Existing federal law, the Indian Gaming Regulatory Act of 1988, provides for the negotiation and execution of tribal-state gaming compacts for the purpose of authorizing certain types of gaming on Indian lands within a state. The California Constitution authorizes the Governor to negotiate and conclude compacts, subject to ratification by the Legislature. Existing law expressly ratifies a number of tribal-state gaming compacts, and amendments to tribal-state gaming compacts, between the State of California and specified Indian tribes.

The California Environmental Quality Act (CEQA) requires a lead agency to prepare, or cause to be prepared, and certify the completion of, an environmental impact report on a project, as defined, that it proposes to carry out or approve that may have a significant effect on the environment, as defined, or to adopt a negative declaration if it finds that the project will not have that effect.

This bill would ratify amendments to the tribal-state gaming compact entered into between the State of California and the Yurok Tribe of the Yurok Reservation, executed on August 4, 2016. The bill would provide that, in deference to tribal sovereignty, certain actions are not projects for the purposes of CEQA.

This bill would declare that it is to take effect immediately as an urgency statute.

Existing federal law, the Indian Gaming Regulatory Act of 1988, provides for the negotiation and execution of tribal-state gaming compacts for the purpose of authorizing certain types of gaming on Indian lands within a state. The California Constitution authorizes the Governor to negotiate and conclude compacts, subject to ratification by the Legislature. Existing law expressly ratifies a number of tribal-state gaming compacts, and amendments to tribal-state gaming compacts, between the State of California and specified Indian tribes.

The California Environmental Quality Act (CEQA) requires a lead agency to prepare, or cause to be prepared, and certify the completion of, an environmental impact report on a project, as defined, that it proposes to carry out or approve that may have a significant effect on the environment, as defined, or to adopt a negative declaration if it finds that the project will not have that effect.

This bill would ratify amendments to the tribal-state gaming compact entered into between the State of California and the Yurok Tribe of the Yurok Reservation, executed on August 4, 2016. The bill would provide that, in deference to tribal sovereignty, certain actions are not projects for the purposes of CEQA.

This bill would declare that it is to take effect immediately as an urgency statute.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of that act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. These provisions require specified services and drugs to be covered by the various health care service plans and health insurers.

This bill would require an individual or group health care service plan or disability insurance policy issued, amended, or renewed after January 1, to provide coverage on its formulary, drug list, or other lists of similar construct for at least one abuse-deterrent opioid analgesic drug product per opioid analgesic active ingredient. The bill would require that the total amount of copayments and coinsurance an enrollee or insured is required to pay for brand name abuse-deterrent opioid analgesic drug products covered pursuant to the bill not exceed the lowest cost-sharing level applied to brand name or generic prescription drugs covered under the applicable health care service plan or insurer, as specified. The bill would prohibit a health care service plan or insurer from requiring an enrollee or an insured to first use a non-abuse-deterrent opioid analgesic drug product before providing coverage for an abuse-deterrent opioid analgesic drug product, subject to uniformly applied utilization review requirements described in the bill. require health care service plans and health insurers representatives, in collaboration with certain entities, to convene an Opioid Abuse Task Force on or before February 1, 2017, for the purpose of developing recommendations regarding the abuse and misuse of opioids, as specified. The bill would require the task force to submit a report detailing its findings and recommendations to specified government entities on or before December 31, 2017. The bill would require the task force to be dissolved on June 1, 2018. The bill would provide that a violation of these provisions by a health care service plan does not constitute a crime under the Knox-Keene Health Care Service Plan Act of 1975. The bill would make related legislative findings and declarations.

(3)Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of that act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. These provisions require specified services and drugs to be covered by the various health care service plans and health insurers.

This bill would require an individual or group health care service plan or disability insurance policy issued, amended, or renewed after January 1, to provide coverage on its formulary, drug list, or other lists of similar construct for at least one abuse-deterrent opioid analgesic drug product per opioid analgesic active ingredient. The bill would require that the total amount of copayments and coinsurance an enrollee or insured is required to pay for brand name abuse-deterrent opioid analgesic drug products covered pursuant to the bill not exceed the lowest cost-sharing level applied to brand name or generic prescription drugs covered under the applicable health care service plan or insurer, as specified. The bill would prohibit a health care service plan or insurer from requiring an enrollee or an insured to first use a non-abuse-deterrent opioid analgesic drug product before providing coverage for an abuse-deterrent opioid analgesic drug product, subject to uniformly applied utilization review requirements described in the bill.

Because a willful violation of these requirements with respect to health care service plans would be a crime, this bill would impose a state-mandated local program.

(4)The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

Existing law, the Knox-Keene Health Care Service Plan Act of 1975, provides for the licensure and regulation of health care service plans by the Department of Managed Health Care and makes a willful violation of that act a crime. Existing law also provides for the regulation of health insurers by the Department of Insurance. These provisions require specified services and drugs to be covered by the various health care service plans and health insurers.

This bill would require an individual or group health care service plan or disability insurance policy issued, amended, or renewed after January 1, to provide coverage on its formulary, drug list, or other lists of similar construct for at least one abuse-deterrent opioid analgesic drug product per opioid analgesic active ingredient. The bill would require that the total amount of copayments and coinsurance an enrollee or insured is required to pay for brand name abuse-deterrent opioid analgesic drug products covered pursuant to the bill not exceed the lowest cost-sharing level applied to brand name or generic prescription drugs covered under the applicable health care service plan or insurer, as specified. The bill would prohibit a health care service plan or insurer from requiring an enrollee or an insured to first use a non-abuse-deterrent opioid analgesic drug product before providing coverage for an abuse-deterrent opioid analgesic drug product, subject to uniformly applied utilization review requirements described in the bill.

Because a willful violation of these requirements with respect to health care service plans would be a crime, this bill would impose a state-mandated local program.

The California Constitution requires the state to reimburse local agencies and school districts for certain costs mandated by the state. Statutory provisions establish procedures for making that reimbursement.

This bill would provide that no reimbursement is required by this act for a specified reason.

CONCURRENCE IN SENATE AMENDMENTS

CSA1 Bill Id:AB 1977

Author:(Wood)

As Amended Ver:August 9, 2016

2/3 vote. Urgency

(vote not relevant)

Original Committee Reference: HEALTH

SUMMARY: Ratifies the amended tribal-state gaming compact (Amended Compact) entered into between the State of California (State) and the Yurok Tribe (Tribe) executed on August 4, 2016. Additionally, this bill provides that, in deference to tribal sovereignty, certain actions are not deemed projects for purposes of the California Environmental Quality Act (CEQA); and, stipulates, except as expressly provided, that none of the provisions shall be construed to exempt a city, county, or city and county, or the Department of Transportation from CEQA requirements.

The Senate amendments delete the Assembly version of this bill, and instead:

1. Ratify the First Amendment to the Tribal-State Gaming Compact between the State of California and the Yurok Tribe (Tribe), executed on August 4, 2016.
2. The Amended Compact conforms the workers' compensation provisions of the Tribe's 2006 compact to those of more recent compacts. All other provisions of the existing compact remain intact.
3. Provide that, in deference to tribal sovereignty, certain actions are not deemed projects for purposes of the California Environmental Quality Act (CEQA); and, stipulate, except as expressly provided, that none of the provisions shall be construed to exempt a city, county, or city and county, or the Department of Transportation from CEQA requirements.
4. Contain an urgency clause, allowing this bill to take effect immediately upon enactment.

EXISTING LAW:

1. Provides, under the Indian Gaming Regulatory Act (IGRA), for the negotiation and conclusion of compacts between federally recognized Indian tribes and the State for the purpose of conducting Class III gaming activities on Indian lands within a State as a means of promoting tribal economic development, self-sufficiency, and strong tribal governments.
2. Authorizes expressly a number of tribal-state gaming compacts between the State of California and specified Indian tribes.
3. Authorizes the conduct of Class III gaming activities to the extent such activities are permitted by state law, a gaming compact has been concluded by a federally recognized tribe and the State, and the compact has been approved by the Secretary of the Interior.
4. Limits the operation of Class III gaming activities to Indian lands acquired on or before October 17, 1988. Provides for certain exceptions to conduct gaming activities on Indian lands acquired after October 17, 1988.
5. Defines Indian lands to mean all lands within the limits of any Indian reservation, and any lands title to which is either held in trust by the United States (U.S.) for the benefit of any Indian tribe, or individual, or held by any Indian tribe or individual subject to restriction by the U.S. against alienation and over which an Indian tribe exercises governmental power.
6. Requires the State to negotiate to conclude a compact in good faith with an Indian tribe having jurisdiction over the Indian lands upon which the Class III gaming activity is to be conducted. Provides the U.S. district courts with jurisdiction over any cause of action initiated by a tribal government alleging that the State failed to negotiate in good faith to conclude a compact. Prescribes the remedy, mediation supervised by the courts, if it is found that the State failed to negotiate in good faith to conclude a compact.
7. Authorizes the Governor, under the California Constitution, to negotiate and conclude compacts, subject to ratification by the Legislature.

