Policy Update: Family Planning, ACA Lawsuit, Work Requirements and Assault Weapons

Summer & Fall Public Health Activities in AZ

Interested in finding out about the various public health conferences, meetings and events this Summer and Fall?  

Bookmark our AzPHA Upcoming Events webpage.  It’s as simple as that.  If I’ve missed something- let me know at willhumble@azpha.org!

 

Proposed Title X Funding Changes Likely to be a PH Burden

The US Department of Health and Human Services has proposed changes to the rules for the federal family planning services program, known as Title X.  If the new rules are adopted as proposed, it’ll require Title X family planning services to be physically and financially separate from abortion services.

Many family planning clinics offer both family planning and abortion referral services, and if the changes are ultimately implemented many of the programs would likely decide not to take Title X funding, which would have a big impact on the network of available services and they’d have fewer resources available for STD screening, treatment and outreach.

BTW: Title X funds have never been allowed to be used for abortions. The proposed rule is available for public comment until the end of July.  You can read more about the proposed rule and comment by visiting the Federal Rulemaking Portal: http://www.regulations.gov. Just follow the instructions to submit.  Your comments might not influence the outcome, but at least you’ll have done your part. That and voting this Fall.

 

Federal Government Won’t Defend the Affordable Care Act in Court

So far, the Affordable Care Act has survived the 2 court challenges that made it to the US Supreme Court.  Back in 2012 the ACA was upheld by the Supreme Court for the first time (by a 5-4 margin) in the National Federation of Independent Business v. Sebelius case.   It was upheld again in 2015 when (in a 6-3 decision) the Supreme Court upheld ACA’s federal tax credits for eligible Americans living in all 50 states (not just the 34 states with federal marketplaces).

But, there are additional challenges out there that haven’t made it to the Supreme Court yet. One that’s progressing through the courts is a challenge filed by 20 states (including Arizona) arguing that the ACA’s individual mandate is unconstitutional and key parts of the act — including the provisions protecting those with pre-existing conditions — are invalid. 

This week Attorney General Jeff Sessions acknowledged that while "the Executive Branch has a longstanding tradition of defending the constitutionality of duly enacted statutes if reasonable arguments can be made in their defense," the Attorney General will not defend the ACA from this challenge.  

The implications could be profound.  The ACA could potentially be completely overturned- or portions that require health plans to cover pre-existing conditions could be eliminated along with the mandate that persons have health insurance.

 

Medicaid Work/Community Engagement & Reporting Requirements

Any day now, the Centers for Medicare and Medicaid Services (CMS) will be approving Arizona’s request to include work requirements and/or community engagement and reporting requirements as a condition of Medicaid enrollment.  The request filed by AHCCCS is required by Senate Bill 1092 (from 2015) which requires them to ask CMS’ permission to implement new eligibility requirements for “able-bodied adults”.

AHCCCS initially proposed implementing the following requirements for able-bodied adults receiving Medicaid services including: 1) a requirement for all able-bodied adults to become employed or actively seeking employment or attend school or a job training program; 2) requiring able-bodied adults to verify monthly compliance with the work requirements and any changes in family income; 3) banning an eligible person from enrollment for one year if the eligible person knowingly failed to report a change in family income or made a false statement regarding compliance with the work requirements; and 4) limiting lifetime coverage for all able-bodied adults to five years except for certain circumstances.

Hundreds of comments were submitted (including comments from AzPHA) urging the agency to consider modifications to the initial waiver request.  AHCCCS later issued a final waiver request which includes exemptions for:

  • Those who are at least 55 years old;
  • American Indians;
  • Women up to the end of the month in which the 90th day of post-pregnancy occurs;
  • Former Arizona foster youths up to age 26;
  • People determined to have a serious mental illness (SMI);
  • People receiving temporary or permanent long-term disability benefits from a private insurer or from the government;
  • People determined to be medically frail;
  • Full-time high school students older than 18 years old;
  • Full-time college or graduate students;
  • Victims of domestic violence;
  • Individuals who are homeless;
  • People recently been directly impacted by a catastrophic event such as a natural disaster or the death of a family member living in the same household;
  • Parents, caretaker relatives, and foster parents; or
  • Caregivers of a family member who is enrolled in the Arizona Long Term Care System

A subsequent letter from the AHCCCS Administrator suggested that they (AHCCCS) are suspending their request for a 5-year limitation on lifetime benefits (for some members) for now.  Here’s our letter from back in February of 2017. 

 

Kaiser Family Foundation Issue Brief on Work Medicaid Requirements

Last month the Kaiser Family Foundation published an Issue Brief regarding CMS’ recent decisions to grant states the ability to experiment with their Medicaid programs that condition Medicaid eligibility on work or community engagement. The Issue Brief examines evidence of the effects of the Medicaid expansion and some changes being implemented through waivers.

Many of the findings on the effects of expansion are drawn from the 202 studies included in our comprehensive literature review that includes additional citations on coverage, access, and economic effects of the Medicaid expansion.

Regarding work requirements, the Brief concludes that “state-specific studies in Colorado, Kentucky, Michigan, Pennsylvania and most recently Montana and Louisiana have documented or predicted significant job growth resulting from expansion. No studies have found negative effects of expansion on employment or employee behavior. In an analysis of Medicaid expansion in Ohio, most expansion enrollees who were unemployed but looking for work reported that Medicaid enrollment made it easier to seek employment, and over half of expansion enrollees who were employed reported that Medicaid enrollment made it easier to continue working.  Another study found an association between Medicaid expansion and increased volunteer work in expansion states.

Furthermore, “work requirements have implications for all populations covered under these demonstrations. Those who are already working will need to successfully document and verify their compliance and those who qualify for an exemption also must successfully document and verify their exempt status, as often as monthly. States would incur costs to pay for the staff and systems to track work verification and exemptions.”

If you’re interested in the public health policy implications of our upcoming work/community engagement and reporting requirements, the KFF Issue Brief is a must-read.

 

Court Challenge to Kentucky’s Work Requirements being Heard this Week

Oral arguments are being heard this week in DC challenging Kentucky’s requirements that members work or participate in "community engagement" activities such as job training, school or volunteering. The case was filed in January by the National Health Law Program, the Kentucky Equal Justice Center and the Southern Poverty Law Center.  The outcome could have implications for AZ’s upcoming requirements.

Read National Health Law Program's guide on what to expect from oral argument.

American Medical Association Endorses Assault Weapon Ban

The American Medical Association – Nation’s largest physician group – endorsed a ban on assault weapons as part of a package of measures aimed at combating the epidemic of gun violence in the US. The member driven initiative was endorsed at their annual policy conference. They also endorsed a ban on bump stocks, which basically turn semi-automatic rifles into automatic weapons. 

In a statement AMA Immediate Past President David O. Barbe, MD, MHA said: “People are dying of gun violence in our homes, churches, schools, on street corners and at public gatherings, and it’s important that lawmakers, policy leaders and advocates on all sides seek common ground to address this public health crisis, in emergency rooms across the country, the carnage of gun violence has become a too routine experience.”

 

AzPHA Public Health Policy Update

Save the date

90th annual azpha fall conference and annual meeting

Integrating Care to Improve Public Health Outcomes:

Primary Care | Behavioral Health | Public Health

October 3, 2018 

Desert Willow Conference Center

There’s widespread support for the goals of the Triple Aim: To deliver the highest quality care with an optimal care experience at the lowest appropriate cost. The key is developing systems of care that best achieve these goals. 

Our 90th Annual Fall Conference and Annual Meeting Integrating Care to Improve Public Health Outcomes: Primary Care | Behavioral Health | Public Health will explore efforts currently underway to integrate care and improve outcomes in Arizona as well as initiatives on the horizon to develop systems of care that best achieve the goals of the Triple Aim.

We’ll kick off our Conference with a presentation of the latest academic research that evaluates the outcomes of co-located and integrated models of behavioral care as part of primary care as well as evidence-based toolkits to assist practices including ways to measure progress. We’ll also be exploring how providers are implementing new strategies to integrate care via AHCCCS’ “Targeted Investment” program which provides financial incentives to eligible providers to develop systems for integrated care.

We’ll conduct a short AzPHA Annual Meeting over a delicious buffet lunch followed by our keynote address from the American Public Health Association President Joseph Telfair, DRPH, MSW, MPH.  In our afternoon sessions, we’ll learn about new initiatives to work with managed care in two key areas that impact health outcomes: tobacco use and housing and homelessness.

We’ll close with a panel discussion of key leaders among Arizona’s Managed Care Organizations as they discuss priorities and strategies for improving outcomes under the new integrated Medicaid contracts which will begin October 1, 2018.  The new contracts will require better coordination between providers which can mean better health outcomes for members.

After the conference we'll have a hosted reception as we celebrate AzPHA’s 90th Anniversary!

I’m still working on the agenda, but I expect to have it fleshed out in a couple of weeks and have our registration site up and sponsorship packets out by the 3rd week in June. A summary of the conference is up on our homepage at www.azpha.org.

 

American Cancer Society Changes Colon Cancer Screening Recommendation

The American Cancer Society changed their recommendation for colon cancer screening by moving down the standard recommendation 5 years- suggesting that most people get screened at age 45. There are a couple of ways people can get screened, either using a sensitive test that looks for signs of cancer in a person’s stool or with an exam that looks at the colon and rectum (a colonoscopy).  The reason they changed the recommendation is because new data shows that cases of colorectal cancer for people under age 55 increased 50% between in the last 20 years (1994-2014).

However, just because the recommendation from the ACS changed doesn’t necessarily mean that insurers will begin paying for it between 45 and 49 years old.  For that to happen, the United States Preventive Services Task Force would need to recommend the change and list it as a Category A or B preventive health service.

In recent years, a prevention model of health has woven its way into the fabric of traditional models of care. With the passage of the Affordable Care Act the role preventive services has expanded significantly in the US health care delivery system.  Preventive health care services prevent diseases and illnesses from happening in the first place rather than treating them after they happen.

Category A & B” preventive services recommended by the United States Preventive Services Task Force  are now included (at no cost to consumers) in all Qualified Health Plans offered on the Marketplace. In addition, many employer-based and government-sponsored health plans have included Category A & B preventive services in the health insurance plans they offer to their respective members.

Currently, the United States Preventive Services Task Force recommends 49 Category A & B Preventive Health Services that include screening tests, counseling, immunizations, and preventive medications for adults, adolescents, and children.  The Task Force consists of a panel of experts representing public health, primary care, family medicine, and academia.  They update the list of recommended services by reviewing best practices research conducted across a wide range of disciplines.

You can also browse the USPHS website and check out the preventive services that they have evaluated but don’t recommend. Most of the services are broken down by age, gender and other risk factors.

 

Medicaid Program Scorecard Released by Feds

The Centers for Medicare & Medicaid Services released a new Medicaid program scorecard this week.  It includes some quality metrics along with federally reported measures in a Scorecard format.

The data that’s built into the state by state scorecard only uses information that states voluntarily submit.  There are 3 main categories (state health system performance; state administrative accountability; and federal administrative accountability) and lots of subcategories.

The most interesting part of the Scorecard I think are the State Health System Performance Measures portion.  Some of the subcategories that are reported in that category on a state by state basis are things like well child visits, mental health conditions, children’s preventive dental services and vaccination rates, and other chronic health conditions.

It looks like a good and valuable tool that will (if they continue to populate the scorecard) provide more transparency into the effectiveness of state Medicaid programs over time. The data that are submitted are voluntary - not compulsory - so that hurts the number of measures that states turn in.  It might be something that you’ll want to bookmark for reference in the future.

 

Federal “Right to Try” Law Passed and Signed

Congress passed and the President signed a new law this week that gives people with a terminal illness new options for treatment by allowing those folks a way to independently seek drugs that are still experimental and not fully approved by the US Food and Drug Administration.

The new law basically gives terminally ill patients the right to seek drug treatments that remain in clinical trials and "have passed Phase 1 of the FDA’s but haven’t been fully approved by the FDA.  

Arizona voters have already approved a similar law (by a wide margin).  In 2014 AZ voters approved Proposition 303  (referred to the ballot by the Legislature) that makes investigational drugs, biological products or devices available to eligible terminally ill patients. The AZ law has uses the same definition of an "investigational" drug that the new federal law uses.

 

Western Region Public Health Training Center Grant Renewed

The Western Region Public Health Training Center was awarded a renewed grant as a center for the Regional Public Health Training Centers Program.  They’ll continue to be housed in the University of Arizona Mel and Enid Zuckerman College of Public Health and we will continue to assess the training needs and strengthen the skills of the public health workforce with their partners in Arizona, California, Hawaii, Nevada, and the Pacific Islands.

The training center has literally hundreds of trainings that focus on all sorts of health professionals and the public health workforce.  So no matter what your public health workforce training needs are – the thing to do first is to check the centers website to see if they have the course that you need.  Most likely they will.

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I’m doing my best to populate the “upcoming events” part of our AzPHA website.  If you have an upcoming public health related event- please let me know and I’ll get it up on our website at: http://www.azpha.org/upcoming-events/

CHW Rulemaking, Opioid Epidemic Ends and Various CEU Opportunities

Community Health Worker Certification Rulemaking

The new law that authorizes the voluntary certification of community health workers will officially take effect on August 3 (HB 2324 Voluntary Certification for Community Health Workers). Voluntary certification can’t begin until the ADHS completes their Administrative Rulemaking (regulations) that’ll flesh out the details of the certification program including defining the core competencies, the criteria for establishing those competencies, continuing education requirements, the fee and other certification details. 

The first step in the Rulemaking process is for the ADHS to populate the 9 member advisory council to help inform the Rulemaking (the ADHS Director makes those appointments based on the criteria in the Session Law - the language at the end of the bill here).  After that, the agency needs to open the docket for the rulemaking and put draft rules out for public comment in what’s called the Arizona Administrative Register.

The public will then have a chance to comment on those initial draft regulations.  The ADHS will then consider those comments and file the final proposed rules with the AZ Secretary of State (here’s a summary of the rulemaking process on the SOS website).

Before the rules become effective- the agency needs to get final approval of the regulations by the Governor's Regulatory Review Council (GRRC).  If GRRC approves the rules- they’d become effective and voluntary certification could begin.

Realistically- even if the ADHS starts right away and appoints the advisory council and they begin meeting this Summer and began writing the initial draft rules later this year, it could easily take a couple of years before they’d become effective- so it's important to begin the process soon with initial advisory council meetings. 

You might be familiar with other agency rulemaking that have gone a lot faster than this.  That’s likely because those were probably “exempt” rulemakings, which provides several rulemaking short cuts including an exemption from the GRRC requirements.  Sadly, the CHW Rulemaking isn’t “exempt”.

The Rulemaking will be among the topics we’ll all be talking about at the AZCHOW Conference on June 21st and 22nd in Tucson.  Hopefully many of you will be able to make it.  AzPHA will be exhibiting at the conference.

 

Opioid Public Health Emergency Executive Order Ends

This week the Governor officially ended the emergency public health declaration that was signed via an Executive Order about a year ago.  Much has been accomplished over the last year including implementing legislation that improves prescribing practices and enhances emergency responses and increases access to treatment.  Of course- the work will go on.  The epidemic didn’t start overnight, and it surely won’t end overnight.  You can read the official end of the emergency declaration here.

Rep. McSally (R) is hosting a House of Representatives Border and Maritime Subcommittee hearing today (May 30) at 9:30 am at the UA College of Medicine Phoenix (Building 2) entitled: “An Unsecure Border and the Opioid Crisis: The Urgent Need for Action to Save Lives” featuring the Governor, various federal officials from the DEA, CBP, and DHS as well as Dr. Christ, Debbie Moak, and some people from faith-based organizations. You can see the panel line up here.  It looks like it’s an open meeting.

 

Aligning Health and Early Childhood Learning

Evidence shows how important early childhood education is in protecting people from disease and disability as an adult-  and that a child’s health impacts his or her ability to learn and succeed in school and later in life. Even with these known positive connections between early learning and wellness- health and education systems sometimes fail to align and provide opportunities to maximize health and early learning outcomes for children.

To address the disconnect between health and education, the HHS & US Department of Education outlined a set of recommendations for states and communities to align health and early learning systems. The recommendations emphasize the need for a comprehensive, seamless, and coordinated set of systems to support children, parents, and families.

 

Legislative Session Webinar Posted

The UA has posted my webinar from a couple of weeks ago that summarizes the legislative session from a public health perspective.  The whole thing is about an hour long.  You can check out the webinar on the UA Telemedicine Website.  Here’s the PowerPoint that I used.

 

CDC’s Learning Connection

The CDC has what they call a “Learning Connection” which connects public health professionals, including healthcare workers, to training opportunities and educational tools developed by CDC. Their Learning Connection also engages public health professionals around the world via social media messaging and a monthly e-newsletter.

The CDC Learning Connection: 1) features quality learning opportunities from CDC, other federal agencies, and federally funded partners; 2) keeps you up-to-date on the latest training through a free monthly e-newsletter; 3) offers access to thousands of training opportunities through CDC TRAIN — CDC’s online learning system; 4) connects you to information about CDC internships and fellowships; and 5) makes it easy to locate courses that offer continuing education. There are literally hundreds of courses one can take- mostly on-line and self-paced.

 

Free Continuing Education from MMWR and Medscape:

CDC MMWR and Medscape introduced a new FREE continuing education (CE) activity that describe trends and demographic differences in health outcomes and healthcare use for childhood asthma, based on a CDC analysis of asthma data from the 2001-2016 National Health Interview Survey for children 17 years and younger.

This activity is intended for pediatricians, pulmonologists, public health officials, nurses, and other clinicians caring for patients with childhood asthma. To access this FREE MMWR / Medscape CE activity visit https://www.cdc.gov/mmwr/cme/medscape_cme.html. If you’re not a registered user on Medscape, you may register for free or login without a password and get unlimited access to all continuing education activities and other Medscape features.

 

Free Continuing Education Training for Opioid Prescribers offered by UA

With the requirement of Arizona prescribers to complete 3 hours of opioid, substance use disorder, or addiction-related CME, the University if Arizona’s Center for Rural Health we offer Arizona based materials and continuing education opportunities including:

Free online CME vouchers worth $150: order vouchers by responding to this email. We can mail them to you in batches of 100 to 500. Please feel free to forward the listserv blast below and attached documents for your attendees.

Free Arizona Opioid Prescribing Guidelines printed copies: order at http://www.azdhs.gov/audiences/clinicians/index.php#clinical-guidelines-and-rx-guidelines-order

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I’m doing my best to populate the “upcoming events” part of our AzPHA website.  If you have an upcoming public health related event- please let me know and I’ll get it up on our website at: http://www.azpha.org/upcoming-events/

 

Dr. Bob’s Travelogue

I’ve gotten a couple more Travelogues from Dr. Bob in the last couple of weeks.  He’s been living for the last couple of months just outside of London. He's writing some entertaining travelogues- with a splash of public health of course. Take a few minutes when you're on a comfortable couch and enjoy Travelogue 1 & 2: Getting Settled and Travelogue 3: Nutrition. Here’s Interlude from last week and this new one Hoof Beats.

Ebola, Family Planning, Public Charge, & Medicaid Network Standards

Ebola Outbreak in Democratic Republic of the Congo

WHO Policy Body Concludes it’s Not a Public Health Emergency of International Concern (yet)

The Democratic Republic of the Congo’s (DRC) Ministry of Health has confirmed 45 cases of Ebola Virus Disease in the last few weeks. Most of them have been in the remote Bikoro health zone, but 1 case is in Mbandaka, a city of 1.2 million, which is bad because of the city's size and because it's next to the Congo river- a major transportation corridor for people and trade. Large cities that are also transportation hubs can serve as a distribution channel for the virus.

The WHO’s Emergency Committee met last week and heard about the DRC’s surveillance & interventions. The Committee concluded that “… the interventions underway provide strong reason to believe that the outbreak can be brought under control, including: enhanced surveillance, establishment of case management facilities, deployment of mobile laboratories, expanded engagement of community leaders, establishment of an airbridge, and other planned interventions.  In addition, the advanced preparations for use of the investigational vaccine provide further cause for optimism.”

The Committee concluded that “… the conditions for a Public Health Emergency of International Concern (PHEIC) have not currently been met.” They advised against travel or trade restrictions as interventions.  Despite not being classified as a PHEIC, resources are still available to the DRC from the WHO consistent with the WHO’s Emergency Response Framework

Activities include distribution of vaccine to Congo (4,000 doses so far and 3,000 more coming), cold chain resources, prepositioning of additional vaccine in Mali and support and treatment and surveillance staff from WHO & Medecins Sans Frontieres. They are using a ring vaccination strategy around cases and contacts.  Surprisingly I don't see anything on the CDC's website about the outbreak right now, but hopefully they're engaged.

Let’s hope that the WHO Emergency Committee is right and the Ministry has the resources, expertise and logistical support they need to quickly identify cases and conduct the needed interventions to stop the spread before this becomes a regional or international epidemic like it did in 2014.  

 

HHS to Restrict Title X Family Planning Program

Last week the President announced that the US Department of Health and Human Services will be changing federal family planning programs (Title X) to “ensure that taxpayers do not indirectly fund abortions”.  The statement suggested that HHS would be shortly proposing regulations that would ban Title X family planning providers from referring patients to abortion clinics.

Title X was enacted almost 50 years ago to provide quality family planning care to those who may not be able to afford it on their own.  Federal funds through Title X already can’t be used for abortion services. The funds are dedicated to access to medically accurate comprehensive healthcare for low-income individuals and families. The reproductive healthcare and family planning services include contraception, cancer and STD testing as well as counseling and education and more.  Title X funding has contributed to the recent and significant decline in unintended and teen pregnancies as well as unplanned births and has reduced abortions.

I searched all over the HHS website and I can’t find the proposed rule change anywhere, so the proposed changes haven’t been released yet. We don’t know if they’ll propose an emergency rule (hitting Title X networks immediately) or go through a normal rulemaking process.  The normal process (including posting the proposed rule in the Administrative Register and a comment period) would be slower because the public would have the chance to comment, and comments would need to be reviewed before the rule could be finalized.

This has already been a chaotic year for Title X applicants for family planning service providers. It’s normally a 3-year funding cycle for Title X providers, but the Administration has changed that to a 1-year cycle- and applications for the coming year are due this Thursday (5/24).

If the proposed rule is the same one that was proposed by the Reagan Administration (and later rescinded by Clinton), it would prevent any provider from referring or providing information on abortion services.  We don’t know the fine points of the rule yet, and cannot speculate about its structure, but we will keep you updated as we learn more. 

 

AzPHA Comments on AHCCCS’ Network & Appointment Standards

AHCCCS is rolling out new integrated care contracts on October 1, and most members will be receiving services for both acute and behavioral care from these managed care organizations.  One of the keys to making sure that members have access to a health care provider when they need it is for AHCCCS to make sure each managed care organization has an adequate network of contracted providers. 

AHCCCS sets their network adequacy standards in what’s called their “AHCCCS Contractors Operations Manuals”, or ACOMs for short.  From now through May 28, 2018 AHCCCS is accepting public comment on their proposed manuals for network expectations for the integrated care contracts that start on October 1.

Our Public Health Policy Committee reviewed the proposals and submitted comments (available on my blog at http://www.azpha.org/). In short- we commented that we liked the fact that the new proposed network standards are more easily measured and therefore easier to ensure compliance.  We also encouraged them to ask the plans to contract with the county health departments for services like vaccinations, sexual transmitted disease testing and treatment, reproductive health, and tuberculosis prevention and control. 

We also asked that when Plans ask for and receive exemptions from the standards that the information be posted on enrollment websites so members have that info as they make enrollment decisions.  Anybody can comment on the proposed standards at this website before May 28.

 

Kaiser Family Foundation “Public Charge” Issue Brief

A few weeks ago I wrote about a change that the US Department of Homeland Security is mulling to allow the federal government to take into account the use of federal health, nutrition, and other non-cash public programs like Medicaid, the Children’s Health Insurance Program, and WIC when making a determination about whether someone is likely to be a “public charge.”  Under these changes, use of these programs by an individual or a family member, including a citizen child, could result in a person being denied lawful permanent resident status or entry into the U.S.

Such changes would apply to coverage provided to legal immigrants and their citizen children, leading to decreased participation in Medicaid, CHIP, Affordable Care Act marketplace coverage and other programs, even though they would remain eligible for them.

The Kaiser Family Foundation published a new issue brief this week that provides an overview of the 10.4 million kids in the U.S. that have a non-citizen parent (the parent is the person that would be affected by the changes).  Then issue brief presents different scenarios of disenrollment from Medicaid and CHIP to illustrate the potential effects on their health coverage and discusses the implications for their health.

How do Lava & Seawater Make Acid Mist?

I heard on the radio that when lava coming from the Kilauea volcano hits the ocean it’s forming an acid mist that’s dangerous to the lungs.  I got curious how the acid forms.  It turns out that the acid comes from 2 different sources.  About 30% of the acid is trapped in the molten lava as a gas and escapes when the lava cools fast in the ocean water. 

The bigger source (70%) is a chemical reaction in which the salt dissolved in the ocean (NaCl and H2O) – in the presence of super-hot lava- forms NaOH (sodium hydroxide) and HCl (hydrochloric acid).  Of course- it’s more complicated than that (a lot more complicated).  If you’re interested in the particulars you can check out this journal article.

