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. 

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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.

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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 Official

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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.

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