FISCAL EFFECT: Unknown

COMMENTS:

The Amended Compact conforms the workers' compensation provisions of the Tribe's existing 2006 compact (SB 106 (Wiggins), Chapter 37, Statutes of 2007) to those of more recent compacts. All other provisions of the existing 2006 compact remain intact.

The 2006 compact allowed the Tribe to operate no more than 99 gaming devices (slot machines) and specified that no more than 20 may be operated at an ancillary gaming facility (Pem-Mey Fuel Mart). The Tribe agreed to pay into the State General Fund an annual fee, as specified, based on a percentage of its Net Win from its operation of gaming devices. As long as the Tribe's membership is at least 4,000 members, it may deduct from the amount to be paid to the State the payments made pursuant to its Intergovernmental Agreements with Del Norte County and Humboldt County. The 2006 compact contained other provisions relating to: exclusivity; licensing; off-reservation environmental impacts; intergovernmental agreements; public and workplace health safety and liability; and labor provisions. The 2006 compact will be in effect until December 31, 2025.

The 2006 compact required the Tribe to participate in the State's workers' compensation program with respect to employees employed at the gaming facility. The Governor's office states, Section 15.1 of the 2006 compact stated that it may be amended upon written agreement of both parties, This year, the parties agreed in writing to negotiate relating to amending the 2006 compact's provision regarding mandatory participation in the state workers' compensation program.

The Governor's office states, that the State and the Tribe share an interest in creating a framework within which the gaming facility can operate successfully to generate revenue for essential government programs for tribal members while also ensuring that other interests, including an efficient and effective system to address the appropriate costs arising from employees who are injured or become sick while performing work-related duties, are also furthered.

Brief Overview of the Tribe: The Yurok Tribe is a federally recognized Indian tribe listed in the Federal Register as the Yurok Tribe of the Yurok Reservation, California. The Tribe's reservation lands include parts of Humboldt and Del Norte Counties, two of the largest land based counties in the state. The Tribe's current reservation was established in 1988, when the United States Congress enacted the Hoopa-Yurok Settlement Act. The Tribe is the largest tribe in the state with over 6,100 tribal members encompassing a reservation of approximately 57,000 acres. The Tribe is a natural resource tribe with federally reserved rights to the water and fish of the Klamath River. The Yurok Reservation is located in the most isolated region of Northwest California, consisting of lands one mile on each side of the 44-miles of the Klamath River from just above the confluence of the Trinity River at Weitchpec to the mouth of the river as it flows into the Pacific Ocean.

The 2006 compact was intended to assist Yurok in addressing the problems it was facing with high unemployment and poverty rates, as well as provide for its infrastructure needs relating to electricity, water, sewage and transportation.

Following the ratification of its 2006 compact, the Tribe opened the Redwood Hotel Casino, located in Klamath, California in 2014 which consists of two separate entities, the Redwood Holiday Inn Express and Redwood Casino. The Redwood Holiday Inn Express is a 60-room hotel complete with exercise room and pool. Currently, the Redwood Casino currently maintains 96 Class III machines and includes the Abalone Bar and Grill, a 50-seat restaurant and sports bar. The development of the Redwood Hotel Casino is only one part of a broader Master Plan for the Tribe, which also includes the Yurok Justice Center, the Yurok Visitor Center, the Klamath Gateway Project, a new wastewater treatment center, and provisions for increased public safety presence by Del Norte County deputized Yurok police officers. In addition to its gaming operation, the Tribe receives $1.1 million annually from the Revenue Sharing Trust Fund (RSTF). Pursuant to existing law, any tribe operating under 350 gaming devices is considered a limited-gaming tribe and is eligible for revenue payments from the RSTF.

Provisions of the Amended Compact:

Workers' Compensation: Terms of the 2006 compact provide that: 1) the Tribe agrees to participate in the State's workers' compensation program with respect to employees at the casino and all disputes arising from the workers' compensation laws shall be heard by the State Workers' Compensation Appeals Board pursuant to the California Labor Code; 2) the Tribe acknowledges the jurisdiction of the Board and the courts of the State of California in such manners; 3) the Tribe agrees that it will participate in the State's unemployment compensation program for providing benefits and unemployment compensation disability benefits to employees at the casino; and, 4) the Tribe shall withhold all taxes due to the State, except for Tribal members living on the Tribe’s reservation, and forward such amounts to the State.

The Amended Compact repeals the above-referenced provisions, recasts them, as defined, and additionally, provides that in lieu of participation in the State's workers' compensation system, the Tribe may create and maintain a system through self-insurance that includes specified provisions, including hearings before an independent tribunal.

The amendments contained in this Compact conform to more recent compacts that have been negotiated by the Governor Brown relating to workers' compensation.

Additional Background Information:

Article IV, section 19, subdivision (e) of the California Constitution: Permits Indian tribes to conduct and operate slot machines, lottery games, and banked and percentage card games on Indian land if 1) the Governor and an Indian tribe reach agreement on a compact; 2) the Legislature approves the compact; and 3) the federal government approves the compact.

Related legislation: AB 629 (Gonzalez) of the current legislative session. Ratifies the tribal-state gaming compact entered into between the State and the Pala Band of Mission Indians, executed on May 6, 2016.

AB 2358 (Gonzalez) of the current legislative session. Ratifies the tribal-state gaming compact entered into between the State and the Pechanga Band of Luiseno Indians, executed August 4, 2016.

AB 2915 (Eduardo Garcia) of the current legislative session. Provides for the ratification of a new Tribal-State gaming compact between the State and Agua Caliente Band of Cahuilla Indians, executed on August 4, 2016.

SB 187 (Hall) of the current legislative session. Ratifies the tribal-state gaming compact entered into between the State and the Jamul Indian Village, executed August 8, 2016.

SB 1313 (Hall) of the current legislative session. Ratifies the tribal-state gaming compact entered into between the State and the Yocha Dehe Wintun Nation, executed on August 4, 2016.

AB 1282 (Gray) of the current legislative session. Ratifies the tribal-state gaming compact entered into between the State and the Buena Vista Rancheria of Me-Wuk Indians, executed on June 28, 2016.

AB 1767 (Bigelow) of the current legislative session. Ratifies the first amendment to the 2015 tribal-state gaming compact entered into between the State and the Jackson Rancheria Band of Miwuk Indians, executed on June 22, 2016.

SB 404 (De León) of the current legislative session. Ratifies the tribal-state gaming compact entered into between the State and the Viejas Band of Kumeyaay Indians, executed on June 22, 2016.

AB 291 (Atkins) of the current legislative session. Ratifies the tribal-state gaming compact entered into between the State and the Barona Band of Mission Indians, executed on June 22, 2016.

Prior legislation: AB 795 (Atkins), Chapter 520, Statutes of 2015. Ratified the tribal state gaming compact entered into between the State and the Sycuan Band of Kumeyaay Nation, executed on September 2, 2015.

AB 1540 (Gray), Chapter 531, Statutes of 2015. Ratified the tribal-state gaming compact entered into between the State and the Santa Ynez Band of Chumash Indians, executed on August 26, 2015.

AB 315 (Bigelow), Chapter 512, Statutes of 2015. Ratified the amended and restated tribal-state gaming compact entered into between the State and the United Auburn Indian Community, executed on August 14, 2015.

AB 475 (Bigelow), Chapter 8, Statutes of 2015. Ratified the tribal-state gaming compact entered into between the State and Jackson Rancheria Band of Miwuk Indians, executed on February 1, 2015.

