AzPHA Public Health Policy Update: April 2, 2018

 

Legislative Session Update

SB 1083 Schools; recess periods passed in the House last week by a wide margin (57–1).  It was amended slightly from its original Senate version (giving grades 4 & 5 an extra year to implement).  It’s headed back to the Senate with the amendment.  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 it passes. Good news.

SB 1445 AHCCCS Dental care, pregnant women unanimously cleared the House Appropriations committee this week!  The next stop is the House Rules committee (which shouldn’t be a problem).  It’ll then be ready for a House floor vote. The big hurdle will be getting an appropriation to cover the state match into the budget. We’re trying to get a closer estimate of what it’ll take for the state match.  Senator Yee is the sponsor- which is a good thing because she’s the Senate Majority leader and will be influential during the budget negotiations.

HB 2127 Children's health insurance program removes the trigger that would automatically freeze the KidsCare program if federal matching drops below 100%.  It was heard but not voted on in the Senate Appropriations committee last week.  The contents of the bill were struck onto SB 1087.  HB 2127 is now dead since it didn’t pass out of a committee in the Senate, but it’s still possible for SB 1087 to get voted out of the House and then it would need to go back to the Senate.

HB 2324 Community health workers; voluntary certification is up for a floor vote in the Senate this afternoon.  To smooth the pathway for final passage, we’re supporting an amendment to the original bill that would “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. If we pass this week in the floor vote (with the amendment) the bill get transmitted back to the House because of the amendment.

HB 2389 Syringe access programs; authorization passed the full Senate last week (22-8) but in a substantially weakened form. The original bill would’ve decriminalized needle exchange programs. The amendment only decriminalize programs when and where the ADHS declares a public health emergency because of the rapid spread of infectious diseases. The bill will now go back to the House to resolve the differences in the House and Senate forms.  Hopefully we can get the amendment removed.  If we can’t and it passes and is signed with the amendment it’ll have limited public health utility.

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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 (Senate floor vote this week)

HB 2389 Syringe access programs; authorization (Passed Senate- going back to House)

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

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

SB 1083 Schools; recess periods (Passed House- going back to Senate)

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 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.

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.

 

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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. 

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 Floor Vote (this week)

This Bill is ready for a floor vote in the Senate, and we’re on the COW calendar in the afternoon of Monday, April 2.  To smooth the pathway for final passage, we’re supporting an amendment to the original bill that would “grandfather” current CHWs who have worked for 6 months over three years and prohibit the state or it's subdivisions from offering preferential public contracts for voluntarily certified CHWs.

This Bill is a top priority for us. It asks the ADHS to develop 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 Senate in Weak Form- going back to House

This passed the full Senate last week (22-8) but in a substantially weakened form. The original bill essentially would have decriminalized needle exchange programs. One of the amendments from the Senate makes it so 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. The bill will now go back to the House to resolve the differences in the House and Senate forms.  Hopefully we can get the amendment removed.  If we can’t and it passes and is signed as amended it’ll have limited 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            

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

Passed House- going back to Senate again

This passed in the House last week by a wide margin.  It was amended slightly from its Senate version by giving grades 4 & 5 an extra year to implement.  It’s now headed back to the Senate with the amendment.  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 it passes.  Good news.

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 2 weeks ago and is now 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. 

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 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 Rules and Floor Vote & a Budget Line Item

Last week SB 1445 AHCCCS Dental care, pregnant women unanimously cleared the House Appropriations committee this week!  The next stop is the House Rules committee (which shouldn’t be a problem). It would then be ready for a House floor vote. The big hurdle will be getting an appropriation to cover the state match into the budget. We’re trying to get a close to accurate estimate of what it will take.  Senator Yee is the sponsor- which is a good thing because she’s the Senate Majority leader and will be influential during the budget negotiations.

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

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.  Still being Held in the House Rules Committee.

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Opioid Prescribing Continuing Medical Education

Beginning April 26, physicians will need to complete 3 credits/hours of opioid-related, substance use-related, or addiction-related continuing medical education each licensing cycle. The Arizona Center for Rural Health and Office of Continuing Medical Education (OCME) have developed free Arizona Opioid Prescribing Guideline courses to help facilitate compliance with this new requirement. The coursework offers modules on:

  • Safe Prescribing of Opioids for Pain Management
  • Safe and Effective Opioid Prescribing While Managing Acute and Chronic Pain
  • Managing Opioid Misuse Disorder in Pregnancy and Neonatal Care

These courses familiarize prescribers with current guidelines for opioid use and prescribing, as well as educate prescribers about non-opioid strategies for pain management. All courses offer AMA PRA Category 1 CreditTM. Access courses at: http://vlh.com/AZPRescribing.

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