Federal Work Requirement Executive Order

Last week the President issued an Executive Order to the US Departments of Health and Human Services, Agriculture, and Housing charging them with reviewing the eligibility regulations for all of their public assistance programs (e.g. Medicaid, Medicare, SNAP, WIC, Section 8 Housing etc.) and check to see whether they have work requirements.  

If they don’t currently have work requirements, the Order charges them with determining whether the current law would allow them to do so.  Then, in 90 days, they’ll need to turn in a list of policy recommendations to “strengthen existing work requirements for work-capable people and introduce new work requirements”. The Order is of course more complex than I’ve described here- but you can read the whole thing here.

BTW: we expect AHCCCS' directed waiver that will require many (about 200,000) AZ Medicaid members to meet their work/school/community engagement requirements starting 10/1 to be approved any day now.

 

Phoenix Complete Streets

If you live or work in Phoenix, click here to send an email to the City Council members asking them to adopt and implement the Complete Streets Design Guidelines. Please be sure to send your email before the council meeting this Wednesday, April 18, and feel free to share this call to action with Phoenix friends. 

The Complete Streets Advisory Board recommended these design guidelines to the Council in 2015, but weren’t given the opportunity to vote and adopt them. It is now more than two years later, and we need your help to urge them to adopt the guidelines and move forward in protecting everyone who walks, bikes, uses public transportation, and drives on our streets. Thank you to Pinnacle Prevention for the heads up about this.

Send an email with one click!

 

Legislative Session Update

A Bill Called SB 1519 protective orders; schools; appropriations was proposed late last week by Senator Smith. It contains many of the things outlined by the Governor a few weeks ago related to firearms, schools and protection orders. The centerpiece is something called a “Severe Threat Order of Protection” which outlines a process to restrict firearm access for people who are a danger to themselves or others. The process is complicated and outside my area of expertise, so I’m trying to learn more about the proposal.  There are also measures that would require AHCCCS to develop and post suicide prevention training.  A statewide school safety hotline would also be established.

There’s no provision in the bill for comprehensive background checks or restrictions on things called “bump stocks” which makes guns fire quicker. Here’s a link to the introduced version of the bill.  You might need to sit down with somebody with a legal background if you really want to understand it. 

Hardly any organizations or persons are signed up either for or against the bill so far, and no hearing has yet been set in the Senate (It’s assigned to the Commerce and Public Safety Committee).  There’s no mirror bill in the House at their point.  Stay tuned.

SB 1445 AHCCCS Dental care, pregnant women is in the home stretch.  It’s cleared the full Senate but still needs a House Rules hearing and a floor vote. It will require some appropriation (to provide oral health coverage to pregnant Medicaid members)… so much of the discussion right now is about how much it would cost.

The direct cost to the state is estimated to be a little less than $268K.  However, the Joint Legislative Budget Committee believes that it could have secondary costs. Their thinking goes like this: some pregnant Medicaid enrollees that are not yet receiving prenatal care will discover that there is an oral health benefit and that the hygienist or dentist would inform their health plan of their pregnancy. These women would then switch their eligibility category to one with a higher state match rate (and presumably begin receiving prenatal care- which if it happened would be a good thing).  

Their analysis assumes that 25% of the estimated 5,000 pregnant women currently enrolled in the expansion population will switch their eligibility to the pregnant category generating a $3.7M refinancing cost because of the dental benefit.  It just seems to me that it’s unlikely that women that aren’t getting prenatal care from an OBGYN will present to a dentist or hygienist for a cleaning.  I can see it if they have a toothache, but that would likely be from the existing emergency dental benefit- not this new proposed preventative oral health benefit.  We’ll see what happens during the upcoming budget process.

HB 2324 Community health workers; voluntary certification is in the home-stretch.  It succeeded in the Senate’s Committee of the Whole (a voice vote) but wasn’t brought up for a final vote in the Senate as we had hoped (called 3rd Read) last week.  We hope to get on the Senate 3rd Read (final floor vote) calendar this week.

HB 2389 Syringe access programs; authorization basically looks dead for this year. The bill that passed the House was great- providing clear decriminalization of needle exchange programs (needle exchange programs are technically a class 6 felony right now).  The version that passed the Senate only decriminalizes syringe exchange programs when and where the ADHS declares a public health emergency because of the rapid spread of infectious diseases. 

