Early Childhood

Many States Using State Earned Income Tax Credits as a Prevention Strategy for ACEs

Is it Arizona’s Turn?

It’s no secret that exposure during childhood to negative events called adverse childhood experiences increase a person’s likelihood of having long-term chronic or behavioral health issues like heart disease, violence, suicide, and substance use.  ACEs like child abuse, neglect, parent incarceration, substance use, or separation are often clustered.

Policymakers in many states are looking for ways to prevent ACEs… which includes strategies to strengthen protective factors like social connectedness, access to healthcare and community resources, enhancing parental skills to promote healthy child development, and providing quality care and early education, and reduce risk factors before they occur. Arizona took a step forward this year by passing a budget bill that will draw down more than $60M in additional funds to support affordable childcare in Arizona.

Leading evidence-based policies to prevent ACEs before they occur are usually linked in some way to strengthening economic supports to help working families out of poverty and reduce parental stress. One well known economic support is the federal Earned Income Tax Credit

Many states are recognizing that they can also play a role through their state-based tax codes – and implementing Earned Income Tax Credits at the state level. Arizona hasn't done so yet.

Here’s how they work. The Earned Income Tax Credit is a refundable income tax credit that can be used to reduce the tax burden for low- to moderate-income working people.  The federal government along with 29 states have established them at the local level. Arizona doesn’t.

Economic support from Earned Income Tax Credits is associated with improved infant and maternal health, better school performance for children, and increased college enrollment. Research suggests they reduce risk factors for child abuse and neglect ACEs by offsetting the costs of raising a child among working families.

This webpage from the National Conference of State Legislatures has a host of information about which states have state based Earned Income Tax Credits and how they work. They’re usually based on a reference to the federal EITC.

State Earned Income Tax Credits are a promising economic support for working families that help to raise more than six million people—half of them children—above the poverty line each year.

Arizona lawmakers have long had a zeal for reducing taxes.  Perhaps next year they should look at taxes from a new angle- using tax policy to support an evidence-based policy a state based earned income tax credit- that will that prevent negative childhood events and bad public health outcomes.

Legislative Session Wrap Up

Another legislative session is in the books.  All in all - a solid legislative session with some pretty significant public health policy gains.  The main areas where progress was made were in access to care, maternal and child health, assurance and licensure and injury prevention. 

There were several bills that didn't progress which would have been a public health benefit and several really good ideas which never even got a hearing- so there were missed opportunities- but overall a solid B+ session I'd say.

We had lots of help with our advocacy efforts this year. Annissa Biggane and Timothy Giblin worked hard each and every week tracking bills, doing triage, ferreting out schedules, and writing risk/benefit analyses.

Eddie Sissions carried a lot of water as usual. She has great insight and a keen ability to figure out the nuances of session and figuring out "how the water flows". Also a big help were our cadre of folks that called in to our bi weekly calls and strategy sessions.

The real key to our advocacy success is you - our membership.  The relationships you make with our elected officials and your focused advocacy efforts are super important to our success at influencing public policy.   Thank you all and well done this year!

I put together a Powerpoint summary of the 2019 legislative session to help y'all digest what happened this year.  I've got links on the pages that'll drive you to the actual bills. Take a look.  BTW- if you open the link with an Apple product like an iPad- the PowerPoint will look weird and unprofessional- so open it on a laptop and in PowerPoint.

Legislative Update

The only committees that met last week were Rules and Appropriations. The other standing committees (e.g. Health and Human Services) have finished their work. The House Appropriations was particularly dramatic with several strike-everything bills and tensions running high- but nothing really tied to the public health bills we’re interested in. 

We have a whole bunch of bills that need to make it through the Rules Committees (especially the House Rules Committee) before they can go to the floor (the Rules Committee's job is to basically make sure the bill is constitutional). 

Lots of the bills that we care about will be heard this week in the Rules Committee Monday at 1:30pm (here's the agenda). I put an asterisk by the bills below that will be heard Monday. If they all pass- they could move quickly to floor votes (3rd read) this week. Here's this week's spreadsheet summary of the bills.

Bills that have been amended in the opposite house will need to return to their house of origin for another vote.  If there isn't agreement on the amendments, there may need to be conference committees set up to hammer out a solution.

In other news, we were delighted to see that the Senate Health and Human Services Committee this week unanimously recommended that Jami Snyder’s confirmation by the full Senate to be the new AHCCCS Director.  Her nomination will now go to the Senate floor for confirmation.

Steve Pierce was appointed to fill Representative Stringer's seat in District 1 late in the week- which is why there was no floor action in the House this week. 

Bills that still need Floor Votes (3rd Read)

* Means bill will be heard in the Rules Committee Monday (1:30pm).

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

Passed the Senate 30-0. Bill Passed the House Health Committee 9-0. Rules Committee this week. 

* SB 1085 Association Health Plans- 

Passed the Senate 24-6.  Passed the House Health and Human Services Committee 6-2-1. Rules Committee this week. 

