Child Separation

Legislative Update

State Legislature Bill Update

All the legislative committees are off to the races now- busy considering the various bills assigned to them by the Speaker of the House or the President of the Senate.  In order to survive, Bills will need to be heard in all their house of origin committees in the next few weeks and then get a floor vote, pass that, and then move over to the other chamber.

Our Public Health Policy Committee met over the phone last week and we took positions on many bills- and we input them into the www.azleg.gov system to demonstrate our support.

This week I’ll start with a summary of bills scheduled for a hearing next week, followed by the bills that were heard last week. 

This week I'm not listing all the bills that haven’t seen action yet- but you’ll be able to find those on my blog at http://www.azpha.org/wills-blog

 

Bills that Will Be Heard in Committee This Week

SB 1247 Residential Care Institutions (Brophy McGee) – AzPHA Position: Yes

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 current 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.  Bill will be heard in Senate Health & Human Services on Wednesday at 8:30am in SHR1.  I’ll be speaking in favor at the hearing.


SB 1211 Intermediate Care Facilities (Carter) – AzPHA Position: Yes

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.  Bill will be heard in Senate Health & Human Services on Wednesday at 8:30am in SHR1.  I’ll be speaking in favor at the hearing.

SB 1088 Dental Care During Pregnancy (Carter) – AzPHA Position: YES

This bill would expand AHCCCS covered services to include comprehensive dental coverage during pregnancy and appropriate the required state match funding. Passed the Senate Health & Human Services Committee on 1/23.  Will be heard in the Senate Appropriation Committee Tuesday, Feb 12 at 2 pm.  I’ll be speaking in favor at the hearing.

 

Bills that Were Heard in Committee Last Week

SB 1009 Electronic Cigarettes, Tobacco Sales (Carter) – AzPHA Position: YES

Expands the definition of tobacco products to include e-cigarettes. Among other things, it'll make it clear that it's illegal to sell e-cigarettes to minors. The penalty for selling to minors remains at $5K. Passed the Senate Health & Human Services Committee 1/23.  Rules Committee is next.

SB 1040 Maternal Mortality Report (Brophy-McGee) – AzPHA Position: YES

This bill would require the Child Fatality Review Team subcommittee on maternal mortality to compile an annual statistical report on the incidence and causes of "severe maternal morbidity" with recommendations for action.  The current law requires a review of the data but no report. Passed the Senate Health & Human Services Committee on 1/23. Passed Rules & COW.  Floor vote soon.

HB 2125 Child Care Subsidies (Udall) – AzPHA Position: YES

Makes a supplemental appropriation of $56 million from the Federal Child Care and Development Fund block grant in FY2018-19 to the Department of Economic Security for child care assistance. Another bill, HB 2124 would allocate the money as follows: $26.7 million for provider rate increases, $14 million to serve children on the waiting list, and $13.1 million to increase tiered reimbursement for infants, toddlers and children in the care of DCS. HB 2436 is a similar bill. Passed the House Health Committee this week.  On to Rules.

SB 1011 Information and Referral Service (Carter) – AzPHA Position: YES

Appropriates $1.5 million from the general fund in FY2019-20 to the ADES for a statewide information and referral service for health care services, community services, human services and governmental services.  Passed the Senate Health & Human Services Committee this week.  On to Approps & Rules.

HB 2350 HB2513 SB1134 Kids Care (Butler, Brophy-McGee, Cobb) – AzPHA Position: YES

SB 1134 passed Senate Health and Human Services this week, on to Approps and Rules. These bills Would appropriate funding so that Kids Care could continue after the federal match rate goes below 100% on October 1, 2019.

SB 1341 Tanning Studios (Carter) – AzPHA Position YES

Would require people under 18 that want to use a commercial tanning bed service to have permission from their parent or guardian. This passed the Senate Commerce Committee Thursday.  On to Rules Committee then the Senate Floor.