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I’m doing my best to populate our “Upcoming Events” section of our AzPHA website.  If you have an upcoming public health related event- let me know and I’ll get it up on our website at: http://www.azpha.org/upcoming-events/

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Grand Canyon University is developing a Bachelor of Science in Public Health and they would like to gather input from the public health professional community to help inform the curriculum. Please take a few minutes to provide them some feedback on this Grand Canyon University Bachelor of Public Health Policy Survey

 

ADHS EMS Regulatory Services Section Chief Post Open

The ADHS Bureau of Emergency Medical Services and Trauma Systems is recruiting for a senior management position in the Bureau of EMS and Trauma System to lead a team of professionals in several functional areas including, statutory committee support, EMS and trauma data collection, system of care performance improvement analysis and reporting, EMS and trauma system initiatives, community paramedicine, and strategic planning and communication

Responsibilities include:

  • Supporting a diverse multi-cultural workforce that reflects the community, promotes equal opportunity at all levels of ADHS, and creates an inclusive work environment that enables all individuals to perform to their fullest potential free from discrimination

  • Assisting in policy and rule development with Bureau and Department leadership

  • Leading a highly motivated, professional team

  • Guiding, monitoring and ensuring success of numerous projects and deliverables

  • Creating and editing EMS and trauma-related reports and plan

  • Ensuring successful meetings of Governor and Director-appointed advisory meetings

  • Seeking out and sharing resources to enhance the Arizona EMS and trauma system

  • Traveling to a limited number of national, state or local meetings

Salary: up to $60,354   Apply Here

 

AzPHA Member Kelli Donley on Horizon Thursday RE Her Latest Book

AzPHA member Kelli Donley will be on Horizon this Thursday at 5:30pm (May 24) to talk about her newest book called COUNTING COUP. The book is about the Phoenix Indian School, and like her other novels, has a strong public health theme. Here’s a short description of her book, which you can order from Amazon:

Happily consumed with her academic career, Professor Avery Wainwright never planned on becoming sole guardian of her octogenarian Aunt Birdie. Forced to move Birdie—and her failing memory—into her tiny apartment, Avery’s precariously balanced life loses its footing. 

Unearthed in the chaos is a stack of sixty-year-old letters. Written in 1951, the letters tell of a year Avery’s grandmother, Alma Jean, spent teaching in the Indian school system, in the high desert town of Winslow, Arizona. The letters are addressed to Birdie, who was teaching at the Phoenix Indian School. The ghostly yet familiar voices in the letters tell of a dark time in her grandmother’s life, a time no one has ever spoken of. 

Torn between caring for the old woman who cannot remember, and her very different memories of a grandmother no longer alive to explain, Avery searches for answers. But the scandal and loss she finds, the revelations about abuses, atrocities, and cover-ups at the Indian schools, threaten far more than she’s bargained for. 

 

Most of you know Dr. Bob England, who's been on the AZ public health scene for the last 30 years including 12 years as the Director of the Maricopa County Public Health Department.  Bob's been living for the last couple of months just outside of London. 

He's writing some entertaining travelogues- with a splash of public health of course. Take a few minutes when you're on a comfortable couch and enjoy Travelogue 1 & 2: Getting Settled and Travelogue 3: Nutrition. Here’s the 5th installment: Interlude.  Back to the 4th Travelogue next week.

AzPHA Comments on AHCCCS' Proposed Network Sufficiency and Appointment Standards

May 11, 2018

 

Thomas J. Betlach

Administrator,

Arizona Health Care Cost Containment System

801 E Jefferson Street

Phoenix, AZ 85034

 

Dear Administrator Betlach:

I write on behalf of the Arizona Public Health Association (AzPHA) – one of Arizona’s oldest and largest membership organizations dedicated to improving the health of Arizona citizens and communities. An affiliate of the American Public Health Association, our members include health care professionals, state and county health employees, health educators, community advocates, doctors, nurses and students.

Thank you for the opportunity to comment on your AHCCCS Contractors Operations Manuals for the upcoming October 1 Integrated Care Contracts.  We have reviewed the proposed 400 Series Manuals and have comments on ACOM 436 (Minimum Network Requirements) and 417 (Appointment Availability, Monitoring and Reporting).

ACOM 436 Minimum Network Requirements

We applaud the Administration for applying measurable and verifiable standards for geographic network adequacy.  We like the way the Administration is using a standard which includes a percentage of the members within both a discrete distance and time from a provider in the various categories. The percentages and distances for rural and urban areas seem reasonable.  We encourage you to keep these types of easily measurable and verifiable standards in the final ACOM 436.

County public health departments support medical homes especially in under-served areas.  Their core services include vaccinations, sexual transmitted disease testing and treatment, reproductive health, and tuberculosis prevention and control.  These are services that patients are not always able or willing to access in their medical home. When county health departments are not a network provider, this critical health care infrastructure component is unavailable to members which can gave a substantial negative impact on community and member health. Please require your new integrated managed care plans to include Public Health departments in their health care provider networks. 

This will ensure fairness in providing services to your members, provide revenue that enables county health departments to continue to serve their communities, and prevent taxpayers from paying twice for access to critical health services.

A key to making member choice meaningful requires contractors to be transparent about whether they are meeting Minimum Network Requirements.  When contractors are out of compliance with the ACOM 436 Standard(s), we encourage the Administration to require contractors to disclose on their websites, newsletters and other member communication materials which standards they have not complied with and/or have requested exceptions from so that Members can take that information into consideration as they choose plans. This disclosure standard may need included in ACOM 404 for compliance purposes. The information should also be added to the AHCCCS enrollment websites

ACOM 417 Appointment Availability, Monitoring, and Reporting

We applaud the Administration for applying statistical methods and measurable and verifiable standards for regulating appointment availability, monitoring and reporting. We like the way the Administration is using a standard which includes an explanation of how sample sizes meet a 95% statistically significant confidence level including the calculations used to confirm the confidence level.  We encourage the Administration to keep these criteria and the reporting template.

As with ACOM 436, we encourage the Administration to require contractors to disclose on their websites, newsletters, and other member materials which standards they have not complied with and/or have requested exceptions from so that Members can take that information into consideration as they choose plans. This disclosure standard may need included in ACOM 404 for compliance purposes. The information should also be added to the AHCCCS enrollment websites.

Sincerely,

 

Will Humble, MPH

Executive Director,

Arizona Public Health Association

Legislative Session Wrap-up & Farm Bill Stuff

Arizona’s Legislative Session in the Books

Well, the 2018 Legislative Session is in the books.  All in all, it was a good year for public health at the state level.  Several more good public health-related bills were signed today including:

HB 2324 Voluntary Certification for Community Health Workers

HB 2088 Public Health Guidelines in Schools

HB 2235 Dental Therapy Licensure

SB 1245 SNAP- Fruits and Vegetables

HB2371 Statewide Food Truck Licensing 

I’ll be doing a free Webinar about the legislative session Thursday May 17 at noon with the UA Center for Rural Health & the UA Telemedicine Program. Visit the AZ Telemedicine Program’s Website to register. 

Here's a link to a PowerPoint that summarizes the Victories, Missed Opportunities, Disappointments, and things that were in the final budget that link to public health. It's the ppt that I'll be using during the webinar on Thursday.

 

US Farm Bill: An Opportunity to Leverage Policy to Reduce Obesity

You’ve probably heard about the “Farm Bill” at one point or another.  While it’s called the Farm Bill- it’s not just about farms. It’s the bill that sets the food and agricultural budget and policy for the US. The bill impacts farming livelihood, and also determines how food is grown and which foods are grown.  It was last reauthorized by Congress in 2014 and Congress is now working on a new reauthorization.
 
The 2014 Farm Bill  (the  Agricultural Act of 2014) included some changes and reforms to the Supplemental Nutrition Assistance Program (SNAP or food stamps) and the Commodity Supplemental Food Program.  In Arizona, SNAP benefits help put food on the table for more than one million people each month, with more than half of the benefits going to kids and teens.

The 2014 Farm Bill did a few things that promoted healthier options by requiring SNAP retailers to provide healthy choices. The ’14 law also provided grant programs to encourage people that receive SNAP benefits to buy more fruits and vegetables, provide funding for loan programs for healthy food retailers, and create opportunities for schools to add different kinds of vegetables as part of school menus.

We’re hoping that Stakeholders like us can better leverage the Farm Bill to improve healthy eating this time around now that we have a member of our delegation on the Agriculture Committee.  Arizona District 1 Congressman Tom O'Halleran is on the House committee. 

Back when I was at the ADHS we worked with ASU on a report to provide information to Congress about how SNAP could be leveraged to improve healthy eating.  The full report has the details but here are a few of the concepts in the evidence review:

  • Improving access to healthy food by establishing guidelines requiring SNAP vendors to carry more healthier options

  • Establishing nutrition standards for foods that qualify for purchase using SNAP benefits.  Right now, SNAP benefits can be used for basically any retail food no matter how unhealthy it is (alcohol can’t be purchased with SNAP benefits). 

  •  Making changes to the SNAP education program to incorporate evidence based public health practices to bring about sustained changes in participant behavior.

Rather than strengthen the food quality requirements, the bill currently being debated by the House Agriculture Committee would expand the existing SNAP work requirements.  Right now, SNAP requires childless adults between 18 and 49 who don’t have disabilities to work or be in work training to qualify. The draft legislation would expand the work requirement to include adults up to 59 and people who care for children older than 6. The draft bill also would set tighter time frames for recipients to find work and stiffen the penalties if they don’t.

SNAP recipients covered under the work requirement would have to document that they are working or getting job training for 20 hours a week. The first time an individual doesn’t comply with that requirement would trigger a loss of benefits for a year. Failing to comply again would result in being locked out of SNAP for three years.

The proposed changes would increase state costs by requiring states to collect monthly information from most SNAP users about their hours worked, their hours of participation in work programs, and the reasons they may not be working in a work program. 

The APHA has set up a way that you can Contact your representative today and urge them to include nutrition standards for foods to qualify for purchase under SNAP and also to comment about the new proposed work/work training requirements.

 

Sonoran Prevention Works Scores Syringe Access Grant

Sonoran Prevention Works received a $125,000 grant from the Vitalyst Health Foundation  to support advocacy and education for syringe access programs – a proven harm reduction strategy in response to the opioid crisis and rising hepatitis-C and HIV infection rates. They’ll be partnering with the University of Arizona College of Medicine Tucson and Creosote Partners to destigmatize syringe access programs and understand the comprehensive needs of people who inject drugs.

The Maricopa County Sheriff's Office will also work with Sonoran Prevention Works to implement a needle stick prevention program and to educate law enforcement on injection drug use. These partnerships will work to support policy change that treats substance use as a public health issue.

Arizona's 2018 Legislative Session in the Books

Well, Arizona’s legislative session ended last week, so you’re spared my impossibly long policy updates.  You can visit this PowerPoint to dive into the good things, bad things, and the missed opportunities this year.  It’s still a draft summary of the Session because the Governor hasn’t taken action on several bills (voluntary certification of community health workers, public health measures in schools, dental therapy, food truck licensing, and fresh produce in SNAP). BTW- Let me know if you see anything I've left out of the draft powerpoint so I can update it before my Webinar next week

I’ll be doing a Webinar about the legislative session on Thursday May 17 at noon in conjunction with the UA Center for Rural Health & the UA Telemedicine Program.  Visit the AZ Telemedicine Program’s Website to register.

 

FDA Finally Implementing ACA’s Menu Labeling Requirement

You might have noticed that more and more restaurants and fast food places are starting to put calorie and other nutrition information on their menus.  That’s not a coincidence or accident- they’re implementing the menu nutrition labeling requirements in the Affordable Care Act.  Section 4205 of the ACA requires restaurants with 20 or more locations to post calorie content information for standard menu items directly on the menu and menu boards.  Vending machine operators with 20 or more machines are also required to disclose calorie content for certain items. 

Nutrition clarity is a real opportunity for public health change.  Not only will the new labels give the public key information to help them make better decisions about what they buy for themselves and their families- it’ll give pause to restaurants before they label their menus- giving them an opportunity to change ingredients to lower calorie counts.  It may even spur a trend away from super-sizes and toward more appropriate and reasonable serving sizes.  With 32% of the calories consumed in the US tied to eating outside the home- this is an important opportunity. 

Anyway, the FDA announced this week that they’re finally implementing the requirements that were established by the ACA.  Another evidence-based policy intervention brought to you by the Affordable Care Act.

 

CMS Denies Kansas’ Request for 3-year Lifetime Medicaid Eligibility

This week the Centers for Medicare and Medicaid Services Administrator denied Kansas’ request to impose a 3-year lifetime limits on Medicaid eligibility. 

Her decision bodes well for us in Arizona- at least when it comes to lifetime coverage limits (although CMS is poised to almost certainly approve AZ’s work/work training request).  Arizona law requires AHCCCS to annually ask CMS for permission to require work (or work training) and income reporting for “able bodied adults” and a 5-year lifetime limit on AHCCCS eligibility (with some exceptions).

A few months ago AHCCCS turned in their official waiver request asking permission to implement those requirements.  The AHCCCS Director recently postponed the negotiation process of the lifetime limit request to expedite approval of the work requirements.  See his letter here.  Word on the street is that AHCCCS expects approval of the work requirements in June.

 

Mid-year Federal Budget Cut Request

This week the White House submitted a special message to Congress requesting they rescind $15B bill in budget authority from the current fiscal year. The proposal includes unobligated balances from prior-year appropriations and reductions to budget authority for mandatory programs.

Below are selected programs proposed for rescission by the Administration that may impact public health programs. For more information, view the entire rescission proposal here.

  • Children’s Health Insurance Fund: The proposal would rescind $5B in amounts made available by the Medicare Access and CHIP Reauthorization Act of 2015 to supplement the 2017 national allotments to states, including $3B in unobligated balances available on October 1, 2017. 

  • Child Enrollment Contingency Fund: The proposal would rescind $2B in amounts available for the CHIP Contingency Fund, of which there were $2.4B available. The Contingency Fund provides payments to states that experience funding shortfalls due to higher than expected enrollment. 

  • Centers for Medicare and Medicaid Innovation (Innovation Center): The proposal would rescind $800M in amounts made available for FY11-19 for the Innovation Center, of which there were $3.5B available on October 2017. The Innovation Center was created to test innovative payment and service delivery models to reduce program expenditures under Medicare, Medicaid, and CHIP while preserving or enhancing quality care.

 

Speak for Health: Fund Public Health in 2019

As Congress begins its work on the FY 2019 appropriations process, Speak for Health and tell our members of Congress  to reject the proposed cuts to important public health programs in the president's budget proposal and instead to prioritize public health by building upon the important increased investments in public health provided by Congress in FY 2018.

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Most of you know Dr. Bob England, who's been on the AZ public health scene for the last 30 years including 12 years as the Director of the Maricopa County Public Health Department.  You know that he's a terrific cartoonist.  But did you know he's an engaging travel writer?

Bob's been living for the last couple of months just outside of London.  He's been writing some terrifically entertaining travelogues- with a splash of public health of course. Take a few minutes when you're on a comfortable couch and enjoy Travelogue 1 & 2: Getting Settled.  Here’s Travelogue 3: Nutrition. Enjoy.

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If you haven’t yet become a member of AzPHA please consider joining our team!

Here’s information about our Individual & Organizational Memberships

Medicaid Network Adequacy: A Key to Access to Care

AHCCCS is rolling out new integrated care contracts on October 1, and most members will be receiving services for both acute and behavioral care from these managed care organizations.  One of the keys to making sure that members have access to a health care provider when they need it is for AHCCCS to make sure each managed care organization has an adequate network of contracted providers.  After all, having health insurance isn’t much good if there’s no place for you to get care in your area or if the doctors are booked and you can’t get an appointment.  That’s where “network adequacy” comes in.

AHCCCS sets their network adequacy standards in what’s called their “AHCCCS Contractors Operations Manuals”, or ACOMs for short.  From now through May 28, 2018 AHCCCS is accepting public comment on their proposed ACOM manuals for network expectations for the integrated care contracts that start on October 1.

Geographic Standards

One of the keys is to make sure that there are providers reasonably nearby Medicaid members.  ACOM 436- Minimum Network Requirements will set the expectations for geographic access to care. It’s pretty long as you’ll see if you click on the link.  But here are a couple examples of the key proposed standards that are out for public comment. 

For kids, they propose requiring their contracted managed care organizations to ensure that 90% of members live within 10 miles or 15 minutes of a primary care provider in Maricopa and Pima counties.  For all other counties, they’re proposing that 90% of members lives within 30 miles or 40 minutes of a primary care provider.  For kids dental in Maricopa & Pima counties, they’re proposing requiring their contractors to make sure that 90% of members live within 15 minutes or 10 miles of a provider.  For the other counties, they’re proposing that 90% of members live within 40 minutes or 30 miles of a provider.

The Manual also proposing a process for managed care organizations ask for an exemption from the standards based on outlined reasons and the criteria by which they’ll consider approving the exemptions.  Those of you that are well versed in these aspects of access to care can comment on the proposed standards and the exemption criteria through May 28 at this web link.

Appointment Wait Time Standards

Another Manual that’s out for public comment is about how long it takes to make an appointment to see various kinds of providers.  That one is called ACOM 417, Appointment Availability, Monitoring and Reporting.

The 417 Manual proposes that routine primary care appointments be set within 21 calendar days of the member’s request.  For more urgent appointments, the proposal is for “… as expeditiously as the member’s health condition requires but no later than 2 business days of request”.  For Specialty provider referrals the proposal is “… as expeditiously as the member’s health condition requires but no later than 3 business days from the request”.  For routine specialty care appointments it’s within 45 calendar days of referral.  For dental provider appointments it’s “… as expeditiously as the member’s health condition requires but no later than 3 business days of request, and for routine care appointments within 45 calendar days of request

They’re also proposing a process for managed care organizations ask for an exemption from the standards based on outlined criteria.  They also outline the criteria by which they’ll consider approving the exemptions.

Those of you that are well versed in these aspects of access to care can comment on the proposed standards and the exemption criteria through May 28 at this web link.  We’ll talk this over with our Public Health Policy Committee and turn in comments sometime in May.  Let me know if you want to get onto our Policy Committee Basecamp and I’ll sign you up.

 

FDA Pursuing E-Cigarette Interventions

Last week the FDA announced several interventions to better regulate e-cigarette makers.  It’s no secret that e-cigarettes have become wildly popular with kids.  E-cig makers have become increasingly crafty in attracting kids to use their products- which often have high nicotine levels.  Some of the new products look like a USB flash drive- making it easier for them to sneak into what are supposed to be tobacco product free-areas.  Many fall under the JUUL Brand but also “myblu” and “KandyPens”.

The strategies that FDA announced last week include: 1) an “undercover” investigation into retailers that are selling these JUUL products to kids and issuing warning letters and other enforcement actions; 2) raising concerns with eBay regarding their listing of JUUL products on their website; 3) contacting manufacturers like JUUL Labs and requiring them to submit like documents like their product marketing strategy, research on the health, toxicological, and behavioral or physiologic effects of the products; and 4) enforcement actions focused on companies that are marketing products in ways that are misleading to kids.

Time will tell whether these strategies make a difference- but one thing is clear- we’ll continue to be in a long-term battle with companies that will continue to creatively find new ways to addict America’s youth to their nicotine products.

 

Legislative Session Update

There wasn’t much action on the public health bills we’re working on and tracking last week. Unless you’ve been out of town or on vacation you know that pretty much all last week was absorbed with the debate about weather and how to fund increases for K-12 schools.  There were huge peaceful marches on the Capitol on both Thursday and Friday.  The Legislature adjourned early last week.

The Governor has proposed increasing teacher salaries by 20% by the year 2020. The teachers are looking for a more robust commitment for all other school staff and a dedicated revenue stream to support the investment.  The Governor proposes paying for the increase in several ways- in part by increasing the assessment on hospitals to help pay for Medicaid, and in part by decreasing planned funding for things like provider increases for programs that serve people with disabilities (because of the increase in the minimum wage).  The plan assumes state revenue will increase by 4.8% per year over the next 3 years (over the last 3 years it’s increased by between 3 and 4% per year). 

Late last Friday afternoon the Governor issued a media release stating that an agreement had been reached with the legislature on a way to fund the 20% by 2020 idea, but the media release didn’t explain how it would be paid for.  Here’s the latest information that I have- but of course this could change when the actual proposal comes out later this week. Robert Robb from the Republic had the most digestible explanation of the plan that I’ve been able to find.

The phased-in cost of the teacher pay increase is $580M. The phased-in school-assistance portion is $370M (a total of $950M).  Maintaining all other state programs over that period is about $850M and that’s without any population increase or inflation.  At 4.8% revenue growth per year (the past 3-year average is between 3 and 4%) there’d be a $150M deficit in 2020 even if there were no increases in spending anywhere else in state government.  If revenue growth were less than 4.8%, there’d be a bigger deficit.  If revenue increases average more than 4.8% things might be OK.  If there’s a recession, we’d be in big trouble. 

You can see how important it is to get the revenue stream right.  If revenues and expenses are unbalanced, the increases for schools and teachers will absorb all other funds and there won’t be anything available to address public health or social determinant priorities and might even force reductions in other state services like health care and public health. 

 

Medicaid Changes Partially Support the Teacher Salary Proposal

There are a couple of “efficiency items” that the Governor identified within our Medicaid program that will partially pay for some of the teacher salary increase.  One relates to the assessment on hospitals that pays the state portion of the Medicaid expansion deal that was reached a few years ago.  The other is a proposed change to eliminate something called “prior quarter coverage”.

Hospital Assessment

One item listed as an “efficiency savings” to help pay for the teacher salary proposal increase the hospital assessment, which pays for Medicaid expansion, by $35 to $39M.  The Governor has proposed moving behavioral health services for childless adults to the same funding stream as acute care (tobacco taxes and the hospital assessment pay for acute care coverage for childless adults and those covered through Medicaid expansion).  The assessment on  hospitals would increase by 12% from $287 million to $326M.

Prior Quarter Coverage

Back on January 1, 2014 AHCCCS began covering people that qualify for Medicaid for the 3 months prior to their eligibility date.  So, if a person applying for AHCCCS qualifies during any portion of three months immediately preceding the month in which the member applied for AHCCCS coverage, they’ll reimburse providers for covered services.  They’ve submitted a waiver request to CMS to stop this practice.  In FY 2017 they spent a total of about $21M for prior quarter coverage- so stopping the practice would save about $11 - $12M in state funds. This waiver is in the hands of CMS right now.

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Here’s a snapshot of where the various bills we’re working on are in the system. 

HB 2038 Drug overdose review teams; records (Signed into Law)

HB 2071 Rear-facing car seats (Stalled in Senate)

HB 2084 Indoor tanning; minors; restricted use (Now called SB 1290 as Striker) 

HB 2127 Children's health insurance program (Now called SB 1087 as Striker)

HB 2197 Health professions, workforce data (Ready for Senate Floor Vote)

HB 2208 Prohibition, photo enforcement (Effectively dead)

HB 2228 Annual waiver, applicability (Signed by Governor)

HB 2323 Schools; inhalers; contracted nurses (Ready for Senate Floor Vote)

HB 2324 Community health workers; voluntary certification (needs Senate floor vote)

HB 2389 Syringe access programs; authorization (Basically dead)

HB 2484 local food tax; equality (Signed by Governor)

SB 1022 ADHS; homemade food products (Signed by Governor) 

SB 1083 Schools; recess periods (Signed by Governor)

SB 1245 Snap Benefit Match (Needs Rules Committee & Budget Line)

SB 1261 Texting while driving (Now HB 2159 traffic violations; traffic survival school)

SB 1420 Medical marijuana; inspection; testing; appropriation (Needs House Rules)

SB 1445 AHCCCS Dental care, pregnant women (Needs House Rules Committee)

SB 1377 Dental therapy, licensure, regulation (Failed in House now HB2235 in Senate)

SB 1389  HIV; needs assessment; prevention signed by the Governor last week.

SB 1394 Abortion reporting (Signed by Governor)

SCR 1005 Voter Initiative Sunset (striker in the House)

 

Public Health-related bills signed so far:

HB 2038 Drug overdose review teams; records was passed and signed.  Once it takes effect later this year, law enforcement agencies will now be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request. 

HB 2228 Annual waiver, applicability was signed by the Governor.  It’s good. It will direct AHCCCS to exempt tribes from their directed waiver request that asks for CMS permission to implement work requirements for some Medicaid members.  The recently submitted Waiver request includes an exemption for American Indians, however, this would place the exemption into statute.

HB 2323  Schools; inhalers; contracted nurses was signed by the Governor.  This bill adds contracted nurses to the list of people who are authorized to provide emergency inhaler medication in case of respiratory emergencies. Some charter and independent schools don’t employ nurses directly but engage them through contracts.

HB 2484 local food tax; equality, which will ban Arizona cities and counties from taxing sugary drinks as a public health intervention.

SB 1022  DHS; homemade food products ADHS will be required to establish an online registry of food preparers that are authorized to prepare "cottage food products" for commercial purposes. Registered food preparers would be required to renew the registration every three years.

SB 1083 Schools; recess periods was passed and signed!  Beginning next school year K-3 will need to have at least 2 recess periods. Grades 4 and 5 will need to have 2 recess periods the year after that.

SB 1389  HIV; needs assessment; prevention was signed by the Governor last week.  It requires the ADHS to establish and implement an HIV Action Program. 