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

Passed the Senate 27-3.  Passed the House Health & Human Services Committee 8-1.  Passed House Appropriations 7-4. Rules Committee Next. Will still need to get into the final budget.

* SB 1089 Telemedicine Insurance Coverage (Carter) – AzPHA Position: Yes

Passed Senate 30-0. Passed the House Health & Human Services Committee 9-0.  Rules Committee this week. 

* SB 1165 Texting and Driving Prohibition (Brophy McGee) – AzPHA Position: YES

Passed Senate 20-10. Passed the House Transportation Committee 5-1-1.  Rules Committee this week. 

SB 1174 Tribal Area Health Education Center – AzPHA Position: Yes

Passed Senate 30-0. Passed the Senate Education Committee 13-0. Rules Committee Next.

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

Passed the Senate 30-0. Passed the House Health & Human Services Committee 9-0. Rules Committee this week. 

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

Passed the Senate 30-0.  Bill passed the House Health Committee 9-0. Rules Committee this week. 

SB 1245 Vital Records- Death Certificates (Brophy McGee) AzPHA Position: Yes

Passed the Senate 30-0.  Passed through all House Committees- ready for a Floor Vote.

SB 1354 Graduate Medical Information & Student Loan Repayment (Carter) AzPHA Position: Yes

Passed Senate 28-2.  Passed House Appropriations Committee 10-1, Withdrawn at the HHS Committee, but can still move forward if it can pass the Rules Committee. This is the most important access to care bills this year- it would do 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 2125 Child Care Subsidies (Udall) – AzPHA Position: YES

Passed House 46-13.  Passed the Senate Health and Human Services Committee 7-0-1. Rules Committee Next.

* HB 2488 Veteran Suicide Annual Report (Lawrence) AzPHA Position: Yes

Passed House 60-0. Passed the Senate Health and Human Services Committee 7-0-1. Passed 29-0 in the Senate, sent back to House because it's different than the original bill.  

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

Passed the Senate 30-0. Assigned to the House Health and Human Services Committee but didn't get a hearing- not a good sign.

* SB 1355 Native American Dental Care – AzPHA Position: Yes

Passed Senate 25-5.  Passed the House Health & Human Services Committee 9-0. Rules Committee this week. 

SB 1456 Vision Screening- AzPHA Position: Yes

Passed Senate 29-0. Passed the House Health & Human Services Committee 9-0. Rules Committee Next.

* SB 1468 Suicide Prevention- Schools- AzPHA Position: Yes

Requires school districts, charter schools, and Arizona teacher training programs to include suicide awareness and prevention training and requires the Arizona Health Care Cost Containment System Administration (AHCCCS) to make suicide awareness and prevention training available. Rules Committee this week. 

SB 1060 (Strike-all Amendment) Electronic Cigarettes. Smoke Free Arizona Act (Carter) – AzPHA Position: YES

Passed the Senate 28-0. Assigned to the House Health and Human Services Committee- but not heard.  Not a good sign. Probably dead.

 

Bills that Have Been Passed & Signed by the Governor

SB 1109 Short Term Limited Health Plans- extension – AzPHA Position: Opposed

This bill has passed both chambers and has been signed by the Governor.  It 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.

Check Out AzPHA's Position on Multiple Bills

State Legislature Bill Update

More than 700 bills have so far been proposed by members of the Arizona State Legislature so far.  Our Public Health Policy Committee is busy sifting through them and looking for those that will have a public health impact.  We’ve taken public positions on the www.azleg.gov website on more than 20 bills with links to public health.  Below is a quick summary of those bills and the positions that AzPHA has taken.

Tobacco Bills

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 last Wednesday.

HB 2024 Electronic Cigarettes. Smoke Free Arizona Act (Kavanaugh) – AzPHA Position: YES

Includes e-cigarettes in the definition of tobacco products and smoking for the purposes of the Smoke Free Arizona Act.  Because the Act was voter approved- this modification to the law will require a 3/4 majority of both houses.

HB 2073 Vapor Products; Regulation (Shope) – AzPHA Position: Opposed

This bill would basically set up a regulatory program at the ADHS to inspect and license electronic cigarette manufacturers in Arizona and specify that only licensed electronic cigarette manufacturers can sell products in Arizona.  It gives no regulatory authority to the ADHS to enforce that vape shops get licensed and they only must do it every 5 years. There are no penalties for noncompliance and penalties are against the purchaser instead of the retailer.

SB 1363 Tobacco Product Sales (Tobacco 21) (Carter) - AzPHA Position: YES

Tis bill would move the tobacco product (and e-cigarette) buy age to 21.  Bill includes definitions and criteria as well as penalties for vendors that sell to people under 21.

 

Maternal & Child Health

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. This bill passed the Senate Health Committee 8-0 this week!

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. This bill passed the Senate Health Committee 8-0 this week!

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.

 

Vaccines

HB 2162 Vaccine Personal Exemptions (Hernandez) -  AzPHA Position: Yes

This bill would remove the personal exemption option for parents to enroll in school when the child hasn’t had all the required school attendance immunizations.