SB 1356 (De León), Chapter 314, Statutes of 2014. Ratified the amendment to the tribal-state gaming compact entered into between the State and the Viejas Band of Kumeyaay Indians, executed on August 12, 2014.

SB 1224 (Correa), Chapter 300, Statutes of 2014. Ratified the tribal-state gaming compact entered into between the State and the Karuk Tribe, executed on December 4, 2013.

AB 1245 (V. Manuel Perez), Chapter 462, Statutes of 2013. Ratified the tribal-state gaming compact entered into between the State and the Ramona Band of Cahuilla Indians located in Riverside County, executed on June 10, 2013.

AB 277 (Hall), Chapter 51, Statutes of 2013. Ratified two new compacts entered into between the State and the following tribes: North Fork Rancheria, executed on August 31, 2012, and the Wiyot Tribe, executed on March 20, 2013.

AB 1267 (Hall), Chapter 6, Statutes of 2013. Ratified the amended tribal-state gaming compact entered into between the State and the Shingle Springs Band of Miwok Indians, executed on November 15, 2012.

SB 668 (Fuller), Chapter 67, Statutes of 2013. Ratified the tribal-state gaming compact entered into between the State and the Fort Independence Indian Community of Paiute Indians, executed on February 28, 2013.

AB 517 (Hall), Chapter 12, Statutes of 2012. Ratified the tribal-state gaming compact entered into between the State and the Federated Indians of Graton Rancheria of Sonoma County, executed on March 27, 2012.

AB 787 (Chesbro), Chapter 340, Statutes of 2012. Ratified the amendment to the tribal-state gaming compact entered into between the State and the Coyote Valley Band of Pomo Indians, executed on July 25, 2012.

AB 1418 (Hall), Chapter 412, Statutes of 2011. Repealed those provisions ratifying the tribal-state gaming compact entered into between the State and Pinoleville Pomo Nation, executed on March 9, 2009, and instead ratified the tribal-state gaming compact entered into between the State and the Pinoleville Pomo Nation, executed on August 8, 2011.

AB 1020 (Chesbro), Chapter 27, Statutes of 2011. Repealed the ratification of the tribal-state gaming compact entered into between the State and the Habematolel Pomo of Upper Lake, executed on September 2, 2009, and instead ratified a new tribal-state gaming compact entered into between the State and the Habematolel Pomo of Upper Lake, executed on March 17, 2011.

SB 89 (Budget and Fiscal Review Committee), Chapter 1, Statutes of 2010. Ratified the tribal-state gaming compact entered into between the State and the Habematolel Pomo of Upper Lake, executed on September 2, 2009.

AB 122 (Coto), Chapter 3, Statutes of 2010. Ratified the tribal-state gaming compact entered into between the State and the Pinoleville Pomo Nation, executed on March 10, 2009.

AB 3072 (Price), Chapter 334, Statutes of 2008. Ratified the first amendment to a tribal-state gaming compact entered into between the State and the Shingle Springs Band of Miwok Indians, executed on June 30, 2008.

SB 106 (Wiggins), Chapter 37, Statutes of 2007. Ratified a new compact between the State and the Yurok Tribe of the Yurok Reservation.

SB 174 (Ducheny), Chapter 38, Statutes of 2007. Ratified the first compact amendment to the compact between the State and Sycuan.

SB 175 (Ducheny), Chapter 39, Statutes of 2007. Ratified the first compact amendment to the compact between the State and Morongo.

SB 903 (Padilla), Chapter 40, Statutes of 2007. Ratified the first compact amendment to the compact between the State and Pechanga.

SB 941 (Padilla), Chapter 226, Statutes of 2007. Ratified the first compact amendment to the compact between the State and San Manuel.

SB 957 (Torlakson), Chapter 41, Statutes of 2007. Ratified the first compact amendment to the compact between the State and Agua Caliente.

SB 470 (Ducheny), Chapter 527, Statutes of 2006. Ratified the first amendment to the compact between the State and the Quechan Tribe of the Fort Yuma Reservation.

SB 1117 (Burton), Chapter 856, Statutes of 2004. Ratified two new and two amended compacts entered into between the State and the following tribes: Coyote Valley Band of Pomo Indians (new compact); Fort Mojave Indian Tribe (new compact); Buena Vista Rancheria of Me-Wuk Indians (amended compact); and, Ewiiaapaayp Band of Kumeyaay Indians (amended compact).

AB 687 (Núñez), Chapter 91, Statutes of 2004. Ratified amendments to five compacts entered into between the State and the following tribes: Pala Band of Mission Indians; Pauma Band of Luiseno Mission Indians of the Pauma and Yuima Reservation; Rumsey Band of Wintun Indians; United Auburn Indian Communities; and, Viejas Group of Kumeyaay Indians.

SB 930 (Burton), Chapter 802, Statutes of 2003. Ratified a compact between the State and the Torres-Martinez Desert Cahuilla Indians.

SB 411 (Ducheny), Chapter 790, Statutes of 2003. Ratified compacts between the State and the La Posta Band of Diegueno Mission Indians and the Santa Ysabel Band of Diegueno Mission Indians in San Diego County.

Proposition 1A, adopted by the people of California on March 7, 2000. Modified the prohibition against casinos and lotteries in the California Constitution to authorize the Governor to negotiate compacts, subject to legislative ratification, for the operation of slot machines, lottery games, and banking and percentage card games by federally recognized Indian tribes on Indian lands in California, in accordance with federal law. Authorized slot machines, lottery games, and banking and percentage card games to be conducted and operated on Indian lands subject to the compacts.

AB 1385 (Battin), Chapter 874, Statutes of 1999. Designated the Governor as the state officer responsible for negotiating and executing compacts between the State and federally recognized Indian tribes located in the State. Also, ratified 57 compacts and created two special funds in the State Treasury (SDF and RSTF), as specified.

SB 287 (Burton), Chapter 409, Statutes of 1998. Ratified 11 compacts negotiated between the State and Indian tribes that permitted class III video gaming devices on tribal lands and established a process for ratifying other compacts.

Analysis Prepared by: Eric Johnson / G.O. / (916) 319-2531 FN: 0004505

 THIRD READING  

Bill No: AB 1977

Author:

:

Vote:

PRIOR VOTES NOT RELEVANT

NOTE: On August 9, 2016, the Senate Committee on Governmental Organization held an informational hearing on the amended tribal gaming compact entered into between the State of California and the Yurok Tribe.

SUBJECT:

SOURCE: Author

DIGEST: This bill ratifies the amended tribal-state gaming compact (Amended Compact) entered into between the State of California and the Yurok Tribe (hereafter “Tribe”) executed on August 4, 2016. Additionally, this bill provides that, in deference to tribal sovereignty, certain actions are not deemed projects for purposes of the California Environmental Quality Act (CEQA); and, stipulates, except as expressly provided, that none of the provisions shall be construed to exempt a city, county, or city and county, or the Department of Transportation from CEQA requirements.

ANALYSIS:

Existing law:

1. Provides, under the Indian Gaming Regulatory Act (IGRA), for the negotiation and conclusion of compacts between federally recognized Indian tribes and the State for the purpose of conducting Class III gaming activities on Indian lands within a State as a means of promoting tribal economic development, self-sufficiency, and strong tribal governments.
2. Authorizes expressly a number of tribal-state gaming compacts between the State of California and specified Indian tribes.
3. Authorizes the conduct of Class III gaming activities to the extent such activities are permitted by state law, a gaming compact has been concluded by a federally recognized tribe and the State, and the compact has been approved by the Secretary of the Interior.
4. Limits the operation of Class III gaming activities to Indian lands acquired on or before October 17, 1988. Provides for certain exceptions to conduct gaming activities on Indian lands acquired after October 17, 1988.
5. Defines Indian lands to mean all lands within the limits of any Indian reservation, and any lands title to which is either held in trust by the United States for the benefit of any Indian tribe, or individual, or held by any Indian tribe or individual subject to restriction by the U.S. against alienation and over which an Indian tribe exercises governmental power.
6. Requires the State to negotiate to conclude a compact in good faith with an Indian tribe having jurisdiction over the Indian lands upon which the Class III gaming activity is to be conducted. Provides the U.S. district courts with jurisdiction over any cause of action initiated by a tribal government alleging that the State failed to negotiate in good faith to conclude a compact. Prescribes the remedy, mediation supervised by the courts, if it is found that the State failed to negotiate in good faith to conclude a compact.
7. Authorizes the Governor, under the California Constitution, to negotiate and conclude compacts, subject to ratification by the Legislature.
   