SB 1394 Abortion reporting was passed by the House and signed by the Governor.  It will require the ADHS to collect and report additional data regarding abortions that are performed in AZ.

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AZ Public Health Policy Update: April 23, 2018

Feds Overhaul Essential Health Benefit Options

The Affordable Care Act required all health insurance policies sold on the Exchange and in the small group & individual markets to cover as set of “essential health benefits”.   Each Governor selects their state’s essential health benefits by choosing among options like their state employee plan, a small group market plan etc.  Each state has 10 options to pick from.  Governor Brewer selected the state employee plan as Arizona’s benchmark and Ducey did the same a couple of years ago.  Not a bad choice, because the benefits are generally robust- except that since the state employee plan doesn’t cover abortion services the state benchmark doesn’t either (although non-Medicaid plans can elect to cover those services).

Last week the Centers for Medicare & Medicaid Services issued an annual "Notice of Benefit Payment Parameters for 2019“. It outlined a big change.  Beginning in 2019 CMS will be giving Governors a lot more flexibility in selecting their state’s essential health benefit package.  Instead of 10 options, states will be able to choose among any of the essential health benefit benchmark plans used by any other state.  The new rules could have a profound impact on health insurance access and benefits.

It remains to be seen whether our Governor will choose a different benchmark plan moving forward.  Here’s a list of the various states’ insurance benefits benchmark mandates: [EHBs by State]

Legislative Session Update

The Governor vetoed 10 bills last Friday - apparently to send a message to the legislature that he wants the "20% by 2020" teacher funding bill on his desk forthwith. 

Luckily, the Community Health Worker voluntary certification bill needed to go back to the House for a Final Read- or it’s quite possible that it would have been veto number 11.  He did veto a good bill HB 2089 which would have required school districts to develop guidelines, information and forms on the dangers of heat-related illnesses, sudden cardiac death and prescription opioid use.

Last week was a busy one for the bills that we’re working on, so this update will be long again.  Once the session is over my updates will get shorter, I promise!

SB 1389   HIV; needs assessment; prevention was signed by the Governor last week.  It requires the ADHS to establish and implement an HIV Action Program to: 1) complete a statewide HIV Prevention and Care Needs Assessment (Assessment) of target populations (by November 1, 2020); 2) identify community-based agencies that serve the HIV population and that are outside of the known HIV service system; 3) conduct outreach to increase community involvement in HIV prevention, education and stigma reduction; 4) develop a social media initiative to engage at-risk populations to be tested for HIV infection; and 5) analyze data from the Assessment annually to develop and implement HIV training and education initiatives.

SB 1445 AHCCCS Dental care, pregnant women cleared the full Senate but still needs a House Rules hearing and a floor vote. It'll need an appropriation (to provide oral health coverage to pregnant Medicaid members)… so much of the discussion right now is about how much it would cost.

The direct cost to AHCCCS is estimated to be a little less than $268K/year.  However, the Joint Legislative Budget Committee (JLBC) believes that it could have secondary costs. Their thinking goes something like this: pregnant Medicaid enrollees that are not yet receiving prenatal care will discover that there's an oral health benefit and will make a dental appointment. The hygienist or dentist will discover the pregnancy and inform their health plan about the pregnancy. At that point, their eligibility category would switch to one with a higher state match rate (and presumably begin receiving prenatal care- which if it happened would be a good thing). 

The JLBC analysis assumes that 25% of the estimated 5,000 pregnant women currently enrolled in the expansion population but not receiving prenatal care will, because of the new benefit, go to the dentist- causing their eligibility to change (to a category called SOBRA), generating a $3.7M refinancing cost. 

Honestly, it seems unlikely to me that women who aren’t getting prenatal care will present to a dentist or hygienist for a cleaning.  I can see it if they have a toothache, but any secondary cos from a dental emergency would be associated with last year’s emergency dental benefit - not this new (proposed) preventative oral health benefit.  We’ll see what happens during the upcoming budget process.

A new problem is that the effort to raise teacher’s pay is probably going to jeopardize many programs that may have otherwise been funded, like this one.  It’s still possible that this might happen- but it’s a lot less likely now because of the effort to raise teacher’s salaries 20% by 2020.

HB 2159 traffic violations; traffic survival school has been languishing for the last few weeks.  Last week the bill passed the House and has been assigned a Conference Committee to resolve the differences with the Senate version.  This would prohibit drivers from “using a portable wireless communication device to read, write, or send an electronic message while driving” (unless the car is stopped).  The first violation would be a petty offense with a fine between $25 and $99.

HB 2228 Annual waiver, applicability was signed by the Governor this week.  It’s good. It will direct AHCCCS to exempt tribes from their directed waiver request that asks for CMS permission to implement work requirements for some Medicaid members.  The recently submitted Waiver request includes an exemption for American Indians, however, this would place the exemption into statute.

HB 2235 dental therapy; regulation; licensure has had a long and somewhat bizarre trip through the legislature.  The original bill (SB 1377) would have set up a new licensed class of dental professionals called a Dental Therapist.  Their scope of practice would be somewhat less than a DDS, but they could do some procedures like filling cavities.  They could also practice anywhere.  The original bill passed the Senate but died in the House Health committee.  It came back to life a couple of weeks ago as what’s called a Strike Everything Amendment but stalled out again.  Then, this week, an amendment to the amendment was offered that seems to please everybody- and it passed the Senate 30-0.  It still needs to go back to the House, but it has a real chance now.

The Senate version limits dental therapists to only practicing at a Federally Qualified Community Health Center (or look-alike), or a nonprofit dental practice or organization that provides dental care to low-income and underserved individuals, or a private dental practice that provides dental care for CHC patients of record.  The amended bill also prohibits a dental therapist from performing nonsurgical extractions of permanent teeth unless under the direct supervision of a dentist.

The “school safety” bill called SB 1519 protective orders; schools; appropriations was proposed late last week by Senator Smith. Here’s a link to the introduced version.  It contains many of the things outlined by the Governor a few weeks ago related to firearms, schools and protection orders. A centerpiece is something called a “Severe Threat Order of Protection” which outlines a process to restrict firearm access for people who are a danger to themselves or others. There are also measures that would require AHCCCS to develop and post suicide prevention training and a statewide school safety hotline would also be established. 

There’s no provision in the bill for comprehensive background checks or restrictions on things called “bump stocks” which makes guns fire quicker. There are some other troublesome parts of the bill. 

Our folks in the Public Health Policy Committee (including AzPHA member Jean Ajamie who is a school safety expert) has been doing some analysis of the bill (you can see that stuff on our Committee Basecamp- let me know if you’d like to join that group). We haven’t taken a position yet- most likely we’ll remain neutral.  The bill passed the Senate Commerce and Public Safety Committee this week. Next week will be the Senate Rules Committee.  There’s no mirror bill in the House at their point.  Stay tuned.

HB 2323  Schools; inhalers; contracted nurses was signed by the Governor this week.  This bill adds contracted nurses to the list of people who are authorized to provide emergency inhaler medication in case of respiratory emergencies. Some charter and independent schools don’t employ nurses directly but engage them through contracts.

HB 2324 Community health workers; voluntary certification was passed by the Senate this week (24-6)!  It passed the Senate in an amended form (including a provision to ensure that state procurements don’t favor contracting with certified vs non-certified CHWs).  There are two important steps left.  Because the Senate amended the House bill, it needs to go back to the House where Rep. Carter will likely formally concur with the Senate changes.  Then it needs a “Final Read” vote in the House to formally agree with the amendments the Senate added.  Assuming it passes the House again, then it’s on to the Governor for his approval (hopefully) The Senate amendments got the Goldwater Institute to be neutral- so I think we’re in good shape for a signature.

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Here’s a snapshot of where the various bills we’re working on are in the system. 

HB 2038 Drug overdose review teams; records (Signed into Law)

HB 2071 Rear-facing car seats (Stalled in Senate)

HB 2084 Indoor tanning; minors; restricted use (Now called SB 1290 as Striker) 

HB 2127 Children's health insurance program (Now called SB 1087 as Striker)

HB 2197 Health professions, workforce data (Ready for Senate Floor Vote)

HB 2208 Prohibition, photo enforcement (Effectively dead)

HB 2228 Annual waiver, applicability (Signed by Governor)

HB 2323 Schools; inhalers; contracted nurses (Ready for Senate Floor Vote)

HB 2324 Community health workers; voluntary certification (Senate floor vote this week)

HB 2389 Syringe access programs; authorization (Basically dead)

HB 2484 local food tax; equality (Signed by Governor)

SB 1022 ADHS; homemade food products (Signed by Governor) 

SB 1083 Schools; recess periods (Signed by Governor)

SB 1245 Snap Benefit Match (Needs Rules Committee & Budget Line)

SB 1261 Texting while driving (Now HB 2159 traffic violations; traffic survival school)

SB 1420 Medical marijuana; inspection; testing; appropriation (Needs House Rules)

SB 1445 AHCCCS Dental care, pregnant women (Needs House Rules Committee)

SB 1377 Dental therapy, licensure, regulation (Failed in House now HB2235 in Senate)

SB 1394 Abortion reporting (Signed by Governor)

SCR 1005 Voter Initiative Sunset (striker in the House)

 

Public Health-related bills that have been passed and signed:

HB 2038 Drug overdose review teams; records was passed and signed.  Once it takes effect later this year, law enforcement agencies will now be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request. 

HB 2228 Annual waiver, applicability was signed by the Governor.  It’s good. It will direct AHCCCS to exempt tribes from their directed waiver request that asks for CMS permission to implement work requirements for some Medicaid members.  The recently submitted Waiver request includes an exemption for American Indians, however, this would place the exemption into statute.

HB 2323  Schools; inhalers; contracted nurses was signed by the Governor.  This bill adds contracted nurses to the list of people who are authorized to provide emergency inhaler medication in case of respiratory emergencies. Some charter and independent schools don’t employ nurses directly but engage them through contracts.

HB 2484 local food tax; equality, which will ban Arizona cities and counties from taxing sugary drinks as a public health intervention.

SB 1022  DHS; homemade food products ADHS will be required to establish an online registry of food preparers that are authorized to prepare "cottage food products" for commercial purposes. Registered food preparers would be required to renew the registration every three years.

SB 1083 Schools; recess periods was passed and signed!  Beginning next school year K-3 will need to have at least 2 recess periods. Grades 4 and 5 will need to have 2 recess periods the year after that.

SB 1389  HIV; needs assessment; prevention was signed by the Governor last week.  It requires the ADHS to establish and implement an HIV Action Program. 

SB 1394 Abortion reporting was passed by the House and signed by the Governor.  It will require the ADHS to collect and report additional data regarding abortions that are performed in AZ.

____

House Bills

HB 2038 Drug overdose review teams; records                

Passed and Signed

Law enforcement agencies will now be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request.  All information and records acquired by a Team are confidential and not subject to subpoena, discovery or introduction into evidence in a civil or criminal proceeding or disciplinary action.

HB 2071 Rear-facing car seats         

Stalled in Senate

This Bill would require kids under 2 years old to be in a rear-facing restraint system unless the child weights at least 40 pounds or is at least 40 inches tall.  We’ve signed up in support of this bill.  No action has yet been taken in the Senate so this bill is effectively dead.

HB 2084 Indoor tanning; minors; restricted use

Passed House but Stalled in Senate- now SB1290

This bill had been languishing in the Senate after passing the House by a 45-15 vote. Because of its lack of movement in the Senate it had appeared to be dead again this year.  However, this week it reappeared as a Strike All amendment in the House again as SB 1290.  It has now passed the House and has been sent back to the Senate.

HB 2127 Children's health insurance program

Stalled in Senate- now SB 1087 in House

After passing the House, this bill had been languishing in the Senate and appeared dead.  However, it was resurrected this week in the form of SB 1087 and was passed again by the House Health Committee last Thursday.  It still needs another House floor vote before it goes back to the Senate again.  It would remove the trigger that automatically freezes the KidsCare program if FMAP (the federal contribution) drops below 100%. 

It allows the state to freeze it if costs are more than the state or federal allotment. The bill does not require the state to appropriate any money for a state share.  We’ve signed up in support of this bill because it provides a pathway to keep KidsCare if the federal government drops its contribution level. 

HB 2197 Health professions, workforce data

Ready for Senate Floor Vote

This bill is looking good and ready for a final Senate floor vote.  It would require AZ health licensing boards to collect certain data from applicants (beginning January 2020) to get better data about health professions workforce distribution and needs.  The data would be confidential.  Over the long-term this bill would be helpful in providing better data with which to improve the distribution and capacity of the public health workforce in Arizona.

HB 2208 Prohibition, photo enforcement

Died in Senate

This one would prohibit cities and other jurisdictions from having photo enforcement of red light and speeding violations.  While nobody likes getting a ticket in the mail, the data suggest that photo enforcement saves lives and prevents injuries (especially red-light photo enforcement).  We’ve signed up in opposition to the bill.  This bill passed the House 31-27 but stalled in the Senate.  Honestly, it looks dead.

HB 2228 Annual waiver, applicability

Signed by Governor

This would direct AHCCCS to exempt tribes from their directed waiver requests to CMS asking permission to implement work requirements for some Medicaid members.  The recently submitted Waiver request includes an exemption for American Indians, however, this would place the exemption into statute.

HB 2323   Schools; inhalers; contracted nurses

Signed by Governor

This bill adds contracted nurses to the list of people who are authorized to provide emergency inhaler medication in case of respiratory emergencies. Some charter and independent schools don’t employ nurses directly but engage them through contracts.

HB 2324 Community health workers; voluntary certification

Needs Final Read in House

This was passed by the Senate this week (24-6)!  It was in an amended form (including a provision to ensure that state procurements don’t favor contracting with certified vs non-certified CHWs).  There are two important steps left.  Because the Senate amended the House bill, it needs to go back to the House where Rep. Carter will likely formally concur with the Senate changes, and then it needs a “Final Read” vote in the House to formally agree with the amendments the Senate added.  Assuming it passes the House again, then it’s on to the Governor for his approval (hopefully) The Senate amendments got the Goldwater Institute to be neutral- so I think we’re in good shape for a signature.

HB 2389 Syringe access programs; authorization 

Dead

This basically looks dead for this year. The bill that passed the House was great- providing clear decriminalization of needle exchange programs (needle exchange programs are technically a class 6 felony right now).  The version that passed the Senate only decriminalizes syringe exchange programs when and where the ADHS declares a public health emergency because of the rapid spread of infectious diseases.

It went to a Conference Committee this consisting of Rivero, Navarrete, Udall, Borelli, Brophy McGee, and Mendez… but Wednesday, Brophy McGee was replaced with Petersen, basically killing the House version- and the bill was dropped from the Conference Committee agenda- basically killing it.  Honestly, the Senate version of the bill wouldn’t have helped public health much if it all. Maybe next year.

HB 2484 local food tax; equality

Signed by Governor

The Governor signed this bill, which bans Arizona cities and counties from taxing sugary drinks as a public health intervention. The bill doesn’t specifically mention taxes on sugary drinks, but states that any tax on food needs to be uniform.  products must be uniform. Right now, there aren’t any Arizona cities or counties that are taxing soda and other sugary drinks, and this new law will ensure that it stays that was. 

 

Senate Bills

SB 1022    DHS; homemade food products            

Signed by Governor

ADHS will be required to establish an online registry of food preparers that are authorized to prepare "cottage food products" for commercial purposes. Registered food preparers would be required to renew the registration every three years. This is a sensible addition to the current cottage industry food law and we’ve signed up in support.

SB 1083    Schools; recess periods

Signed by Governor

This was passed and signed!  Beginning next school year K-3 will need to have at least 2 recess periods.  Grades 4 and 5 will be added the following year. This makes AZ a national leader in state school recess policy. A big shout out to AzPHA member Scott Turner and Christine Davis from Arizonan’s for Recess for their heavy lifting to make this happen!

SB 1245 Snap Benefit Match

Needs House Rules Committee and Budget Line Item

This Bill needs House Rules review before a House floor vote (and of course needs to make it through the budget process). This good Bill would appropriate $400K to ADES to develop a produce incentive program within the Supplemental Nutrition Assistance Program for members to buy Arizona-grown fruits and vegetables.  It would also provide matching funds to SNAP-authorized vendors as an incentive to participate in the fruits and vegetable program. 

SB 1261 Texting while driving

Now HB 2159 and Moving Again in House

This has been languishing for the last few weeks because it hasn’t been called up for a floor vote in the Senate.  Last week, the language from SB 1261 was added as an amendment onto HB 2159 traffic violations; traffic survival school.  This bill, with the addition of the texting language, passed the House and is headed back to the Senate and has been assigned a Conference Committee.

This would prohibit drivers from “using a portable wireless communication device to read, write, or send an electronic message while driving” (unless the car is stopped).  The first violation would be a petty offense with a fine between $25 and $99.

SB 1377 Dental therapy, licensure, regulation

Moving Again in Amended Form

This has had a long and somewhat bizarre trip through the legislature.  The original bill (SB 1377) would have set up a new licensed class of dental professionals called a Dental Therapist.  Their scope of practice would be somewhat less than a DDS, but they could do some procedures like filling cavities.  They could also practice anywhere.  The original bill passed the Senate but died in the House Health committee.  It came back to life a couple of weeks ago as what’s called a Strike Everything Amendment but stalled out again.  Then, this week, an amendment to the amendment was offered that seems to please everybody- and it passed the Senate 30-0.  It still needs to go back to the House, but it has a real chance now.

The Senate version limits dental therapists to only practicing at a Federally Qualified Community Health Center (or look-alike), or a nonprofit dental practice or organization that provides dental care to low-income and underserved individuals, or a private dental practice that provides dental care for CHC patients of record.  The amended bill also prohibits a dental therapist from performing nonsurgical extractions of permanent teeth unless under the direct supervision of a dentist.

SB 1394 Abortion reporting

Signed by Governor

This one would require the ADHS to collect and report additional data regarding abortions that are performed in AZ. The data would be collected and reported by providers and would include the reason for the abortion (economic, emotional health, physical health, whether the pregnancy was the result of rape or incest, or relationship issues etc.).

SB 1420 Medical marijuana; inspection; testing; appropriation

Needs House Rules Approval

This would require the ADHS to set up testing standards for medical marijuana and begin enforcing the standards beginning in 2019.  We’re supporting this legislation.  It passed the full Senate last week and was given a Pass recommendation by the House Military, Veterans & Regulatory Affairs Committee this week.

SB 1445 AHCCCS Dental care, pregnant women

Needs House Rules and Floor Vote & a Budget Line Item

This unanimously cleared the House Appropriations committee last week.  We were hoping to get a Rules committee hearing next week, but it’s not on the agenda, sadly.  The big hurdle will be getting an appropriation to cover the state match into the budget.

SB 1470  Sunrise process; health professions

After a dramatic start, this bill looks like it will have a consensus ending.  The sunrise process bill stakeholders negotiated changes to the current scope of practice sunrise process that everybody seems to be able to live with.  It passed in House this week by a 59-0 vote. It’s now ready for the Senate to concur in the House’s amendment.

Federal Work Requirement Executive Order

Last week the President issued an Executive Order to the US Departments of Health and Human Services, Agriculture, and Housing charging them with reviewing the eligibility regulations for all of their public assistance programs (e.g. Medicaid, Medicare, SNAP, WIC, Section 8 Housing etc.) and check to see whether they have work requirements.  

If they don’t currently have work requirements, the Order charges them with determining whether the current law would allow them to do so.  Then, in 90 days, they’ll need to turn in a list of policy recommendations to “strengthen existing work requirements for work-capable people and introduce new work requirements”. The Order is of course more complex than I’ve described here- but you can read the whole thing here.

BTW: we expect AHCCCS' directed waiver that will require many (about 200,000) AZ Medicaid members to meet their work/school/community engagement requirements starting 10/1 to be approved any day now.

 

Phoenix Complete Streets

If you live or work in Phoenix, click here to send an email to the City Council members asking them to adopt and implement the Complete Streets Design Guidelines. Please be sure to send your email before the council meeting this Wednesday, April 18, and feel free to share this call to action with Phoenix friends. 

The Complete Streets Advisory Board recommended these design guidelines to the Council in 2015, but weren’t given the opportunity to vote and adopt them. It is now more than two years later, and we need your help to urge them to adopt the guidelines and move forward in protecting everyone who walks, bikes, uses public transportation, and drives on our streets. Thank you to Pinnacle Prevention for the heads up about this.

Send an email with one click!

 

Legislative Session Update

A Bill Called SB 1519 protective orders; schools; appropriations was proposed late last week by Senator Smith. It contains many of the things outlined by the Governor a few weeks ago related to firearms, schools and protection orders. The centerpiece is something called a “Severe Threat Order of Protection” which outlines a process to restrict firearm access for people who are a danger to themselves or others. The process is complicated and outside my area of expertise, so I’m trying to learn more about the proposal.  There are also measures that would require AHCCCS to develop and post suicide prevention training.  A statewide school safety hotline would also be established.

There’s no provision in the bill for comprehensive background checks or restrictions on things called “bump stocks” which makes guns fire quicker. Here’s a link to the introduced version of the bill.  You might need to sit down with somebody with a legal background if you really want to understand it. 

Hardly any organizations or persons are signed up either for or against the bill so far, and no hearing has yet been set in the Senate (It’s assigned to the Commerce and Public Safety Committee).  There’s no mirror bill in the House at their point.  Stay tuned.

SB 1445 AHCCCS Dental care, pregnant women is in the home stretch.  It’s cleared the full Senate but still needs a House Rules hearing and a floor vote. It will require some appropriation (to provide oral health coverage to pregnant Medicaid members)… so much of the discussion right now is about how much it would cost.

The direct cost to the state is estimated to be a little less than $268K.  However, the Joint Legislative Budget Committee believes that it could have secondary costs. Their thinking goes like this: some pregnant Medicaid enrollees that are not yet receiving prenatal care will discover that there is an oral health benefit and that the hygienist or dentist would inform their health plan of their pregnancy. These women would then switch their eligibility category to one with a higher state match rate (and presumably begin receiving prenatal care- which if it happened would be a good thing).  

Their analysis assumes that 25% of the estimated 5,000 pregnant women currently enrolled in the expansion population will switch their eligibility to the pregnant category generating a $3.7M refinancing cost because of the dental benefit.  It just seems to me that it’s unlikely that women that aren’t getting prenatal care from an OBGYN will present to a dentist or hygienist for a cleaning.  I can see it if they have a toothache, but that would likely be from the existing emergency dental benefit- not this new proposed preventative oral health benefit.  We’ll see what happens during the upcoming budget process.

HB 2324 Community health workers; voluntary certification is in the home-stretch.  It succeeded in the Senate’s Committee of the Whole (a voice vote) but wasn’t brought up for a final vote in the Senate as we had hoped (called 3rd Read) last week.  We hope to get on the Senate 3rd Read (final floor vote) calendar this week.

HB 2389 Syringe access programs; authorization basically looks dead for this year. The bill that passed the House was great- providing clear decriminalization of needle exchange programs (needle exchange programs are technically a class 6 felony right now).  The version that passed the Senate only decriminalizes syringe exchange programs when and where the ADHS declares a public health emergency because of the rapid spread of infectious diseases. 

It went to a Conference Committee this consisting of Rivero, Navarrete, Udall, Borelli, Brophy McGee, and Mendez… but Wednesday, Brophy McGee was replaced with Petersen, basically killing the House version- and the bill was dropped from the Conference Committee agenda- basically killing it.  Honestly, the Senate version of the bill wouldn’t have helped public health much if it all. Maybe next year.

HB 2228 Annual waiver, applicability was passed by the Senate and transmitted to the Governor.  It will direct AHCCCS to exempt tribes from their directed waiver request that asks for CMS permission to implement work requirements for some Medicaid members.  The recently submitted Waiver request includes an exemption for American Indians, however, this would place the exemption into statute.

SB 1394 Abortion reporting was passed by the House and signed by the Governor.  It will require the ADHS to collect and report additional data regarding abortions that are performed in AZ.

_______

Here’s a snapshot of where the various bills we’re working on are in the system. 

HB 2038 Drug overdose review teams; records (Signed into Law)

HB 2071 Rear-facing car seats (Stalled in Senate)

HB 2084 Indoor tanning; minors; restricted use (Now called SB 1290 as Striker) 

HB 2127 Children's health insurance program (Now called SB 1087 as Striker)

HB 2197 Health professions, workforce data (Ready for Senate Floor Vote)

HB 2208 Prohibition, photo enforcement (Effectively dead)

HB 2228 Annual waiver, applicability (Sent to Governor)

HB 2323 Schools; inhalers; contracted nurses (Ready for Senate Floor Vote)

HB 2324 Community health workers; voluntary certification (Needs Senate floor vote)

HB 2389 Syringe access programs; authorization (Effectively dead)

HB 2484 local food tax; equality (Signed by Governor)

SB 1022 ADHS; homemade food products (Signed by Governor) 

SB 1083 Schools; recess periods (Passed and Signed)

SB 1245 Snap Benefit Match (Needs Rules Committee & Budget Line)

SB 1261 Texting while driving (Now HB 2159 traffic violations; traffic survival school)

SB 1420 Medical marijuana; inspection; testing; appropriation (Needs House Rules)

SB 1445 AHCCCS Dental care, pregnant women (Needs House Rules Committee)

SB 1377 Dental therapy, licensure, regulation (Failed in House now HB2235 in Senate)

SB 1394 Abortion reporting (Signed by Governor)

SCR 1005 Voter Initiative Sunset (striker in the House)

 

Public Health-related bills that have been passed and signed so far:

HB 2038 Drug overdose review teams; records was passed and signed last week.  Once it takes effect later this year, law enforcement agencies will now be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request. 