HB 2352 School Nurse and Immunization Postings (Butler) – AzPHA Position: Yes

School districts and charter schools would be required to post on their websites whether a registered nurse is assigned to each school as well as required reports on immunization rates.

SB 1115 and HB 2471 Informed Consent (Boyer, Barto) - AzPHA Position: Opposed

These bills 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 and SB 1116 Vaccinations- Antibody Titer (Boyer, Barto) - AzPHA Position: Opposed

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. 

 

Injury Prevention

SB 1165 Texting and Driving Prohibition (Brophy McGee) – AzPHA Position: YES

This bill prohibits 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.  Penalties are a civil penalty (no driving points) with the first offense being between $75- $150 and the 2nd offense between $150 and $250.  We are signed up in support of this bill.

HB 2069 Texting and Driving (Kavanaugh) - AzPHA Position: Supporting SB 1165

Makes texting while driving on a highway a nonmoving civil traffic violation.  The penalty for the 1qst violation would be $100 and the second offense would be $300.  If a crash is involved the penalty would be $500 but if someone died it would be $10K.   subject to a civil penalty of $500, except that if the accident results in the death of another person, the civil penalty is $10,000.

HB 2165  Distracted Driving (Townsend) - AzPHA Position: Supporting SB 1165

A person who drives a vehicle while participating in an activity that willfully distracts the person from safely operating the vehicle is guilty of reckless driving, a class 2 (mid-level) misdemeanor.  I’m not sure if texting and driving would qualify or not- it probably does.

HB 2172  Rear Facing Car Seats (Bolding) - AzPHA Position: YES

Kids under two years of age need to be in a rear-facing restraint system unless the child weights at least 40 pounds or is at least 40 inches tall.

HB 2246  Motorcycle Helmets (Friese) – AzPHA Position YES

Motorcycle riders over 18 would be required to wear a helmet unless they pay a fee that would be set by ADOT. Violations would be a $500 civil penalty, but no points or other sanctions. 

HB 2075  Electronic Prescribing (Cobb) – AzPHA Position: Yes

Pushes the electronic prescribing requirement in last year’s Opioid Epidemic Act back to January 2, 2020 in all counties.  Being heard in House Health & Human Services Committee Thursday Feb 24 at 9 am.

Firearm Safety

SB 1219 Domestic Violence Offenses & Firearm Transfer AzPHA Position: Yes

Persons that have been adjudicated and the court rules that they may not possess a firearm must surrender their firearms to a law enforcement agency.  The law enforcement agency may then dispose of the firearm(s) in accordance with law.  People that have an Order of Protection against them must also surrender their firearms, although the law enforcement agency must return the firearm when the Order expires (after a background check).

HB 2247 Bump Stocks (Friese) – AzPHA Position: Yes

This bill would outlaw the sale of bump stocks on firearms.

HB 2248 Firearm Sales (Friese) – AzPHA Position: Yes

This bill would require a background check for all sales at gun shows.

HB 2161 Order of Protection (Hernandez) AzPHA Position: Undetermined

A person who is at least 18 years of age and who is either a law enforcement officer, a “family or household member” (defined), a school administrator or teacher or a licensed behavioral health professional who has personal knowledge that the respondent is a danger to self or others is permitted to file a verified petition in the superior court for a one-year Severe Threat Order of Protection (STOP order), which prohibits the respondent from owning, purchasing, possessing or receiving or having in the respondent’s custody or control a firearm or ammunition for up to one year.

HB 2249  Mental Health and Firearm Possession (Friese) AzPHA Position: Undetermined

An immediate family member or a peace officer is authorized to file a verified petition with a magistrate, justice of the peace or superior court judge for an injunction that prohibits a person from possessing, controlling, owning or receiving a firearm. Any court may issue or enforce a mental health injunction against firearm possession, regardless of the location of the person. Information that must be included in the petition is specified. If the court finds that there is clear and convincing evidence to issue a mental health injunction against firearm possession, the court must issue the injunction. Information that must be included in the injunction is specified.

 

Harm Reduction

HB 2148 Syringe Services Programs (Rivero) AzPHA Position: Yes

Decriminalizes 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 1119 Tanning Studios (Mendez) – 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.

Agency Administration

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.

HB 2004 Nuclear Management Fund (Kavanaugh) – AzPHA Position: Undetermined

Assesses the Palo Verde nuclear plant $2.55M and gives it to ADEM, ADHS and other jurisdictions to compensate them for off-site nuclear emergency response plan response activities.  Being heard in House Appropriations Committee Wednesday Feb 23 at 2 pm.

HB 2280  Interfacility Ambulance Transports (Weninger) - AzPHA Position: Undetermined

A person may operate an "interfacility transfer ambulance service" by applying to the Department of Health Services for a certificate of operation with defined requirements.   The requirement to transport a patient under medical direction to the nearest, most appropriate facility as defined by federal Medicare guidelines does not apply to an interfacility transfer ambulance service with a certificate of operation.

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.  

