Weekly AzPHA Public Health Policy Committee

From all indications, it looks like this year's legislative session is about to wrap. Most of the bills besides the budget bill have been through the legislative process and either have been passed and signed or have died. The last bolus of work is to pass and sign a state budget for the next fiscal year.  That will happen in the next few days- maybe even before the end of the week.  

We're still hopeful that the budget will include funding for adult emergency dental services for all Medicaid members. Right now kids that have their insurance through AHCCCS get comprehensive dental coverage- which is a good thing.  

Adult Medicaid members that are part of the Arizona Long Term Care System have coverage for emergency dental treatment up to $1,000 per year, but other adult Medicaid members don't have any dental care coverage- which leads to poor oral health outcomes.  We're crossing our fingers that the financial match will be provided for this in the final state budget.

Here's a summary of where we are with the various bills that relate to public health this legislative session:

Good New Public Health Laws

Asthma Management

HB 2208 was passed and signed a few weeks ago.  Once it becomes effective later this summer, it will authorize trained school districts and charter schools to administer (or help administer) an inhaler for a student in respiratory distress.   The new law also outlines the training required and provides immunity from civil liability (lawsuits).

The old statute allowed kids to have & use inhalers if it was prescribed by a doctor and the school had an annual written documentation from the parent or guardian authorizing the student to have and self-administer their inhaler.  The new law will let trained school district and charter school staff to help the child to use their inhaler.  The new law will also protect the school from lawsuits.

Lucky for Arizona, we're ready to implement this already thanks to AzPHA members Dr. Lynn Gerald at the UA's Mel and Enid Zuckerman College of Public Health and Dr. Doug Taren at the UA's WesternRegion Public Health Training Center. The Training Center has Stock Albuterol Inhaler Training for School Personnel available on their website already.  

The e-learning course provides the training needed for schools to implement this new law.  Thank you Dr.'s Gerald & Taren for your leadership in this area of public health!

Sunscreen Use at Schools & Camps

HB 2134 will become law 90 days after the end of the legislative session. It'll  make it clear that kids can take and use sunscreen at school and camps... and that school, pre-school and camp staff can help them put it on. 

Why was this needed, you ask?  Well, the FDA regulates sunscreen as an over-the-counter drug.  School districts set their own policies concerning the administration of "medication" (including over the counter sunscreen) to kids.  Some school districts and camps prohibit the administration of "over-the-counter drugs" (e.g. sunscreen) unless a parent provides written consent and an order from a physician.  
 
This new law will make it clear for schools, camps, and day cares that it's OK for kids to have and use sunscreen.  It'll also give schools, camps and day cares protection from lawsuits.  Hooray.

Involuntary Commitment Procedures

The Governor signed HB2084 which will allow a mental treatment facility to admit a patient for involuntary treatment for a mental health disorder pending the filing of a tribal courts involuntary commitment order.  We advocated for this bill because it provides a mechanism for a more smooth access to care- especially for tribal members.  Now that it's been signed, it'll become law 90 days after the legislative session ends.

State law already has requirements and procedures for civil commitment if a court finds enough evidence that the person (as a result of mental disorder), is a danger to self or others, or has a disability in need of treatment but won't or can't accept voluntary treatment.  The court can then order the patient to undergo treatment.

Currently, an order from an Arizona tribal court is recognized by the other courts in AZ and enforceable by any court of record in this state, subject to the same procedures, defenses and proceedings for reopening, vacating or staying as a judgment of the court. 

Current statute says a patient committed to a state mental health treatment facility by a tribal court order is subject to state jurisdiction.  Last year, the State Supreme Court amended the rules for enforcement of Tribal Court Involuntary Commitment Orders, to allow the enforcement of tribal court orders upon the acceptance by the clerk of the filing of the tribal court order rather than upon the certification of the order.  In other words- some tribal members had delays in getting treatment because of the new rules. 

This new law will fix that delay in treatment, which is a good thing for public health we think.

Nurse Anesthetists  

SB 1336 was passed and signed a couple of weeks ago.  In a nutshell, the new law outlines medication orders and prescribing authority for nurse anesthetists and ill make it clear that a physician isn't liable for anesthetic administration by a nurse anesthetist.  It also modifies the definition of "presence" (relating to supervision), and outlines medication orders and prescribing authority for a nurse anesthetis.  

AzPHAsupported this Bill and submitted information to the committee providing information about how this bill would be good for access to care in rural AZ- which had been facing challenges as a result of the existing laws.