HB 2484 local food tax; equality, which will ban Arizona cities and counties from taxing sugary drinks as a public health intervention.

SB 1022  DHS; homemade food products ADHS will be required to establish an online registry of food preparers that are authorized to prepare "cottage food products" for commercial purposes. Registered food preparers would be required to renew the registration every three years. 

SB 1083 Schools; recess periods was passed and signed!  Beginning next school year K-3 will need to have at least 2 recess periods. Grades 4 and 5 will need to have 2 recess periods the year after that.

SB 1394 Abortion reporting was passed by the House and signed by the Governor.  It will require the ADHS to collect and report additional data regarding abortions that are performed in AZ.

____

 

House Bills

HB 2038 Drug overdose review teams; records                

Passed and Signed

Law enforcement agencies will now be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request.  All information and records acquired by a Team are confidential and not subject to subpoena, discovery or introduction into evidence in a civil or criminal proceeding or disciplinary action.

 

HB 2071 Rear-facing car seats         

Stalled in Senate

This Bill would require kids under 2 years old to be in a rear-facing restraint system unless the child weights at least 40 pounds or is at least 40 inches tall.  We’ve signed up in support of this bill.  No action has yet been taken in the Senate so this bill is effectively dead.

 

HB 2084 Indoor tanning; minors; restricted use

Stalled in Senate- now SB1290 in House

This bill had been languishing in the Senate after passing the House by a 45-15 vote. Because of its lack of movement in the Senate it had appeared to be dead again this year.  However, this week it reappeared as a Strike All amendment in the House again as SB 1290.  It got a unanimous pass recommendation from the House Health Committee last Thursday- so was back in business but is now being held in House Rules. 

 

HB 2127 Children's health insurance program

Stalled in Senate- now SB 1087 in House

After passing the House, this bill had been languishing in the Senate and appeared dead.  However, it was resurrected this week in the form of SB 1087 and was passed again by the House Health Committee last Thursday.  It still needs another House floor vote before it goes back to the Senate again.  It would remove the trigger that automatically freezes the KidsCare program if FMAP (the federal contribution) drops below 100%.  

It allows the state to freeze it if costs are more than the state or federal allotment. The bill does not require the state to appropriate any money for a state share.  We’ve signed up in support of this bill because it provides a pathway to keep KidsCare if the federal government drops its contribution level. 

 

HB 2197 Health professions, workforce data

Ready for Senate Floor Vote

This bill is looking good and ready for a final Senate floor vote.  It would require AZ health licensing boards to collect certain data from applicants (beginning January 2020) to get better data about health professions workforce distribution and needs.  The data would be confidential.  Over the long-term this bill would be helpful in providing better data with which to improve the distribution and capacity of the public health workforce in Arizona.

 

HB 2208 Prohibition, photo enforcement

Died in Senate

This one would prohibit cities and other jurisdictions from having photo enforcement of red light and speeding violations.  While nobody likes getting a ticket in the mail, the data suggest that photo enforcement saves lives and prevents injuries (especially red-light photo enforcement).  We’ve signed up in opposition to the bill.  This bill passed the House 31-27 but stalled in the Senate.  Honestly, it looks dead.

 

HB 2228 Annual waiver, applicability

Transmitted to Governor

This would direct AHCCCS to exempt tribes from their directed waiver requests to CMS asking permission to implement work requirements for some Medicaid members.  The recently submitted Waiver request includes an exemption for American Indians, however, this would place the exemption into statute.

 

HB 2323  Schools; inhalers; contracted nurses

Ready for Senate Floor Vote

This bill adds contracted nurses to the list of people who are authorized to provide emergency inhaler medication in case of respiratory emergencies. Some charter and independent schools don’t employ nurses directly but engage them through contracts. Ready for a final Senate floor vote.

 

HB 2324 Community health workers; voluntary certification

Still needs Senate 3rd Read (Passed COW)

This succeeded in the Senate’s Committee of the Whole (a voice vote) but wasn’t brought up for a final vote in the Senate as we had hoped (called 3rd Read).  To get through COW, we supported an amendment to “grandfather” current CHWs who’ve worked for 6 months over 3 years as a CHW & to prohibit the state and subdivisions from offering preferential public contracts for voluntarily certified CHWs. We hope to get on the Senate 3rd Read calendar this week.

 

HB 2389  Syringe access programs; authorization

Effectively Dead

The bill that passed the House was great- providing clear decriminalization of needle exchange programs (needle exchange programs are technically a class 6 felony right now).  The version that passed the Senate only decriminalizes syringe exchange programs when and where the ADHS declares a public health emergency because of the rapid spread of infectious diseases. The bill died in a conference committee.

Maybe next year.

 

HB 2484 local food tax; equality

Signed by Governor

The Governor signed this bill, which bans Arizona cities and counties from taxing sugary drinks as a public health intervention. The bill doesn’t specifically mention taxes on sugary drinks, but states that any tax on food needs to be uniform.  products must be uniform. Right now, there aren’t any Arizona cities or counties that are taxing soda and other sugary drinks, and this new law will ensure that it stays that was.  

 

Senate Bills

SB 1022    DHS; homemade food products            

Signed by Governor

ADHS will be required to establish an online registry of food preparers that are authorized to prepare "cottage food products" for commercial purposes. Registered food preparers would be required to renew the registration every three years. This is a sensible addition to the current cottage industry food law and we’ve signed up in support.

 

SB 1083    Schools; recess periods

Signed by Governor

This was passed and signed!  Beginning next school year K-3 will need to have at least 2 recess periods.  Grades 4 and 5 will be added the following year. This makes AZ a national leader in state school recess policy. A big shout out to AzPHA member Scott Turner and Christine Davis from Arizonan’s for Recess for their heavy lifting to make this happen!

 

SB 1245 Snap Benefit Match

Needs House Rules Committee and Budget Line Item

This Bill needs House Rules review before a House floor vote (and of course needs to make it through the budget process). This good Bill would appropriate $400K to ADES to develop a produce incentive program within the Supplemental Nutrition Assistance Program for members to buy Arizona-grown fruits and vegetables.  It would also provide matching funds to SNAP-authorized vendors as an incentive to participate in the fruits and vegetable program. 

 

SB 1261 Texting while driving

Now HB 2159 and Moving Again in House

This has been languishing for the last few weeks because it hasn’t been called up for a floor vote in the Senate.  Last week, the language from SB 1261 was added as an amendment onto HB 2159 traffic violations; traffic survival school.  This bill, with the addition of the texting language, is now in the House awaiting a final vote.  

This would prohibit drivers from “using a portable wireless communication device to read, write, or send an electronic message while driving” (unless the car is stopped).  The first violation would be a petty offense with a fine between $25 and $99.

 

SB 1377 Dental therapy, licensure, regulation

Stalled in House now HB 2235

This bill failed to get a Pass recommendation from the House Health Committee last week (5-4) and is now HB 2235 as a striker.  It would have set up a new licensed class of dental professionals called a Dental Therapist. Their scope of practice would be somewhat less than a DDS, but they could do some procedures like filling cavities. This has been a somewhat controversial bill as there are stakeholders of both sides that are quite passionate about their position on this Bill.  

 

SB 1394 Abortion reporting

Signed by Governor

This one would require the ADHS to collect and report additional data regarding abortions that are performed in AZ. The data would be collected and reported by providers and would include the reason for the abortion (economic, emotional health, physical health, whether the pregnancy was the result of rape or incest, or relationship issues etc.).

 

SB 1420 Medical marijuana; inspection; testing; appropriation

Needs House Rules Approval

This would require the ADHS to set up testing standards for medical marijuana and begin enforcing the standards beginning in 2019.  We’re supporting this legislation.  It passed the full Senate last week and was given a Pass recommendation by the House Military, Veterans & Regulatory Affairs Committee this week.

 

SB 1445 AHCCCS Dental care, pregnant women

Needs House Rules and Floor Vote & a Budget Line Item

This unanimously cleared the House Appropriations committee last week.  We were hoping to get a Rules committee hearing next week, (Monday April 9) but it’s not on the agenda, sadly.  The big hurdle will be getting an appropriation to cover the state match into the budget.

 

SB 1470  Sunrise process; health professions

After a dramatic start, this bill looks like it will have a consensus ending.  The sunrise process bill stakeholders negotiated changes to the current scope of practice sunrise process that everybody seems to be able to live with.  It passed in House this week by a 59-0 vote. It’s now ready for the Senate to concur in the House’s amendment.

____________

 

Thanks to all of you that planned, sponsored, exhibited, presented, or attended our conference last week.  We still need to input the data from the evaluations- but we think it was a real success!

 

Mark your calendars for Wednesday, October 3, 2018 for our fall conference and annual members meeting.  Our topic will be about engaging public and behavioral health to improve outcomes.  It'll also commemorate our 90th anniversary!

 

 

AzPHA Public Health Policy Update: April 9, 2018

AzPHA Spring Conference is Wednesday!

We’re looking forward to seeing many of you at our Conference on Wednesday: Together for Tomorrow: Protecting Arizona’s Children at the Desert Willow Conference Center. Here’s the Conference Program with all the particulars. Check in starts at 7:30 am with the agenda starting at 8:30 am (breakfast is provided). We hope many of you will stay for our hosted reception immediately following the conference!

New Immigration Rule Could Damage Public Health

The Department of Homeland Security Secretary Kirstjen Nielsen is in the final stages of proposing a new Rule that would require the Immigration and Naturalization Service (INS) to consider a much broader range of factors when determining whether immigrants or their U.S.-citizen children are using public benefits (using certain public benefits hurts applicant’s chances at changing their legal immigration status).

Currently, the INS uses information about whether applicants for legal permanent residency (and other immigration categories) receive cash assistance as a factor when considering applications. Applicants that receive have received cash assistance are less likely to be approved.  Proposed new changes expected to be out for public comment shortly that will broaden the benefits considered to include non-cash assistance like WIC, SNAP, Medicaid, CHIP, school lunch programs, and perhaps even participation in the Vaccines for Children program.

In 1999, the INS issued Rules to "address the public’s concerns about immigrant fears of accepting public benefits for which they remained eligible, specifically medical care, children's immunizations, basic nutrition and treatment of medical conditions that may jeopardize public health.” Here's that final Rule from 1999. 

The (1999) Rule states that "Other non-cash public benefits that will not be considered include Medicaid; CHIP; emergency medical assistance; other health insurance and health services for the testing and treatment of symptoms of communicable diseases; emergency disaster relief; nutrition programs, such as Food Stamps and WIC; housing benefits; energy benefits; job training programs; child care; and non-cash benefits funded under the TANF program." 

The new proposed Rule is expected to be released shortly and says that: "DHS does not believe it is appropriate to set aside such benefits in its public charge analyses. DHS, therefore, proposes to consider cash and non-cash public benefits that are means-tested or otherwise used to meet basic living requirements” as they consider applications (e.g. WIC, SNAP, Medicaid, CHIP, school lunch programs, and perhaps even VFC).  These kinds of changes will have a chilling effect on whether people who can now legally participate in these programs would continue to do so. It would also make it less likely that folks will participate in other kinds of public health programs like disease control and childhood vaccinations.

We’ll keep an eye on the Federal Register (DHS Docket No. USCIS 2010-0012) and comment on the package at www.regulations.gov from a public health perspective.

 

School Safety Bill Expected this Week

We expect somebody from the legislature to propose a school/firearm safety bill this week. A couple of weeks ago the Governor floated the idea of a new law that would do several things related to school safety like: 1) Increase behavioral health resources in schools; 2) Increase school resource officer funding and training and increases the presence of law enforcement on school grounds; 3) Severe Threat Order of Protection orders that would restrict firearm access for people who are a danger to themselves or others; and 4) Establish a “Center for School Safety” with a centralized reporting tip line to report and investigate concerns of school safety.  There was no discussion of a universal background check provision.

We’ll withhold our judgment about whether to support the bill until after it’s released and we have a chance to talk to some subject matter experts about the nuances of the proposal.

 

Legislative Session Update

SB 1083 Schools; recess periods was passed and signed!  Beginning next school year K-3 will need to have at least 2 recess periods. Grades 4 and 5 will be added the following year. This makes AZ a national leader in state school recess policy. A big shout out to AzPHA member Scott Turner and Christine Davis from Arizonan’s for Recess for their heavy lifting to make this happen!

SB 1445 AHCCCS Dental care, pregnant women unanimously cleared the House Appropriations committee last week.  We were hoping to get a Rules committee hearing next week (Monday April 9) but it’s not on the agenda for today. The big hurdle will be getting an appropriation to cover the state match into the budget.

HB 2324 Community health workers; voluntary certification succeeded in the Senate’s Committee of the Whole (a voice vote) but wasn’t brought up for a final vote in the Senate as we had hoped (called 3rd Read).  To get through COW, we supported an amendment to “grandfather” current CHWs who’ve worked for 6 months over 3 years as a CHW & to prohibit the state and subdivisions from offering preferential public contracts for voluntarily certified CHWs. We hope to get on the Senate 3rd Read (final floor vote) calendar this week.

HB 2389 Syringe access programs; authorization passed the full Senate 2 weeks ago but in a substantially weakened form. The original bill would’ve decriminalized needle exchange programs. The amendment only decriminalizes syringe exchange programs when and where the ADHS declares a public health emergency because of the rapid spread of infectious diseases. When the amended bill went back to the House for concurrence- it was refused (a good thing) and it’ll now go to a conference consisting of Rivero, Navarrete, Udall, Borelli, Brophy McGee, and Mendez. We sent information to the urging the conference committee members to drop the amendment requiring a ARS 36-761 emergency to provide prosecutorial protection for syringe exchange programs.

SCR 1005 is troubling new Resolution that’s a Strike Everything amendment in the House. It states that voter initiatives that have any kind of money attached need to go back to the ballot every 10 years. It’s unclear whether it’s intended to be prospective or whether it applies to previously approved measures (it’s quite cryptic).  Here’s what it says: “AN INITIATIVE (which has money attached) IS REPEALED TEN YEARS AFTER THE EFFECTIVE DATE OF THE INITIATIVE UNLESS AN EARLIER REPEAL DATE APPLIES TO THE INITIATIVE”. 

If it makes it through the Legislature it would still need to be approved by voters- but it’s a troubling proposal indeed as things like First Things First, the Smoke Free Arizona Act, and Proposition 204 which provides a lot of Medicaid funding could get caught up in the requirement. Fortunately, there are a few steps left in the process so perhaps we can stop this in its tracks.

_______

Here’s a snapshot of where the various bills we’re working on are in the system. 

HB 2038 Drug overdose review teams; records (Signed into Law)

HB 2071 Rear-facing car seats (Stalled in Senate)

HB 2084 Indoor tanning; minors; restricted use (Now called SB 1290 as Striker) 

HB 2127 Children's health insurance program (Now called SB 1087 as Striker)

HB 2197 Health professions, workforce data (Ready for Senate Floor Vote)

HB 2208 Prohibition, photo enforcement (Effectively dead)

HB 2228 Annual waiver, applicability (Passed Senate COW, Needs 3rd Read)

HB 2323 Schools; inhalers; contracted nurses (Ready for Senate Floor Vote)

HB 2324 Community health workers; voluntary certification (Senate floor vote this week)

HB 2389 Syringe access programs; authorization (Passed Senate- going bk to House)

HB 2484 local food tax; equality (Signed by Governor)

SB 1022 ADHS; homemade food products (Signed by Governor) 

SB 1083 Schools; recess periods (Passed and Signed)

SB 1245 Snap Benefit Match (Needs Rules Committee & Budget Line)

SB 1261 Texting while driving (Now HB 2159 traffic violations; traffic survival school)

SB 1420 Medical marijuana; inspection; testing; appropriation (Needs House Rules)

SB 1445 AHCCCS Dental care, pregnant women (Needs House Rules Committee)

SB 1377 Dental therapy, licensure, regulation (Failed in House now HB2235 in Senate)

SB 1394 Abortion reporting (Ready for House Floor Vote)

SCR 1005 Voter Initiative Sunset (striker in the House)

 

Public Health-related bills that have been passed and signed so far:

HB 2038 Drug overdose review teams; records was passed and signed last week.  Once it takes effect later this year, law enforcement agencies will now be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request. 

HB 2484 local food tax; equality, which will ban Arizona cities and counties from taxing sugary drinks as a public health intervention.

SB 1022  DHS; homemade food products ADHS will be required to establish an online registry of food preparers that are authorized to prepare "cottage food products" for commercial purposes. Registered food preparers would be required to renew the registration every three years.

SB 1083 Schools; recess periods was passed and signed!  Beginning next school year K-3 will need to have at least 2 recess periods.

____

 

House Bills

HB 2038 Drug overdose review teams; records                

Passed and Signed

Law enforcement agencies will now be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request.  All information and records acquired by a Team are confidential and not subject to subpoena, discovery or introduction into evidence in a civil or criminal proceeding or disciplinary action.

HB 2071 Rear-facing car seats         

Stalled in Senate

This Bill would require kids under 2 years old to be in a rear-facing restraint system unless the child weights at least 40 pounds or is at least 40 inches tall.  We’ve signed up in support of this bill.  No action has yet been taken in the Senate so this bill is effectively dead.

HB 2084 Indoor tanning; minors; restricted use

Stalled in Senate- now SB1290 in House

This bill had been languishing in the Senate after passing the House by a 45-15 vote. Because of its lack of movement in the Senate it had appeared to be dead again this year.  However, this week it reappeared as a Strike All amendment in the House again as SB 1290.  It got a unanimous pass recommendation from the House Health Committee last Thursday- so was back in business but is now being held in House Rules. 

HB 2127 Children's health insurance program

Stalled in Senate- now SB 1087 in House

After passing the House, this bill had been languishing in the Senate and appeared dead.  However, it was resurrected this week in the form of SB 1087 and was passed again by the House Health Committee last Thursday.  It still needs another House floor vote before it goes back to the Senate again.  It would remove the trigger that automatically freezes the KidsCare program if FMAP (the federal contribution) drops below 100%.  It allows the state to freeze it if costs are more than the state or federal allotment. The bill does not require the state to appropriate any money for a state share.  We’ve signed up in support of this bill because it provides a pathway to keep KidsCare if the federal government drops its contribution level. 

HB 2197 Health professions, workforce data

Ready for Senate Floor Vote

This bill is looking good and ready for a final Senate floor vote.  It would require AZ health licensing boards to collect certain data from applicants (beginning January 2020) to get better data about health professions workforce distribution and needs.  The data would be confidential.  Over the long-term this bill would be helpful in providing better data with which to improve the distribution and capacIty of the public health workforce in Arizona.

HB 2208 Prohibition, photo enforcement

Died in Senate

This one would prohibit cities and other jurisdictions from having photo enforcement of red light and speeding violations.  While nobody likes getting a ticket in the mail, the data suggest that photo enforcement saves lives and prevents injuries (especially red-light photo enforcement).  We’ve signed up in opposition to the bill.  This bill passed the House 31-27 but stalled in the Senate.  Honestly, it looks dead.

HB 2228 Annual waiver, applicability

Needs Senate 3rd Read

This would direct AHCCCS to exempt tribes from their directed waiver requests to CMS asking permission to implement work requirements for some Medicaid members.  The recently submitted Waiver request includes an exemption for American Indians, however, this would place the exemption into statute.

HB 2323   Schools; inhalers; contracted nurses

Ready for Senate Floor Vote

This bill adds contracted nurses to the list of people who are authorized to provide emergency inhaler medication in case of respiratory emergencies. Some charter and independent schools don’t employ nurses directly but engage them through contracts. Ready for a final Senate floor vote.

HB 2324 Community health workers; voluntary certification

Still needs Senate 3rd Read (Passed COW)

This succeeded in the Senate’s Committee of the Whole (a voice vote) but wasn’t brought up for a final vote in the Senate as we had hoped (called 3rd Read).  To get through COW, we supported an amendment to “grandfather” current CHWs who’ve worked for 6 months over 3 years as a CHW & to prohibit the state and subdivisions from offering preferential public contracts for voluntarily certified CHWs. We hope to get on the Senate 3rd Read calendar this week.

HB 2389  Syringe access programs; authorization

Passed Senate in Weak Form- going back to House

This passed the full Senate 2 weeks ago but in a substantially weakened form. The original bill would’ve decriminalized needle exchange programs. The amendment only decriminalize programs when and where the ADHS declares a public health emergency because of the rapid spread of infectious diseases. When the amended bill went back to the House for concurrence- it was refused (a good thing) and it’ll now go to a conference committee consisting of Rivero, Navarrete, Udall, Borelli, Brophy McGee, and Mendez. We will encourage them to drop the amendment requiring a ARS 36-761 emergency to provide prosecutorial protection for syringe exchange programs.

HB 2484 local food tax; equality

Signed by Governor

The Governor signed this bill, which bans Arizona cities and counties from taxing sugary drinks as a public health intervention. The bill doesn’t specifically mention taxes on sugary drinks, but states that any tax on food needs to be uniform.  products must be uniform. Right now, there aren’t any Arizona cities or counties that are taxing soda and other sugary drinks, and this new law will ensure that it stays that was. 

 

Senate Bills

SB 1022    DHS; homemade food products            

Signed by Governor

ADHS will be required to establish an online registry of food preparers that are authorized to prepare "cottage food products" for commercial purposes. Registered food preparers would be required to renew the registration every three years. This is a sensible addition to the current cottage industry food law and we’ve signed up in support.

SB 1083    Schools; recess periods

Signed by Governor

This was passed and signed!  Beginning next school year K-3 will need to have at least 2 recess periods.  Grades 4 and 5 will be added the following year. This makes AZ a national leader in state school recess policy. A big shout out to AzPHA member Scott Turner and Christine Davis from Arizonan’s for Recess for their heavy lifting to make this happen!

SB 1245 Snap Benefit Match

Needs House Rules Committee and Budget Line Item

This Bill needs House Rules review before a House floor vote (and of course needs to make it through the budget process). This good Bill would appropriate $400K to ADES to develop a produce incentive program within the Supplemental Nutrition Assistance Program for members to buy Arizona-grown fruits and vegetables.  It would also provide matching funds to SNAP-authorized vendors as an incentive to participate in the fruits and vegetable program. 

SB 1261 Texting while driving

Now HB 2159 and Moving Again in House

This has been languishing for the last few weeks because it hasn’t been called up for a floor vote in the Senate.  Last week, the language from SB 1261 was added as an amendment onto HB 2159 traffic violations; traffic survival school.  This bill, with the addition of the texting language, is now in the House awaiting a final vote. 

This would prohibit drivers from “using a portable wireless communication device to read, write, or send an electronic message while driving” (unless the car is stopped).  The first violation would be a petty offense with a fine between $25 and $99.

SB 1377 Dental therapy, licensure, regulation

Stalled in House now HB 2235

This bill failed to get a Pass recommendation from the House Health Committee last week (5-4) and is now HB 2235 as a striker.  It would have set up a new licensed class of dental professionals called a Dental Therapist. Their scope of practice would be somewhat less than a DDS, but they could do some procedures like filling cavities. This has been a somewhat controversial bill as there are stakeholders of both sides that are quite passionate about their position on this Bill.  

SB 1394 Abortion reporting

Ready for House Floor Vote

This one would require the ADHS to collect and report additional data regarding abortions that are performed in AZ. The data would be collected and reported by providers and would include the reason for the abortion (economic, emotional health, physical health, whether the pregnancy was the result of rape or incest, or relationship issues etc.).  The bill was given a Do Pass recommendation last week by the House Judiciary & Public Safety Committee- although it was amended slightly by removing the requirement that physicians ask and report specifically why the woman is asking for the procedure.

SB 1420 Medical marijuana; inspection; testing; appropriation

Needs House Rules Approval

This would require the ADHS to set up testing standards for medical marijuana and begin enforcing the standards beginning in 2019.  We’re supporting this legislation.  It passed the full Senate last week and was given a Pass recommendation by the House Military, Veterans & Regulatory Affairs Committee this week.

SB 1445 AHCCCS Dental care, pregnant women

Needs House Rules and Floor Vote & a Budget Line Item

This unanimously cleared the House Appropriations committee last week.  We were hoping to get a Rules committee hearing next week, (Monday April 9) but it’s not on the agenda, sadly.  The big hurdle will be getting an appropriation to cover the state match into the budget.

SB 1470  Sunrise process; health professions

After a dramatic start, this bill looks like it will have a consensus ending.  The sunrise process bill stakeholders negotiated changes to the current scope of practice sunrise process that everybody seems to be able to live with.  It passed in House this week by a 59-0 vote. It’s now ready for the Senate to concur in the House’s amendment.

Celebrate Public Health Week

 

What do you think is most responsible for the increase in life expectancy over the last century – the improvements in medical technology or improvements in public health? 

The answer is clear, it’s public health.  During the 20th century, the health and life expectancy of Americans persons improved dramatically. Since 1900, the average lifespan lengthened by more than 30 years- and 25 of that was from public health interventions like vaccinations, car safety, workplace health and safety improvements and safer and healthier foods.

This week marks the American Public Health Association’s National Public Health Week.  During Public Health Week we celebrate the successes of public health over the decades and look to the present and future as we build action plans to continue our success.   As Arizona’s Affiliate Organization to the APHA, the Arizona Public Health Association we’re proud to celebrate in unity with our public health system. Today we focus on infectious diseases.

