The 2019 Legislative Session is in the books. There were several good things that came out of Session this year. Of course, there were also some missed opportunities that would have improved public health. There were also a few close calls on bills that would have done some damage to public health.
The session ended Monday night when the House and Senate agreed on a series of budget bills. Once those were passed and sent to the Governor, Legislators voted to adjourn for the year.
The budget highlights included funding to protect Arizona’s Kids Care program, some additional investment in the state loan repayment program and graduate medical education, some funding for prenatal care equipment in rural Arizona, needed funding for providers that serve folks with disabilities, and an appropriation of federal funds to draw down federal funds from the Child Care Block Grant. Disappointments in the budget included a failure to fund preventative oral health coverage for pregnant women and investing in the state’s 211 information hotline.
Here’s the subset of the budget that was passed related to public health and human services and a link to the health budget reconciliation bill and the Budget Bill Summary: https://apps.azleg.gov/BillStatus/GetDocumentPdf/471479
Fully funds KidsCare and eliminates the risk of an enrollment freeze by paying the increased state match requirements that are coming up. The language also eliminates the former trigger language that would have frozen KidsCare when the federal match requirement changes again.
Makes last year’s one-time $13M increase for providers that serve persons with developmental disabilities ongoing (because of the Prop 206 minimum wage increase) and an additional $13M in provider funding (rate increases) for the upcoming fiscal year. There’s an additional $4M in provider rate increases for Prop. 206 impacted services for January 1, 2020 (this funding is for half a fiscal year to address the January 1, 2020 minimum wage increase).
Provides new Prop 206 (minimum wage increase) funding for Elderly Long-Term Care (for persons with developmental disabilities) of $4.8M.
Child Care Subsidies
Appropriates $56M Childcare Block Grant funding (this is entirely federal funding- but the feds still require a state appropriation to draw down the funds). Will go a long way toward reducing the wait list for child care subsidies and will help improve reimbursement rates.
Miscellaneous Health Items
Appropriates an additional $750,000 for the State Loan Repayment Program (in addition to the current $1M/year).
Appropriates $1.6M for rural Graduate Medical Education ($5.5M w fed match) and $1.3M for urban GME ($4.4M w fed match)
$750,000 for North Country Graduate Medical Education
$1M for rural prenatal equipment
Provides $10M to the Housing Trust Fund for programs related to homelessness
$700K for Colorado City primary care clinic
$1.5M for Benson and Northern Cochise critical access hospitals
Continues $3M annual appropriation for TGEN for 3 years
Increases Alzheimer's funding by $2M ($1M base)
Provides an additional $15M for an Arizona Department of Education school safety grant program for School Resource Officers, behavioral health counselors and social workers
Provides $1.6M for Veteran's Suicide Prevention (includes $450K for trauma training)
$8.0 million for the UofA Health Sciences Center
Arizona State Hospital
Provides $2.8M in pay raises for AZ State Hospital staff
Provides $300K for AZ State Hospital for a temporary staffing contract increase
I’m still in the process of putting together a PowerPoint that will summarize the legislative session. Below is a summary of the various bills related to public health that passed followed by some of the missed opportunities and the close calls.
Bills Passed and Signed
SB 1468 Suicide Prevention Training
This new law will require school districts, charter schools, and Arizona teacher training programs to include suicide awareness and prevention training in their continuing education curricula. It’ll require AHCCCS to make suicide awareness and prevention training available (fortunately some evidence- based tools curricula already exist).
Starting in the 2020 school year, school districts and charter schools would need to provide training in suicide awareness and prevention to school personnel in grades 6 to 12. The bill also establishes requirements for suicide awareness and prevention training and specifically says that the training use evidenced-based training materials and instruct participants on how to identify the warning signs of suicidal behavior in adolescents and teens.
HB 2488 Veteran Suicide Annual Report
Requires ADHS (starting this year) to complete an annual report on veteran suicides in Arizona that includes the number and rate of veterans who died by suicide, trends, an analysis of the years of potential life lost, a comparison of Arizona's resident veteran suicide rate to those of the nation, and the relative risk of suicide by race or ethnicity, age group, gender and region.
The report is also supposed to analyze patterns of drugs, or combinations of drugs, that were used by Arizona's resident veterans when drug poisoning was the mechanism of suicide. The idea is to create the surveillance and data linkages needed to inform suicide prevention strategies based upon medical risk factors that significantly correlate to suicide.
HB 2318 Hands Free Cell Requirement
This bill was a long time coming- but were on the precipice of having this good public policy finally happen. It will prohibit using a hand-held cell phone while driving. There are some common-sense exemptions for example if the person is using it hands free etc. It'll change driving behaviors and save lives.
Violations are a civil money penalty (no driving points) with the first offense being between $75- $150 and the 2nd offense between $150 and $250. The bill would provide a state overlay so the cell phone use laws would no longer be different from jurisdiction to jurisdiction. Warnings for a year and a half - and then the penalties kick in.
SB 1247 Residential Care Institutions
This good bill will require more robust staffing background checks for facilities that provide services for children and will remove the “deemed status” designation for child residential behavioral health facilities.
Under the old law, facilities in this category (e.g. Southwest Key) can be accredited by a third party (e.g. Council on Accreditation) and avoid annual surprise inspections by the ADHS. This intervention will provide more oversight to ensure background checks are done and that the facilities are compliant with state regulations.
