AzPHA Public Health Policy Update - November 22, 2017

Az Supreme Court Upholds Hospital Assessment & Medicaid Restoration

There was a super important ruling last week by the State Supreme Court.  They decided that the hospital assessment authorized by the Legislature and enacted by AHCCCS to pay the state match for restoring “childless adult” eligibility back in ’13 was legal.  The effect of the ruling is that Governor Brewer’s initiative to restore and expand Medicaid stands.

Here’s an excerpt of what the court decided in their ruling last week.

“We hold that the hospital assessment is not subject to article 9, section 22 of the Arizona Constitution, which generally requires that acts providing for a net increase in state revenues be approved by a two-thirds vote in each house of the legislature.  This requirement does not apply to statutorily authorized assessments that “are not prescribed by formula, amount or limit, and are set by a state officer or agency.”  Ariz. Const. art. 9, § 22(C)(2).  Because the exception applies here, we reject the constitutional challenge to the assessment.”

The issue is now finally put to rest with last week’s ruling because the state's highest court has found that the hospital assessment is a "... statutorily authorized assessment that is not prescribed by formula, amount or limit, and is set by a state officer or agency".

 

Preventing and Controlling Infectious Disease Takes a Village

The public health system is an interconnected group of folks that use evidence based practices to improve the health of communities.  At first, one might think that the public health system consists of the CDC and state and county health departments.  The public health system is a whole lot bigger than that.

A public health system not only includes public health agencies at state and local levels, but also includes healthcare providers of all types, public safety and first responders, healthcare institutions, clinical and public health labs, human service and charity organizations, education and youth development organizations, recreation and arts-related organizations, economic and philanthropic organizations, and environmental agencies and organizations.

In many ways, the public health’s system to prevent and control the spread of infectious disease reflects some of the complexity of the public health system. The Arizona Department of Health Services published new rules (called Administrative Code) to govern infectious disease prevention and control that go into effect on January 1.  A review of those rules gives you a picture of the various players that assist the public health system to prevent and control the spread of infectious diseases.

 

New Communicable Diseases Reporting Rules

For the last 18 months the ADHS has been working with stakeholders in the public health system on revisions to the “Communicable Diseases and Infestation Reporting” rules for reporting and controlling infectious diseases.  The new rules will go into effect on January 1.

What are the rules? They determine which communicable diseases need to be reported, by whom, how quickly, and what information needs to be included (Article 2).  They also outline the intervention measures that various players should follow to prevent further disease spread (Article 3).  You’ll see that the interventions (described in Article 3) are the responsibility of many different entities: local public health departments, healthcare providers and institutions, and vector control agencies, among others.

One thing that’s really striking is how much of the heavy lifting is done by the local health departments.  One glance at the “control measures” shows you how much of the boots on the ground public health work is done at the local health department level in coordination with healthcare providers, schools, restaurants, and patients and their families.

Why were the rules changed? They were updated to include emerging diseases (e.g. Zika), account for changes in technology like new laboratory methodologies and electronic reporting, and to remove unnecessary requirements and improve clarity.

What will change? Reporting requirements for healthcare providers and clinical laboratories have been modified, with the removal of several conditions (e.g., aseptic meningitis, genital herpes; the addition or clarification of others (e.g., Zika, spotted fever rickettsiosis, carbapenem-resistant Enterobacteriaceae); and changes in timeframes for reporting of various specific conditions or organisms. 

For control measures, changes include: requiring inter-facility notification when persons with an active infection of a multidrug-resistant organism are transferred to a new healthcare facility; modifying the testing and criteria allowing persons in certain jobs to return to work after an illness (e.g. food handlers); giving more discretion to local public health officials for determining when people with certain illnesses can return to their usual activities; exclusions from aquatic venues (e.g. pools) for people with certain enteric illnesses; environmental assessments for several emerging mosquito-borne infections; and language to help county health departments issue additional control measures.  