This bill ratifies the Amended Compact entered into between the State of California and the Yurok Tribe on August 4, 2016. The Amended Compact conforms the workers’ compensation provisions of the Tribe’s 2006 compact to those of more recent compacts. All other provisions of the existing compact remain intact.

In 2006, the Tribe entered into a tribal-state compact (SB 106, Wiggins, Chapter 37, Statutes of 2007) that authorized it to operate one gaming facility at a future site and an additional one at an ancillary facility (a fuel mart), both of which are located within its existing reservation in Del Norte County. The 2006 compact authorized the Tribe to operate no more than 99 gaming devices (slot machines) and specified that no more than 20 of the devices may be operated at the ancillary gaming facility.

Under terms of the 2006 compact, the Tribe agreed to pay into the State General Fund an annual fee, as specified, based on a percentage of its net win from its operation of gaming devices. Also, the 2006 compact provided that as long as the Tribe’s membership remained at least 4,000 members it could deduct from the amount to be paid to the State certain payments made pursuant to intergovernmental agreements with Del Norte County and Humboldt County.

Additionally, the 2006 compact contained other provisions relating to: exclusivity; licensing requirements and procedures for employees and gaming suppliers; testing and inspection of gaming devices; rules and regulations for the operation and management of the gaming facility; off-reservation environmental impacts; public and workplace health and safety; and labor provisions.

Furthermore, the 2006 compact required the Tribe to participate in the State’s workers’ compensation program with respect to employees employed at the gaming facility. The 2006 compact provides that its terms may be amended upon written agreement of both parties. The parties recently agreed in writing to negotiate regarding amending the 2006 compact’s provisions pertaining to mandatory participation in the State’s workers’ compensation program.

The Amended Compact’s preamble notes that the State and the Tribe share an interest in creating a framework within which the gaming facility can operate successfully to generate revenue for essential government programs for tribal members while also ensuring that other interests, including an efficient and effective system to address the appropriate costs arising from employees who are injured or become sick while performing work-related duties, are also furthered.

BRIEF HISTORY AND BACKGROUND OF THE YUROK TRIBE

According to information provided by the Tribe, the Yurok Tribe is the largest tribe in California with over 6,100 tribal members encompassing a reservation of approximately 57,000 acres. The Tribe is a natural resource tribe with federally reserved rights to the water and fish of the Klamath River. The Yurok Reservation is located in the most isolated region of Northwest California, consisting of lands one mile on each side of the lower 44 miles of the Klamath River from just above the confluence of the Trinity River at Weitchpec to the mouth of the river as it flows into the Pacific Ocean. Reservation lands include parts of Humboldt and Del Norte Counties, two of the largest land based counties in the state of California. 

Following ratification of its 2006 tribal-state gaming compact, the Tribe opened the Redwood Hotel Casino in 2014 which consists of two separate entities, the Redwood Holiday Inn Express and the Redwood Casino. The Redwood Holiday Inn Express is a 60-room hotel complete with exercise room and pool. The Redwood Casino, located in Klamath, CA, currently hosts 96 Class III machines and includes the Abalone Bar and Grill – a 50-seat restaurant and sports bar. The development of the Redwood Hotel Casino is only a portion of a broader Master Plan for the down-river Yurok community, which also includes the Yurok Justice Center, the Yurok Visitor Center, the Klamath Gateway Project, a new wastewater treatment center, and provisions for increased public safety presence by Del Norte County deputized Yurok police officers.

PROVISIONS OF THIS AMENDED COMPACT

Workers’ Compensation. Terms of the 2006 compact provide that: (a) the Tribe agrees to participate in the State’s workers’ compensation program with respect to employees at the casino and all disputes arising from the workers’ compensation laws shall be heard by the State Workers’ Compensation Appeals Board pursuant to the California Labor Code; (b) the Tribe acknowledges the jurisdiction of the Board and the courts of the State of California in such manners; (c) the Tribe agrees that it will participate in the State’s unemployment compensation program for providing benefits and unemployment compensation disability benefits to employees at the casino; and, (d) the Tribe shall withhold all taxes due to the State, except for Tribal members living on the Tribe’s reservation, and forward such amounts to the State.

This Amended Compact repeals the above-referenced provisions, recasts them, as specified, and additionally, provides that in lieu of participation in the State’s workers’ compensation system, the Tribe may create and maintain a system through self-insurance, which includes specified provisions, including hearings before an independent tribunal. The changes reflect conformity with more recent compacts

ADDITIONAL BACKGROUND INFORMATION

Indian Gaming Regulatory Act (IGRA)

In 1988, Congress enacted the Indian Gaming Regulatory Act (IGRA) to provide a statutory basis for the operation and regulation of gaming on Indian lands. IGRA provides that an Indian tribe may conduct gaming activity on Indian lands if the activity “is not specifically prohibited by federal law and is conducted within a State which does not prohibit such gaming activity.”

IGRA distinguishes between three classes of gaming (Class I, Class II, and Class III) and provides for different forms of regulation for each class. Class I gaming includes “social games” for minor prizes or “traditional forms of Indian gaming.” Class II gaming is defined to include bingo and card games that are explicitly authorized by the laws of the state, or that are not explicitly prohibited by the laws of the state and are played at any location in the State, so long as the card games are played in conformity with those laws and regulations. Class III gaming includes such things as slot machines, casino games and banked card games such as black jack and baccarat. Class III gaming may only be conducted under terms of a compact negotiated between an Indian tribe and a State.

IGRA was enacted against a legal background in which Indian tribes and individuals generally are exempt from state taxation within their own territory. IGRA provides that with the exception of assessments permitted under the statute, to defray the State’s costs of regulating gaming activity, IGRA shall not be interpreted as conferring upon a State authority to impose any tax, fee, charge, or other assessment upon an Indian tribe to engage in Class III activity. Nor may a State refuse to enter into negotiations based on the lack of authority to impose such a tax, fee, charge, or other assessment.

When a tribe requests negotiations for a Class III compact, IGRA requires the State to negotiate with the Indian tribe in good faith. IGRA provides a comprehensive process to prevent an impasse in compact negotiations, which is triggered when a tribe files suit alleging that the State has refused to negotiate or has failed to negotiate in good faith.

Before 2000, the California Constitution prohibited Class III gaming. In 2000, California voters approved Proposition 1A which had been proposed by the Governor and passed by the Legislature. Proposition 1A amended the California Constitution to permit the State to negotiate compacts with federally recognized Indian tribes for certain Class III gaming activities. Because non-Indian parties were still forbidden from operating gaming facilities, Proposition 1A granted Indian tribes a “constitutionally protected monopoly on most types of Class III games in California.”

Prior Legislation

AB 795 (Atkins, Chapter 520, Statutes of 2015) ratified the tribal-state gaming compact entered into between the State of California and the Sycuan Band of Kumeyaay Nation, executed on September 2, 2015.

AB 1540 (Gray, Chapter 531, Statutes of 2015) ratified the tribal-state gaming compact entered into between the State of California and the Santa Ynez Band of Chumash Indians, executed on August 26, 2015.

AB 315 (Bigelow, Chapter 512, Statutes of 2015) ratified the amended and restated tribal-state gaming compact entered into between the State of California and the United Auburn Indian Community, executed on August 14, 2015.

AB 475 (Bigelow, Chapter 8, Statutes of 2015) ratified the tribal-state gaming compact entered into between the State of California and Jackson Rancheria Band of Miwuk Indians, executed on February 1, 2015.

SB 1356 (De León, Chapter 314, Statutes of 2014) ratified the amendment to the tribal-state gaming compact entered into between the State of California and the Viejas Band of Kumeyaay Indians, executed on August 12, 2014.

SB 1224 (Correa, Chapter 300, Statutes of 2014) ratified the tribal-state gaming compact entered into between the State of California and the Karuk Tribe, executed on December 4, 2013.