 

Why should I care?

To date, the world has eradicated only one infectious human disease, smallpox, and one animal disease, rinderpest. (Though after decades of work, we're closer than ever to eradicating polio, too .) What keeps the rest of those communicable diseases at bay is prevention. And that requires a combination of strong public health systems, access to medical and preventive care and individual responsibility. No one can fight off infectious disease on his or her own.

Public Health: If there's a front line in the fight against communicable disease, it's being manned by your local, state and federal public health officials. These are the professionals who monitor our environments for dangerous viruses and bacteria, investigate and contain disease outbreaks and administer key education and immunization programs. Public health workers are also our first responders, protecting us from emerging communicable disease threats such as Zika, Ebola and pandemic flu.

Access to care: Widening people's access to health insurance and medical care can prevent communicable disease in the first place, offer timely treatments to those who are sick and cut down the chance of community transmission. For example, after the Affordable Care Act required insurers to cover preventive services, young women were much more likely to get immunized against human papillomavirus, the communicable disease linked to cervical cancer. People with health insurance are also more likely to report timely care and are less likely to go without needed care because it costs too much. Finally, ensuring everyone has access to care protects the larger community from preventable and costly disease: For example, early access to antiretroviral therapy reduces the chance of HIV transmission.

Individual responsibility: Fending off communicable disease requires personal action, too. It's up to us to get immunized against the flu and encourage our loved ones to do the same. Flu vaccine effectiveness can vary year to year, but it can reduce your chance of getting sick by up to 60 percent. And remember: immunizations aren't just about you — it’s also about protecting those for whom vaccine-preventable diseases are a deadly threat, such as the very young, very old and people with compromised immune systems.

What can I do?

Learn how to protect yourself from communicable diseases. Visit APHA’s Get Ready campaign for resources on flu immunizations and hand-washing. Talk to your teens about preventing sexually transmitted diseases — surveys show parents actually have a big influence on teen decisions abut sex. And take precautions to protect yourself from disease vectors like mosquitoes and ticks. If you’re traveling out of the country, take the necessary precautions to keep yourself healthy and avoid bringing an uninvited guest back home.

Let's Celebrate National Public Health Week Together

Join AzPHA in Celebrating National Public Health Week!

What do you think is most responsible for the increase in life expectancy over the last century – the improvements in medical technology or improvements in public health? 

The answer is clear, it’s public health.  During the 20th century, the health and life expectancy of Americans persons improved dramatically. Since 1900, the average lifespan lengthened by more than 30 years- and 25 of that was from public health interventions like vaccinations, car safety, workplace health and safety improvements and safer and healthier foods.

This week marks the American Public Health Association’s National Public Health Week.  During Public Health Week we celebrate the successes of public health over the decades and look to the present and future as we build action plans to continue our success.   As Arizona’s Affiliate Organization to the APHA, the Arizona Public Health Association we’re proud to celebrate in unity with our public health system. Today we start with Behavioral Health

About one in every five U.S. adults — or more than 43 million people — experience mental illness in a given year. And one in five youth ages 13 to 18 experiences a severe mental disorder at some point in their lives. Mental illness is associated with billions of dollars in care and lost productivity each year.

At the forefront of today's behavioral health concerns is an epidemic of opioid addiction that's killing thousands of Americans each year — 91 people each day — and overwhelming local law enforcement, public health and child protective systems. The epidemic is so bad that it's the main factor driving the recent decline in average American life expectancy.

Addiction: Since 1999, overdose deaths from opioids, both prescription opioids and heroin, have increased by more than five times. In 2016 alone, opioids were involved in more than 42,000 U.S. deaths — that's more than any year on record. Every state has felt the impact of the addiction and overdose epidemic, but some states are being particularly hard hit. For example, in Ohio, increasing abuse of fentanyl, a synthetic opioid, drove a more than 32 percent increase in drug overdose deaths between 2015 and 2016.

Mental illness: Across illnesses and injuries, brain disorders represent the single largest source of disability-adjusted life years in the U.S., accounting for nearly 20 percent of disability from all causes. Nearly 7 percent of U.S. adults, or 16 million people, have had at least one major depressive episode in the last year; about 18 percent experienced an anxiety disorder; and about half of the more than 20 million adults struggling with addiction have a co-occurring mental illness. Less than half of U.S. adults with a mental health condition received any care in the past year.

Suicide: The U.S. suicide rate increased 24 percent between 1999 and 2014, going up for both men and women and among people of nearly all ages. In 2015, suicide was one of the nation's leading causes of death, taking the lives of more than 44,000 people. As with most health issues, suicide doesn't affect all communities the same: Lesbian, gay and bisexual youth are at significantly higher risk of suicide , as are American Indians and Alaska Natives.

What can you do?

Support policies that acknowledge addiction as a chronic and preventable disease. Recent data show that only about 10 percent of the millions who need addiction treatment actually get it. But some policies do make a positive difference, namely the Affordable Care Act and Medicaid expansion. Spending on Medicaid-covered prescriptions for both opioid addiction treatment and overdose prevention went up dramatically after ACA implementation — meaning the law is opening access to what is often life-saving care. Advocates warn that rolling back Medicaid access would be especially devastating for states dealing with rising overdose death rates.

If you’re a health professional, learn about CDC’s opioid prescribing guidelines for chronic pain and share them with colleagues.

Support parity for mental health. The ACA established parity between physical and mental care, designating mental health and substance use disorder services as essential health benefits that insurers must cover. The result:the ACA expanded parity protections for 62 million Americans.

#SpeakForHealth in support of the ACA and its success in opening access to mental health and addiction care. Visit APHA's advocacy page to stay informed on the latest policy issues, and write to your members of Congress.

Learn more about suicide warning signs and help others find support: https://suicidepreventionlifeline.org.

AzPHA Public Health Policy Update: April 2, 2018

 

Legislative Session Update

SB 1083 Schools; recess periods passed in the House last week by a wide margin (57–1).  It was amended slightly from its original Senate version (giving grades 4 & 5 an extra year to implement).  It’s headed back to the Senate with the amendment.  District and charter schools would be required to provide at least 2 recess periods during the school day for pupils in grades K-5 if it passes. Good news.

SB 1445 AHCCCS Dental care, pregnant women unanimously cleared the House Appropriations committee this week!  The next stop is the House Rules committee (which shouldn’t be a problem).  It’ll then be ready for a House floor vote. The big hurdle will be getting an appropriation to cover the state match into the budget. We’re trying to get a closer estimate of what it’ll take for the state match.  Senator Yee is the sponsor- which is a good thing because she’s the Senate Majority leader and will be influential during the budget negotiations.

HB 2127 Children's health insurance program removes the trigger that would automatically freeze the KidsCare program if federal matching drops below 100%.  It was heard but not voted on in the Senate Appropriations committee last week.  The contents of the bill were struck onto SB 1087.  HB 2127 is now dead since it didn’t pass out of a committee in the Senate, but it’s still possible for SB 1087 to get voted out of the House and then it would need to go back to the Senate.

HB 2324 Community health workers; voluntary certification is up for a floor vote in the Senate this afternoon.  To smooth the pathway for final passage, we’re supporting an amendment to the original bill that would “grandfather” current CHWs who’ve worked for 6 months over 3 years as a CHW & to prohibit the state and subdivisions from offering preferential public contracts for voluntarily certified CHWs. If we pass this week in the floor vote (with the amendment) the bill get transmitted back to the House because of the amendment.

HB 2389 Syringe access programs; authorization passed the full Senate last week (22-8) but in a substantially weakened form. The original bill would’ve decriminalized needle exchange programs. The amendment only decriminalize programs when and where the ADHS declares a public health emergency because of the rapid spread of infectious diseases. The bill will now go back to the House to resolve the differences in the House and Senate forms.  Hopefully we can get the amendment removed.  If we can’t and it passes and is signed with the amendment it’ll have limited public health utility.

______

Here’s a snapshot of where the various bills we’re working on are in the system. 

HB 2038 Drug overdose review teams; records (Signed into Law)

HB 2071 Rear-facing car seats (Stalled in Senate)

HB 2084 Indoor tanning; minors; restricted use (Now called SB 1290 as Striker) 

HB 2127 Children's health insurance program (Now called SB 1087 as Striker)

HB 2197 Health professions, workforce data (Ready for Senate Floor Vote)

HB 2208 Prohibition, photo enforcement (Effectively dead)

HB 2228 Annual waiver, applicability (Needs Senate Rules Committee Approval)

HB 2323 Schools; inhalers; contracted nurses (Ready for Senate Floor Vote)

HB 2324 Community health workers; voluntary certification (Senate floor vote this week)

HB 2389 Syringe access programs; authorization (Passed Senate- going back to House)

HB 2484 local food tax; equality (Signed by Governor)

SB 1022 ADHS; homemade food products (Signed by Governor) 

SB 1083 Schools; recess periods (Passed House- going back to Senate)

SB 1245 Snap Benefit Match (Needs Rules Committee & Budget Line)

SB 1261 Texting while driving (Now HB 2159 traffic violations; traffic survival school)

SB 1420 Medical marijuana; inspection; testing; appropriation (Needs House Rules)

SB 1445 AHCCCS Dental care, pregnant women (Needs House Rules Committee)

SB 1377 Dental therapy, licensure, regulation (Failed in House now HB2235 in Senate as striker)

SB 1394 Abortion reporting (Ready for House Floor Vote)

 

Public Health-related bills that have been passed and signed so far:

HB 2038 Drug overdose review teams; records was passed and signed last week.  Once it takes effect later this year, law enforcement agencies will now be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request. 

HB 2484 local food tax; equality, which will ban Arizona cities and counties from taxing sugary drinks as a public health intervention.

SB 1022  DHS; homemade food products ADHS will be required to establish an online registry of food preparers that are authorized to prepare "cottage food products" for commercial purposes. Registered food preparers would be required to renew the registration every three years.

 

____

House Bills

HB 2038 Drug overdose review teams; records                

Passed and Signed

Law enforcement agencies will now be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request.  All information and records acquired by a Team are confidential and not subject to subpoena, discovery or introduction into evidence in a civil or criminal proceeding or disciplinary action.

 

HB 2071 Rear-facing car seats         

Stalled in Senate

This Bill would require kids under 2 years old to be in a rear-facing restraint system unless the child weights at least 40 pounds or is at least 40 inches tall.  We’ve signed up in support of this bill.  No action has yet been taken in the Senate so this bill is effectively dead.

HB 2084 Indoor tanning; minors; restricted use

Stalled in Senate- now SB1290 in House

This bill had been languishing in the Senate after passing the House by a 45-15 vote. Because of its lack of movement in the Senate it had appeared to be dead again this year.  However, this week it reappeared as a Strike All amendment in the House again as SB 1290.  It got a unanimous pass recommendation from the House Health Committee last Thursday- so was back in business but is now being held in House Rules. 

If it passes and is signed, tanning facility operators would be prohibited from allowing a person under 18 years of age to use a "tanning device" and tanning facilities couldn’t claim that using a tanning device is free from risk or has health benefits. We’ve signed on in support of this of course.

HB 2127 Children's health insurance program

Stalled in Senate- now SB 1087 in House

After passing the House, this bill had been languishing in the Senate and appeared dead.  However, it was resurrected this week in the form of SB 1087 and was passed again by the House Health Committee last Thursday.  It still needs another House floor vote before it goes back to the Senate again.  It would remove the trigger that automatically freezes the KidsCare program if FMAP (the federal contribution) drops below 100%.  It allows the state to freeze it if costs are more than the state or federal allotment. The bill does not require the state to appropriate any money for a state share.  We’ve signed up in support of this bill because it provides a pathway to keep KidsCare if the federal government drops its contribution level. 

HB 2197 Health professions, workforce data

Ready for Senate Floor Vote

This bill is looking good and ready for a final Senate floor vote.  It would require AZ health licensing boards to collect certain data from applicants (beginning January 2020) to get better data about health professions workforce distribution and needs.  The data would be confidential.  Over the long-term this bill would be helpful in providing better data with which to improve the distribution and capacity of the public health workforce in Arizona.

HB 2208 Prohibition, photo enforcement

Died in Senate

This one would prohibit cities and other jurisdictions from having photo enforcement of red light and speeding violations.  While nobody likes getting a ticket in the mail, the data suggest that photo enforcement saves lives and prevents injuries (especially red-light photo enforcement).  We’ve signed up in opposition to the bill.  This bill passed the House 31-27 but stalled in the Senate.  Honestly, it looks dead.

HB 2228 Annual waiver, applicability

Still Needs Senate Rules Committee

This would direct AHCCCS to exempt tribes from their directed waiver requests to CMS asking permission to implement work requirements for some Medicaid members.  The recently submitted Waiver request includes an exemption for American Indians, however, this would place the exemption into statute.

HB 2323  Schools; inhalers; contracted nurses

Ready for Senate Floor Vote

This bill adds contracted nurses to the list of people who are authorized to provide emergency inhaler medication in case of respiratory emergencies. Some charter and independent schools don’t employ nurses directly but engage them through contracts. Ready for a final Senate floor vote.

HB 2324 Community health workers; voluntary certification

Still needs Senate Floor Vote (this week)

This Bill is ready for a floor vote in the Senate, and we’re on the COW calendar in the afternoon of Monday, April 2.  To smooth the pathway for final passage, we’re supporting an amendment to the original bill that would “grandfather” current CHWs who have worked for 6 months over three years and prohibit the state or it's subdivisions from offering preferential public contracts for voluntarily certified CHWs.

This Bill is a top priority for us. It asks the ADHS to develop a voluntary certification program for community health workers. The rulemaking would include certification standards including qualifications, core competencies, and continuing education requirements.

HB 2389  Syringe access programs; authorization

Passed Senate in Weak Form- going back to House

This passed the full Senate last week (22-8) but in a substantially weakened form. The original bill essentially would have decriminalized needle exchange programs. One of the amendments from the Senate makes it so that needle exchange would only be decriminalized when and where the ADHS declares a public health emergency because of the rapid spread of infectious diseases. The bill will now go back to the House to resolve the differences in the House and Senate forms.  Hopefully we can get the amendment removed.  If we can’t and it passes and is signed as amended it’ll have limited public health utility.

HB 2484 local food tax; equality

Signed by Governor

Last week the Governor signed which will ban Arizona cities and counties from taxing sugary drinks as a public health intervention. The bill doesn’t specifically mention taxes on sugary drinks, but states that any tax on food needs to be uniform.  products must be uniform. Right now, there aren’t any Arizona cities or counties that are taxing soda and other sugary drinks, and this new law will ensure that it stays that was. 

The APHA has a Policy Statement on the topic that states in part that: Research has shown that “Sugar-sweetened beverages are price elastic: it is estimated that every 10% increase in price would decrease consumption by 10%. A recent study revealed that a penny-per-ounce tax would reduce consumption by 15% among adults 25–64 years of age and prevent 2.4 million diabetes person-years, 95,000 coronary heart events, 8,000 strokes, and 26,000 premature deaths.”

 

Senate Bills

SB 1022    DHS; homemade food products            

Signed by Governor

ADHS will be required to establish an online registry of food preparers that are authorized to prepare "cottage food products" for commercial purposes. Registered food preparers would be required to renew the registration every three years. This is a sensible addition to the current cottage industry food law and we’ve signed up in support.

SB 1083    Schools; recess periods

Passed House- going back to Senate again

This passed in the House last week by a wide margin.  It was amended slightly from its Senate version by giving grades 4 & 5 an extra year to implement.  It’s now headed back to the Senate with the amendment.  District and charter schools would be required to provide at least 2 recess periods during the school day for pupils in grades K-5 if it passes.  Good news.

SB 1245 Snap Benefit Match

Needs House Rules Committee and Budget Line Item

This Bill earned a Do Pass recommendation from the House Appropriations Committee 2 weeks ago and is now needs House Rules review before a House floor vote (and of course needs to make it through the budget process). This good Bill would appropriate $400K to ADES to develop a produce incentive program within the Supplemental Nutrition Assistance Program for members to buy Arizona-grown fruits and vegetables.  It would also provide matching funds to SNAP-authorized vendors as an incentive to participate in the fruits and vegetable program. 

This Bill would appropriate $400K to ADES to develop the infrastructure for a produce incentive program within the Supplemental Nutrition Assistance Program (SNAP) for members to buy Arizona-grown fruits and vegetables.  It would also provide matching funds to SNAP-authorized vendors as an incentive to participate in the fruits and vegetable program. 

SB 1377 Dental therapy, licensure, regulation

Stalled in House now HB 2235

This bill failed to get a Pass recommendation from the House Health Committee last week (5-4) and is now HB 2235 as a striker.  It would have set up a new licensed class of dental professionals called a Dental Therapist. Their scope of practice would be somewhat less than a DDS, but they could do some procedures like filling cavities. This has been a somewhat controversial bill as there are stakeholders of both sides that are quite passionate about their position on this Bill.  

SB 1394 Abortion reporting

Ready for House Floor Vote

This one would require the ADHS to collect and report additional data regarding abortions that are performed in AZ. The data would be collected and reported by providers and would include the reason for the abortion (economic, emotional health, physical health, whether the pregnancy was the result of rape or incest, or relationship issues etc.).  The bill was given a Do Pass recommendation last week by the House Judiciary & Public Safety Committee- although it was amended slightly by removing the requirement that physicians ask and report specifically why the woman is asking for the procedure.

SB 1420 Medical marijuana; inspection; testing; appropriation

Needs House Rules Approval

This would require the ADHS to set up testing standards for medical marijuana and begin enforcing the standards beginning in 2019.  We’re supporting this legislation.  It passed the full Senate last week and was given a Pass recommendation by the House Military, Veterans & Regulatory Affairs Committee this week.

SB 1445 AHCCCS Dental care, pregnant women

Needs House Rules and Floor Vote & a Budget Line Item

Last week SB 1445 AHCCCS Dental care, pregnant women unanimously cleared the House Appropriations committee this week!  The next stop is the House Rules committee (which shouldn’t be a problem). It would then be ready for a House floor vote. The big hurdle will be getting an appropriation to cover the state match into the budget. We’re trying to get a close to accurate estimate of what it will take.  Senator Yee is the sponsor- which is a good thing because she’s the Senate Majority leader and will be influential during the budget negotiations.

This is a priority Bill for AzPHA.  It would provide oral health coverage for pregnant Medicaid members.  The benefit would be limited to $1,000 and could be used for other than emergency dental procedures (beginning October 1, 2017 all adult Medicaid members became eligible for up to $1,000 in emergency dental services per year).  Lots of good public health reasons to support this one. 

SB 1470  Sunrise process; health professions

Passed Senate 21 – 9; being amended

SB 1470 would change the scope of practice system so that all a profession needs to do is prepare a written sunrise report right before the regular legislative session. It would allow the legislative standing committees (rather than Committees of Reference) to consider a sunrise proposal. During legislative session, long agendas and the fast pace limits the time to consider serious issues impacted by changes in scope of practice, including prescribing, complex health care procedures, complicated review, and reflection on curriculum, training and education.

We had a Public Health Policy Committee call last week and recommended to our Board that we take a position opposing the bill- which we did last week.  I testified that, rather than eliminating the pre-session hearings for scope of practice changes that they consider modifying the bill so that requests for new Scope changes go to the ADHS Director for a recommendation back to the Legislature. 

The Bill passed the House Government Committee last week.  There was reportedly a stakeholder meeting on the bill last week.  Still being Held in the House Rules Committee.

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Opioid Prescribing Continuing Medical Education

Beginning April 26, physicians will need to complete 3 credits/hours of opioid-related, substance use-related, or addiction-related continuing medical education each licensing cycle. The Arizona Center for Rural Health and Office of Continuing Medical Education (OCME) have developed free Arizona Opioid Prescribing Guideline courses to help facilitate compliance with this new requirement. The coursework offers modules on:

  • Safe Prescribing of Opioids for Pain Management
  • Safe and Effective Opioid Prescribing While Managing Acute and Chronic Pain
  • Managing Opioid Misuse Disorder in Pregnancy and Neonatal Care

These courses familiarize prescribers with current guidelines for opioid use and prescribing, as well as educate prescribers about non-opioid strategies for pain management. All courses offer AMA PRA Category 1 CreditTM. Access courses at: http://vlh.com/AZPRescribing.

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Remember to register for our April 11 Spring Conference:

Together for Tomorrow: Protecting Arizona’s Children

View Agenda | Sponsorship Packet

 REGISTER TODAY!

AzPHA Public Health Policy Update: March 26, 2018

Governor’s School & Firearm Safety Proposal

Last week the Governor proposed a conceptual initiative that would do several things related to school safety. I haven’t seen an actual bill, but the media release mentions the following items:

  • Increase behavioral health resources in schools

  • Increase school resource officer funding and training and increases the presence of law enforcement on school grounds

  • Severe Threat Order of Protection orders that would restrict firearm access for people who are a danger to themselves or others

  • Enhances some background checks by improving the completeness and accuracy of the criminal history database

  • Establishes a “Center for School Safety” with a centralized reporting tip line to report and investigate concerns of school safety

 

Federal Budget Drama is Finally Over

Last week the US House and Senate passed and the President finally signed a budget for this fiscal year. Here’s what the budget contains related to the federal public health agencies:

  • CDC: $8.3 billion, an increase of $1B from the FY17 level of $7.2 billion. Total funding includes $800 million from the Prevention and Public Health Fund. Specific allocations include: $350 million to address the opioid epidemic; $480 million for construction of a new BSL 4 lab at CDC; $160 million for the Preventive Health and Health Services Block Grant; and increases for several CDC programs.

  • HRSA: $7 billion, an increase of $550 million above FY17. This funding includes a $10 million increase for the Title V Maternal and Child Health Services Block Grant.

  • SAMHSA: $5 billion, an increase of $1.3 billion above FY17. It includes more than $1.7 billion to address opioid and heroin abuse—an increase of $1.5 billion above FY17. This includes $500 million for the state opioid response grants.

 

Legislative Session Update 

Committee Highlights Last Week

HB 2038 Drug overdose review teams; records was passed and signed last week.  Once it takes effect later this year, law enforcement agencies will now be required to provide reports to the chairperson of a local Drug Overdose Fatality Review Team on request.  All information and records acquired by a Team are confidential and not subject to subpoena, discovery or introduction into evidence in a civil or criminal proceeding or disciplinary action.

HB 2084 Indoor tanning; minors; restricted use had been languishing in the Senate after passing the House by a 45-15 vote. Because of its lack of movement in the Senate it had appeared to be dead again this year.  However, this week it reappeared as a Strike All amendment in the House again as SB 1290.  It got a unanimous pass recommendation from the House Health Committee last Thursday- so it’s back in business.  It’ll still need another House Floor vote before going back to the Senate again.  If it passes and is signed, tanning facility operators would be prohibited from allowing a person under 18 years of age to use a "tanning device" and tanning facilities couldn’t claim that using a tanning device is free from risk or has health benefits. We’ve signed on in support of this of course.

HB 2127 Children's health insurance program had been languishing in the Senate and appeared dead. However, it was resurrected this week in the form of SB 1087 and was passed again by the House Health Committee last Thursday.  It still needs another House floor vote before it goes back to the Senate again.  It would remove the trigger that automatically freezes the KidsCare program if FMAP (the federal contribution) drops below 100%.  It allows the state to freeze it if costs are more than the state or federal allotment. The bill does not require the state to appropriate any money for a state share.  We’ve signed up in support of this bill because it provides a pathway to keep KidsCare if the federal government drops its contribution level. 

SB 1245 Snap Benefit Match earned a Do Pass recommendation from the House Appropriations Committee last week and is now ready for a House floor vote (and of course needs to make it through the budget process). It has passed through the Senate already.  This good Bill would appropriate $400K to ADES to develop a produce incentive program within the Supplemental Nutrition Assistance Program for members to buy Arizona-grown fruits and vegetables.  It would also provide matching funds to SNAP-authorized vendors as an incentive to participate in the fruits and vegetable program.  It would appropriate $400K to ADES to develop the infrastructure for a produce incentive program within the Supplemental Nutrition Assistance Program (SNAP) for members to buy Arizona-grown fruits and vegetables.  It would also provide matching funds to SNAP-authorized vendors as an incentive to participate in the fruits and vegetable program. 

SB 1261 Texting while driving has been languishing for the last few weeks, as it hasn’t been called up for a floor vote in the Senate.  Last week, the language from SB 1261 was added as an amendment onto HB 2159 traffic violations; traffic survival school.  This bill, with the addition of the texting language, is now in the House awaiting a final vote.  If anybody has influence with Speaker Mesnard now would be a great time to contact him and ask him to bring it to the floor.

Last week the Governor signed HB 2484 local food tax; equality which will ban Arizona cities and counties from taxing sugary drinks as a public health intervention. The bill doesn’t specifically mention taxes on sugary drinks, but states that any tax on food needs to be uniform.  products must be uniform. Right now, there aren’t any Arizona cities or counties that are taxing soda and other sugary drinks, and this new law will ensure that it stays that was. 

The APHA has a Policy Statement on the topic that states in part that: Research has shown that “Sugar-sweetened beverages are price elastic: it is estimated that every 10% increase in price would decrease consumption by 10%. A recent study revealed that a penny-per-ounce tax would reduce consumption by 15% among adults 25–64 years of age and prevent 2.4 million diabetes person-years, 95,000 coronary heart events, 8,000 strokes, and 26,000 premature deaths.”