ADHS Threatens to Revoke SW Key Shelter Licenses

Results Bring into Question Arizona’s Regulatory Oversight Statutes

Some of the kids that have been separated from their parents by the federal government have been and are being cared for at places run by an organization named Southwest Key. There are 13 such facilities in AZ.  SW Key is contracted by the federal government to provide these services and the facilities are licensed by the ADHS. They’re classified as Child Behavioral Health Facilities. 

Here’s the public health policy rub- even though they’re licensed by the ADHS, the Agency doesn’t conduct routine unannounced inspections at these facilities because they’re accredited by the Council on Accreditation, and Arizona law says that when a facility like this is accredited by “an appropriate independent body”, the ADHS shall accept the accreditation in lieu of a routine agency inspection. Specifically, ARS 36-424 (B) states that: “The (ADHS) director shall accept proof that a health care institution is an accredited health care institution in lieu of all compliance inspections required by this chapter if the director receives a copy of the institution's accreditation report for the licensure period”.

The ADHS still has an obligation to investigate complaints at these facilities because ARS 36-424 (C) says that: “On a determination by the director that there is reasonable cause to believe a health care institution is not adhering to the licensing requirements of this chapter… (the ADHS) may enter on and into the premises…  (to) determine the state of compliance with this chapter, the rules adopted pursuant to this chapter and local fire ordinances or rules.”

A few weeks ago, the ADHS did some on site investigations of the facilities (under the ARS 36-424 (C) provision) and presented SW Key with a list of deficiencies to correct (including better documentation of employee background checks).  SW Key’s response appears to have been wholly inadequate.  In a strongly worded letter, the ADHS let all 13 licensees know that the Department is beginning license revocation procedures. 

SW Key will likely now take their deficiencies seriously (including the requirement to document background checks) and avoid revocation…  but this incident demonstrates (to me) that the statutory framework that allows applicants to submit 3rd party accreditation documents instead of being subjected to an unannounced inspection by the regulatory agency (ADHS) provides inadequate protection when vulnerable children are involved.

Perhaps there will be a bipartisan plan next legislative session to update the regulatory framework for facilities that provide services to vulnerable kids.

You can view the status of these facilities at www.azcarecheck.com and search for the words Southwest Key.  You’d be able to see the results of any complaint investigations or enforcement actions against these facilities- but not the backup accreditation documents from the Council on Accreditation.

AzPHA Policy Update: Child Separation, Government Restructuring, House Health Budget Bill

APHA Policy Statement on Child Separation

More than 2,300 children have recently suffered the traumatic experience of being forcibly separated from their parents by the federal government.  Despite the fact that the president has issued an Executive Order to end the practice, thousands of kids are currently separated from their parents.  Some of them are in various facilities in Arizona.

The American Public Health Association (our parent organization) issued a statement last week regarding the policy of child separation recently implemented (and now suspended) by the federal government.  Rather than paraphrase- I thought I’d just block and paste it below:

"The Trump administration’s policy of separating parents and children at the U.S.-Mexico border will have a dire impact on their health, both now and into the future. 

"As public health professionals we know that children living without their parents face immediate and long-term health consequences. Risks include the acute mental trauma of separation, the loss of critical health information that only parents would know about their children’s health status, and in the case of breastfeeding children, the significant loss of maternal child bonding essential for normal development. Parents’ health would also be affected by this unjust separation.

"More alarming is the interruption of these children’s chance at achieving a stable childhood. Decades of public health research have shown that family structure, stability and environment are key social determinants of a child’s and a community’s health.

"Furthermore, this practice places children at heightened risk of experiencing adverse childhood events and trauma, which research has definitively linked to poorer long-term health. Negative outcomes associated with adverse childhood events include some of society’s most intractable health issues: alcoholism, substance misuse, depression, suicide, poor physical health and obesity.