Who should report? Health care providers, health care institutions and correctional facilities; and schools, child care establishments and shelters should report to their local health department

Clinical laboratories report to the ADHS.  These groups each have their own reporting requirements (see Article 2). State and local health departments work closely to use these reports to maintain statewide surveillance, conduct case investigations, and implement control measures. 

Where to find more information? More information about communicable disease reporting requirements can be found at http://azdhs.gov/reporting.  A copy of the new rules can be found at New Article 2 and 3 Rules, effective January 1, 2018 until published by the Secretary of State.   

Below is an example of what some of the reporting and control regulations look like.  I used Measles as an example because it gives a dynamic picture of the things that need to be done when there is a case of measles in the community.

R9-6-355. Measles (Rubeola)

Case control measures:

An administrator of a school or child care establishment, either personally or through a representative, shall:

·         Exclude a measles case from the school or child care establishment and from school- or child-care-establishment-sponsored events from the onset of illness through the fourth calendar day after the rash appears; and

·         Exclude a measles suspect case from the school or child care establishment and from school- or child-care-establishment-sponsored events until the local health agency has determined that the suspect case is unlikely to infect other individuals.

A diagnosing health care provider or an administrator of a health care institution, either personally or through a representative, shall isolate and institute airborne precautions for a measles case from onset of illness through the fourth calendar day after the rash appears.

An administrator of a health care institution, either personally or through a representative, shall exclude a measles:

·         Case from working at the health care institution from the onset of illness through the fourth calendar day after the rash appears; and

·         Suspect case from working at the health care institution until the local health agency has determined that the suspect case may return to work.

A local health agency shall:

·         Upon receiving a report under R9-6-202 or R9-6-203 of a measles case or suspect case, notify the Department within 24 hours after receiving the report and provide to the Department the information contained in the report;

·         Conduct an epidemiologic investigation of each reported measles case or suspect case;

·         For each measles case, submit to the Department, as specified in Table 2.4, the information required under R9-6-206(D); and

·         Ensure that one or more specimens from each measles case or suspect case, as required by the Department, are submitted to the Arizona State Laboratory.

An administrator of a correctional facility or shelter, either personally or through a representative, shall comply with the measles control measures recommended by a local health agency or the Department. When a measles case has been at a school or child care establishment, the administrator of the school or child care establishment, either personally or through a representative, shall:

·         Consult with the local health agency to determine who shall be excluded and how long each individual shall be excluded from the school or child care establishment, and

·         Comply with the local health agency’s recommendations for exclusion.

·         A local health agency shall determine which measles contacts will be quarantined or excluded, according to R96-303, to prevent transmission; and provide or arrange for immunization of each non-immune measles contact within 72 hours after last exposure, if possible.

An administrator of a health care institution shall ensure that a paid or volunteer full-time or part-time worker at a health care institution does not participate in the direct care of a measles case or suspect case unless the worker is able to provide evidence of immunity to measles through one of the following:

·         A record of immunization against measles with two doses of live virus vaccine given on or after the first birthday and at least one month apart;

·         A statement signed by a physician, physician assistant, registered nurse practitioner, state health officer, or local health officer affirming serologic evidence of immunity to measles; or

·         Documentary evidence of birth before January 1, 1957.

 

November Month's AZ Asthma Coalition Meeting

Wednesday, November 29th from 3:00 - 5:00 pm

Super-Brain Approach to Tobacco Cessation

Mercy Care Plan and Mercy Maricopa Integrated Care developed a "gold standard tobacco cessation program" in partnership with ASHLine. During this presentation, you'll learn about this system-level program and the importance of partnerships to achieve a collective impact which Mercy Care refers to as the Super-Brain Approach to tobacco cessation.

Date:    Wednesday, November 29, 2017 from 3:00 to 5:00 p.m.

Location: Vitalyst Health Foundation, 2929 N Central Ave, Suite 1550, Phoenix

Join at https://zoom.us/j/466379282 or Telephone: US: +1 646 876 9923 or +1 669 900 6833 or +1 408 638 0968