FISCAL EFFECT: Appropriation: Fiscal Com.: Local:

SUPPORT: (Verified 8/15/16)

Agua Caliente Band of Cahuilla Indians

Barona Band of Mission Indians

California Labor Federation

Jamul Indian Village

Pechanga Band of Luiseno Indians

Teamsters

UNITE HERE, AFL-CIO

Viejas Band of Kumeyaay Indians

Yocha Dehe Wintun Nation

Yurok Tribe

OPPOSITION: (Verified 8/15/16)

None received

Prepared by:

8/15/16 20:27:00

**** END ****

 THIRD READING  

Bill No: AB 1977

Author:

:

Vote:

SENATE HEALTH COMMITTEE: 8-0, 6/29/16

AYES: Hernandez, Nguyen, Hall, Mitchell, Monning, Nielsen, Pan, Roth

NO VOTE RECORDED: Wolk

ASSEMBLY FLOOR: 78-0, 5/9/16 (Consent) - See last page for vote

SUBJECT:

SOURCE: Author

DIGEST: This bill requires health plan and health insurer representatives, in collaboration with others, to convene an Opioid Abuse Task Force.

ANALYSIS: Existing law establishes the California Department of Public Health (CDPH), which among other activities and responsibilities convenes the Prescription Opioid Misuse and Overdose Prevention (POMOP) Workgroup.

This bill:

1. Requires on or before February 1, 2017, health plan and health insurer representatives, in collaboration with advocates, experts, health care professionals, and other entities and stakeholders that they deem appropriate, to convene an Opioid Abuse Task Force (OATF).
2. Requires OATF to develop recommendations regarding the abuse and misuse of opioids as a serious problem that affects the health, social welfare, and economic welfare of persons in the state, and requires OATF to address all of the following:
   1. Interventions that have been scientifically validated and have demonstrated clinical efficacy;
   2. Interventions that have measurable treatment outcomes;
   3. Collaborative, evidence-based approaches to resolving opioid abuse and misuse that incorporate both the provider and the patient into the solution;
   4. Education that engages and encourages providers to be prudent in prescribing opioids and to be proactive in defining care plans that include a plan to taper and stop opioid use; and,
   5. Review and consideration of medication coverage policies and formulary management and development of an interdisciplinary case management program that addresses quality, fraud, waste, and abuse.
3. Requires on or before December 31, 2017, OATF to submit a report detailing its findings and recommendations to the Governor, the President pro Tempore of the Senate, the Speaker of the Assembly, the Senate Committee on Health, and the Assembly Committee on Health.
4. Dissolves OATF on June 1, 2018.
5. States that a violation of this bill is not subject to a fine or imprisonment, as specified.
6. Finds and declares that abuse and misuse of opioids is a serious problem that affects the health, social, and economic welfare of this state, and after alcohol, prescription drugs are the most commonly abused substances by Americans over 12 years of age.
7. Finds and declares that almost two million people in the Unites States suffer from substance use disorders related to opioid pain relievers and the number of unintentional overdose deaths has more than quadrupled since 1999.

Comments

1. Author’s statement. According to the author, not enough is being done to curb the growth of opioid abuse, and health care providers and parents need tools to help guard against the abuse of opioid medication. The author cites increasing patient awareness on proper storage and disposal, limiting initial prescriptions for acute pain, as well as the development and availability of abuse-deterrent opioids, which are formulated to prevent manipulation of the drug for the purpose of misuse, as strategies that should be encouraged to combat opioid abuse. The CDPH is engaged in efforts to address this epidemic through the grant funded formation of the POMOP Workgroup. The author is concerned that CDPH efforts have not engaged external stakeholders who may have unique expertise or experience in combating this problem. Additionally, the OATF in this bill could focus on immediate, actionable strategies which complement the CDPH workgroup efforts, which are more comprehensive and appropriately focused on longitudinal changes in behavior.
2. Opioid abuse. According to a March 2015 federal Department of Health and Human Services issue brief on Opioid Abuse in the U. S., mortality data show that there was a 6% increase in drug overdose deaths between 2012 and 2013. Approximately 37% (16,235) of overdose deaths involved prescription opioids, a number essentially unchanged from 2012. However, the mortality rate from heroin overdose increased each year from 2010 to 2013. Deaths from heroin overdoses increased by 39% from 2012 to 2013 alone and were approximately 19% (8,257) of all drug overdose deaths in 2013. According to CDPH in the past, prescription opioids (such as hydrocodone, oxycodone, morphine and codeine) were prescribed for relieving short-term (acute) pain. Today, they are increasingly being used for long-term (chronic) pain management. As a result, sales of opioid pain relievers quadrupled in the past 10 years. By 2010, enough opioid pain relievers were sold to medicate every American adult (about 240 million people) every four hours for an entire month. In California, deaths involving opioid prescription medications have increased 16.5% since 2006. In 2012, there were more than 1,800 deaths from all types of opioids – 72% involved prescription opioids. Prescription opioid misuse is a public health problem that can lead to long-term health consequences, including limitations in daily activity, impaired driving, mental health problems, trouble breathing, overdose and death.
3. POMOP. CDPH and its state partners convened POMOP Workgroup in the spring of 2014. This workgroup is exploring opportunities to improve collaboration and expand joint efforts among state departments working to address this epidemic. It has identified two priorities: expansion and strengthening of prevention strategies and improvement of monitoring and surveillance. Initial workgroup discussions have focused on information sharing about existing efforts and roles, identification of challenges, and potential opportunities for partnership. Participants in the Workgroup include: CDPH, Department of Health Care Services, Department of Justice, Department of Consumer Affairs, California State Board of Pharmacy, Medical Board of Californian, Dental Board of California, Board of Nursing, Emergency Medical Services Authority, California Department of Education, Department of Corrections and Rehabilitation, and Division of Workers Compensation.

FISCAL EFFECT: Appropriation: Fiscal Com.: Local:

SUPPORT: (Verified 8/1/16)

California Council of Community Behavioral Health Agencies

California Dental Association

California District Attorneys Association

California Health+Advocates

California State Sheriffs’ Association

County Health Executives Association of California

L.A. Care Health Plan

Medical Board of California

Mental Health America of California

OPPOSITION: (Verified 8/1/16)

California Department of Public Health

ARGUMENTS IN SUPPORT: L.A. Care Health Plan writes in support that creating OATF to address widespread opioid abuse is a logical and necessary first step for California. The California Council of Community Behavioral Health Agencies writes that the creation and operation of OATF could go a long way toward finding solutions to this increasing threat to public health. The County Health Executives Association of California believes this bill is a modest, but important, step in addressing a complicated and rising prescription drug abuse problem. The California Dental Association writes that this bill will begin to address this need for interventions to opioid abuse. The California State Sheriffs’ Association believes OATF’s work could prove central to future efforts to deal with this growing problem. The Medical Board of California indicates that this bill furthers the Board’s mission of consumer protection and is in line with the Board’s work on this important issue.

ARGUMENTS IN OPPOSITION: CDPH opposes this bill because CDPH currently convenes the POMOP Workgroup in collaboration with over 20 state agencies, and it is expanding this year to include representatives from federal and local entities, foundations and academic partners. Part of the current planning of the Workgroup is outreach to engage health system and health plan partners. CDPH believes OATF duplicates and significantly overlaps with the goals of the ongoing POMOP Workgroup, and it may dilute, divert, or otherwise reduce resources that have been allocated to the Workgroup, potentially limiting its efficacy, and result in policy inaction should recommendations from the groups be misaligned.

ASSEMBLY FLOOR: 78-0, 5/9/16

AYES: Achadjian, Alejo, Travis Allen, Arambula, Atkins, Baker, Bigelow, Bloom, Bonilla, Bonta, Brough, Brown, Burke, Calderon, Campos, Chang, Chau, Chávez, Chiu, Chu, Cooley, Cooper, Dababneh, Dahle, Daly, Dodd, Eggman, Frazier, Gallagher, Cristina Garcia, Gatto, Gipson, Gomez, Gonzalez, Gordon, Gray, Grove, Hadley, Harper, Roger Hernández, Holden, Irwin, Jones, Jones-Sawyer, Kim, Lackey, Levine, Linder, Lopez, Low, Maienschein, Mathis, Mayes, McCarty, Medina, Melendez, Mullin, Nazarian, Obernolte, O'Donnell, Olsen, Patterson, Quirk, Ridley-Thomas, Rodriguez, Salas, Santiago, Steinorth, Mark Stone, Thurmond, Ting, Wagner, Waldron, Weber, Wilk, Williams, Wood, Rendon

NO VOTE RECORDED: Beth Gaines, Eduardo Garcia

Prepared by:

8/4/16 14:34:10

**** END ****

SENATE COMMITTEE ON HEALTH

Senator Ed Hernandez, O.D., Chair

BILL NO: AB 1977

SUBJECT: Opioid Abuse Task Force

SUMMARY:

Requires health plan and health insurer representatives, in collaboration with others, to convene an Opioid Abuse Task Force.