SB 1445 AHCCCS Dental care, pregnant women cleared the House Health committee this week. The next stop is the House Appropriations committee (It previously was passed in the Senate).  This Bill would provide oral health coverage for pregnant Medicaid members.   Because it involves money, it’ll also need to get funded during the budget making process.

This is a priority Bill for AzPHA.  It would provide oral health coverage for pregnant Medicaid members.  The benefit would be limited to $1,000 and could be used for other than emergency dental procedures all adult Medicaid members became eligible for up to $1,000 in emergency dental services per year.  Lots of good public health reasons to support this one. 

______ 

Committee Hearings this Week

HB 2324 Community health workers; voluntary certification and HB 2389 Syringe access programs; authorization are on the Monday, March 26 Senate Rules Committee on Rules Agenda at 1pm in Caucus Room 1 (no testimony is taken in Rules committees)

HB 2127 Children's health insurance program is on the Tuesday, March 27 Senate Appropriations Committee Agenda at 2pm in Room SHR109

SB1445 AHCCCS Dental care, pregnant women is on the Wednesday, March 28 House Appropriations Committee Agenda at 1pm in Room HHR1

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Here’s a snapshot of where the various bills we’re working on are in the system. 

HB 2038 Drug overdose review teams; records (Signed into Law)

HB 2071 Rear-facing car seats (Stalled in Senate)

HB 2084 Indoor tanning; minors; restricted use (Now called SB 1290 as Striker) 

HB 2127 Children's health insurance program (Now called SB 1087 as Striker)

HB 2197 Health professions, workforce data (Ready for Senate Floor Vote)

HB 2208 Prohibition, photo enforcement (Effectively dead)

HB 2228 Annual waiver, applicability (Needs Senate Rules Committee Approval)

HB 2323 Schools; inhalers; contracted nurses (Ready for Senate Floor Vote)

HB 2324 Community health workers; voluntary certification (Needs Sen. Rules Com. Approval)

HB 2389 Syringe access programs; authorization (Needs Sen. Rules Com. Approval)

HB 2484 local food tax; equality (Signed by Governor)

SB 1022 ADHS; homemade food products (On Governor’s Desk) 

SB 1083 Schools; recess periods (Needs House Floor Vote)

SB 1245 Snap Benefit Match (Needs Rules Committee & Budget Line)

SB 1261 Texting while driving (Now HB 2159 traffic violations; traffic survival school)

SB 1420 Medical marijuana; inspection; testing; appropriation (Needs House Rules)

SB 1445 AHCCCS Dental care, pregnant women (Needs House Approps and Rules Com)

SB 1377 Dental therapy, licensure, regulation (Failed in House now HB2235 in Senate as striker)

SB 1394 Abortion reporting (Ready for House Floor Vote)

 

Public Health-related bills that have been passed and signed so far:

HB 2038 Drug overdose review teams; records was passed and signed last week.  Once it takes effect later this year, law enforcement agencies will now be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request. 

HB 2484 local food tax; equality, which will ban Arizona cities and counties from taxing sugary drinks as a public health intervention.

____

Remember to stay engaged and voice your opinion via the www.azleg.gov commenting system.  Click the following links for: Request to Speak account registration form; a Step-by-step use of the Request to Speak platform; and to Locate your Elected Official

_____

 

House Bills

HB 2038 Drug overdose review teams; records                

Passed and Signed

Law enforcement agencies will now be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request.  All information and records acquired by a Team are confidential and not subject to subpoena, discovery or introduction into evidence in a civil or criminal proceeding or disciplinary action.

HB 2071 Rear-facing car seats         

Stalled in Senate

This Bill would require kids under 2 years old to be in a rear-facing restraint system unless the child weights at least 40 pounds or is at least 40 inches tall.  We’ve signed up in support of this bill.  No action has yet been taken in the Senate so this bill is effectively dead.

HB 2084 Indoor tanning; minors; restricted use

Stalled in Senate- now SB1290 in House

This bill had been languishing in the Senate after passing the House by a 45-15 vote. Because of its lack of movement in the Senate it had appeared to be dead again this year.  However, this week it reappeared as a Strike All amendment in the House again as SB 1290.  It got a unanimous pass recommendation from the House Health Committee last Thursday- so it’s back in business.  It’ll still need another House Floor vote before going back to the Senate again.  If it passes and is signed, tanning facility operators would be prohibited from allowing a person under 18 years of age to use a "tanning device" and tanning facilities couldn’t claim that using a tanning device is free from risk or has health benefits. We’ve signed on in support of this of course.

HB 2127 Children's health insurance program

Stalled in Senate- now SB 1087 in House

After passing the House, this bill had been languishing in the Senate and appeared dead.  However, it was resurrected this week in the form of SB 1087 and was passed again by the House Health Committee last Thursday.  It still needs another House floor vote before it goes back to the Senate again.  It would remove the trigger that automatically freezes the KidsCare program if FMAP (the federal contribution) drops below 100%.  It allows the state to freeze it if costs are more than the state or federal allotment. The bill does not require the state to appropriate any money for a state share.  We’ve signed up in support of this bill because it provides a pathway to keep KidsCare if the federal government drops its contribution level. 

HB 2197 Health professions, workforce data

Ready for Senate Floor Vote

This bill is looking good and ready for a final Senate floor vote.  It would require AZ health licensing boards to collect certain data from applicants (beginning January 2020) to get better data about health professions workforce distribution and needs.  The data would be confidential.  Over the long-term this bill would be helpful in providing better data with which to improve the distribution and capacity of the public health workforce in Arizona.

HB 2208 Prohibition, photo enforcement

Died in Senate

This one would prohibit cities and other jurisdictions from having photo enforcement of red light and speeding violations.  While nobody likes getting a ticket in the mail, the data suggest that photo enforcement saves lives and prevents injuries (especially red-light photo enforcement).  We’ve signed up in opposition to the bill.  This bill passed the House 31-27 but stalled in the Senate.  Honestly, it looks dead.

HB 2228 Annual waiver, applicability

Still Needs Senate Rules Committee

This would direct AHCCCS to exempt tribes from their directed waiver requests to CMS asking permission to implement work requirements for some Medicaid members.  The recently submitted Waiver request includes an exemption for American Indians, however, this would place the exemption into statute.

HB 2323   Schools; inhalers; contracted nurses

Ready for Senate Floor Vote

This bill adds contracted nurses to the list of people who are authorized to provide emergency inhaler medication in case of respiratory emergencies. Some charter and independent schools don’t employ nurses directly but engage them through contracts. Ready for a final Senate floor vote.

HB 2324 Community health workers; voluntary certification

Still needs Senate Rules Committee

This Bill got a Do Pass recommendation from the Senate Commerce and Public Safety Committee last week (7-0-1).  As you’ll recall, the week before the Senate Health and Human Services Committee gave it a Do Pass recommendation. We’re getting a lot closer to the finish line. Our next hurdle will be the Senate Rules Committee followed by a floor vote in the Senate.  Because there are some changes in the language since it passed the House, it’ll need to go back to accommodate those differences after that.  But it is looking good! 

This Bill is a top priority for us. It asks the ADHS with developing a voluntary certification program for community health workers. The rulemaking would include certification standards including qualifications, core competencies, and continuing education requirements.

HB 2389  Syringe access programs; authorization

Amended and Weakened- and Needs Senate Rules

This Bill was substantially amended in the Senate Government Committee last week.  The bill (as amended) passed the committee, but in its amended form will be much less helpful as a public health intervention.  The original bill essentially would have decriminalized needle exchange programs.  The amendment makes it such that needle exchange would only be decriminalized when and where the ADHS declares a public health emergency because of the rapid spread of infectious diseases. Hopefully we can get the amendment removed.  If we can’t and it passes and is signed as amended it’ll have very little public health utility.

HB 2484 local food tax; equality

Signed by Governor

Last week the Governor signed which will ban Arizona cities and counties from taxing sugary drinks as a public health intervention. The bill doesn’t specifically mention taxes on sugary drinks, but states that any tax on food needs to be uniform.  products must be uniform. Right now, there aren’t any Arizona cities or counties that are taxing soda and other sugary drinks, and this new law will ensure that it stays that was. 

The APHA has a Policy Statement on the topic that states in part that: Research has shown that “Sugar-sweetened beverages are price elastic: it is estimated that every 10% increase in price would decrease consumption by 10%. A recent study revealed that a penny-per-ounce tax would reduce consumption by 15% among adults 25–64 years of age and prevent 2.4 million diabetes person-years, 95,000 coronary heart events, 8,000 strokes, and 26,000 premature deaths.”

 

Senate Bills

SB 1022    DHS; homemade food products            

Sent to Governor

ADHS would be required to establish an online registry of food preparers that are authorized to prepare "cottage food products" for commercial purposes. Registered food preparers would be required to renew the registration every three years. This is a sensible addition to the current cottage industry food law and we’ve signed up in support. Being heard in the House Health Committee this week (Thursday).  Should have no problems at all.

SB 1083    Schools; recess periods

Ready for House Floor Vote

District and charter schools would be required to provide at least 2 recess periods during the school day for pupils in grades K-5 if this passes. We’ve signed in support of this bill because there is good evidence that opportunities for physical activity at school are associated with improved health, behavior, and academic achievement of students.  Here is a good evidence review from the CDC entitled The Association Between School-based Physical Activity and Academic Performance. Great couple of weeks for this bill. Hopefully there’s a floor vote on this shortly.

SB 1245 Snap Benefit Match

Needs House Rules Committee and Budget Line Item

This Bill earned a Do Pass recommendation from the House Appropriations Committee last week and is now ready for a floor vote (and of course needs to make it through the budget process). This good Bill would appropriate $400K to ADES to develop a produce incentive program within the Supplemental Nutrition Assistance Program for members to buy Arizona-grown fruits and vegetables.  It would also provide matching funds to SNAP-authorized vendors as an incentive to participate in the fruits and vegetable program. 

This Bill would appropriate $400K to ADES to develop the infrastructure for a produce incentive program within the Supplemental Nutrition Assistance Program (SNAP) for members to buy Arizona-grown fruits and vegetables.  It would also provide matching funds to SNAP-authorized vendors as an incentive to participate in the fruits and vegetable program. 

SB 1261 Texting while driving

Now HB 2159 and Moving Again in House

This has been languishing for the last few weeks because it hasn’t been called up for a floor vote in the Senate.  Last week, the language from SB 1261 was added as an amendment onto HB 2159 traffic violations; traffic survival school.  This bill, with the addition of the texting language, is now in the House awaiting a final vote.  If anybody has influence with Speaker Mesnard now would be a great time to contact him and ask him to bring it to the floor.

This would prohibit drivers from “using a portable wireless communication device to read, write, or send an electronic message while driving” (unless the car is stopped).  The first violation would be a petty offense with a fine between $25 and $99.  It has passed its committees and is ready for a floor vote, which hasn’t happened yet.  Not a good sign.

SB 1377 Dental therapy, licensure, regulation

Stalled in House now HB 2235

This bill failed to get a Pass recommendation from the House Health Committee last week (5-4), and is now HB 2235 as a striker.  It would have set up a new licensed class of dental professionals called a Dental Therapist. Their scope of practice would be somewhat less than a DDS, but they could do some procedures like filling cavities. This has been a somewhat controversial bill as there are stakeholders of both sides that are quite passionate about their position on this Bill.  

SB 1394 Abortion reporting

Ready for House Floor Vote

This one would require the ADHS to collect and report additional data regarding abortions that are performed in AZ. The data would be collected and reported by providers and would include the reason for the abortion (economic, emotional health, physical health, whether the pregnancy was the result of rape or incest, or relationship issues etc.).  The bill was given a Do Pass recommendation last week by the House Judiciary & Public Safety Committee- although it was amended slightly by removing the requirement that physicians ask and report specifically why the woman is asking for the procedure

SB 1420 Medical marijuana; inspection; testing; appropriation

Needs House Rules Approval

This would require the ADHS to set up testing standards for medical marijuana and begin enforcing the standards beginning in 2019.  We’re supporting this legislation.  It passed the full Senate last week and was given a Pass recommendation by the House Military, Veterans & Regulatory Affairs Committee this week.

SB 1445 AHCCCS Dental care, pregnant women

Needs House Approps and Rules Still

Last week SB 1445 AHCCCS Dental care, pregnant women was given a pass recommendation by the House Health committee. The next stop is the House Appropriations committee (It previously was passed in the Senate).  This Bill would provide oral health coverage for pregnant Medicaid members.   Because it involves money, it’ll also need to get funded during the budget making process.

This is a priority Bill for AzPHA.  It would provide oral health coverage for pregnant Medicaid members.  The benefit would be limited to $1,000 and could be used for other than emergency dental procedures (beginning October 1, 2017 all adult Medicaid members became eligible for up to $1,000 in emergency dental services per year).  Lots of good public health reasons to support this one. 

SB 1470  Sunrise process; health professions

Passed Senate 21 – 9; being amended

To be honest- this bill has been flying under the radar at least with me.  If it passes and is signed it’d make huge changes to the health professions scope of practice system we use today. The current sunrise process is a collaborative, inclusive process that allows time for consideration and review of the complicated health care delivery proposals.  The current process requires a Committee of Reference hearing, which allows a consideration of a proposed scope change and its potential patient safety and care implications.

SB 1470 would change the scope of practice system so that all a profession needs to do is prepare a written sunrise report right before the regular legislative session. It would allow the legislative standing committees (rather than Committees of Reference) to consider a sunrise proposal. During legislative session, long agendas and the fast pace limits the time to consider serious issues impacted by changes in scope of practice, including prescribing, complex health care procedures, complicated review, and reflection on curriculum, training and education.

We had a Public Health Policy Committee call last week and recommended to our Board that we take a position opposing the bill- which we did last week.  I testified that, rather than eliminating the pre-session hearings for scope of practice changes that they consider modifying the bill so that requests for new Scope changes go to the ADHS Director for a recommendation back to the Legislature. 

The Bill passed the House Government Committee last week.  There was reportedly a stakeholder meeting on the bill last week.  Being Held in the House Rules Committee.

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Public Health Bills that Failed

HB 2064 Medical marijuana; packaging; labeling              

Dead for now

This Bill proposes that medical marijuana dispensaries be prohibited from selling a marijuana product that’s packaged or labeled in a manner that’s "attractive to minors". Due to voter protection, this legislation requires the affirmative vote of at least 3/4 of the members of each house of the Legislature for passage.  Dead for now.

HB 2109 Tobacco possession; sale; age; signage                

Sadly, dead for now

This Bill would prohibit furnishing a tobacco product to a person who is under 21 years of age. The definition of "tobacco product" is expanded to include "electronic smoking devices". We’ve signed up in support. It received a Do Pass recommendation from the House Health Committee three weeks ago but the Commerce chair hasn’t put it on the agenda, so it’s effectively dead for now. Kudos to Rep. Boyer for sponsoring this.

_____

 

Remember to register for our April 11 Spring Conference: 

Together for Tomorrow: Protecting Arizona’s Children 

View Agenda &

 REGISTER TODAY!

 

 

 

AzPHA Public Health Policy Update: March 19, 2018

AHCCCS Update: Coding the Social Determinants of Health

ICD-10 diagnosis codes that relate to the Social Determinants of Health can be a valuable source of information to improve health outcomes.  Social Determinants of Health codes can identify the conditions in which people are born, grow, live, work, and age like education, employment, physical environment, socioeconomic status and social support networks- data that can provide managed care organizations information with which to improve outcomes and reduce costs.

AHCCCS is recommending that providers routinely screen for and document the presence of social determinants (as appropriate within their scope of practice) and to document them in claims data. AHCCCS will begin to monitor claims for the presence of these codes after April 1, 2018. You can review the Social Determinant ICD-10 Codes on the AHCCCS website.

 

FDA Proposes Rulemaking to Reduce Nicotine Levels in Tobacco Products

The FDA issued an “advance notice of proposed rulemaking” last week to get input for them to develop new standards for the maximum nicotine level in cigarettes. They say they’re interested in reducing the level of nicotine in cigarettes to make them “minimally addictive or nonaddictive”.  

Those of you that are familiar with the evidence base in this area should take this opportunity to provide input to the FDA. It has the potential to be a big intervention in our decades long battle public health battle with tobacco.  Electronic comments can be submitted through June 14 at https://www.regulations.gov

 

AzPHA Comments on ADHS School Vaccination Rulemaking

The ADHS has an administrative rulemaking open to adjust their school and child care vaccine requirements. Our public health policy committee turned in a response last week (it had a short comment period- just a week).  You can see our comments on the proposed rules on our AzPHA Blog). 

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Legislative Session Update 

Committee Highlights Last Week

HB 2324 Community health workers; voluntary certification had another terrific week. The bill got a Do Pass recommendation from the Senate Commerce and Public Safety Committee last week (7-0-1).  As you’ll recall, the week before the Senate Health and Human Services Committee gave it a Do Pass recommendation. We’re getting a lot closer to the finish line. Our next hurdle will be the Senate Rules Committee followed by a floor vote in the Senate.  Because there are some changes in the language since it passed the House, it’ll need to go back to accommodate those differences after that. But it is looking good!  

This Bill is a top priority for us. It asks the ADHS with developing a voluntary certification program for community health workers. The rulemaking would include certification standards including qualifications, core competencies, and continuing education requirements.

HB 2197 Health professions, workforce data also had a good week, getting a pass recommendation from the Senate Commerce and Public Safety Committee last week.  It would require AZ health licensing boards to collect certain data from applicants (beginning January 2020) to get better data about health professions workforce distribution and needs.  The data would be confidential.  Over the long-term this bill would be helpful in providing better data with which to improve the distribution and capacity of the public health workforce in Arizona.

HB 2228 Annual waiver, applicability received a pass recommendation from the Senate HHS Committee last week.  This bill would direct AHCCCS to exempt tribes from their directed waiver requests to CMS (asking permission to implement work requirements for some Medicaid members).  The recently submitted Waiver request includes an exemption for American Indians, but this would place the exemption into statute.

HB 2389  Syringe access programs; authorization was substantially amended in the Senate Government Committee last week (not in a good way).  The amended bill passed the committee, but its amended form will be much less helpful as a public health intervention. The original bill essentially would have decriminalized needle exchange programs. The amendment makes it such that needle exchange would only be decriminalized when and where the ADHS declares a public health emergency because of the rapid spread of an infectious disease. Hopefully we can get the amendment removed.  If we can’t and it passes and is signed as amended it’ll have little public health utility.

SB 1245 Snap Benefit Match earned a pass recommendation from the House Health Committee last week.  Its next stop is the House Appropriation Committees.  This good Bill would appropriate $400K to ADES to develop a produce incentive program within the Supplemental Nutrition Assistance Program for members to buy Arizona-grown fruits and vegetables.  It would also provide matching funds to SNAP-authorized vendors as an incentive to participate in the fruits and vegetable program.  

SB 1377 Dental therapy, licensure, regulation failed to get a pass recommendation from the House Health Committee last week (5-4).  It would have set up a new licensed class of dental professionals called a Dental Therapist. Their scope of practice would be somewhat less than a DDS, but they could do some procedures like filling cavities. This has been a somewhat controversial bill as there are stakeholders of both sides that are quite passionate about their position on this Bill. 

SB 1420 medical marijuana; inspection; testing; appropriation received a pass recommendation by the House Military, Veterans & Regulatory Affairs Committee last week. This bill would require the ADHS to set up testing standards for medical marijuana and begin enforcing the standards beginning in 2019.

SB 1261 Texting while driving has been languishing for the last few weeks, as it hasn’t been called up for a floor vote in the Senate.  Last week, the language from SB 1261 was added as an amendment onto HB 2159 traffic violations; traffic survival school.  This bill, with the addition of the texting language, is now in the House awaiting a final vote.  If anybody has influence with Speaker Mesnard now would be a great time to contact him and ask him to bring it to the floor.

______ 

Committee Highlights this Week

Monday, March 19th, Senate Commerce & Public Safety 2 pm, SHR 1

HB 2064:  medical marijuana; packaging; labeling

 

Wednesday, March 21st, House Appropriations 9 am, HHR1

SB 1245:  appropriation; SNAP; benefit match; produce

SB 1420:  medical marijuana; inspection; testing; appropriation

 

Thursday, March 22nd, House Health 9am, HHR 4

SB 1445:  AHCCCS; dental care; pregnant women

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The following public health related bills passed their committee of origin and have gone over to the other chamber. Some have been assigned to committees in the new chamber, but some haven't yet.  Where available, I've listed the committee assignments in the detail section below.  We’re keeping track of the hearing dates and times. 

HB 2038 Drug overdose review teams; records                

HB 2071 Rear-facing car seats

HB 2084 Indoor tanning; minors; restricted use      

HB 2127 Children's health insurance program

HB 2208 Prohibition, photo enforcement (we’re against this one)

HB 2228 Annual waiver, applicability (tribes)

HB 2323 Schools; inhalers; contracted nurses

HB 2324 Community health workers; voluntary certification

HB 2389 Syringe access programs; authorization

SB 1022 ADHS; homemade food products            

SB 1083 Schools; recess periods

SB 1445 AHCCCS Dental care, pregnant women

SB 1377 Dental therapy, licensure, regulation

SB 1394 Abortion reporting 

____

Remember to stay engaged and voice your opinion via the www.azleg.gov commenting system.  Click the following links for: Request to Speak account registration form; a Step-by-step use of the Request to Speak platform; and to Locate your Elected Officials

_____

House Bills

HB 2038 Drug overdose review teams; records                

Passed the House 57-0-2

Assigned to Senate Health and Human Services Committee

Under this proposed Bill, law enforcement agencies would be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request.  All information and records acquired by a Team are confidential and not subject to subpoena, discovery or introduction into evidence in a civil or criminal proceeding or disciplinary action.  We’re signed up in support of this one of course.

 

HB 2071 Rear-facing car seats         

Passed House 33-25-1

Assigned to Senate HHS & Commerce and Public Safety Committees 

This Bill would require kids under 2 years old to be in a rear-facing restraint system unless the child weights at least 40 pounds or is at least 40 inches tall.  We’ve signed up in support of this bill.  Dual assigned in the Senate, and not yet scheduled in either of the Senate committees.

 

HB 2084 Indoor tanning; minors; restricted use

Passed House 45 - 15

Assigned to Senate HHS and Commerce & Public Safety Committees

Tanning facility operators would be prohibited from allowing a person under 18 years of age to use a "tanning device". Tanning facilities couldn’t advertise or distribute materials that claim that using a tanning device is free from risk or will result in medical or health benefits. We’ve signed on in support of this of course. Bummer that it's dual assigned in the Senate.

 

HB 2127 Children's health insurance program

Passed House 46-12-1

Assigned to HHS & Appropriations Committees

This removes the trigger that automatically freezes the KidsCare program if FMAP (the federal contribution) drops below 100%.  It allows the state to freeze it if costs are more than the state or federal allotment. The bill does not require the state to appropriate any money for a state share.  We’ve signed up in support of this bill because it provides a pathway to keep KidsCare if the federal government drops its contribution level. 

 

HB 2197 Health professions, workforce data

Passed House 60 – 0

Assigned to HHS and Commerce & Public Safety Committees

This bill had a good week, getting a Do Pass recommendation from the Senate Commerce and Public Safety Committee last week.  It would require AZ health licensing boards to collect certain data from applicants (beginning January 2020) to get better data about health professions workforce distribution and needs.  The data would be confidential.  Over the long-term this bill would be helpful in providing better data with which to improve the distribution and capacity of the public health workforce in Arizona.

 

HB 2208 Prohibition, photo enforcement

Passed the House 31-27-1

Assigned to the Senate Transportation Committee

This one would prohibit cities and other jurisdictions from having photo enforcement of red light and speeding violations.  While nobody likes getting a ticket in the mail, the data suggest that photo enforcement saves lives and prevents injuries (especially red-light photo enforcement).  We’ve signed up in opposition to the bill.  This bill passed the House 31-27 last week and is moving on to the Senate Transportation Committee- not on their agenda yet.

 

HB 2228 Annual waiver, applicability

Passed the House 58-0-1

Passed in the Senate HHS Committee

This would direct AHCCCS to exempt tribes from their directed waiver requests to CMS asking permission to implement work requirements for some Medicaid members.  The recently submitted Waiver request includes an exemption for American Indians, however, this would place the exemption into statute.

 

HB 2323  Schools; inhalers; contracted nurses

Passed House 58 – 0 - 1

Assigned to Senate Education Committee

This bill adds contracted nurses to the list of people who are authorized to provide emergency inhaler medication in case of respiratory emergencies. Some charter and independent schools don’t employ nurses directly but engage them through contracts.

 

HB 2324 Community health workers; voluntary certification

Passed House 56 – 1 - 3

Assigned to HHS and Commerce & Public Safety Committees

This Bill had another terrific week. The Bill got a Do Pass recommendation from the Senate Commerce and Public Safety Committee last week (7-0-1).  As you’ll recall, the week before the Senate Health and Human Services Committee gave it a Do Pass recommendation. We’re getting a lot closer to the finish line. Our next hurdle will be the Senate Rules Committee followed by a floor vote in the Senate.  Because there are some changes in the language since it passed the House, it’ll need to go back to accommodate those differences after that.  But it is looking good!  

