AzPHA Public Health Policy Update: April 9, 2018

AzPHA Spring Conference is Wednesday!

We’re looking forward to seeing many of you at our Conference on Wednesday: Together for Tomorrow: Protecting Arizona’s Children at the Desert Willow Conference Center. Here’s the Conference Program with all the particulars. Check in starts at 7:30 am with the agenda starting at 8:30 am (breakfast is provided). We hope many of you will stay for our hosted reception immediately following the conference!

New Immigration Rule Could Damage Public Health

The Department of Homeland Security Secretary Kirstjen Nielsen is in the final stages of proposing a new Rule that would require the Immigration and Naturalization Service (INS) to consider a much broader range of factors when determining whether immigrants or their U.S.-citizen children are using public benefits (using certain public benefits hurts applicant’s chances at changing their legal immigration status).

Currently, the INS uses information about whether applicants for legal permanent residency (and other immigration categories) receive cash assistance as a factor when considering applications. Applicants that receive have received cash assistance are less likely to be approved.  Proposed new changes expected to be out for public comment shortly that will broaden the benefits considered to include non-cash assistance like WIC, SNAP, Medicaid, CHIP, school lunch programs, and perhaps even participation in the Vaccines for Children program.

In 1999, the INS issued Rules to "address the public’s concerns about immigrant fears of accepting public benefits for which they remained eligible, specifically medical care, children's immunizations, basic nutrition and treatment of medical conditions that may jeopardize public health.” Here's that final Rule from 1999. 

The (1999) Rule states that "Other non-cash public benefits that will not be considered include Medicaid; CHIP; emergency medical assistance; other health insurance and health services for the testing and treatment of symptoms of communicable diseases; emergency disaster relief; nutrition programs, such as Food Stamps and WIC; housing benefits; energy benefits; job training programs; child care; and non-cash benefits funded under the TANF program." 

The new proposed Rule is expected to be released shortly and says that: "DHS does not believe it is appropriate to set aside such benefits in its public charge analyses. DHS, therefore, proposes to consider cash and non-cash public benefits that are means-tested or otherwise used to meet basic living requirements” as they consider applications (e.g. WIC, SNAP, Medicaid, CHIP, school lunch programs, and perhaps even VFC).  These kinds of changes will have a chilling effect on whether people who can now legally participate in these programs would continue to do so. It would also make it less likely that folks will participate in other kinds of public health programs like disease control and childhood vaccinations.

We’ll keep an eye on the Federal Register (DHS Docket No. USCIS 2010-0012) and comment on the package at www.regulations.gov from a public health perspective.

 

School Safety Bill Expected this Week

We expect somebody from the legislature to propose a school/firearm safety bill this week. A couple of weeks ago the Governor floated the idea of a new law that would do several things related to school safety like: 1) Increase behavioral health resources in schools; 2) Increase school resource officer funding and training and increases the presence of law enforcement on school grounds; 3) Severe Threat Order of Protection orders that would restrict firearm access for people who are a danger to themselves or others; and 4) Establish a “Center for School Safety” with a centralized reporting tip line to report and investigate concerns of school safety.  There was no discussion of a universal background check provision.

We’ll withhold our judgment about whether to support the bill until after it’s released and we have a chance to talk to some subject matter experts about the nuances of the proposal.

 

Legislative Session Update

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 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 1445 AHCCCS Dental care, pregnant women 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 for today. The big hurdle will be getting an appropriation to cover the state match into the budget.

HB 2324 Community health workers; voluntary certification 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 (final floor vote) calendar this week.

HB 2389 Syringe access programs; authorization passed the full Senate 2 weeks ago but in a substantially weakened form. The original bill would’ve decriminalized needle exchange programs. The amendment only decriminalizes syringe exchange programs when and where the ADHS declares a public health emergency because of the rapid spread of infectious diseases. When the amended bill went back to the House for concurrence- it was refused (a good thing) and it’ll now go to a conference consisting of Rivero, Navarrete, Udall, Borelli, Brophy McGee, and Mendez. We sent information to the urging the conference committee members to drop the amendment requiring a ARS 36-761 emergency to provide prosecutorial protection for syringe exchange programs.

SCR 1005 is troubling new Resolution that’s a Strike Everything amendment in the House. It states that voter initiatives that have any kind of money attached need to go back to the ballot every 10 years. It’s unclear whether it’s intended to be prospective or whether it applies to previously approved measures (it’s quite cryptic).  Here’s what it says: “AN INITIATIVE (which has money attached) IS REPEALED TEN YEARS AFTER THE EFFECTIVE DATE OF THE INITIATIVE UNLESS AN EARLIER REPEAL DATE APPLIES TO THE INITIATIVE”. 

If it makes it through the Legislature it would still need to be approved by voters- but it’s a troubling proposal indeed as things like First Things First, the Smoke Free Arizona Act, and Proposition 204 which provides a lot of Medicaid funding could get caught up in the requirement. Fortunately, there are a few steps left in the process so perhaps we can stop this in its tracks.

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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 (Passed Senate COW, Needs 3rd Read)

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 bk 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 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 (Ready for House Floor Vote)

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.

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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

Needs Senate 3rd Read

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

Passed Senate in Weak Form- going back to House

This passed the full Senate 2 weeks ago 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. When the amended bill went back to the House for concurrence- it was refused (a good thing) and it’ll now go to a conference committee consisting of Rivero, Navarrete, Udall, Borelli, Brophy McGee, and Mendez. We will encourage them to drop the amendment requiring a ARS 36-761 emergency to provide prosecutorial protection for syringe exchange programs.

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

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

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.