Existing law:

1. Establishes the California Department of Public Health (CDPH), which among other activities and responsibilities convenes the Prescription Opioid Misuse and Overdose Prevention Workgroup (POMOP).

This bill:

1. Requires on or before February 1, 2017, health plan and health insurer representatives, in collaboration with advocates, experts, health care professionals, and other entities and stakeholders that they deem appropriate, to convene an Opioid Abuse Task Force (OATF).
   
2. Requires OATF to develop recommendations regarding the abuse and misuse of opioids as a serious problem that affects the health, social welfare, and economic welfare of persons in the state, and requires OATF to address all of the following:
   1. Interventions that have been scientifically validated and have demonstrated clinical efficacy;
   2. Interventions that have measurable treatment outcomes;
   3. Collaborative, evidence-based approaches to resolving opioid abuse and misuse that incorporate both the provider and the patient into the solution;
   4. Education that engages and encourages providers to be prudent in prescribing opioids and to be proactive in defining care plans that include a plan to taper and stop opioid use; and,
   5. Review and consideration of medication coverage policies and formulary management and development of an interdisciplinary case management program that addresses quality, fraud, waste, and abuse.
      
3. Requires on or before December 31, 2017, OATF to submit a report detailing its findings and recommendations to the Governor, the President pro Tempore of the Senate, the Speaker of the Assembly, the Senate Committee on Health, and the Assembly Committee on Health.
   
4. Dissolves OATF on June 1, 2018.
   
5. States that a violation of this bill is not subject to a fine or imprisonment, as specified.
   
6. Finds and declares that abuse and misuse of opioids is a serious problem that affects the health, social, and economic welfare of this state, and after alcohol, prescription drugs are the most commonly abused substances by Americans over 12 years of age.
   
7. Finds and declares that almost 2 million people in the Unites States suffer from substance use disorders related to opioid pain relievers and the number of unintentional overdose deaths has more than quadrupled since 1999.

FISCAL EFFECT:

None

PRIOR VOTES:

COMMENTS:

1. Author’s statement. According to the author, not enough is being done to curb the growth of opioid abuse, and health care providers and parents need tools to help guard against the abuse of opioid medication.  The author cites increasing patient awareness on proper storage and disposal, limiting initial prescriptions for acute pain, as well as the development and availability of abuse-deterrent opioids, which are formulated to prevent manipulation of the drug for the purpose of misuse, as strategies that should be encouraged to combat opioid abuse.  The CDPH is engaged in efforts to address this epidemic through the grant funded formation of the POMOP Workgroup.   The author is concerned that CDPH efforts have not engaged external stakeholders who may have unique expertise or experience in combating this problem.  Additionally, the OATF in this bill could focus on immediate, actionable strategies which complement the DPH workgroup efforts, which are more comprehensive and appropriately focused on longitudinal changes in behavior. 
   
2. Opioid abuse. According to a March 2015 federal Department of Health and Human Services issue brief on Opioid Abuse in the U. S., mortality data show that there was a 6% increase in drug overdose deaths between 2012 and 2013. Approximately 37% (16,235) of overdose deaths involved prescription opioids, a number essentially unchanged from 2012. However, the mortality rate from heroin overdose increased each year from 2010 to 2013. Deaths from heroin overdoses increased by 39% from 2012 to 2013 alone and were approximately 19% (8,257) of all drug overdose deaths in 2013. According to CDPH in the past, prescription opioids (such as hydrocodone, oxycodone, morphine and codeine) were prescribed for relieving short-term (acute) pain. Today, they are increasingly being used for long-term (chronic) pain management. As a result, sales of opioid pain relievers quadrupled in the past 10 years. By 2010, enough opioid pain relievers were sold to medicate every American adult (about 240 million people) every four hours for an entire month. In California, deaths involving opioid prescription medications have increased 16.5% since 2006. In 2012, there were more than 1,800 deaths from all types of opioids – 72% involved prescription opioids. Prescription opioid misuse is a public health problem that can lead to long-term health consequences, including limitations in daily activity, impaired driving, mental health problems, trouble breathing, overdose and death. In 2014, the Association of State and Territorial Health Officials (ASTHO) issued its “President’s Challenge” to decrease both the rate of non-medical use and the incidence of unintentional overdose deaths resulting from controlled prescription medications by 15% by the end of 2015.
   
3. POMOP. CDPH and its state partners convened POMOP workgroup in the spring of 2014. 
   This workgroup is exploring opportunities to improve collaboration and expand joint efforts among state departments working to address this epidemic. It has identified two priorities: expansion and strengthening of prevention strategies and improvement of monitoring and surveillance. Initial workgroup discussions have focused on information sharing about existing efforts and roles, identification of challenges, and potential opportunities for partnership. Participants in the workgroup include: CDPH, the Department of Health Care Services, Department of Justice, Department of Consumer Affairs, including the California State Board of Pharmacy, the Medical Board of Californian, the Dental Board of California the Board of Nursing, the Emergency Medical Services Authority, The California Department of Education, Department of Corrections and Rehabilitation, and the Division of Workers Compensation.

POMOP will engage physicians and health care professionals, patients and consumers, and the general public to deliver the following messages: 1) Prescription drugs, including opioids, have an appropriate use. However, there are risks so it is important that doctors and patients discuss the options, benefits and risks when considering prescription drugs for pain management. Both medical use and non-medical use of prescription medications contribute to health complications and deaths; and, 2) Experiencing pain can be devastating and treating it can be complicated. All options need to be considered. Taking unnecessary pills, or taking too many, can kill. A major milestone occurred in October 2014, when the Medical Board of California revised its guidelines for prescribing controlled substances for pain.

1. Related legislation. AB 2592 (Cooper), would have created within CDPH a pilot program that would award grants to eligible pharmacies for the purpose of supplying medicine locking closure packages to patients with prescriptions for opioids. AB 2592 was held in the Assembly Appropriations Committee.
2. Prior legislation. AB 623 (Wood of 2015), would have prohibited a health plan or health insurer from requiring the use of opioid drug products that have no abuse-deterrent properties in order to access abuse-deterrent opioid drug products; required pharmacists to provide a patient receiving an opioid drug product information about proper storage and disposal of the drug; and, authorized a provider to prescribe a less than 30-day supply of opioids analgesic drugs. AB 623 was held in the Assembly Appropriations Committee.

AB 831 (Bloom of 2013), would have required, until January 1, 2016, the California Health and Human Services Agency (CHHSA) to convene a temporary working group to develop a state plan to reduce the rate of fatal drug overdoses and appropriates $500,000 from the General Fund to CHHSA to provide grants to local agencies to implement drug overdose prevention and response programs. This bill was held in the Assembly Appropriations Committee.

AB 369 (Huffman of 2012), would have prohibited health plans and health insurers that restrict medications for the treatment of pain from requiring a patient to try and fail on more than two pain medications before allowing the patient access to the pain medication, or its generic equivalent, prescribed by his or her physician. AB 369 was vetoed with the Governor's veto message stating that a doctor's judgment and a health plan's clinical protocols have a role in ensuring prudent prescribing of pain medications, and any limitations on the practice of step therapy should better reflect a health plan or insurer's legitimate role in determining the allowable steps.

AB 1826 (Huffman of 2010), would have required a health plan or health insurer that covers prescription drug benefits to provide coverage for a drug that has been prescribed for the treatment of pain without first requiring the enrollee or insured to use an alternative drug or product. AB 1826 was held in the Senate Appropriations Committee.

AB 1144 (Price of 2009), would have required health plans and health insurers to report to DMHC and CDI specified information related to chronic pain medication management, including when the health plan or health insurer requires an enrollee or insured to use more than two formulary alternative medications prior to providing access to a pain medication prescribed by a provider, or to use pain medication other than what was prescribed for more than seven days prior to providing access to the prescribed pain medication. This bill was held in the Assembly Appropriations Committee.