This Bill is a top priority for us. It asks the ADHS with developing a voluntary certification program for community health workers. The rulemaking would include certification standards including qualifications, core competencies, and continuing education requirements.

 

HB 2389  Syringe access programs; authorization

Passed House 56 – 0 - 4

Assigned to the Senate Government Committee

This Bill was substantially amended in the Senate Government Committee last week.  The bill (as amended) passed the committee, but in its amended form will be much less helpful as a public health intervention.  The original bill essentially would have decriminalized needle exchange programs.  The amendment makes it such that needle exchange would only be decriminalized when and where the ADHS declares a public health emergency because of the rapid spread of infectious diseases. Hopefully we can get the amendment removed.  If we can’t and it passes and is signed as amended it’ll have very little public health utility.

 

Senate Bills

SB 1022    DHS; homemade food products            

Passed Senate 30-0

Assigned to House Health Committee

ADHS would be required to establish an online registry of food preparers that are authorized to prepare "cottage food products" for commercial purposes. Registered food preparers would be required to renew the registration every three years. This is a sensible addition to the current cottage industry food law and we’ve signed up in support. Being heard in the House Health Committee this week (Thursday).  Should have no problems at all.

 

SB 1083    Schools; recess periods

Passed Senate 26-3-1

Assigned to and Passed House Education Committee 9-0 on Monday

District and charter schools would be required to provide at least 2 recess periods during the school day for pupils in grades K-5 if this passes. We’ve signed in support of this bill because there is good evidence that opportunities for physical activity at school are associated with improved health, behavior, and academic achievement of students.  Here is a good evidence review from the CDC entitled The Association Between School-based Physical Activity and Academic Performance. Great couple of weeks for this bill. Hopefully there’s a floor vote on this shortly.

 

SB 1245 Snap Benefit Match

Passed Senate 25 - 5

Assigned to House Health and Appropriation Committees

This Bill earned a Do Pass recommendation from the House Health Committee last week.  Its next stop is the House Appropriation Committees.  This good Bill would appropriate $400K to ADES to develop a produce incentive program within the Supplemental Nutrition Assistance Program for members to buy Arizona-grown fruits and vegetables.  It would also provide matching funds to SNAP-authorized vendors as an incentive to participate in the fruits and vegetable program.  

This Bill would appropriate $400K to ADES to develop the infrastructure for a produce incentive program within the Supplemental Nutrition Assistance Program (SNAP) for members to buy Arizona-grown fruits and vegetables.  It would also provide matching funds to SNAP-authorized vendors as an incentive to participate in the fruits and vegetable program.  It has passed the full Senate and will be heard this Thursday at 9 am in House Health.  

 

SB 1261 Texting while driving

Passed Transportation Committee- Ready for a Senate Floor Vote

This would prohibit drivers from “using a portable wireless communication device to read, write, or send an electronic message while driving” (unless the car is stopped).  The first violation would be a petty offense with a fine between $25 and $99.  It has passed its committees and is ready for a floor vote, which hasn’t happened yet.  Not a good sign.

 

SB 1377 Dental therapy, licensure, regulation

Passed Senate 22 – 8

Assigned to House Health Committee

This bill failed to get a Pass recommendation from the House Health Committee last week (5-4).  It would have set up a new licensed class of dental professionals called a Dental Therapist. Their scope of practice would be somewhat less than a DDS, but they could do some procedures like filling cavities. This has been a somewhat controversial bill as there are stakeholders of both sides that are quite passionate about their position on this Bill.   Being heard this week (Thursday at 9 am) in the House Health Committee.

 

SB 1394 Abortion reporting

Passed Senate 17 - 13

Assigned to the Judiciary and Federalism, Property Rights & Public Policy Committees

This one would require the ADHS to collect and report additional data regarding abortions that are performed in AZ. The data would be collected and reported by providers and would include the reason for the abortion (economic, emotional health, physical health, whether the pregnancy was the result of rape or incest, or relationship issues etc.).  The bill was given a Do Pass recommendation last week by the House Judiciary & Public Safety Committee- although it was amended slightly by removing the requirement that physicians ask and report specifically why the woman is asking for the procedure.

 

SB 1420 Medical marijuana; inspection; testing; appropriation

Passed Senate 27 – 3

Assigned to House Military, Veteran and Regulatory Affairs Committee

This would require the ADHS to set up testing standards for medical marijuana and begin enforcing the standards beginning in 2019.  We’re supporting this legislation.  It passed the full Senate last week and was given a Pass recommendation by the House Military, Veterans & Regulatory Affairs Committee this week.

 

SB 1445 AHCCCS Dental care, pregnant women

Passed Senate 27 - 3

Assigned to House Health & Appropriations Committees

Last week SB 1445 AHCCCS Dental care, pregnant women was passed by the Senate (27 – 3).  This Bill would provide oral health coverage for pregnant Medicaid members. It has moved on to the House and is assigned to the House Health Committee (which gave as similar bill a pass recommendation last year).  Because it involves money its also assigned to the House Appropriations Committee.  The benefit would be limited to $1000/year.  Lots of good public health reasons to support this one. 

This is a priority Bill for AzPHA.  It would provide oral health coverage for pregnant Medicaid members.  The benefit would be limited to $1000 and could be used for other than emergency dental procedures (beginning October 1, 2017 all adult Medicaid members became eligible for up to $1000 in emergency dental services per year).  Lots of good public health reasons to support this one. 

 

SB 1470  Sunrise process; health professions

Passed Senate 21 - 9

Assigned to House Government Committee

To be honest- this bill has been flying under the radar at least with me.  If it passes and is signed it’d make huge changes to the health professions scope of practice system we use today. The current sunrise process is a collaborative, inclusive process that allows time for consideration and review of the complicated health care delivery proposals.  The current process requires a Committee of Reference hearing, which allows a consideration of a proposed scope change and its potential patient safety and care implications. 

SB 1470 would change the scope of practice system so that all a profession needs to do is prepare a written sunrise report right before the regular legislative session. It would allow the legislative standing committees (rather than Committees of Reference) to consider a sunrise proposal. During legislative session, long agendas and the fast pace limits the time to consider serious issues impacted by changes in scope of practice, including prescribing, complex health care procedures, complicated review, and reflection on curriculum, training and education.

We had a Public Health Policy Committee call last week and recommended to our Board that we take a position opposing the bill- which we did last week.  I testified that, rather than eliminating the pre-session hearings for scope of practice changes that they consider modifying the bill so that requests for new Scope changes go to the ADHS Director for a recommendation back to the Legislature.  

The Bill passed the House Government Committee last week.  There was reportedly a stakeholder meeting on the bill last week.  We’ll stay tuned.

__

 

Public Health Bills that Failed to Thrive

HB 2064 Medical marijuana; packaging; labeling              

Dead for now

This Bill proposes that medical marijuana dispensaries be prohibited from selling a marijuana product that’s packaged or labeled in a manner that’s "attractive to minors". Due to voter protection, this legislation requires the affirmative vote of at least 3/4 of the members of each house of the Legislature for passage.  Dead for now.

HB 2109 Tobacco possession; sale; age; signage                

Sadly, dead for now

This Bill would prohibit furnishing a tobacco product to a person who is under 21 years of age. The definition of "tobacco product" is expanded to include "electronic smoking devices". We’ve signed up in support. It received a Do Pass recommendation from the House Health Committee three weeks ago but the Commerce chair hasn’t put it on the agenda, so it’s effectively dead for now. Kudos to Rep. Boyer for sponsoring this.

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AzPHA Member Kelli Donley Publishes Again

COUNTING COUP is the latest novel by AzPHA member Kelli Donley, who works in public health in Phoenix. The book is about the Phoenix Indian School, and like Donley's other novels, has a strong public health theme. Here’s a short description of her book, which you can order from Amazon:

Happily consumed with her academic career, Professor Avery Wainwright never planned on becoming sole guardian of her octogenarian Aunt Birdie. Forced to move Birdie—and her failing memory—into her tiny apartment, Avery’s precariously balanced life loses its footing. 

Unearthed in the chaos is a stack of sixty-year-old letters. Written in 1951, the letters tell of a year Avery’s grandmother, Alma Jean, spent teaching in the Indian school system, in the high desert town of Winslow, Arizona. The letters are addressed to Birdie, who was teaching at the Phoenix Indian School. The ghostly yet familiar voices in the letters tell of a dark time in her grandmother’s life, a time no one has ever spoken of. 

Torn between caring for the old woman who cannot remember, and her very different memories of a grandmother no longer alive to explain, Avery searches for answers. But the scandal and loss she finds, the revelations about abuses, atrocities, and cover-ups at the Indian schools, threaten far more than she’s bargained for. 

About the author: 

Kelli Donley is a native Arizonan. She is the author of three novels, Under the Same Moon, Basket Baby and Counting Coup. Inspiration for this novel was found hearing colleagues’ stories about childhoods spent at the Phoenix Indian School. Kelli lives with her husband Jason, children and small ark of animals in Mesa, Arizona. She works in public health, and blogs at: www.africankelli.com.

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Remember to register for our April 11 Conference: Together for Tomorrow- Protecting Arizona's Children

View Agenda | Sponsorship Packet

 REGISTER TODAY!

AzPHA Letter to ADHS on Proposed Immunization Rulemaking for School Vaccination Requirements

March 15, 2018

 

Cara M. Christ MD

Director,

Arizona Department of Health Services

150 N 18th Avenue

Phoenix, AZ  85007


 

RE: Vaccination Rulemaking

Dear Director Christ:

I write on behalf of the Arizona Public Health Association (AzPHA) – one of Arizona’s oldest and largest membership organizations dedicated to improving the health of Arizona citizens and communities.  An affiliate of the American Public Health Association, our members include health care professionals, state and county health employees, health educators, community advocates, doctors, nurses and students.

The AzPHA has examined the Arizona Department of Health Services (ADHS) proposed Rulemaking to revise the rules in 9 A.A.C. 6, Article 7, Required Immunizations for Child Care or School Entry.  We are generally supportive of the rule package as it appears to clarify and improve the requirements for personal, medical and religious exemptions, makes the rules more consistent with standard medical practices, and better allows for electronic records and record-keeping.

However, we believe that the Department is missing an opportunity to update the child care and school vaccine requirements so that they are consistent with the CDC’s Advisory Committee for Immunization Practices (ACIP) recommendations.  As you know, rulemaking packages are resource intensive and time consuming, and this may be the only opportunity for many years to update the Department’s vaccine requirements.

We urge the ADHS to update the requirements so that they (over time) are consistent with ACIP recommendations by adding a 2nd Varicella vaccine, the PCV 13 series, Rotavirus, and 2 Hepatitis A doses to the child care requirements.  We also urge you to add a 2nd Meningococcal vaccine, and the Meningococcal B at 16 years old to the school requirements.  We recognize that ARS 36-672 (C) prevents you from being able to add the Human Papilloma Virus Vaccine to the vaccine requirements.

We understand that the requirements may need to be phased in so that pediatricians and families have the time needed to become compliant with the new requirements. 

For example, the ADHS could write the final Rule such that the vaccines with the highest current coverage levels (as reported in ASIIS) are phased in over the next 18 months.  Vaccines with lower current coverage levels could be phased in at later dates. 

This approach would allow the Department to responsibly phase the vaccine requirements using coverage projections while being a good steward of future Department Rulemaking resources and at the same time secure a healthier future for Arizona children and families.

Sincerely,

Will Humble, MPH

Executive Director,

Arizona Public Health Association

AzPHA Public Health Policy Update: March 12, 2018

 

Firearm Safety Public Policy Changes in AZ?

There are rumors around the Capitol that the Governor’s Office is talking to stakeholders about potential firearm safety laws in Arizona. However, I haven’t seen or heard anything official. Here’s a piece from the Capitol Times that mentions the topic

The APHA and the American Journal of Public Health have opened up access to their collection of research papers, commentaries and essays on public health and firearms to non-members in an effort to share the surveillance and evidence that exists freely in hopes that it can be used to influence public policy. They’re hoping that it’ll contribute to “greater collaboration and smarter evidence-based policies that enhance firearm safety and prevent injury and violence”.

 

AHCCCS Awards Contracts to Provide Integrated Services
AHCCCS awarded managed care contracts to 7 managed care organizations last week.  They’ll be responsible for coordinating the provision of physical and behavioral health care services to 1.5 million Medicaid members starting October 1. Here are the awardees for the various regions:

  • Maricopa, Gila and Pinal Counties: Banner-University Family Care Plan, Care1st Health Plan Arizona, Health Choice Arizona (Steward Health Choice Arizona), Health Net Access, Magellan Complete Care of Arizona, Mercy Care, and UnitedHealthcare Community Plan.

  • Pima, Cochise, Graham, Greenlee, La Paz, Santa Cruz, and Yuma Counties: Banner-University Family Care Plan, Health Net Access, and UnitedHealthcare Community Plan (in Pima County only).

  • Mohave, Coconino, Apache, Navajo, and Yavapai Counties: Care1st Health Plan Arizona, Health Choice Arizona (Steward Health Choice Arizona).

 

Report: Federal, state public health funding 'insufficient'
A new Trust for America's Health (TFAH) analysis finds that federal and state spending on public health "is insufficient." According to the report, available here, the CDC's core budget - not including the Prevention and Public Health Fund - has been "essentially flat for the last decade." Additionally, spending for public health by states has been declining.

 

Legislative Session News

HB 2324 Community health workers; voluntary certification was given a Pass recommendation by the Senate Health and Human Services Committee last Wednesday (5-2) (after passing the full House by a wide margin a few weeks ago).  We have a big test on Monday 3/12 in the Senate Commerce and Public Safety Committee. This Bill is a top priority for us. It asks the ADHS with developing a voluntary certification program for community health workers. The rulemaking would include certification standards including qualifications, core competencies, and continuing education requirements.

HB 2197 Health professions, workforce data got a unanimous Do Pass recommendation (7-0) in Senate HHS. It passed the full House a few weeks ago by a wide margin.  It would require AZ health licensing boards to collect certain data from applicants (beginning January 2020) to get better data about health professions workforce distribution and needs.  The data would be confidential.  Over the long-term this bill would be helpful in providing better data with which to improve the distribution and capacity of the public health workforce in Arizona.

Meanwhile, HB 2389  Syringe access programs; authorization was scheduled to be heard in the Senate Government Committee last week but was tabled until this week’s agenda Wednesday at 2 pm.

______

 

Committee Highlights this Week

Monday- Senate Commerce & Public Safety - 2 pm, SHR 1

HB 2197:  health professionals; workforce data

HB 2324:  community health workers; voluntary certification

 

Monday- House Military, Veterans & Regulatory Affairs - 2 pm, HHR 3

SB 1420:  medical marijuana; inspection; testing; appropriation

 

Wednesday- House Judiciary & Public Safety - 2 pm, HHR4

SB 1394:  ADHS; reporting; abortions

 

Wednesday- Senate Government - 2 pm, SHR109

HB 2389:  syringe access programs; authorization

 

Thursday- House Health 9am, HHR 4

SB 1245:  appropriation; SNAP; benefit match; produce

SB 1377:  dental therapy; licensure; regulation

SB 1504:  developmental disability rates; appropriation

 

Thursday- Senate Education - 9am, SHR 1

HB 2088:  pupils; concussions; parental notification

HB 2323:  schools; inhalers; contracted nurses

________

 

The following public health related bills passed their committee of origin and have gone over to the other chamber. Some have been assigned to committees in the new chamber, but some haven't yet.  Where available, I've listed the committee assignments in the detail section below.  We’re keeping track of the hearing dates and times.

HB 2038 Drug overdose review teams; records                

HB 2071 Rear-facing car seats

HB 2084 Indoor tanning; minors; restricted use      

HB 2127 Children's health insurance program

HB 2208 Prohibition, photo enforcement (we’re against this one)

HB 2228 Annual waiver, applicability (tribes)

HB 2323 Schools; inhalers; contracted nurses

HB 2324 Community health workers; voluntary certification

HB 2389 Syringe access programs; authorization

SB 1022 ADHS; homemade food products            

SB 1083 Schools; recess periods

SB 1445 AHCCCS Dental care, pregnant women

SB 1377 Dental therapy, licensure, regulation

SB 1394 Abortion reporting 

____

Remember to stay engaged and voice your opinion via the www.azleg.gov commenting system.  Click the following links for: Request to Speak account registration form; a Step-by-step use of the Request to Speak platform; and to Locate your Elected Officials

_____

 

House Bills

HB 2038 Drug overdose review teams; records                

Passed the House 57-0-2

Assigned to Senate Health and Human Services Committee

Under this proposed Bill, law enforcement agencies would be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request.  All information and records acquired by a Team are confidential and not subject to subpoena, discovery or introduction into evidence in a civil or criminal proceeding or disciplinary action.  We’re signed up in support of this one of course.

 

HB 2071 Rear-facing car seats         

Passed House 33-25-1

Assigned to Senate HHS & Commerce and Public Safety Committees 

This Bill would require kids under 2 years old to be in a rear-facing restraint system unless the child weights at least 40 pounds or is at least 40 inches tall.  We’ve signed up in support of this bill.  Dual assigned in the Senate, and not yet scheduled in either of the Senate committees.

 

HB 2084 Indoor tanning; minors; restricted use

Passed House 45 - 15

Assigned to Senate HHS and Commerce & Public Safety Committees

Tanning facility operators would be prohibited from allowing a person under 18 years of age to use a "tanning device". Tanning facilities couldn’t advertise or distribute materials that claim that using a tanning device is free from risk or will result in medical or health benefits. We’ve signed on in support of this of course. Bummer that it's dual assigned in the Senate.

HB 2127 Children's health insurance program

Passed House 46-12-1

Assigned to HHS & Appropriations Committees

This removes the trigger that automatically freezes the KidsCare program if FMAP (the federal contribution) drops below 100%.  It allows the state to freeze it if costs are more than the state or federal allotment. The bill does not require the state to appropriate any money for a state share.  We’ve signed up in support of this bill because it provides a pathway to keep KidsCare if the federal government drops its contribution level. 

 

HB 2197 Health professions, workforce data

Passed House 60 – 0

Assigned to HHS and Commerce & Public Safety Committees

This would require AZ health licensing boards to collect certain data from applicants (beginning January 2020) to get better data about health professions workforce distribution and needs.  The data would be confidential.  

This bill will also be heard in Senate Health and Human Services Bill Wednesday afternoon.  It would require AZ health licensing boards to collect certain data from applicants (beginning January 2020) to get better data about health professions workforce distribution and needs.  The data would be confidential.  Over the long-term this bill would be helpful in providing better data with which to improve the distribution and capacity of the public health workforce in Arizona.

Being heard this week in Monday’s the Senate Commerce and Public Safety Committee.

 

HB 2208 Prohibition, photo enforcement

Passed the House 31-27-1

Assigned to the Senate Transportation Committee

This one would prohibit cities and other jurisdictions from having photo enforcement of red light and speeding violations.  While nobody likes getting a ticket in the mail, the data suggest that photo enforcement saves lives and prevents injuries (especially red-light photo enforcement).  We’ve signed up in opposition to the bill.  This bill passed the House 31-27 last week and is moving on to the Senate Transportation Committee- not on their agenda yet..

 

HB 2228 Annual waiver, applicability

Passed the House 58-0-1

Assigned to Senate HHS Committee

This would direct AHCCCS to exempt tribes from their directed waiver requests to CMS asking permission to implement work requirements for some Medicaid members.  The recently submitted Waiver request includes an exemption for American Indians, however, this would place the exemption into statute.

 

HB 2323  Schools; inhalers; contracted nurses

Passed House 58 – 0 - 1

Assigned to Senate Education Committee

This bill adds contracted nurses to the list of people who are authorized to provide emergency inhaler medication in case of respiratory emergencies. Some charter and independent schools don’t employ nurses directly but engage them through contracts.

 

HB 2324 Community health workers; voluntary certification

Passed House 56 – 1 - 3

Assigned to HHS and Commerce & Public Safety Committees

This is a top priority for us. It would charge the ADHS with developing a voluntary certification program for community health workers.  The Department rulemaking would include certification standards including qualifications, core competencies, and continuing education requirements. We’ve signed up in support of this bill. Passed the Health and Human Services Committee last week and is up on Monday this week in the Senate Commerce and Public Safety Committee.

 

HB 2389  Syringe access programs; authorization

Passed House 56 – 0 - 4

Assigned to the Senate Government Committee

This important bill will also be heard Wednesday afternoon in the Senate Government Committee. It would decriminalize needle exchange programs.  It’s currently a felony to distribute needles to illegal drug users. Persons, employees and volunteers operating within the scope of the law can’t be charged or prosecuted for their activities. We’ve signed up in support of this bill because this type of program is evidence-based and reduces the spread of bloodborne diseases as well as engaging in intravenous drug users into treatment. 

Up this Wednesday in the Senate Government Committee- 2 pm in SHR 109.

 

Senate Bills

SB 1022    DHS; homemade food products            

Passed Senate 30-0

Assigned to House Health Committee

ADHS would be required to establish an online registry of food preparers that are authorized to prepare "cottage food products" for commercial purposes. Registered food preparers would be required to renew the registration every three years. This is a sensible addition to the current cottage industry food law and we’ve signed up in support. Being heard in the House Health Committee this week (Thursday).  Should have no problems at all.

 

SB 1083    Schools; recess periods

Passed Senate 26-3-1

Assigned to and Passed House Education Committee 9-0 on Monday

District and charter schools would be required to provide at least 2 recess periods during the school day for pupils in grades K-5 if this passes. We’ve signed in support of this bill because there is good evidence that opportunities for physical activity at school are associated with improved health, behavior, and academic achievement of students.  Here is a good evidence review from the CDC entitled The Association Between School-based Physical Activity and Academic Performance. Great couple of weeks for this bill. Hopefully there’s a floor vote on this shortly.

 

SB 1245 Snap Benefit Match

Passed Senate 25 - 5

Assigned to House Health and Appropriation Committees

There was more good news with the passage of SB 1245 Snap Benefit Match by the Senate (25 – 5).  It’s assigned to House Health and Appropriation Committees too.  This good Bill would appropriate $400K to ADES to develop a produce incentive program within the Supplemental Nutrition Assistance Program (SNAP) for members to buy Arizona-grown fruits and vegetables.  It would also provide matching funds to SNAP-authorized vendors as an incentive to participate in the fruits and vegetable program. 

This Bill would appropriate $400K to ADES to develop the infrastructure for a produce incentive program within the Supplemental Nutrition Assistance Program (SNAP) for members to buy Arizona-grown fruits and vegetables.  It would also provide matching funds to SNAP-authorized vendors as an incentive to participate in the fruits and vegetable program.  It has passed the full Senate and will be heard this Thursday at 9 am in House Health.   

 

SB 1261 Texting while driving

Passed Transportation Committee- Ready for a Senate Floor Vote

This would prohibit drivers from “using a portable wireless communication device to read, write, or send an electronic message while driving” (unless the car is stopped).  The first violation would be a petty offense with a fine between $25 and $99.  It has passed its committees and is ready for a floor vote, which hasn’t happened yet.  Not a good sign.

 

SB 1377 Dental therapy, licensure, regulation

Passed Senate 22 – 8

Assigned to House Health Committee

This would set up a new licensed class of dental professionals called a Dental Therapist. Their scope of practice would be somewhat less than a DDS, but they could do some procedures like filling cavities. This has been a somewhat controversial bill as there are stakeholders of both sides that are quite passionate about their position on this Bill.   Being heard this week (Thursday at 9 am) in the House Health Committee.

 

SB 1394 Abortion reporting

Passed Senate 17 - 13

Assigned to the Judiciary and Federalism, Property Rights & Public Policy Committees

This one would require the ADHS to collect and report additional data regarding abortions that are performed in AZ. The data would be collected and reported by providers and would include the reason for the abortion (economic, emotional health, physical health, whether the pregnancy was the result of rape or incest, or relationship issues etc.).  Up Wednesday this week in the House Judiciary & Public Safety at 2 pm.

 

SB 1420 medical marijuana; inspection; testing; appropriation

Passed Senate 27 – 3

Assigned to House Military, Veteran and Regulatory Affairs Committee

This would require the ADHS to set up testing standards for medical marijuana and begin enforcing the standards beginning in 2019.  We’re supporting this legislation.  It passed the full Senate last week.  Up this week in the House Military, Veterans & Regulatory Affairs - 2 pm, HHR 3.

 

SB 1445 AHCCCS Dental care, pregnant women

Passed Senate 27 - 3

Assigned to House Health & Appropriations Committees

This Bill would provide oral health coverage for pregnant Medicaid members. It has moved on to the House and is assigned to the House Health Committee (which gave as similar bill a pass recommendation last year).  Because it involves money its also assigned to the House Appropriations Committee.  The benefit would be limited to $1000/year.  Lots of good public health reasons to support this one. 

This is a priority Bill for AzPHA.  It would provide oral health coverage for pregnant Medicaid members.  The benefit would be limited to $1000 and could be used for other than emergency dental procedures (beginning October 1, 2017 all adult Medicaid members became eligible for up to $1000 in emergency dental services per year).  Lots of good public health reasons to support this one. 

 

SB 1470  Sunrise process; health professions

Passed Senate 21 - 9

Assigned to House Government Committee

To be honest- this bill has been flying under the radar at least with me.  If it passes and is signed it’d make huge changes to the health professions scope of practice system we use today. The current sunrise process is a collaborative, inclusive process that allows time for consideration and review of the complicated health care delivery proposals.  The current process requires a Committee of Reference hearing, which allows a consideration of a proposed scope change and its potential patient safety and care implications.