"There is no law requiring the separation of parents and children at the border. This policy violates fundamental human rights. We urge the administration to immediately stop the practice of separating immigrant children and parents and ensure those who have been separated are rapidly reunited, to ensure the health and well-being of these children.”

 

AZ’s System for Regulating the Facilities Caring for Separated Children

Some of the children that have been separated from their parents by the federal government are being cared for in AZ at places run by an organization named Southwest Key. There are 13 such facilities in AZ.  They’re licensed by the Arizona Department of Health Services and classified as Child Behavioral Health Facilities.  Even though they’re licensed by the ADHS, the agency doesn’t conduct routine unannounced inspections at them because they’re accredited by the Council on Accreditation.

Arizona law says that when a facility like this is accredited by an appropriate independent body, the ADHS shall accept the accreditation in lieu of a routine agency inspection. Specifically, ARS 36-424 (B) states that: “The (ADHS) director shall accept proof that a health care institution is an accredited health care institution in lieu of all compliance inspections required by this chapter if the director receives a copy of the institution's accreditation report for the licensure period”.

However, the ADHS still has an obligation to investigate complaints at these facilities because ARS 36-424 (C) says that: “On a determination by the director that there is reasonable cause to believe a health care institution is not adhering to the licensing requirements of this chapter… (the ADHS) may enter on and into the premises…  for the purpose of determining the state of compliance with this chapter, the rules adopted pursuant to this chapter and local fire ordinances or rules.”

You can view the status of these facilities at www.azcarecheck.com and search for the words Southwest Key.  You’d be able to see the results of any complaint investigations or enforcement actions against these facilities- but not the backup accreditation documents from the Council on Accreditation.

 

Supporting Separated Children & Parents

A publication called “Child Trends” put out a blog last week entitled Supporting Children and Parents Affected by the Trauma of Separation that contains evidenced-based guidance for parents and officials.  Hopefully some of the persons within the federal government and care facilities are familiar with and are applying this important information (like Trauma Informed Care) in their policies and procedures like:

 

Federal Government Restructuring Proposed by President

Last week the President Trump unveiled a wide-ranging plan to reorganize many functions within the federal government.  The proposal is posted on the White House website.  It’s 132 pages long- but it’s formatted in a way that’s easy to follow – with an index and formatting that makes it easy to read.

It proposes reorganizing various federal government functions in a wide range of programs.  For example, it proposes creating a new Federal Food Safety Agency that would absorb the various USDA and FDA food safety programs- moving everything to a stand-alone food safety agency.

WIC and SNAP would move out of the USDA and into HHS. Environmental programs at the Department of Interior and the USDA would move over to the EPA.  It also proposes reducing the size of the US Public Health Service Commission Corps from 6,500 officers to 4,000 officers with a Reserve Corps for public health emergencies.  It also plans to merge the Education and Labor Departments to consolidate work force programs.

There are many, many other proposals, like privatizing the US Postal Service.

So far this is just a proposal from the President and his team.  Any such restructuring would need to be authorized by congress.  Here’s a link to the wide-ranging report.  Of course, we’ll continue to track the public health portions of this.  It seems super-unlikely to see any action before the November election.

 

Federal FY 19 Health-related Budget Bill

The House Labor, Health and Human Services, and Education Appropriations Subcommittee released the FY19 House Appropriations report. The bill includes $177B in discretionary funding, which is essentially the same as FY18.  Here’s a summary:

CDC

The bill proposes total funding level of $7.6 billion, or $663 million decrease from FY18, but most of the decrease is due to the transfer of the strategic national stockpile to another part of HHS.

HRSA

The bill proposes a total funding level of $6.5 billion, a $196 million decrease from FY18. Title X Family Planning funding would be eliminated completely.  Primary Health Care would get a 7% decrease.

SAMHSA

The bill proposes a total funding level of $5.6 billion for SAMHSA, a $448 million increase above FY18, mostly because the Substance Abuse Block Grant and the State Opioid Response Grants would be significantly increased.