 

AHCCCS Coverage & Private Insurance Coverage

HB 2347 Medicaid Buy-in (Butler) AzPHA Position: Undetermined

Would require AHCCCS to set up a program in which eligible people could pay a premium and receive Medicaid health insurance.

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

These bills Would appropriate funding so that Kids Care could continue after the federal match rate goes below 100% on October 1, 2019.

HB 2351 Medical Services Study Committee (Butler) – AzPHA Position: Yes

Establishes a 14-member Medical Services Purchase Program Study Committee to research and make recommendations for establishing and implementing a medical services purchase program. The Committee is required to submit a report of its findings and recommendations to the Governor

HB 2120  Chiropractic Coverage (Barto) - AzPHA Position: Undetermined

Would add chiropractic services to the list of reimbursable services under AHCCCS.  Being heard in House Health & Human Services Committee Thursday Feb 24 at 9 am.

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.

SB 1089 Telemedicine Insurance Coverage (Carter) – AzPHA Position: Yes

This Bill would put into law specific standards requiring non-Medicaid insurance companies to cover telemedicine.  There are criteria and standards in the law regarding contracting standards. Note: this is all Title 20 language and does not apply to Medicaid (AHCCCS).

Food Safety & Insecurity

HB 2178  Milk Manufacturing License Exemption - AzPHA Position: Undetermined

A restaurant wouldn’t be required to get a license to manufacture or distribute frozen desserts or frozen milk products if the product is manufactured or distributed and sold at the same facility for on-site consumption.

HB 2186  School Meals (Udall) AzPHA Position: Yes

Schools are required to provide a school meal to a student who requests it regardless of whether the student pays for a school meal or owes money for previous meals. Local education agencies are prohibited from taking a list of specified actions relating to unpaid school meal fees, including announcing or publicizing the names of students with unpaid school meal fees, requiring a student who cannot pay for a meal or who owes unpaid meal fees to work for a meal, and attempting to collect unpaid school meal fees from a student. Local education agencies are prohibited from using a debt collector to attempt to collect unpaid school meal fees.

 

Access to Care

HB 2218 State Loan Repayment (Blanc) – AzPHA Position: YES

Makes a supplemental appropriation of $500,000 from the general fund in FY2019-20 to the Department of Health Services to pay off portions of education loans taken out by physicians, dentists, pharmacists, advance practice providers and behavioral health providers participating in the primary care provider loan repayment program.  An additional $500K would be appropriated to pay off education loans taken out by physicians, dentists, pharmacists, advance practice providers and behavioral health providers participating in the rural private primary care provider loan repayment program.

HB 2376  Associated Health Plans (Barto) AzPHA Position: Undetermined

An association health plan is authorized to operate in Arizona if the plan is following federal laws and regulations, and if the plan's governing documents require the plan to be actuarially sound and the plan is actuarially sound.

Medical Marijuana

HB 2149  Cannabis Definition (Rivero) AzPHA Position: YES

Synchronizes the definitions of marijuana and cannabis in the state criminal code and the Arizona Medical Marijuana Act.  There has been some confusion in certain counties- as medical marijuana patients have been prosecuted for possessing extracts and preparations of marijuana that they bought at dispensaries. The appeal of this prosecutions will be heard by the state supreme court. This would make it clearer in state law that extracts and preparations are included in the Act.

State Legislature Bill Update

More than 700 bills have so far been proposed by members of the Arizona State Legislature so far.  Our Public Health Policy Committee is busy sifting through them and looking for those that will have a public health impact.  We’re not done looking through them yet- but below is a summary of what we know so far.

Tobacco Bills:

SB 1009 Electronic Cigarettes, Tobacco Sales (Carter)

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. Being heard in Senate Health & Human Services Committee Wednesday Feb 23 at 9 am.

HB 2024 Electronic Cigarettes. Smoke Free Arizona Act (Kavanaugh)

Includes e-cigarettes in the definition of tobacco products and smoking for the purposes of the Smoke Free Arizona Act.  Because the Act was voter approved- this modification to the law will require a 3/4 majority of both houses.

HB 2073 Vapor Products; Regulation (Shope)

This bill would basically set up a regulatory program at the ADHS to inspect and license electronic cigarette manufacturers in Arizona and specify that only licensed electronic cigarette manufacturers can sell products in Arizona.  It’s unclear what the objective of this bill is and we have not yet taken a position on it yet.


Maternal & Child Health:

SB 1088 Dental Care During Pregnancy (Carter)

This bill would expand AHCCCS covered services to include comprehensive dental coverage during pregnancy and appropriate the required state match funding.

SB 1040 Maternal Mortality Report (Brophy-McGee)

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.

 

HB 2125 Child Care Subsidies (Udall)

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.

HB 2337 Family Planning (Salman)

Would repeal the statute requiring the Department of Health Services to apply for the federal Title X family planning grant.