SB 1470 would change the scope of practice system so that all a profession needs to do is prepare a written sunrise report right before the regular legislative session. It would allow the legislative standing committees (rather than Committees of Reference) to consider a sunrise proposal. During legislative session, long agendas and the fast pace limits the time to consider serious issues impacted by changes in scope of practice, including prescribing, complex health care procedures, complicated review, and reflection on curriculum, training and education.

We had a Public Health Policy Committee call last week and recommended to our Board that we take a position opposing the bill- which we did last week.  I testified that, rather than eliminating the pre-session hearings for scope of practice changes that they consider modifying the bill so that requests for new Scope changes go to the ADHS Director for a recommendation back to the Legislature. 

The Bill passed the House Government Committee last week.  There is reportedly a stakeholder meeting on the bill this week.  We’ll stay tuned.

__

 

Public Health Bills that Failed to Thrive

 

HB 2064 Medical marijuana; packaging; labeling              

Dead for now

This Bill proposes that medical marijuana dispensaries be prohibited from selling a marijuana product that’s packaged or labeled in a manner that’s "attractive to minors". Due to voter protection, this legislation requires the affirmative vote of at least 3/4 of the members of each house of the Legislature for passage.  Dead for now.

 

HB 2109 Tobacco possession; sale; age; signage                

Sadly, dead for now

This Bill would prohibit furnishing a tobacco product to a person who is under 21 years of age. The definition of "tobacco product" is expanded to include "electronic smoking devices". We’ve signed up in support. It received a Do Pass recommendation from the House Health Committee three weeks ago but the Commerce chair hasn’t put it on the agenda, so it’s effectively dead for now. Kudos to Rep. Boyer for sponsoring this.

____________

 

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AzPHA Public Health Policy Update: March 6, 2018

Legislative Session Update

Good news.  Last week SB 1445 AHCCCS Dental care, pregnant women was passed by the Senate (27 – 3).  This Bill would provide oral health coverage for pregnant Medicaid members. It has moved on to the House and is assigned to the House Health Committee (which gave as similar bill a pass recommendation last year).  Because it involves money its also assigned to the House Appropriations Committee.  The benefit would be limited to $1000/year.  Lots of good public health reasons to support this one. 

There was more good news with the passage of SB 1245 Snap Benefit Match by the Senate (25 – 5).  It’s assigned to House Health and Appropriation Committees too.  This good Bill would appropriate $400K to ADES to develop a produce incentive program within the Supplemental Nutrition Assistance Program (SNAP) for members to buy Arizona-grown fruits and vegetables.  It would also provide matching funds to SNAP-authorized vendors as an incentive to participate in the fruits and vegetable program.  

______

 

Committee Highlights this Week

 

Senate Health and Human Services Committee- 2 pm Wednesday March 7

HB 2324 Community health workers; voluntary certification

This Bill is a top priority for us. It asks the ADHS with developing a voluntary certification program for community health workers. The rulemaking would include certification standards including qualifications, core competencies, and continuing education requirements.  The good news is that it’s being heard this week (Wednesday afternoon) in the Senate Health & Human Services Committee.

The members of the committee are Nancy Barto, Katie Hobbs, David Bradley, Kate Brophy McGee, Kimberly Yee,  Judy Burges, and Rick Gray.  Please contact these members today and let them know you support voluntary registration of community health workers.  You can also sign in using the RTS system.  Here’s some sample language to use:

“Thank you for hearing HB2324 (community health worker voluntary certification) in your HHS Committee next week. Community health workers establish and maintain trust, enabling them to serve as a liaison between health/social services and facilitating access to services and work to provide high quality and culturally competent service delivery- important tools to reduce costs and improve outcomes- especially for chronic diseases like diabetes.

Voluntary certification is an important next step in better using the CHW workforce in AZ's managed care healthcare system.  While many providers currently employ and contract with CHWs, voluntary certification will provide an additional level of assurance that voluntarily certified CHWs meet a set of core competency requirements- allowing AZs provider network to elect to use this workforce to improve outcomes and reduce costs.”

 

HB 2197 Health professions, workforce data

This bill will also be heard in Senate Health and Human Services Bill Wednesday afternoon.  It would require AZ health licensing boards to collect certain data from applicants (beginning January 2020) to get better data about health professions workforce distribution and needs.  The data would be confidential.  Over the long-term this bill would be helpful in providing better data with which to improve the distribution and capacity of the public health workforce in Arizona.

 

Senate Government Committee - 2 pm Wednesday March 7

HB 2389  Syringe access programs; authorization

This important bill will also be heard Wednesday afternoon in the Senate Government Committee. It would decriminalize needle exchange programs.  It’s currently a felony to distribute needles to illegal drug users. Under this bill, persons, employees and volunteers operating within the scope of the law couldn't be charged or prosecuted for their activities. We’ve signed up in support of this bill because this type of program is evidence-based and reduces the spread of bloodborne diseases as well as engaging in intravenous drug users into treatment. 

________

The following public health related bills passed their committee of origin and have gone over to the other chamber. Some have been assigned to committees in the new chamber, but some haven't yet.  Where available, I've listed the committee assignments in the detail section below.  We’re keeping track of the hearing dates and times.

HB 2038 Drug overdose review teams; records                

HB 2071 Rear-facing car seats

HB 2084 Indoor tanning; minors; restricted use      

HB 2127 Children's health insurance program

HB 2208 Prohibition, photo enforcement (we’re against this one)

HB 2228 Annual waiver, applicability (tribes)

HB 2324 Community health workers; voluntary certification

HB 2389 Syringe access programs; authorization

SB 1022 ADHS; homemade food products            

SB 1083 Schools; recess periods

SB 1445 AHCCCS Dental care, pregnant women

SB 1377 Dental therapy, licensure, regulation

SB 1394 Abortion reporting

____

Remember to stay engaged and voice your opinion via the www.azleg.gov commenting system.  Click the following links for: Request to Speak account registration form; a Step-by-step use of the Request to Speak platform; and to Locate your Elected Officials 

_____

House Bills

HB 2038 Drug overdose review teams; records                

Passed the House 57-0-2

Assigned to Senate Health and Human Services Committee

Under this proposed Bill, law enforcement agencies would be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request.  All information and records acquired by a Team are confidential and not subject to subpoena, discovery or introduction into evidence in a civil or criminal proceeding or disciplinary action.  We’re signed up in support of this one of course.

 

HB 2071 Rear-facing car seats         

Passed House 33-25-1

Assigned to HHS & Commerce and Public Safety Committees 

This Bill would require kids under 2 years old to be in a rear-facing restraint system unless the child weights at least 40 pounds or is at least 40 inches tall.  We’ve signed up in support of this bill.  Dual assigned in the Senate.

 

HB 2084 Indoor tanning; minors; restricted use

Passed House 45 - 15

Assigned to Senate HHS and Commerce & Public Safety Committees

Tanning facility operators would be prohibited from allowing a person under 18 years of age to use a "tanning device". Tanning facilities couldn’t advertise or distribute materials that claim that using a tanning device is free from risk or will result in medical or health benefits. We’ve signed on in support of this of course. Bummer that it's dual assigned in the Senate.

 

HB 2127 Children's health insurance program

Passed House 46-12-1

Assigned to HHS & Appropriations Committees

This removes the trigger that automatically freezes the KidsCare program if FMAP (the federal contribution) drops below 100%.  It allows the state to freeze it if costs are more than the state or federal allotment. The bill does not require the state to appropriate any money for a state share.  We’ve signed up in support of this bill because it provides a pathway to keep KidsCare if the federal government drops its contribution level. 

 

HB 2197 Health professions, workforce data

Passed House 60 – 0

Assigned to HHS and Commerce & Public Safety Committees

This would require AZ health licensing boards to collect certain data from applicants (beginning January 2020) to get better data about health professions workforce distribution and needs.  The data would be confidential.  

 

HB 2208 Prohibition, photo enforcement

Passed the House 31-27-1

Assigned to the Senate Transportation Committee

This one would prohibit cities and other jurisdictions from having photo enforcement of red light and speeding violations.  While nobody likes getting a ticket in the mail, the data suggest that photo enforcement saves lives and prevents injuries (especially red-light photo enforcement).  We’ve signed up in opposition to the bill.  This bill passed the House 31-27 last week and is moving on to the Senate Transportation Committee.

 

HB 2228 Annual waiver, applicability

Passed the House 58-0-1

Assigned to Senate HHS Committee

This would direct AHCCCS to exempt tribes from their directed waiver requests to CMS asking permission to implement work requirements for some Medicaid members.  The recently submitted Waiver request includes an exemption for American Indians, however, this would place the exemption into statute.

 

HB 2324 Community health workers; voluntary certification

Passed House 56 – 1 - 3

Assigned to HHS and Commerce & Public Safety Committees

This is a top priority for us. It would charge the ADHS with developing a voluntary certification program for community health workers.  The Department rulemaking would include certification standards including qualifications, core competencies, and continuing education requirements. We’ve signed up in support of this bill.

Members of the committee are Nancy Barto, David Bradley, Kate Brophy McGee, Judy Burges, Rick Gray, Katie Hobbs, and Kimberly Yee.  You can contact these members directly by email (here is the list) and you can also sign in using the RTS system.

 

HB 2389  Syringe access programs; authorization

Passed House 56 – 0 - 4

Assigned to the Senate Government Committee

This important bill will also be heard Wednesday afternoon in the Senate Government Committee. It would decriminalize needle exchange programs.  It’s currently a felony to distribute needles to illegal drug users. Persons, employees and volunteers operating within the scope of the law can’t be charged or prosecuted for their activities. We’ve signed up in support of this bill because this type of program is evidence-based and reduces the spread of bloodborne diseases as well as engaging in intravenous drug users into treatment. 

 

Senate Bills

SB 1022    DHS; homemade food products            

Passed Senate 30-0

Assigned to House Health Committee

ADHS would be required to establish an online registry of food preparers that are authorized to prepare "cottage food products" for commercial purposes. Registered food preparers would be required to renew the registration every three years. This is a sensible addition to the current cottage industry food law and we’ve signed up in support. Being heard in the House Health Committee this week (Thursday).  Should have no problems at all.

 

SB 1083    Schools; recess periods

Passed Senate 26-3-1

Assigned to and Passed House Education Committee 9-0 on Monday

District and charter schools would be required to provide at least 2 recess periods during the school day for pupils in grades K-5 if this passes.  We’ve signed in support of this bill because there is good evidence that opportunities for physical activity at school are associated with improved health, behavior, and academic achievement of students.  Here is a good evidence review from the CDC entitled The Association Between School-based Physical Activity and Academic Performance. Great couple of weeks for this bill.

 

SB 1245 Snap Benefit Match

Passed Senate 25 - 5

Assigned to House Health and Appropriation Committees

This Bill would appropriate $400K to ADES to develop the infrastructure for a produce incentive program within the Supplemental Nutrition Assistance Program (SNAP) for members to buy Arizona-grown fruits and vegetables.  It would also provide matching funds to SNAP-authorized vendors as an incentive to participate in the fruits and vegetable program.  It passed the Health and Human Services Committee and the Appropriations Committee. We’ve signed up in support of this Bill. Being heard in Senate HHS Wednesday.

 

SB 1261 Texting while driving

Passed Transportation Committee- Ready for a Senate Floor Vote

This would prohibit drivers from “using a portable wireless communication device to read, write, or send an electronic message while driving” (unless the car is stopped).  The first violation would be a petty offense with a fine between $25 and $99.  It has passed its committees and is ready for a floor vote, which hasn’t happened yet.  Not a good sign.

 

SB 1377 Dental therapy, licensure, regulation

Passed Senate 22 – 8

Assigned to House Health Committee

This would set up a new licensed class of dental professionals called a Dental Therapist. Their scope of practice would be somewhat less than a DDS, but they could do some procedures like filling cavities. This has been a somewhat controversial bill as there are stakeholders of both sides that are quite passionate about their position on this Bill. 

 

SB 1394 Abortion reporting

Passed Senate 17 - 13

Assigned to the Judiciary and Federalism, Property Rights & Public Policy Committees

This one would require the ADHS to collect and report additional data regarding abortions that are performed in AZ. The data would be collected and reported by providers and would include the reason for the abortion (economic, emotional health, physical health, whether the pregnancy was the result of rape or incest, or relationship issues etc.).

 

SB 1420 medical marijuana; inspection; testing; appropriation

Passed Senate 27 – 3

Assigned to House Military, Veteran and Regulatory Affairs Committee

This would require the ADHS to set up testing standards for medical marijuana and begin enforcing the standards beginning in 2019.  We’re supporting this legislation.  It passed the full Senate last week.

 

SB 1445 AHCCCS Dental care, pregnant women

Passed Senate

Assigned to House Health & Appropriations Committees

This is a priority Bill for AzPHA.  It would provide oral health coverage for pregnant Medicaid members.  The benefit would be limited to $1000 and could be used for other than emergency dental procedures (beginning October 1, 2017 all adult Medicaid members became eligible for up to $1000 in emergency dental services per year).  Lots of good public health reasons to support this one. 

 

SB 1470  Sunrise process; health professions

Passed Senate

Assigned to House Government Committee

To be honest- this bill has been flying under the radar at least with me.  If it passes and is signed it’d make huge changes to the health professions scope of practice system we use today. The current sunrise process is a collaborative, inclusive process that allows time for consideration and review of the complicated health care delivery proposals.  The current process requires a Committee of Reference hearing, which allows a consideration of a proposed scope change and its potential patient safety and care implications.

SB 1470 would change the scope of practice system so that all a profession needs to do is prepare a written sunrise report right before the regular legislative session. It would allow the legislative standing committees (rather than Committees of Reference) to consider a sunrise proposal. During legislative session, long agendas and the fast pace limits the time to consider serious issues impacted by changes in scope of practice, including prescribing, complex health care procedures, complicated review, and reflection on curriculum, training and education.

We haven’t taken a position on this yet- but we’ll talk about it on our Public Health Policy Committee call on Monday.  Seems like the risks outweigh the benefits on this one.

__

 

Public Health Bills that Failed to Thrive

HB 2064 Medical marijuana; packaging; labeling              

Dead for now

This Bill proposes that medical marijuana dispensaries be prohibited from selling a marijuana product that’s packaged or labeled in a manner that’s "attractive to minors". Due to voter protection, this legislation requires the affirmative vote of at least 3/4 of the members of each house of the Legislature for passage.  Dead for now.

 

HB 2109 Tobacco possession; sale; age; signage                

Sadly, dead for now

This Bill would prohibit furnishing a tobacco product to a person who is under 21 years of age. The definition of "tobacco product" is expanded to include "electronic smoking devices". We’ve signed up in support. It received a Do Pass recommendation from the House Health Committee three weeks ago but the Commerce chair hasn’t put it on the agenda, so it’s effectively dead for now. Kudos to Rep. Boyer for sponsoring this.

____________

APHA Legislative Update

On Feb. 9, President Trump signed the Bipartisan Budget Act of 2018. The new law raises the current spending caps for defense and nondefense discretionary spending in fiscal year 2018 and fiscal year 2019 by $165 billion and $131 billion, respectively. While APHA welcomed the increase in nondefense discretionary funding, the category of money that funds public health and other federal nondefense programs, the association is deeply disappointed that the bill also cut the Prevention and Public Health Fund by $1.35 billion over the next decade.

The bill used the cuts from the prevention fund in part to pay for reauthorizing community health centers, the National Health Service Corps and other expired health programs for two years. The bill also added an additional four years to the reauthorization of the Children’s Health Insurance program, bringing the total reauthorization for CHIP to 10 years. The bill passed the U.S. Senate by a vote of 71-28 and passed the House by a vote of 240-186.

After the bill passed, APHA issued a statement supporting the additional funding available for nondefense discretionary spending and urging Congress to work to ensure that some of the additional funding is directed to public health programs at the Centers for Disease Control and Prevention and the Health Resources and Services Administration.

The statement also expressed deep disappointment that Congress turned to cutting the prevention fund, a critical source of public health funding that currently makes up around 12 percent of the CDC’s entire budget. The Prevention Fund supports critical public health activities — including lead poisoning surveillance, vaccination initiatives and other programs — in every state and community across the country.

APHA members can send a message to their members of Congress urging them to ensure public health is adequately funded in FY2018.

AzPHA Public Health Policy Update: February 27, 2018

Last week was pretty busy with lots of floor votes on many of the public health bills- the highlights were full chamber approvals of HB2324 (voluntary certification of community health workers), HB2389 (syringe access), and SB1083 (recess in schools).

Unfortunately the community health worker bill got assigned to both the Health and Human Services and the Commerce & Public Safety Committees in the Senate this week. That's a tough break- especially the PS/Commerce assignment.  The syringe access bill got a Government Committee assignment- which is encouraging I think.

Yesterday the House Education Committee voted 9-0 to give SB 1083 Schools; recess periods a Do Pass Recommendation.  The Bill passed through the Senate a couple of weeks ago.  It would require public and charter schools to provide at least 2 recess periods during the school day in grades K-5. There was a lot of community support at the hearing yesterday, which is encouraging.

The following public health related bills passed their committee of origin and have gone over to the other chamber. Some have been assigned to committees in the new chamber, but some haven't yet.  Where available, I've listed the committee assignments in the detail section below.  Hearings will begin next week.

HB 2038 Drug overdose review teams; records                

HB 2071 Rear-facing car seats

HB 2084 Indoor tanning; minors; restricted use      

HB 2127 Children's health insurance program

HB 2208 Prohibition, photo enforcement (we’re against this one)

HB 2228 Annual waiver, applicability (tribes)

HB 2324 Community health workers; voluntary certification

HB 2389 Syringe access programs; authorization

SB 1022 ADHS; homemade food products            

SB 1083 Schools; recess periods

SB 1377 Dental therapy, licensure, regulation

SB 1394 Abortion reporting

This week is light in terms of committee hearings.  That’ll pick up a lot next week.

____

Remember to stay engaged and voice your opinion via the www.azleg.gov commenting system.  Click the following links for: Request to Speak account registration form; a Step-by-step use of the Request to Speak platform; and to Locate your Elected Officials 

_____ 

House Bills

HB 2038 Drug overdose review teams; records                

Passed the House 57-0-2

Assigned to Senate Health and Human Services (HHS) Committee

Under this proposed Bill, law enforcement agencies would be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request.  All information and records acquired by a Team are confidential and not subject to subpoena, discovery or introduction into evidence in a civil or criminal proceeding or disciplinary action.  We’re signed up in support of this one of course.

 

HB 2071 Rear-facing car seats         

Passed House 33-25-1

Assigned to HHS & Commerce and Public Safety Committees 

This Bill would require kids under 2 years old to be in a rear-facing restraint system unless the child weights at least 40 pounds or is at least 40 inches tall.  We’ve signed up in support of this bill.  Dual assigned in the Senate.

 

HB 2084 Indoor tanning; minors; restricted use

Passed House 45 - 15

Assigned to HHS and Commerce & Public Safety Committees

Under this proposal, tanning facility operators would be prohibited from allowing a person under 18 years of age to use a "tanning device". Tanning facilities are prohibited from advertising or distributing promotional materials that claim that using a tanning device is free from risk or will result in medical or health benefits. We’ve signed on in support of this of course. Bummer that it's dual assigned in the Senate.

 

HB 2127 Children's health insurance program

Passed House 46-12-1

Assigned to HHS & Appropriations Committees

This Bill removes the trigger that automatically freezes the KidsCare program if FMAP (the federal contribution) drops below 100%.  It allows the state to freeze it if costs are more than the state or federal allotment. The bill does not require the state to appropriate any money for a state share.  We’ve signed up in support of this bill because it provides a pathway to keep KidsCare if the federal government drops its contribution level. 

 

HB 2197 Health professions, workforce data

Passed House 60 – 0

Assigned to HHS and Commerce & Public Safety Committees

This Bill would require AZ health licensing boards to collect certain data from applicants (beginning January 2020) to get better data about health professions workforce distribution and needs.  The data would be confidential.  

 

HB 2208 Prohibition, photo enforcement

Passed the House 31-27-1

Assigned to the Senate Transit Committee

This Bill would prohibit cities and other jurisdictions from having photo enforcement of red light and speeding violations.  While nobody likes getting a ticket in the mail, the data suggest that photo enforcement saves lives and prevents injuries (especially red-light photo enforcement).  We’ve signed up in opposition to the bill.  This bill passed the House 31-27 last week and is moving on to the Senate Transportation Committee.

 

HB 2228 Annual waiver, applicability

Passed the House 58-0-1

Assigned to Senate HHS Committee

This Bill would direct AHCCCS to exempt tribes from their directed waiver requests to CMS asking permission to implement work requirements for some Medicaid members.  The recently submitted Waiver request includes an exemption for American Indians, however, this would place the exemption into statute.

 

HB 2324 Community health workers; voluntary certification

Passed House 56 – 1 - 3

Assigned to HHS and Commerce & Public Safety Committees

This Bill is a top priority for us. It would charge the ADHS with developing a voluntary certification program for community health workers.  The Department rulemaking would include certification standards including qualifications, core competencies, and continuing education requirements. We’ve signed up in support of this bill. Tough break this week because it's assigned to both the HHS and Commerce and Public Safety Committees. 

 

HB 2389  Syringe access programs; authorization

Passed House 56 – 0 - 4

Assigned to the Senate Government Committee

Under this Bill, organizations in Arizona may establish and operate a needle exchange program.  Persons, employees and volunteers operating within the scope of the law may not be charged or prosecuted for their activities. It’s currently a felony to distribute needles to illegal drug users. While many people thought that this should be included in the Opioid Special Session, it was not.

We’ve signed up in support of this bill because this type of program is evidence-based and reduces the spread of bloodborne diseases as well as engaging in intravenous drug users into treatment. 

 

Senate Bills

SB 1022    DHS; homemade food products            

Passed Senate 30-0

Assigned to House Health Committee

Under this Bill, ADHS would be required to establish an online registry of food preparers that are authorized to prepare "cottage food products" for commercial purposes. Registered food preparers would be required to renew the registration every three years. This is a sensible addition to the current cottage industry food law and we’ve signed up in support.

 

SB 1083    Schools; recess periods

Passed Senate 26-3-1

Assigned to and Passed House Education Committee 9-0 on Monday

District and charter schools would be required to provide at least 2 recess periods during the school day for pupils in grades K-5.  We’ve signed in support of this bill because there is good evidence that opportunities for physical activity at school are associated with improved health, behavior, and academic achievement of students.  Here is a good evidence review from the CDC entitled The Association Between School-based Physical Activity and Academic Performance. Great couple of weeks for this bill.

 

SB 1245 Snap Benefit Match

Ready for a Floor Vote in the Senate

This Bill would appropriate $400K to ADES to develop the infrastructure for a produce incentive program within the Supplemental Nutrition Assistance Program (SNAP) for members to buy Arizona-grown fruits and vegetables.  It would also provide matching funds to SNAP-authorized vendors as an incentive to participate in the fruits and vegetable program.  It passed the Health and Human Services Committee and the Appropriations Committee. We’ve signed up in support of this Bill. Still needs a Senate floor vote.

 

SB 1261 Texting while driving

Passed Transportation Committee- Ready for a Senate Floor Vote

This bill would prohibit drivers from “using a portable wireless communication device to read, write, or send an electronic message while driving” (unless the car is stopped).  The first violation would be a petty offense with a fine between $25 and $99.  It has passed its committees and is ready for a floor vote, hopefully that happens this week.

 

SB 1377 Dental therapy, licensure, regulation

Passed Senate 22 – 8

Not yet assigned to House Committees

This Bill was introduced last week and would set up a new licensed class of dental professionals called a Dental Therapist.  Their scope of practice would be somewhat less than a DDS, but they could do some procedures like filling cavities. This has been a somewhat controversial bill as there are stakeholders of both sides that are quite passionate about their position on this Bill. 

 

SB 1394 Abortion reporting

Passed Senate 17 - 13

Not yet assigned to House Committees

This Bill would require the ADHS to collect and report additional data regarding abortions that are performed in AZ. The data would be collected and reported by providers and would include the reason for the abortion (economic, emotional health, physical health, whether the pregnancy was the result of rape or incest, or relationship issues etc.).

 

SB 1420 medical marijuana; inspection; testing; appropriation

Passed Senate 27 – 3

Not yet assigned to House Committees

This Bill would require the ADHS to set up testing standards for medical marijuana and begin enforcing the standards beginning in 2019.  We’re supporting this legislation.  It passed the full Senate last week.

__

Public Health Bills that Failed to Thrive

HB 2064 Medical marijuana; packaging; labeling              

Dead for now

This Bill proposes that medical marijuana dispensaries be prohibited from selling a marijuana product that’s packaged or labeled in a manner that’s "attractive to minors". Due to voter protection, this legislation requires the affirmative vote of at least 3/4 of the members of each house of the Legislature for passage.  Dead for now.

 

HB 2109 Tobacco possession; sale; age; signage                

Sadly, dead for now

This Bill would prohibit furnishing a tobacco product to a person who is under 21 years of age. The definition of "tobacco product" is expanded to include "electronic smoking devices". We’ve signed up in support. It received a Do Pass recommendation from the House Health Committee three weeks ago but the Commerce chair hasn’t put it on the agenda, so it’s effectively dead for now. Kudos to Rep. Boyer for sponsoring this.