It went to a Conference Committee this consisting of Rivero, Navarrete, Udall, Borelli, Brophy McGee, and Mendez… but Wednesday, Brophy McGee was replaced with Petersen, basically killing the House version- and the bill was dropped from the Conference Committee agenda- basically killing it.  Honestly, the Senate version of the bill wouldn’t have helped public health much if it all. Maybe next year.

HB 2228 Annual waiver, applicability was passed by the Senate and transmitted to the Governor.  It will direct AHCCCS to exempt tribes from their directed waiver request that asks for CMS 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.

SB 1394 Abortion reporting was passed by the House and signed by the Governor.  It will require the ADHS to collect and report additional data regarding abortions that are performed in AZ.

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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 (Sent to Governor)

HB 2323 Schools; inhalers; contracted nurses (Ready for Senate Floor Vote)

HB 2324 Community health workers; voluntary certification (Needs Senate floor vote)

HB 2389 Syringe access programs; authorization (Effectively dead)

HB 2484 local food tax; equality (Signed by Governor)

SB 1022 ADHS; homemade food products (Signed by Governor) 

SB 1083 Schools; recess periods (Passed and Signed)

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 Rules Committee)

SB 1377 Dental therapy, licensure, regulation (Failed in House now HB2235 in Senate)

SB 1394 Abortion reporting (Signed by Governor)

SCR 1005 Voter Initiative Sunset (striker in the House)

 

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.

SB 1022  DHS; homemade food products ADHS will 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. 

SB 1083 Schools; recess periods was passed and signed!  Beginning next school year K-3 will need to have at least 2 recess periods. Grades 4 and 5 will need to have 2 recess periods the year after that.

SB 1394 Abortion reporting was passed by the House and signed by the Governor.  It will require the ADHS to collect and report additional data regarding abortions that are performed in AZ.

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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 was back in business but is now being held in House Rules. 

 

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

Transmitted to Governor

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 3rd Read (Passed COW)

This succeeded in the Senate’s Committee of the Whole (a voice vote) but wasn’t brought up for a final vote in the Senate as we had hoped (called 3rd Read).  To get through COW, we supported an amendment to “grandfather” current CHWs who’ve worked for 6 months over 3 years as a CHW & to prohibit the state and subdivisions from offering preferential public contracts for voluntarily certified CHWs. We hope to get on the Senate 3rd Read calendar this week.

 

HB 2389  Syringe access programs; authorization

Effectively Dead

The bill that passed the House was great- providing clear decriminalization of needle exchange programs (needle exchange programs are technically a class 6 felony right now).  The version that passed the Senate only decriminalizes syringe exchange programs when and where the ADHS declares a public health emergency because of the rapid spread of infectious diseases. The bill died in a conference committee.

Maybe next year.

 

HB 2484 local food tax; equality

Signed by Governor

The Governor signed this bill, which bans 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.  

 

Senate Bills

SB 1022    DHS; homemade food products            

Signed by Governor

ADHS will 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.

 

SB 1083    Schools; recess periods

Signed by Governor

This was passed and signed!  Beginning next school year K-3 will need to have at least 2 recess periods.  Grades 4 and 5 will be added the following year. This makes AZ a national leader in state school recess policy. A big shout out to AzPHA member Scott Turner and Christine Davis from Arizonan’s for Recess for their heavy lifting to make this happen!

 

SB 1245 Snap Benefit Match

Needs House Rules Committee and Budget Line Item

This Bill needs House Rules review before a House 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. 

 

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.  

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.

 

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

Signed by Governor

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.).

 

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 Rules and Floor Vote & a Budget Line Item

This unanimously cleared the House Appropriations committee last week.  We were hoping to get a Rules committee hearing next week, (Monday April 9) but it’s not on the agenda, sadly.  The big hurdle will be getting an appropriation to cover the state match into the budget.

 

SB 1470  Sunrise process; health professions

After a dramatic start, this bill looks like it will have a consensus ending.  The sunrise process bill stakeholders negotiated changes to the current scope of practice sunrise process that everybody seems to be able to live with.  It passed in House this week by a 59-0 vote. It’s now ready for the Senate to concur in the House’s amendment.

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Thanks to all of you that planned, sponsored, exhibited, presented, or attended our conference last week.  We still need to input the data from the evaluations- but we think it was a real success!

 

Mark your calendars for Wednesday, October 3, 2018 for our fall conference and annual members meeting.  Our topic will be about engaging public and behavioral health to improve outcomes.  It'll also commemorate our 90th anniversary!