Ebola, Family Planning, Public Charge, & Medicaid Network Standards

Ebola Outbreak in Democratic Republic of the Congo

WHO Policy Body Concludes it’s Not a Public Health Emergency of International Concern (yet)

The Democratic Republic of the Congo’s (DRC) Ministry of Health has confirmed 45 cases of Ebola Virus Disease in the last few weeks. Most of them have been in the remote Bikoro health zone, but 1 case is in Mbandaka, a city of 1.2 million, which is bad because of the city's size and because it's next to the Congo river- a major transportation corridor for people and trade. Large cities that are also transportation hubs can serve as a distribution channel for the virus.

The WHO’s Emergency Committee met last week and heard about the DRC’s surveillance & interventions. The Committee concluded that “… the interventions underway provide strong reason to believe that the outbreak can be brought under control, including: enhanced surveillance, establishment of case management facilities, deployment of mobile laboratories, expanded engagement of community leaders, establishment of an airbridge, and other planned interventions.  In addition, the advanced preparations for use of the investigational vaccine provide further cause for optimism.”

The Committee concluded that “… the conditions for a Public Health Emergency of International Concern (PHEIC) have not currently been met.” They advised against travel or trade restrictions as interventions.  Despite not being classified as a PHEIC, resources are still available to the DRC from the WHO consistent with the WHO’s Emergency Response Framework

Activities include distribution of vaccine to Congo (4,000 doses so far and 3,000 more coming), cold chain resources, prepositioning of additional vaccine in Mali and support and treatment and surveillance staff from WHO & Medecins Sans Frontieres. They are using a ring vaccination strategy around cases and contacts.  Surprisingly I don't see anything on the CDC's website about the outbreak right now, but hopefully they're engaged.

Let’s hope that the WHO Emergency Committee is right and the Ministry has the resources, expertise and logistical support they need to quickly identify cases and conduct the needed interventions to stop the spread before this becomes a regional or international epidemic like it did in 2014.  

 

HHS to Restrict Title X Family Planning Program

Last week the President announced that the US Department of Health and Human Services will be changing federal family planning programs (Title X) to “ensure that taxpayers do not indirectly fund abortions”.  The statement suggested that HHS would be shortly proposing regulations that would ban Title X family planning providers from referring patients to abortion clinics.

Title X was enacted almost 50 years ago to provide quality family planning care to those who may not be able to afford it on their own.  Federal funds through Title X already can’t be used for abortion services. The funds are dedicated to access to medically accurate comprehensive healthcare for low-income individuals and families. The reproductive healthcare and family planning services include contraception, cancer and STD testing as well as counseling and education and more.  Title X funding has contributed to the recent and significant decline in unintended and teen pregnancies as well as unplanned births and has reduced abortions.

I searched all over the HHS website and I can’t find the proposed rule change anywhere, so the proposed changes haven’t been released yet. We don’t know if they’ll propose an emergency rule (hitting Title X networks immediately) or go through a normal rulemaking process.  The normal process (including posting the proposed rule in the Administrative Register and a comment period) would be slower because the public would have the chance to comment, and comments would need to be reviewed before the rule could be finalized.

This has already been a chaotic year for Title X applicants for family planning service providers. It’s normally a 3-year funding cycle for Title X providers, but the Administration has changed that to a 1-year cycle- and applications for the coming year are due this Thursday (5/24).

If the proposed rule is the same one that was proposed by the Reagan Administration (and later rescinded by Clinton), it would prevent any provider from referring or providing information on abortion services.  We don’t know the fine points of the rule yet, and cannot speculate about its structure, but we will keep you updated as we learn more. 

 

AzPHA Comments on AHCCCS’ Network & Appointment Standards

AHCCCS is rolling out new integrated care contracts on October 1, and most members will be receiving services for both acute and behavioral care from these managed care organizations.  One of the keys to making sure that members have access to a health care provider when they need it is for AHCCCS to make sure each managed care organization has an adequate network of contracted providers. 

AHCCCS sets their network adequacy standards in what’s called their “AHCCCS Contractors Operations Manuals”, or ACOMs for short.  From now through May 28, 2018 AHCCCS is accepting public comment on their proposed manuals for network expectations for the integrated care contracts that start on October 1.

Our Public Health Policy Committee reviewed the proposals and submitted comments (available on my blog at http://www.azpha.org/). In short- we commented that we liked the fact that the new proposed network standards are more easily measured and therefore easier to ensure compliance.  We also encouraged them to ask the plans to contract with the county health departments for services like vaccinations, sexual transmitted disease testing and treatment, reproductive health, and tuberculosis prevention and control. 

We also asked that when Plans ask for and receive exemptions from the standards that the information be posted on enrollment websites so members have that info as they make enrollment decisions.  Anybody can comment on the proposed standards at this website before May 28.

