AZ Public Health Policy Update: April 23, 2018

Feds Overhaul Essential Health Benefit Options

The Affordable Care Act required all health insurance policies sold on the Exchange and in the small group & individual markets to cover as set of “essential health benefits”.   Each Governor selects their state’s essential health benefits by choosing among options like their state employee plan, a small group market plan etc.  Each state has 10 options to pick from.  Governor Brewer selected the state employee plan as Arizona’s benchmark and Ducey did the same a couple of years ago.  Not a bad choice, because the benefits are generally robust- except that since the state employee plan doesn’t cover abortion services the state benchmark doesn’t either (although non-Medicaid plans can elect to cover those services).

Last week the Centers for Medicare & Medicaid Services issued an annual "Notice of Benefit Payment Parameters for 2019“. It outlined a big change.  Beginning in 2019 CMS will be giving Governors a lot more flexibility in selecting their state’s essential health benefit package.  Instead of 10 options, states will be able to choose among any of the essential health benefit benchmark plans used by any other state.  The new rules could have a profound impact on health insurance access and benefits.

It remains to be seen whether our Governor will choose a different benchmark plan moving forward.  Here’s a list of the various states’ insurance benefits benchmark mandates: [EHBs by State]

Legislative Session Update

The Governor vetoed 10 bills last Friday - apparently to send a message to the legislature that he wants the "20% by 2020" teacher funding bill on his desk forthwith. 

Luckily, the Community Health Worker voluntary certification bill needed to go back to the House for a Final Read- or it’s quite possible that it would have been veto number 11.  He did veto a good bill HB 2089 which would have required school districts to develop guidelines, information and forms on the dangers of heat-related illnesses, sudden cardiac death and prescription opioid use.

Last week was a busy one for the bills that we’re working on, so this update will be long again.  Once the session is over my updates will get shorter, I promise!

SB 1389   HIV; needs assessment; prevention was signed by the Governor last week.  It requires the ADHS to establish and implement an HIV Action Program to: 1) complete a statewide HIV Prevention and Care Needs Assessment (Assessment) of target populations (by November 1, 2020); 2) identify community-based agencies that serve the HIV population and that are outside of the known HIV service system; 3) conduct outreach to increase community involvement in HIV prevention, education and stigma reduction; 4) develop a social media initiative to engage at-risk populations to be tested for HIV infection; and 5) analyze data from the Assessment annually to develop and implement HIV training and education initiatives.

SB 1445 AHCCCS Dental care, pregnant women cleared the full Senate but still needs a House Rules hearing and a floor vote. It'll need an 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 AHCCCS is estimated to be a little less than $268K/year.  However, the Joint Legislative Budget Committee (JLBC) believes that it could have secondary costs. Their thinking goes something like this: pregnant Medicaid enrollees that are not yet receiving prenatal care will discover that there's an oral health benefit and will make a dental appointment. The hygienist or dentist will discover the pregnancy and inform their health plan about the pregnancy. At that point, their eligibility category would switch to one with a higher state match rate (and presumably begin receiving prenatal care- which if it happened would be a good thing). 

The JLBC analysis assumes that 25% of the estimated 5,000 pregnant women currently enrolled in the expansion population but not receiving prenatal care will, because of the new benefit, go to the dentist- causing their eligibility to change (to a category called SOBRA), generating a $3.7M refinancing cost. 

Honestly, it seems unlikely to me that women who aren’t getting prenatal care will present to a dentist or hygienist for a cleaning.  I can see it if they have a toothache, but any secondary cos from a dental emergency would be associated with last year’s emergency dental benefit - not this new (proposed) preventative oral health benefit.  We’ll see what happens during the upcoming budget process.

A new problem is that the effort to raise teacher’s pay is probably going to jeopardize many programs that may have otherwise been funded, like this one.  It’s still possible that this might happen- but it’s a lot less likely now because of the effort to raise teacher’s salaries 20% by 2020.

HB 2159 traffic violations; traffic survival school has been languishing for the last few weeks.  Last week the bill passed the House and has been assigned a Conference Committee to resolve the differences with the Senate version.  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.

HB 2228 Annual waiver, applicability was signed by the Governor this week.  It’s good. 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.