Injury Prevention:

HB 2069 Texting and Driving (Kavanaugh)

Makes texting while driving on a highway a nonmoving civil traffic violation.  The penalty for the 1qst violation would be $100 and the second offense would be $300.  If a crash is involved the penalty would be $500 but if someone died it would be $10K.   subject to a civil penalty of $500, except that if the accident results in the death of another person, the civil penalty is $10,000.

HB 2165  Distracted Driving (Townsend)

A person who drives a vehicle while participating in an activity that willfully distracts the person from safely operating the vehicle is guilty of reckless driving, a class 2 (mid-level) misdemeanor.  I’m not sure if texting and driving would qualify or not- it probably does.

HB 2172  Rear Facing Car Seats (Bolding)

Kids under two years of age need to be in a rear-facing restraint system unless the child weights at least 40 pounds or is at least 40 inches tall.

HB 2246  Motorcycle Helmets (Friese)

Motorcycle riders over 18 would be required to wear a helmet unless they pay a fee that would be set by ADOT. Violations would be a $500 civil penalty, but no points or other sanctions. 

HB 2075  Electronic Prescribing (Cobb)

Pushes the electronic prescribing requirement in last year’s Opioid Epidemic Act back to January 2, 2020 in all counties.  Being heard in House Health & Human Services Committee Thursday Feb 24 at 9 am.

Firearm Safety

HB 2247 Bump Stocks (Friese)

This bill would outlaw the sale of bump stocks on firearms.

HB 2248 Firearm Sales (Friese)

This bill would require a background check for all sales at gun shows.

HB 2161 Order of Protection (Hernandez)

A person who is at least 18 years of age and who is either a law enforcement officer, a “family or household member” (defined), a school administrator or teacher or a licensed behavioral health professional who has personal knowledge that the respondent is a danger to self or others is permitted to file a verified petition in the superior court for a one-year Severe Threat Order of Protection (STOP order), which prohibits the respondent from owning, purchasing, possessing or receiving or having in the respondent’s custody or control a firearm or ammunition for up to one year.

HB 2249  Mental Health and Firearm Possession (Friese)

An immediate family member or a peace officer is authorized to file a verified petition with a magistrate, justice of the peace or superior court judge for an injunction that prohibits a person from possessing, controlling, owning or receiving a firearm. Any court may issue or enforce a mental health injunction against firearm possession, regardless of the location of the person. Information that must be included in the petition is specified. If the court finds that there is clear and convincing evidence to issue a mental health injunction against firearm possession, the court must issue the injunction. Information that must be included in the injunction is specified.

Harm Reduction:

HB 2148 Syringe Access Programs (Rivero)

Decriminalizes 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 1119 Tanning Studios (Mendez)

Would require people under 18 that want to use a commercial tanning bed service to have permission from their parent or guardian.

Vaccines

HB 2162 Vaccine Personal Exemptions (Hernandez)

This bill would remove the personal exemption option for parents to enroll in school even though they haven’t had all the required immunizations.

HB 2352 School Nurse and Immunization Postings (Butler)

School districts and charter schools would be required to post on their websites whether a registered nurse is assigned to each school as well as required reports on immunization rates.

Agency Administration

HB 2004 Nuclear Management Fund (Kavanaugh)

Assesses the Palo Verde nuclear plant $2.55M and gives it to ADEM, ADHS and other jurisdictions to compensate them for off-site nuclear emergency response plan response activities.  Being heard in House Appropriations Committee Wednesday Feb 23 at 2 pm.

 

HB 2280  Interfacility Ambulance Transports (Weninger)

A person may operate an "interfacility transfer ambulance service" by applying to the Department of Health Services for a certificate of operation with defined requirements.   The requirement to transport a patient under medical direction to the nearest, most appropriate facility as defined by federal medicare guidelines does not apply to an interfacility transfer ambulance service with a certificate of operation.

SB 1011 Information and Referral Service (Carter)

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.  


AHCCCS Coverage & Services

HB 2347 Medicaid Buy-in (Butler)

Would require AHCCCS to set up a program in which eligible people could pay a premium and receive Medicaid health insurance.

HB 2350 HB2513 SB1134 Kids Care (Butler, Brophy-McGee, Cobb)

These bills Would appropriate funding so that Kids Care could continue after the federal match rate goes below 100% on October 1, 2019.

HB 2351 Medical Services Study Committee (Butler)

Establishes a 14-member Medical Services Purchase Program Study Committee to research and make recommendations for establishing and implementing a medical services purchase program. The Committee is required to submit a report of its findings and recommendations to the Governor

HB 2120  Chiropractic Coverage (Barto)

Would add chiropractic services to the list of reimbursable services under AHCCCS.  Being heard in House Health & Human Services Committee Thursday Feb 24 at 9 am.

SB 1088 Dental Care During Pregnancy (Carter)

This bill would expand AHCCCS covered services to include comprehensive dental coverage during pregnancy and appropriate the required state match funding.