 

Kaiser Family Foundation “Public Charge” Issue Brief

A few weeks ago I wrote about a change that the US Department of Homeland Security is mulling to allow the federal government to take into account the use of federal health, nutrition, and other non-cash public programs like Medicaid, the Children’s Health Insurance Program, and WIC when making a determination about whether someone is likely to be a “public charge.”  Under these changes, use of these programs by an individual or a family member, including a citizen child, could result in a person being denied lawful permanent resident status or entry into the U.S.

Such changes would apply to coverage provided to legal immigrants and their citizen children, leading to decreased participation in Medicaid, CHIP, Affordable Care Act marketplace coverage and other programs, even though they would remain eligible for them.

The Kaiser Family Foundation published a new issue brief this week that provides an overview of the 10.4 million kids in the U.S. that have a non-citizen parent (the parent is the person that would be affected by the changes).  Then issue brief presents different scenarios of disenrollment from Medicaid and CHIP to illustrate the potential effects on their health coverage and discusses the implications for their health.

How do Lava & Seawater Make Acid Mist?

I heard on the radio that when lava coming from the Kilauea volcano hits the ocean it’s forming an acid mist that’s dangerous to the lungs.  I got curious how the acid forms.  It turns out that the acid comes from 2 different sources.  About 30% of the acid is trapped in the molten lava as a gas and escapes when the lava cools fast in the ocean water. 

The bigger source (70%) is a chemical reaction in which the salt dissolved in the ocean (NaCl and H2O) – in the presence of super-hot lava- forms NaOH (sodium hydroxide) and HCl (hydrochloric acid).  Of course- it’s more complicated than that (a lot more complicated).  If you’re interested in the particulars you can check out this journal article.

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I’m doing my best to populate our “Upcoming Events” section of our AzPHA website.  If you have an upcoming public health related event- let me know and I’ll get it up on our website at: http://www.azpha.org/upcoming-events/

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Grand Canyon University is developing a Bachelor of Science in Public Health and they would like to gather input from the public health professional community to help inform the curriculum. Please take a few minutes to provide them some feedback on this Grand Canyon University Bachelor of Public Health Policy Survey

 

ADHS EMS Regulatory Services Section Chief Post Open

The ADHS Bureau of Emergency Medical Services and Trauma Systems is recruiting for a senior management position in the Bureau of EMS and Trauma System to lead a team of professionals in several functional areas including, statutory committee support, EMS and trauma data collection, system of care performance improvement analysis and reporting, EMS and trauma system initiatives, community paramedicine, and strategic planning and communication

Responsibilities include:

  • Supporting a diverse multi-cultural workforce that reflects the community, promotes equal opportunity at all levels of ADHS, and creates an inclusive work environment that enables all individuals to perform to their fullest potential free from discrimination

  • Assisting in policy and rule development with Bureau and Department leadership

  • Leading a highly motivated, professional team

  • Guiding, monitoring and ensuring success of numerous projects and deliverables

  • Creating and editing EMS and trauma-related reports and plan

  • Ensuring successful meetings of Governor and Director-appointed advisory meetings

  • Seeking out and sharing resources to enhance the Arizona EMS and trauma system

  • Traveling to a limited number of national, state or local meetings

Salary: up to $60,354   Apply Here

 

AzPHA Member Kelli Donley on Horizon Thursday RE Her Latest Book

AzPHA member Kelli Donley will be on Horizon this Thursday at 5:30pm (May 24) to talk about her newest book called COUNTING COUP. The book is about the Phoenix Indian School, and like her other novels, has a strong public health theme. Here’s a short description of her book, which you can order from Amazon:

Happily consumed with her academic career, Professor Avery Wainwright never planned on becoming sole guardian of her octogenarian Aunt Birdie. Forced to move Birdie—and her failing memory—into her tiny apartment, Avery’s precariously balanced life loses its footing. 

Unearthed in the chaos is a stack of sixty-year-old letters. Written in 1951, the letters tell of a year Avery’s grandmother, Alma Jean, spent teaching in the Indian school system, in the high desert town of Winslow, Arizona. The letters are addressed to Birdie, who was teaching at the Phoenix Indian School. The ghostly yet familiar voices in the letters tell of a dark time in her grandmother’s life, a time no one has ever spoken of. 

Torn between caring for the old woman who cannot remember, and her very different memories of a grandmother no longer alive to explain, Avery searches for answers. But the scandal and loss she finds, the revelations about abuses, atrocities, and cover-ups at the Indian schools, threaten far more than she’s bargained for. 

 

Most of you know Dr. Bob England, who's been on the AZ public health scene for the last 30 years including 12 years as the Director of the Maricopa County Public Health Department.  Bob's been living for the last couple of months just outside of London. 

He's writing some entertaining travelogues- with a splash of public health of course. Take a few minutes when you're on a comfortable couch and enjoy Travelogue 1 & 2: Getting Settled and Travelogue 3: Nutrition. Here’s the 5th installment: Interlude.  Back to the 4th Travelogue next week.