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.

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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 

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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

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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.

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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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