Food Safety & Insecurity

HB 2178  Milk Manufacturing License Exemption

A restaurant wouldn’t be required to get a license to manufacture or distribute frozen desserts or frozen milk products if the product is manufactured or distributed and sold at the same facility for on-site consumption

HB 2186  School Meals (Udall)

Schools are required to provide a school meal to a student who requests it regardless of whether the student pays for a school meal or owes money for previous meals. Local education agencies are prohibited from taking a list of specified actions relating to unpaid school meal fees, including announcing or publicizing the names of students with unpaid school meal fees, requiring a student who cannot pay for a meal or who owes unpaid meal fees to work for a meal, and attempting to collect unpaid school meal fees from a student. Local education agencies are prohibited from using a debt collector to attempt to collect unpaid school meal fees.


Access to Care

HB 2218 State Loan Repayment (Blanc)

Makes a supplemental appropriation of $250,000 from the general fund in FY2019-20 to the Department of Health Services to pay off portions of education loans taken out by physicians, dentists, pharmacists, advance practice providers and behavioral health providers participating in the primary care provider loan repayment program. 

HB 2376  Associated Health Plans (Barto)

An association health plan is authorized to operate in Arizona if the plan is in compliance with federal laws and regulations, and if the plan's governing documents require the plan to be actuarially sound and the plan is actuarially sound.

Medical Marijuana

HB 2149  Cannabis Definition (Rivero)

Syncronizes the definitions of marijuana and cannabis in the state criminal code and the Arizona Medical Marijuana Act.  There has been some confusion in certain counties- as medical marijuana patients have been prosecuted for possessing extracts and preparations of marijuana that they bought at dispensaries. The appeal of this prosecutions will be heard by the state supreme court. This would make it more clear in state law that extracts and preparations are included in the Act.

HB 2412  Medical Marijuana Cards (Powers Hannley)

This bill would make medical marijuana cards valid for 2 years instead of the current 1 year.

Governor's Proposed Budget

The Governor released his proposed FY19-20 budget late last week.  It’s over 500 pages long - but we went through and looked for important items that relate to public health and or social determinants.  Here’s a quick summary.

Kids Care Funding

Happily, the Governor’s budget includes the needed funding to continue our Kids Care program after the federal contribution goes below 100% on October 1, 2019.  KidsCare provides insurance for more than 30,000 children in families with incomes above the limit for Medicaid eligibility but below 200% of the federal poverty level (FPL). Families with children who are insured through KidsCare pay premiums that vary with family size and income from $10 to $70 per month.  Of course- this still needs to work its way through the legislature but it sure is encouraging to see it in the Governor’s budget.

Telemedicine Services for Prenatal Services

The Governor’s proposed budget includes $500K in one-time funding for telemedicine and sonogram equipment to help rural hospitals that lack adequate access to prenatal providers to provide care to expectant mothers. The initiative will allow rural hospitals to buy telemedicine and sonogram equipment and enhance their ability to reach out to urban partners for assistance when providing prenatal care to expectant mothers, reducing the need to travel.  An additional $500K is proposed in one-time funding to provide student loan repayment options for health care professionals who provide prenatal care in one of the designated rural areas.

 

Child Care Subsidies

The federal government is offering Arizona $56M in funding to provide child care subsidies in Arizona.  Last year Arizona did not request this funding- in part because the state legislature did not appropriate these federal funds.  The Governor’s budget this year asks the legislature to appropriate the funds to increase the child care subsidy rate and to serve children on the waitlist.

The program serves three client categories: Temporary Assistance for Needy Families (TANF), Transitional Child Care (TCC), and Low-Income Working (LIW). LIW has a waiting list and limits eligibility to low-income families who are working, teen parents in high school or GED classes, or residents of homeless or domestic violence shelters.

The proposed funding will serve approximately 400 children per month from the waitlist and increase the average child care subsidy rate from $365 per month to $438 per month.

Oral Health Coverage During Pregnancy

There's no mention of the money that would be needed to cover the state portion of  providing comprehensive oral health services for pregnant Medicaid members- but that's OK.  As you see below there is a bill that would accomplish that goal.

Recently Passed Federal Public Health Legislation

Congress has passed several bills in the last few weeks related to public health.  Here’s a quick summary and links to the laws.

Improving Access to Maternity Care HR 315

This bill requires HRSA to identify maternity care health professional target areas and publish data comparing the availability of and need for maternity care health services in health professional shortage areas and areas within those areas.

Preventing Maternal Deaths Act of 2018 HR 1318

This bill authorizes HHS grants to states to review maternal deaths, publish reports with the results.

PREEMIE Reauthorization Act of 2018  S 3029

This bill increases federal research on preterm labor and delivery, improve the care, treatment, and outcomes of preterm birth and low birthweight infants. 

Agriculture Improvement Act of 2018 – The Farm Bill HR 2

The Farm Bill reauthorizes food security programs through FY23 including Supplemental Assistance Program (SNAP) and SNAP nutrituon education.  It also removes hemp from the Controlled Substances Act, which would legalize hemp production and therefore changes how CBD is regulated.