Teen Texting & Driving

SB 1080 was signed by the Governor last week and will ban brand-new teen drivers from using their smart phone for the first 6 months of their license - if they're under 18.  Using the phone in an emergency will still be OK.  Tickets can only be issued if the driver committed another violation.  It allows anaudible tool like Mapquest under specified conditions.

The only other limitation in AZ to this kind of distraction is for school bus drivers.  Arizona will now join 48 other states that restrict smart phone use!

Drug Overdose Review Team

HB 2493, which sets up a drug overdose review team at the ADHS (much like the child fatality review team) will also become law later this summer.  The new law sets up a21-member consisting of nine heads of various government entities (or their designees) and 12 members appointed by the ADHS Director.

The Mission for the Team is to:

  • Develop a data collection system;
  • Conduct an annual analysis relating to drug overdose fatalities from the preceding year;
  • Aid in the development of local Teams;
  • Develop standards and protocols;
  • Provide training and technical assistance to local Teams;
  • Develop investigation protocols for law enforcement and the medical community;
  • Study state and local laws, training and services in order to determine if changes are needed to decrease drug overdose fatalities and, as appropriate, take steps to implement these changes; and
  • Educate the public regarding drug overdose fatalities.

Looks like a good opportunity to get some better surveillance, standards, protocols, and explore new laws that could help with the ongoing opioid painkiller epidemic.

Good Public Health Bills Not Yet Passed

Emergency Dental Coverage for Medicaid Members

We're still hopeful that the budget will include funding for adult emergency dental services for all Medicaid (AHCCCS) members. Right kids that have their insurance through AHCCCS get comprehensive dental coverage- which is a good thing. 

Adult Medicaid members that are part of the Arizona Long Term Case System have coverage for emergency dental treatment up to $1,000 per year, but other adult Medicaid members don't have any dental care coverage at all- which has led to all sorts of bad oral health outcomes among adult Medicaid members (they had emergency dental coverage before the Recession- but that funding was a casualty of the recession).  We're crossing our fingers that the financial match will be provided for this in the final state budget.

Newborn Screening for SCID

SB 1368, which would authorize the ADHS to collect the newborn screening fees needed to add Severe Combined Immune Deficiency syndrome to the list of newborn screening tests passed through the Senate and the was unanimously approved by the House Health Committee. 

Babies born with Severe Combined Immunodeficiency look normal at birth but they can’t fight infections. They often die before 1 year of age without medical treatment, but if caught at birth,  before the onset of infection, a bone marrow transplant can successfully treat the disorder.  It’s particularly important to test for SCID in Arizona because the disorder is much more common in certain populations in Arizona: 1/2,000 among Navajo’s and Apache’s and about 1/20,000 among Latinos. 

Bills Good for Public Health that Died

Community Health Workers

Sadly, HB 2426, which would have set up a pathway for Community Health Workers in AZ, appears to be dead for this year.  Had it passed, it would have set up a pathway for Community Health Workers in AZ to voluntarily become certified... which would be a big step forward for this important health profession.  It would have  expanded  the use of CHWs in Arizona’s healthcare system in part by making it easier to get reimbursement for their services.

The Arizona Community Health Workers Association did a great job of organizing and is in a solid position to keep the momentum going next legislative session.  

Influenza Vaccines in Hospitals

HB 2090 which would have required hospitals to offer influenza vaccines to seniors during the cold and flu months appears dead for whatever reason.  It would've provided an additional access point for getting a flu vaccine among a high risk population- but alas- it won't become law this year (although hospitals could of course elect to offer the vaccines if they want).

Physical Activity

HB 2082, which would have required that schools have some recess time went down in flames.  To be honest, I think it would have passed but didn'tbecause of a heated remark made by the Bill's sponsor made on social media about the school voucher bill that the Governor signed.  Here's the story about it in the AZ Republic.   Lesson: relationships are important.

Tanning Beds

HB 2194 which would have prohibited kids under 18 from using tanning beds and prevents studios from claiming that tanning beds are risk-free is effectively dead for this year, again. 

Bills Bad for Public Health that Luckily Died

Traffic Safety Cameras

Let's face it. Getting a ticket in the mail for speeding or running a red light is no fun.  But evidence suggests that photo enforcement of red lights is an effective public health intervention, which is why we advocated against HB2525.  It would have banned traffic safety cameras in AZ.  While it passed out of the House, it stalled and died in the Senate. 

It's sure to be back next year.  My advice to some towns that are over-using photo enforcement is to tone it down- or you'll end up ruining it for everybody.