AzPHA Public Health Policy Update - October 24, 2017

Health Profession Sunrise Applications to be Heard November 28

Whenever health related professions ask to be regulated or want to expand their scope of practice a state law (A.R.S. § 32-3103) says that the regulation needs to be done only to protect the public interest.  Here are the standards that define “public interest”:

  • If the unregulated practice harms or endangers the public, health safety or welfare and the potential for harm is easily recognizable and not remote or dependent on tenuous agreement;
  • If the public needs and can reasonably be expected to benefit from an assurance of initial and continuing professional ability; and
  • If the public can’t be effectively protected by other means in a more cost beneficial manner.

Applicants that want to go through the process need to submit a report to the state legislature explaining the factors demonstrating that their request meets these standards. A “Committee of Reference” studies the sunrise applications and delivers its recommendations to House and Senate leadership. 

This year there are 3 applications in the hopper and they’ll be heard on Tuesday, November 28 starting at 9 am in one of the rooms over at the legislature (I don’t know where yet).  I’ve included links below to the 3 sunrise applications for this year.

In a nutshell the Community Health Worker application asks for a pathway to set up a process for voluntary registration of CHWs; the Naturopath application would like permission for them to sign medical waivers from the state’s school vaccination requirements; and the Dental Therapist application asks for authorization from the legislature to license a new class of dental professionals.

We’re for sure in favor of the CHW application.  We’re going to dig a little deeper before making a decision about the other two.  We’re in the process of setting up a Policy Committee call next week to discuss the Naturopath and Dental Therapist applications.

 

Huge Hearing this Week in State Supreme Court

There’s a super-important hearing this Thursday in the State Supreme Court.  The outcome of the Biggs v. Betlach case will decide whether thousands and thousands of current Arizona Medicaid members (childless adults) will lose their AHCCCS eligibility and possibly causing a cascade of events jeopardizing coverage for the Medicaid expansion population (FPL of between 100 – 138%).

Oral Arguments on the Biggs v. Betlach case are Thursday, October 26 starting at 9 am at the Arizona Supreme Court at 1501 West Washington in Phoenix (Case CV-17-0130-PR).  In a nutshell- the case is about whether the hospital assessment that’s used to fund the state match for “childless adults” enrolled in AHCCCS is a fee or a tax.

When Arizona expanded our Medicaid program (AHCCCS) to cover people up to 138% of poverty we used a provision in the ACA that allows states to expand coverage with the federal government absorbing all the cost at first.

To qualify, AZ had to first restore coverage for “childless adults” that have income below the federal poverty level (a group that lost AHCCCS coverage during the recession).  AZ paid for covering the childless adults with an assessment (fee) on hospitals set by AHCCCS (right now it’s about $264M).

The bill that authorized the hospital assessment barely passed with just over 50% of the House and Senate.  Many of the lawmakers that voted “no” (and the Goldwater Institute) believe that the assessment is not a fee, but a tax, and requires a supermajority of 2/3 of each chamber in order to pass (a voter initiative requires laws that raise taxes to have a supermajority).

If the Court agrees with the Plaintiffs that the assessment is a tax and not a fee, AHCCCS wouldn’t be able to collect the $264M hospital assessment and there won’t be enough money to fund the childless adults…  which could also jeopardize our coverage for the expansion population (people between 100 – 138% of the federal poverty level). 

Unless the legislature were to vote by a 2/3 majority to fund the program, the only path to keeping the coverage would be via a voter initiative- which just got a lot harder with the passage and signing of HB 2404 (preventing signature gatherers from getting paid by the signature) and HB2244 (changing the citizen's initiative compliance standard from "substantial compliance" to "strict compliance").

 

Leaders Across Borders Applications Due 11/10/17

The U.S.-Mexico Border Health Commission was is currently seeking candidates for the 2018 Leaders across Borders Program.   Leaders across Borders (LaB) is an advanced leadership development program funded by the U.S.-Mexico Border Health Commission aimed at building the binational leadership capacity of public health, health care, and other community professionals working to improve the health of communities in the U.S.-México border region. 

This program is intended for public health, health care, and other community-sector leaders who meet the following requirements:

  • Are proficient in English and Spanish with an understanding of both languages, translation will not be provided at in-person learning event;
  • Have at least five years’ experience working in the U.S.-México border region;
  • Committed to working with vulnerable populations and promoting health equity, eliminating health disparities, and increasing quality of life within the U.S.-México border region; and
  • Seeking to enhance their leadership and health diplomacy skills, professional networks, and understanding of binational public health assets, challenges, and systems as a means to identify solutions

U.S. candidates must me formally nominated by their employers or professional organizations.  The nomination process is quick and easy and can be found on the U.S.-Mexico Border Health Commission website.

Please note that November 10, 2017 is the application deadline.

 

Community Health Center and Nat’l Health Service Corps Funding Hanging

Representatives Stefanik (R-NY) and Tsongas (D-MA) are leading bi-partisan Health Center effort seeking action to extend Health Center and National Health Service Corps funding and fix the cliff by passing the “CHIME Act” ( S. 1899 in the Senate and HR 3770 in the House). The CHIME Act lays out a five-year extension to Health Center funding to fix the Health Center and National Health Service Corps funding cliff without cutting the Prevention and Public Health Fund (like the Champion Act does).

You can Send your Members of Congress a message through the Health Center Advocacy Network asking them to co-sponsor the CHIME Act – click here to send your message and call your Representative using the toll-free Advocacy Hotline 1-866-456-3949 and ask that they co-sign the Stefanik-Tsongas Health Center Cliff Letter addressed to House Leadership asking for immediate action to fix the cliff.

 

Kids Care Extension Update

The US House of Representatives is in a holding pattern and is delaying consideration of a bill to extend funding for the Children’s Health Insurance Program (called Kids Care in Arizona). The hope is to reach a bipartisan agreement on paying for KidsCare- probably in November. 

The main drama isn’t whether to extend CHIP (KidsCare), it’s how to pay for it.  There are some that want to reduce the Prevention and Public Health Fund as an offset (which we oppose).

Word on the street is that AHCCCS still has funding for a few more weeks to keep KidsCare going, so it’s not an emergency to get the federal funding on board again- but we’re running out of time for sure.  We’ll keep tracking this.