State Offices of Rural Health Reauthorization Act: S 2278

This bill reauthorizes $12.5M annually through FY22 for the Federal Office of Rural Health Policy to make grants to each state office of rural health to improve health care in rural areas. This bill was approved by both the House and Senate but is not yet signed.

The Action for Dental Health Act of 2018

This bill provides an opportunity to improve oral health across the country.  The bill will provide additional resources to the CDC to increase funding for groups and organizations to qualify for federal grants that develop programs and expand access to oral health education and care in states and tribal areas

CDC will still need to flesh out the grant guidance in the coming months before they put out their announcement with the application and expectations. 

PEPFAR Extension Act of 2018  HR 6651

This bill extends certain provisions of the U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003.

Sickle Cell Disease Research, Surveillance, Prevention, and Treatment Act of 2018  S 2465

This bill reauthorizes a sickle cell disease prevention and treatment program and to authorizes funding for grants for research, surveillance, prevention, and treatment of heritable blood disorders.

Infrastructure for Alzheimer's Act S 2076

This bill would create an Alzheimer's public health infrastructure across the country to implement effective Alzheimer's interventions focused on public health issues such as increasing early detection and diagnosis, reducing risk and preventing avoidable hospitalizations.

2018 Child Fatality Review Report Published

The death of any child is a tragedy – for the family and for the community. Everybody wants to prevent childhood deaths. But making policy interventions to prevent childhood deaths requires information in order to develop effective policy interventions.  That’s where the Arizona Child Fatality Review State Team comes in.

More than 25 years ago the state legislature passed a law establishing the Arizona Child Fatality Review Program (A.R.S. § 36-342, 36-3501-4).  It’s a great example of establishing public policy designed to build data and evidence so policy makers can use evidence to build future interventions.

The State Team includes representatives from the Academy of Pediatrics and from the ADES Divisions of Developmental Disabilities and Children and Family Services, as well as from law enforcement and the ADHS. The team’s role is to review all childhood deaths in AZ and produce an annual report to the Governor and legislature with a summary of findings and recommendations based on promising and proven strategies regarding the prevention of child deaths.

In past years this focus has raised the awareness about child drowning and the importance of putting babies to sleep on their backs or making sure all children are always secured in car seats. Other recommendations included taking action to reduce the number of uninsured, decrease medical complications of pregnancy and increase safe sleep practices.

The 2018 Child Fatality Review Report was published last week- and as usual it provides a host of data and recommendations that are directly tied to evidence. Here are some examples from this year’s report.

Child suicides increased an astonishing 32% and accounted for 6% percent of all child deaths. A history of family discord was the most commonly identified preventable factor in suicides followed closely by a history of recent break-up, drug/alcohol use and an argument with a parent. 

Firearm deaths increased 19% from the previous report.  Suicides and homicides accounted for 88% of firearm-related deaths in 2017. Fifty-one percent of firearm related deaths were a result of suicide (n=22) and 37% of firearm related deaths were homicides (n=16).

Injury deaths increased 4% from the previous reporting period and comprised 23% of all child deaths. The leading cause was car crashes and 31% of the injury deaths were among kids less than 1 year old… and important piece of data considering Arizona has yet to adopt a law requiring kids under 2 years old to be in a rear facing car seat.

The number of unsafe sleep deaths increased 5% from the previous year.  60% were bed sharing with adults and/or other children. Child fatalities due to maltreatment decreased 4% and accounted for 10% of all child deaths in Arizona.   Substance use was a factor in 65% of maltreatment deaths.

Drowning deaths increased 30% over the period and accounted for 4% of all child deaths. 63% occurred in a pool or hot tub. Lack of supervision was a factor in 69% of drowning deaths.

Substance use was a factor in 17% of all child fatalities (n=136).  The majority of substance use related deaths involved the child or the child’s parent as the main user contributing to the death of the child. In 49% of substance use related deaths, the parent was misusing or abusing alcohol or drugs.

The full report covers each of these areas including some recommendations for policy and program interventions in each area.  Sometimes the recommendations are more related to increasing awareness but many are more policy based.

Lots of work went into this report- so if you're somebody in a position to influence either lawmakers or agency officials to implement preventative policies in these areas- please get familiar with this   important research product - it will really help inform your advocacy efforts.

CHW Rulemaking, Opioid Epidemic Ends and Various CEU Opportunities

Community Health Worker Certification Rulemaking

The new law that authorizes the voluntary certification of community health workers will officially take effect on August 3 (HB 2324 Voluntary Certification for Community Health Workers). Voluntary certification can’t begin until the ADHS completes their Administrative Rulemaking (regulations) that’ll flesh out the details of the certification program including defining the core competencies, the criteria for establishing those competencies, continuing education requirements, the fee and other certification details. 

The first step in the Rulemaking process is for the ADHS to populate the 9 member advisory council to help inform the Rulemaking (the ADHS Director makes those appointments based on the criteria in the Session Law - the language at the end of the bill here).  After that, the agency needs to open the docket for the rulemaking and put draft rules out for public comment in what’s called the Arizona Administrative Register.