SB 1211 Intermediate Care Facilities
Like SB 1247, this bill closes a licensing loophole. This good bill will require more robust staffing background checks for facilities that provide services to people with disabilities at intermediate care facilities. These facilities would also require a license to operate from the Arizona Department of Health Services beginning on January 1, 2020. Under current law these facilities (Hacienda de los Angeles and similar facilities run by the ADES are exempt from state licensing requirements).
HB 1494 Medical Marijuana Testing
This bill will require medical marijuana dispensaries to test their product for potency and contaminants. It will also require the ADHS to develop testing standards and laboratory certification criteria to implement the requirements. Still needs to be signed by the Governor.
Maternal & Child Health
SB 1040 Maternal Mortality Report
The new law will establish an Advisory Committee on Maternal Fatalities and Morbidity. It requires ADHS and the Committee to hold a public hearing to receive public input regarding the recommended improvements to information collection concerning the incidence and causes of maternal fatalities and severe maternal morbidity and complete a report (including recommendations) by the end of this year.
SB 1456 Vision Screening
This bill would require schools to provide vision screening services to students in grades prescribed by future ADHS rules, kids being considered for special education services, and students who are not reading at grade level by the third grade. Appropriates $100,000 from the state General Fund to the ADHS for the tracking and follow up.
Access to Care
SB 1089 Telemedicine
Any healthcare service covered in-person by a commercial insurer will also be covered when provided through telemedicine. Currently, Arizona law limits telemedicine coverage to a handful of medical services.
SB 1109 Short Term Limited Health Plans
This authorizes the sale of short- term limited health plans in Arizona for terms up to 3 years. The previous limit was 1 year. These plans don’t cover pre-existing conditions and have limited consumer protection because they aren’t required to cover the essential health services under the ACA and can drop enrollees. We urged a not vote because of the poor consumer protections.
SB 1085 Association Health Plans
This new law basically provides a regulatory structure at the state level for Association Health Plans - serving to make them more available in Arizona. A primary concern for folks interested in public health and consumer protection is that this category of health plan won’t need to cover the essential health benefits and can charge differently depending on gender and age.
SB 1354 Graduate Medical Information & Student Loan Repayment
The final budget did make some investments that were included in this bill, but not all. This bill would have done a great deal both in the short-term by boosting the primary care loan repayment program and really enhancing graduate medical education residencies over the coming years (important because where a practitioner does her or his residency greatly influences where they ultimately practice).
HB 2718 Syringe Services Programs
This bill would have decriminalized syringe access programs, currently a class 6 felony. To qualify, programs need to list their services including disposal of used needles and hypodermic syringes, injection supplies at no cost, and access to kits that contain an opioid antagonist or referrals to programs that provide access to an opioid antagonist.
SB 1088 Dental Care During Pregnancy
This bill would have expanded AHCCCS covered services to include comprehensive dental coverage during pregnancy and appropriate the required state match funding. Good oral health is well established to improve birth outcomes including reducing pre-term birth while also preventing the transmission of caries from mom to infant after birth.
SB 1174 Tribal Area Health Education Center
Health Education System consists of five area health education centers each representing a geographic area with specified populations that currently lack services by the health care professions.
SB 1355 Native American Dental Care
This bill would have required AHCCCS to seek federal authorization to reimburse the Indian health services and tribal facilities to cover the cost of adult dental services.
SB 1245 Vital Records- Death Certificates
This bill would have made it clear that both state and county Registrars can provide certified copies of death certificates to licensed funeral home directors upon request. There’s been some confusion about this authority and this bill would clear it up.
SB1399 School Health Pilot Program
This bill would have charged the AZ Department of Education with conducting a 3-year physical and health education professional development pilot program to improve the ability of physical and health educators in this state to provide high quality physical and health education to students in this state, improving student health and reducing Arizona health care cost containment 10 system and other health-related costs.
SB 1363 Tobacco Product Sales (Tobacco 21) (Carter)
HB 2162 Vaccine Personal Exemptions (Hernandez)
HB 2352 School Nurse and Immunization Postings (Butler)
HB 2172 Rear Facing Car Seats (Bolding)
HB 2246 Motorcycle Helmets (Friese)
SB 1219 Domestic Violence Offenses & Firearm Transfer
HB 2247 Bump Stocks (Friese)
HB 2248 Firearm Sales (Friese)
HB 2161 Order of Protection (Hernandez)
SB 1119 Tanning Studios (Mendez)
HB 2347 Medicaid Buy-in (Butler)
HB 2351 Medical Services Study Committee (Butler)
Bills that Didn’t Pass that We Opposed:
HB 2471 Informed Consent
This bill would add a requirement that physicians provide to parents and guardians the full vaccine package insert and excipient summary for each vaccine that will be administered. Physicians already provide a Vaccine Information Summary to parents and guardians for each vaccine administered, which is noted in the medical record. This new requirement would mandate provision of the 12-15 page insert, which is not presented in a format that incorporates health literacy principles.
HB 2472 Vaccinations- Antibody Titer
These bills would mandate that doctors inform parents and guardians that antibody titer tests (which involve a venous draw) are an option in lieu of receiving a vaccination and that there are exemptions available for the state requirements for attending school.
HB 2470 Vaccination Religious Exemptions
This bill would add an additional exemption to the school vaccine requirements into state law. Currently there are medical and personal exemptions. The bill doesn't include any verification of the religious exemption from a religious leader, just a declaration from the parent that they are opposed to vaccines on religious grounds.