the locations to which they were discharged. Discharge protocol would become effective Jan. 1, 2019. All other requirements go into effect July 1, 2019. PSJH advocacy: We agree with intent of bill to protect vulnerable patients. Government affairs obtained key amendmentsthat bring the proposed standards more in alignment with our existing discharge policies. The bill was signed into law by the governor. PSJH opposeda provision allowing municipalities to adopt standards beyond the statewide requirements. We remain concerned about the lack of local resources for our homeless populations.

19. Advocacy outcomes on other strategic billsLegislation we supported

20. Advocacy outcomes on other strategic billsLegislation we opposed

21. Political dynamics at play

22. 2018 elections Expected: Dianne Feinstein Expected: Gavin Newsom • Governor • U.S. Senate Democrats maintain supermajority Republicans pick up seat in primary recall • CA Assembly • CA Senate Bonds for affordable and mental health housing; children’s hospital construction bond; capping dialysis treatment charges; gas tax repeal; rent control; daylight savings • Ballot measures

23. California outlook: 2018 2019 Key timelines • Nov. 6General election • Dec. 3Session convenes, bill introductions • Jan.1, 2019 • New statutes, new statewide offices • Four things to watch • Leading health policy issues • Statewide offices: Democrats hold all offices • Leadership: Speaker Rendon and Senate President pro tem Atkins will remain in leadership positions • Supermajorities: Democrats maintain supermajority in the Assembly; fall one seat short in Senate. • Organized labor: Growing influence • Universal health care • Cost containment/contracting • Health care transactions • Charity care/community benefit • Staffing ratios • Women’s health

24. Looking ahead: Interim activities and the 2019 session

25. Policy and regulatory priorities ahead • Pediatric palliative care DHCS is proposing to redesign program to continue to deliver palliative care services to eligible children • Surgical plume and smoke Cal/OSHA standard to protect employees from surgical plume and smoke hazards • Occupational exposure to antineoplastic drugs Cal/OSHA standard to minimize health care worker exposure to antineoplastic drugs • Indoor heat illness prevention Cal/OSHA standard to minimize heat-related illness among workers in indoor places of employment • Care coordination DHCS conducting systemic review of care coordination across the Medi-Cal delivery system • Sterile compounding Board of Pharmacy aligning state regulations with USP 797 & 800

26. Interim focus areas Providence St. Joseph Health is having conversations and preparing our advocacy plan for the 2019 California legislative session. Issue areas include:

27. Local advocacy

28. All politics is local Policy trends across our six counties

29. Mobilizing our collective voice

30. Voices of Advocacy now live • Grassroots action centers • Advocacy agenda • Leadership policy blog • Videos • Curated news www.psjhealth.org/advocacy

31. Action center for grassroots • Grassroots home page • Links to customized state pages • Caregivers can check for active campaigns at any time • Open for board members, volunteers, sponsors, Sisters

32. California Action Center

33. Caregiver grassroots get results

34. Government Affairs Update • Latest advocacy & policy news • Covers our top issues • E-newsletter to your inbox • Every two weeks during sessions • Subscribe: governmentaffairs@providence.org Look for this

35. Thank you