1. Support. LA Care Health Plan writes in support that creating OATF to address widespread opioid abuse is a logical and necessary first step for California. The California Council of Community Behavioral Health Agencies writes that the creation and operation of OATF could go a long way toward finding solutions to this increasing threat to public health. The County Health Executives Association of California believes this bill is a modest, but important, step in addressing a complicated and rising prescription drug abuse problem. The California Dental Association writes that this bill will begin to address this need for interventions to opioid abuse. The California State Sheriffs’ Association believes OATF’s work could prove central to future efforts to deal with this growing problem. The Medical Board of California indicates that this bill furthers the Board’s mission of consumer protection and is in line with the Board’s work on this important issue.
   
2. Opposition. CDPH opposes this bill because CDPH currently convenes POMOP Workgroup in collaboration with over twenty state agencies, and it is expanding this year to include representatives from federal and local entities, foundations and academic partners. Part of the current planning of the workgroup is outreach to engage health system and health plan partners. CDPH believes OATF duplicates and significantly overlaps with the goals of the ongoing POMOP Workgroup, and it may dilute, divert, or otherwise reduce resources that have been allocated to the Workgroup, potentially limiting its efficacy, and result in policy inaction should recommendations from the groups be misaligned.
   
3. Suggested Amendments. The author and committee may wish to amend this bill to take advantage of the POMOP workgroup and apply the requirements of this bill to POMOP. Additionally, the bill could be amended to require an expansion of POMOP to include health care providers, health plans, insurers, and other relevant stakeholders who are not affiliated with existing state departments or state entities.

SUPPORT AND OPPOSITION:

Support: California Council of Community Behavioral Health Agencies

California Dental Association

California District Attorneys Association

California Health+Advocates

California State Sheriffs’ Association

County Health Executives Association of California

L.A. Care Health Plan

Medical Board of California

Mental Health America of California

Oppose: California Department of Public Health

-- END --

Date of Hearing: May 3, 2016

ASSEMBLY COMMITTEE ON HEALTH

Jim Wood, Chair

ABPCA Bill Id:AB 1977 (

Author:Wood) – As Amended Ver:April 13, 2016

SUBJECT: Opioid Abuse Task Force.

SUMMARY: Establishes the Opioid Abuse Task Force (Task Force) to develop recommendations to the Legislature regarding the abuse and misuse of opioids in California. Specifically, this bill:

1. Requires health care service plans (health plan) and health insurer representatives, in collaboration with advocates, experts, health care professionals, and other entities and stakeholders that they deem appropriate, to convene a Task Force, on or before February 1, 2017, that will develop recommendations regarding the abuse and misuse of opioids, as specified.
2. Requires the Task Force to address all of the following:
   1. Interventions that have been scientifically validated and have demonstrated clinical efficacy;
   2. Interventions that have measurable treatment outcomes;
   3. Collaborative, evidence-based approaches to resolving opioid abuse and misuse that incorporate both the provider and the patient into the solution;
   4. Education that engages and encourages providers to be prudent in prescribing opioids and to be proactive in defining care plans that include a plan to taper and stop opioid use; and,
   5. Review and consider medication coverage policies and formulary management and development of an interdisciplinary case management program that addresses quality, fraud, waste, and abuse.
3. Requires the Task Force to submit a report detailing its findings and recommendations to the Governor, President pro Tempore of the Senate, Speaker of the Assembly, and the Senate and Assembly Committees on Health, on or before December 31, 2017.
4. Terminates the Task Force on June 1, 2018.
5. Repeals the provisions of this bill on January 1, 2019, unless a later enacted statute deletes or extends that date.

EXISTING LAW:

1. Establishes the Knox-Keene Health Care Service Plan Act of 1975, which provides for the licensure and regulation of health plans by the Department of Managed Health Care (DMHC), and provides for the regulation of health insurers under the Insurance Code by the California Department of Insurance (CDI).
2. Mandates 10 federally required essential health benefits (EHBs) in the individual and small group market and establishes the Kaiser Small Group health plan as California’s EHB benchmark plan, including prescription drug benefits, as specified, and incorporates by reference state law and regulations related to outpatient prescription drug coverage.
3. Classifies controlled substances into five designated schedules, with the most restrictive limitations generally placed on controlled substances classified in Schedule I, and the least restrictive limitations generally placed on controlled substances classified in Schedule V.
4. Provides for the licensure and regulation of pharmacists by the California Board of Pharmacy.
5. Prohibits the delivery of Schedule II, III, or IV controlled substances to a pharmacy unless a receipt for the merchandise is signed by a pharmacist or authorized receiving personnel.

FISCAL EFFECT: None.

COMMENTS:

1. PURPOSE OF THIS BILL. According to the author, not enough is being done to curb the growth of opioid abuse, and health care providers and parents need tools to help guard against the abuse of opioid medication. The author cites education for patients on the proper storage and disposal of opioids, as well as the development and availability of abuse-deterrent opioids, which are formulated to prevent manipulation of the drug for the purpose of misuse, as strategies that should be encouraged to combat opioid abuse. The Task Force will engage various stakeholders to discuss such strategies to specifically address the problems related to the abuse and misuse of opioids. The Task Force will then submit a report detailing its findings and recommendations to the Legislature for consideration of a hopefully more comprehensive approach to deal with this issue.
2. BACKGROUND.
   1. Opioids and opioid abuse. Certain drugs are classified under the federal Controlled Substances Act of 1970 (CSA) into one of five schedules. Placement in a given schedule depends on whether a drug has a currently accepted medical use, its relative abuse potential, and its likelihood of causing either addiction or physical dependency when abused. The Attorney General, acting through the Drug Enforcement Administration, is responsible for scheduling controlled substances. Most opioid analgesics are schedule II drugs, in that they have a recognized medical use, but also have a high potential for abuse which may lead to severe psychological dependence or severe physical dependence. The CSA places a number of restrictions on prescribers and pharmacies that dispense controlled substances like opioids. Additionally, refills are not permitted and a new written prescription must be presented each time the drug is dispensed.

Opioids are a class of narcotic drugs that include medications such as hydrocodone, oxycodone, morphine, codeine, and other related drugs. Taken as prescribed, opioids can be used to manage pain safely and effectively. However, opioids may also produce other effects, and according to the National Institute on Drug Abuse (NIDA), some individuals experience a euphoric response to opioid medications since these drugs affect the regions of the brain involving reward response.
NIDA states that those who abuse opioids may seek to intensify their experience by taking the drug in ways other than those prescribed. For example, OxyContin is an oral medication used to treat moderate to severe pain through a slow, steady release of the opioid. However, NIDA states that people who abuse the drug may crush or dissolve the drug in order to snort or inject it, thereby increasing their risk for serious medical complications, including overdose. NIDA states that when abused, even a single large dose of opioids can cause severe respiratory depression and death.

According to the California Department of Public Health (DPH), in the past, prescription opioids were prescribed for relieving short-term, acute pain. However, today, they are increasingly being used for long-term (chronic) pain management. As a result, sales of opioid pain relievers quadrupled in the past 10 years. By 2010, enough opioid pain relievers were sold to medicate every American adult (about 240 million people) every four hours for an entire month. DPH states that in California, deaths involving opioid prescription medications have increased 16.5% since 2006. In 2012, there were more than 1,800 deaths from all types of opioids – 72% involved prescription opioids.