The public will then have a chance to comment on those initial draft regulations.  The ADHS will then consider those comments and file the final proposed rules with the AZ Secretary of State (here’s a summary of the rulemaking process on the SOS website).

Before the rules become effective- the agency needs to get final approval of the regulations by the Governor's Regulatory Review Council (GRRC).  If GRRC approves the rules- they’d become effective and voluntary certification could begin.

Realistically- even if the ADHS starts right away and appoints the advisory council and they begin meeting this Summer and began writing the initial draft rules later this year, it could easily take a couple of years before they’d become effective- so it's important to begin the process soon with initial advisory council meetings. 

You might be familiar with other agency rulemaking that have gone a lot faster than this.  That’s likely because those were probably “exempt” rulemakings, which provides several rulemaking short cuts including an exemption from the GRRC requirements.  Sadly, the CHW Rulemaking isn’t “exempt”.

The Rulemaking will be among the topics we’ll all be talking about at the AZCHOW Conference on June 21st and 22nd in Tucson.  Hopefully many of you will be able to make it.  AzPHA will be exhibiting at the conference.

 

Opioid Public Health Emergency Executive Order Ends

This week the Governor officially ended the emergency public health declaration that was signed via an Executive Order about a year ago.  Much has been accomplished over the last year including implementing legislation that improves prescribing practices and enhances emergency responses and increases access to treatment.  Of course- the work will go on.  The epidemic didn’t start overnight, and it surely won’t end overnight.  You can read the official end of the emergency declaration here.

Rep. McSally (R) is hosting a House of Representatives Border and Maritime Subcommittee hearing today (May 30) at 9:30 am at the UA College of Medicine Phoenix (Building 2) entitled: “An Unsecure Border and the Opioid Crisis: The Urgent Need for Action to Save Lives” featuring the Governor, various federal officials from the DEA, CBP, and DHS as well as Dr. Christ, Debbie Moak, and some people from faith-based organizations. You can see the panel line up here.  It looks like it’s an open meeting.

 

Aligning Health and Early Childhood Learning

Evidence shows how important early childhood education is in protecting people from disease and disability as an adult-  and that a child’s health impacts his or her ability to learn and succeed in school and later in life. Even with these known positive connections between early learning and wellness- health and education systems sometimes fail to align and provide opportunities to maximize health and early learning outcomes for children.

To address the disconnect between health and education, the HHS & US Department of Education outlined a set of recommendations for states and communities to align health and early learning systems. The recommendations emphasize the need for a comprehensive, seamless, and coordinated set of systems to support children, parents, and families.

 

Legislative Session Webinar Posted

The UA has posted my webinar from a couple of weeks ago that summarizes the legislative session from a public health perspective.  The whole thing is about an hour long.  You can check out the webinar on the UA Telemedicine Website.  Here’s the PowerPoint that I used.

 

CDC’s Learning Connection

The CDC has what they call a “Learning Connection” which connects public health professionals, including healthcare workers, to training opportunities and educational tools developed by CDC. Their Learning Connection also engages public health professionals around the world via social media messaging and a monthly e-newsletter.

The CDC Learning Connection: 1) features quality learning opportunities from CDC, other federal agencies, and federally funded partners; 2) keeps you up-to-date on the latest training through a free monthly e-newsletter; 3) offers access to thousands of training opportunities through CDC TRAIN — CDC’s online learning system; 4) connects you to information about CDC internships and fellowships; and 5) makes it easy to locate courses that offer continuing education. There are literally hundreds of courses one can take- mostly on-line and self-paced.

 

Free Continuing Education from MMWR and Medscape:

CDC MMWR and Medscape introduced a new FREE continuing education (CE) activity that describe trends and demographic differences in health outcomes and healthcare use for childhood asthma, based on a CDC analysis of asthma data from the 2001-2016 National Health Interview Survey for children 17 years and younger.

This activity is intended for pediatricians, pulmonologists, public health officials, nurses, and other clinicians caring for patients with childhood asthma. To access this FREE MMWR / Medscape CE activity visit https://www.cdc.gov/mmwr/cme/medscape_cme.html. If you’re not a registered user on Medscape, you may register for free or login without a password and get unlimited access to all continuing education activities and other Medscape features.

 

Free Continuing Education Training for Opioid Prescribers offered by UA

With the requirement of Arizona prescribers to complete 3 hours of opioid, substance use disorder, or addiction-related CME, the University if Arizona’s Center for Rural Health we offer Arizona based materials and continuing education opportunities including:

Free online CME vouchers worth $150: order vouchers by responding to this email. We can mail them to you in batches of 100 to 500. Please feel free to forward the listserv blast below and attached documents for your attendees.

Free Arizona Opioid Prescribing Guidelines printed copies: order at http://www.azdhs.gov/audiences/clinicians/index.php#clinical-guidelines-and-rx-guidelines-order

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

 

Dr. Bob’s Travelogue

I’ve gotten a couple more Travelogues from Dr. Bob in the last couple of weeks.  He’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 Interlude from last week and this new one Hoof Beats.