HB 2235 dental therapy; regulation; licensure has had a long and somewhat bizarre trip through the legislature.  The original bill (SB 1377) 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.  They could also practice anywhere.  The original bill passed the Senate but died in the House Health committee.  It came back to life a couple of weeks ago as what’s called a Strike Everything Amendment but stalled out again.  Then, this week, an amendment to the amendment was offered that seems to please everybody- and it passed the Senate 30-0.  It still needs to go back to the House, but it has a real chance now.

The Senate version limits dental therapists to only practicing at a Federally Qualified Community Health Center (or look-alike), or a nonprofit dental practice or organization that provides dental care to low-income and underserved individuals, or a private dental practice that provides dental care for CHC patients of record.  The amended bill also prohibits a dental therapist from performing nonsurgical extractions of permanent teeth unless under the direct supervision of a dentist.

The “school safety” bill called SB 1519 protective orders; schools; appropriations was proposed late last week by Senator Smith. Here’s a link to the introduced version.  It contains many of the things outlined by the Governor a few weeks ago related to firearms, schools and protection orders. A 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. There are also measures that would require AHCCCS to develop and post suicide prevention training and 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. There are some other troublesome parts of the bill. 

Our folks in the Public Health Policy Committee (including AzPHA member Jean Ajamie who is a school safety expert) has been doing some analysis of the bill (you can see that stuff on our Committee Basecamp- let me know if you’d like to join that group). We haven’t taken a position yet- most likely we’ll remain neutral.  The bill passed the Senate Commerce and Public Safety Committee this week. Next week will be the Senate Rules Committee.  There’s no mirror bill in the House at their point.  Stay tuned.

HB 2323  Schools; inhalers; contracted nurses was signed by the Governor this week.  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 was passed by the Senate this week (24-6)!  It passed the Senate in an amended form (including a provision to ensure that state procurements don’t favor contracting with certified vs non-certified CHWs).  There are two important steps left.  Because the Senate amended the House bill, it needs to go back to the House where Rep. Carter will likely formally concur with the Senate changes.  Then it needs a “Final Read” vote in the House to formally agree with the amendments the Senate added.  Assuming it passes the House again, then it’s on to the Governor for his approval (hopefully) The Senate amendments got the Goldwater Institute to be neutral- so I think we’re in good shape for a signature.

_______

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 (Signed by Governor)

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 (Basically dead)

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

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

SB 1083 Schools; recess periods (Signed by Governor)

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:

HB 2038 Drug overdose review teams; records was passed and signed.  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 2228 Annual waiver, applicability was signed by the Governor.  It’s good. 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.

HB 2323  Schools; inhalers; contracted nurses was signed by the Governor.  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 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 1389  HIV; needs assessment; prevention was signed by the Governor last week.  It requires the ADHS to establish and implement an HIV Action Program. 

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.

____

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

Passed House but Stalled in Senate- now SB1290

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 has now passed the House and has been sent back to the Senate.

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

Signed by 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

Signed by Governor

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

Needs Final Read in House

This was passed by the Senate this week (24-6)!  It was in an amended form (including a provision to ensure that state procurements don’t favor contracting with certified vs non-certified CHWs).  There are two important steps left.  Because the Senate amended the House bill, it needs to go back to the House where Rep. Carter will likely formally concur with the Senate changes, and then it needs a “Final Read” vote in the House to formally agree with the amendments the Senate added.  Assuming it passes the House again, then it’s on to the Governor for his approval (hopefully) The Senate amendments got the Goldwater Institute to be neutral- so I think we’re in good shape for a signature.

HB 2389 Syringe access programs; authorization 

Dead

This 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 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, passed the House and is headed back to the Senate and has been assigned a Conference Committee.

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

Moving Again in Amended Form

This has had a long and somewhat bizarre trip through the legislature.  The original bill (SB 1377) 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.  They could also practice anywhere.  The original bill passed the Senate but died in the House Health committee.  It came back to life a couple of weeks ago as what’s called a Strike Everything Amendment but stalled out again.  Then, this week, an amendment to the amendment was offered that seems to please everybody- and it passed the Senate 30-0.  It still needs to go back to the House, but it has a real chance now.

The Senate version limits dental therapists to only practicing at a Federally Qualified Community Health Center (or look-alike), or a nonprofit dental practice or organization that provides dental care to low-income and underserved individuals, or a private dental practice that provides dental care for CHC patients of record.  The amended bill also prohibits a dental therapist from performing nonsurgical extractions of permanent teeth unless under the direct supervision of a dentist.

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, 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.