• 1. Prescription Opioid Misuse and Overdose Prevention Workgroup. In response to the national epidemic of prescription medication misuse and overdose, DPH and its state partners, including the Board of Pharmacy and the Medical Board of California, convened a Prescription Opioid Misuse and Overdose Prevention Workgroup in Spring 2014. This workgroup is exploring opportunities to improve collaboration and expand joint efforts among state departments working to address this epidemic. It has identified two priorities: expansion and strengthening of prevention strategies and improvement of monitoring and surveillance.
  2. Opioid Safety Coalitions Network. The California HealthCare Foundation (CHCF) is currently providing technical assistance to 16 Opioid Safety Coalitions in 24 counties across California. Opioid Safety Coalitions throughout the state bring together a broad group of stakeholders committed to decreasing opioid overuse and overdose deaths. CHCF requested that the Opioid Safety Coalitions identify and implement collective actions to reduce the opioid overuse epidemic through at least one intervention in each of the following federal priority areas: supporting safe prescribing practices; expanding access to medication-assisted addiction treatment; and, increasing naloxone access.
  3. Federal Responses. Recently, President Obama introduced a number of policy changes and new grant opportunities to address the growing opioid abuse epidemic. Among the new steps announced, the Obama Administration is launching a new task force on mental health parity aimed at ensuring that 23 million people in Medicaid receive the same access to mental health and drug addiction benefits as people with private health plans. Additionally, President Obama announced $120 million worth of grants, $94 million of which had already been promised to community health centers under the Patient Protection and Affordable Care Act. Most substantially, President Obama unveiled that the Administration is aiming to expand access to medication-assisted treatment by releasing a proposed rule that changes restrictions on the amount of patients per practitioner that may be prescribed medications that treat opioid dependence.  Specifically, the proposal would raise the existing limit of 100 patients per practitioner to 200 patients for a subset of practitioners, provided they fulfill several additional requirements.

The House Committee on Oversight and Government Reform recently convened a hearing to discuss ways to improve the federal response to the heroin and opioid abuse problem as the House considers a path forward on bipartisan legislation. This hearing follows Senate passage of a bill earlier this year, the Comprehensive Addiction and Recovery Act (S. 524) (CARA), which would authorize the Administration to offer grants to states to expand their treatment offerings and increase access to naloxone, an overdose prevention drug. CARA would also give the U.S. Department of Justice additional tools to combat drug trafficking.

Additionally, the Centers for Disease Control and Prevention (CDC) issued new prescribing guidelines for opioids, which may help doctors and patients better understand the risks associated with prescription painkiller use. In addition to the CDC guidelines, the Obama Administration requested more than $1 billion in new mandatory funding in next year’s budget to address opioid drug abuse. The Food and Drug Administration (FDA) announced changes to the safety warnings that are required on the labels of prescription painkillers – the labels must now include a boxed warning about risks of misuse, addiction, overdose, and death. FDA also revealed new steps to scrutinize applications for prescribing opioids.

• 1. Legislation in other states. According to the National Conference of State Legislatures, there are approximately 32 bills introduced in 2016 having to do with opioid drug abuse. In 2015, Tennessee enacted legislation that requires the commissioner of mental health and substance abuse services to convene a working group to examine the problem of opioid abuse in the state and the potential impact of the use of FDA-approved abuse-deterrent opioids and the issue of prescription drugs.

Massachusetts became the first state to establish a seven–day limit on first–time opioid prescriptions. The new law, An Act Relative to Substance Use, Treatment, Education and Prevention, was passed unanimously by the Massachusetts state legislature, and requires a seven–day supply limit on initial opioid prescriptions for adults and all opioid prescriptions for minors.

1. SUPPORT. The County Behavioral Health Directors Association of California states that this bill is consistent with federal initiatives, like the Mental Health and Substance Use Disorder Parity Task Force, and takes an important step toward addressing opioid abuse by establishing a statewide Task Force. The County Health Executives Association of California (CHEAC), the California State Sheriffs’ Association (CSSA), and the California Primary Care Association supported a previous version of this bill. CHEAC notes that with the inclusion of abuse-deterrent opioids, physicians in California would have the option to prescribe drugs that would effectively manage patient pain while also minimizing the risk of abuse and diversion. CHEAC also states that local health departments support efforts to reduce and prevent drug addiction and related problems. The California State Sheriffs’ Association (CSSA) notes that the abuse of prescription drugs continue to increase and particularly alarming is the frequency with which minors use medicine meant for therapeutic purposes and/or for other persons for non-medical reasons.
2. NEUTRAL. The America’s Health Insurance Plans was previously opposed to this bill and is now neutral and appreciates the author’s leadership role in addressing the issue of opioid abuse and looks forward to continuing a constructive dialogue regarding how best to address this growing epidemic.
3. OPPOSE UNLESS AMENDED. The California Medical Association (CMA) opposed a previous version of this bill and states that effective solutions require a sustained, cooperative effort on the part of all stakeholders, including physicians, patients, law enforcement, regulatory agencies, insurers, and the pharmaceutical industry.
4. OPPOSITION. California Association of Health Plans (CAHP), the Association of California Life and Health Insurance Companies, and America’s Health Insurance Plans were opposed to a previous version of this bill and contend that health insurance mandates threaten the efforts of all health care stakeholders to provide consumers with meaningful health care choices and affordable coverage options. CAHP also states that more work also needs to be done in finding a pathway to lower-cost options in the opioid market. Kaiser Permanente (Kaiser) was also opposed to a previous version of this bill and states that abuse-deterrent drugs are fairly new, quite costly, and there is insufficient evidence about their efficacy in deterrence and prevention of abuse. Blue Shield of California (Blue Shield) was also opposed to a previous version of this bill and states that coverage of abuse-deterrent formulations on a health plan’s formulary at the lowest copayment or coinsurance does little to address the underlying causes of opioid overuse and abuse. It should be noted that all the provisions that were opposed have been deleted from this bill.
5. RELATED LEGISLATION. AB 2592 (Cooper) creates within DPH a pilot program that would award grants to eligible pharmacies for the purpose of supplying medicine locking closure packages to patients with prescriptions for opioids. AB 2592 is currently pending in the Assembly Appropriations Committee.
6. PREVIOUS LEGISLATION.
   1. AB 623 (Wood) from 2015 would have prohibited a health plan or health insurer from requiring the use of opioid drug products that have no abuse-deterrent properties in order to access abuse-deterrent opioid drug products; required pharmacists to provide a patient receiving an opioid drug product information about proper storage and disposal of the drug; and, authorized a provider to prescribe a less than 30-day supply of opioids analgesic drugs. AB 623 was held in the Assembly Appropriations Committee.
   2. AB 831 (Bloom) from 2013 would have required, until January 1, 2016, the California Health and Human Services Agency (CHHSA) to convene a temporary working group to develop a state plan to reduce the rate of fatal drug overdoses and appropriates $500,000 from the General Fund to CHHSA to provide grants to local agencies to implement drug overdose prevention and response programs. This bill was held in the Assembly Appropriations Committee.
   3. AB 369 (Huffman) of 2012 would have prohibited health plans and health insurers that restrict medications for the treatment of pain from requiring a patient to try and fail on more than two pain medications before allowing the patient access to the pain medication, or its generic equivalent, prescribed by his or her physician. This bill was vetoed with the Governor's veto message stating that a doctor's judgment and a health plan's clinical protocols have a role in ensuring prudent prescribing of pain medications, and any limitations on the practice of step therapy should better reflect a health plan or insurer's legitimate role in determining the allowable steps.
   4. AB 1826 (Huffman) of 2010 would have required a health plan or health insurer that covers prescription drug benefits to provide coverage for a drug that has been prescribed for the treatment of pain without first requiring the enrollee or insured to use an alternative drug or product. This bill was held in the Senate Appropriations Committee.
   5. AB 1144 (Price) of 2009 would have required health plans and health insurers to report to DMHC and CDI specified information related to chronic pain medication management, including when the health plan or health insurer requires an enrollee or insured to use of more than two formulary alternative medications prior to providing access to a pain medication prescribed by a provider, or to use pain medication other than what was prescribed for more than seven days prior to providing access to the prescribed pain medication. This bill was held in the Assembly Appropriations Committee.

REGISTERED SUPPORT / OPPOSITION:

Support

California District Attorneys Association

California Health Executives Association of California (previous version)

California Narcotic Officers’ Association (previous version)

California Primary Care Association (previous version)

California State Sheriffs’ Association (previous version)

County Behavioral Health Directors Association of California

L.A. Care

Pharmaceutical Care Management Association

Public Policy Advocates

Opposition

America’s Health Insurance Plans (previous version)

Association of California Life and Health Insurance Companies (previous version)

Blue Shield of California

California Association of Health Plans (previous version)

California Association of Joint Powers Authorities (previous version)

California Chamber of Commerce (previous version)

California Retailers Association (previous version)

California Medical Association (previous version)

CVS Health (previous version)

Express Scripts Holding Company (previous version)

Kaiser Permanente

Pharmaceutical Care Management Association (previous version)

Analysis Prepared by: Kristene Mapile / HEALTH / (916) 319-2097