State Legislature

March 17 Legislative Update

Legislative Update

It was a busy week especially in the House with the various bills that were advocating for and against (mostly for).  Here’s a run down on this week’s action and a forecast for next week.

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Bills that have passed one chamber and received a do pass committee recommendation in the sister chamber:

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. Rules Committee Next.

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 Next. 

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

Passed the Senate 27-3.  Passed the House Health & Human Services Committee 8-1.  House Appropriations 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.

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

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

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 1085 Association Health Plans- AzPHA Position- Opposed

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

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.

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On this Week’s Agenda:

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

Passed the Senate 30-0. Bill will be heard in the House Health and Human Services Committee on Thursday at 9am in HHR4.

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

Passed the Senate 30-0.  Bill will be heard in the House Health and Human Services Committee on Thursday at 9am in HHR4.

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Bills that passed one chamber and have been assigned to a committee but have not yet been put on an agenda yet include:

SB 1355 Native American Dental Care – AzPHA Position: Yes

Passed Senate 25-5.  Assigned to House Health & Human Services Committee.

SB 1456 Vision Screening- AzPHA Position: Yes

Passed Senate 29-0. Assigned to Senate Education Committee.

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Several other bills have passed one chamber but have not yet been assigned to a committee in the alternate chamber include:

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

Passed Senate 28-2.  Not assigned to a House Committee yet. 

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

Passed the Senate 30-0.  Assigned to House Health and Human Services Committee.

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

Passed the Senate 30-0. Not assigned to a House Committee yet.

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

Passed the Senate 28-0. Not assigned to a House Committee yet.

Public Health Bills that have Passed a Chamber

Access to Care & Healthcare Workforce

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

Passed the Senate 27-3.  Assigned to House Health & Human Services Committee.

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

Passed Senate 28-2.  Not assigned to a House Committee yet. 

 

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

Passed Senate 30-0. Assigned to House Health & Human Services Committee.

 

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

Passed Senate 30-0. Assigned to Senate Education Committee.

 

SB 1355 Native American Dental Care – AzPHA Position: Yes

Passed Senate 25-5.  Assigned to House Health & Human Services Commottee.

 

SB 1456 Vision Screening- AzPHA Position: Yes

Passed Senate 29-0. Assigned to Senate Education Committee.

** Kids Care: The Kids Care Reauthorization bills have all languished in their chamber of origin, however, we have good reason to believe that reauthorizing Kids Care including the appropriation needed to pay the state match (10%) will be negotiation in the state budget bills.

 

Injury Prevention

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

Passed Senate 20-10. Assigned to House Transportation Committee. 

 

Licensing & Vital Records

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

Passed the Senate 30-0.  Assigned to House Health and Human Services Committee.

 

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

Passed the Senate 30-0. Assigned to House Health & Human Services Committee.

 

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

Passed the Senate 30-0.  Assigned to House Health and Human Services Committee.

 

Tobacco & Nicotine

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

Passed the Senate 30-0. Not assigned to a House Committee yet.

 

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

Passed the Senate 28-0. Not assigned to a House Committee yet.

 

Surveillance & Social Determinants

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

Passed House 46-13.  Assigned to House Health and Human Services Committee.

 

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

Passed House 60-0. Assigned to Senate Health and Human Services Committee.

 

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

Passed the Senate 30-0. Assigned to House Health and Human Services Committee.

Disappointments

HB 2718 Syringe Services Programs (Rivero) AzPHA Position: Yes

This terrific bill stalled in the House after not being heard by the Rules Committee. Perhaps it can be restored somehow in the Senate with a Strike Amendment.

Here's this week's detail report

It’s Switchover Time at the Legislature

The week before last was the deadline for bills to be heard in their chamber of origin- and much of last week’s action was on floor votes (called Third Read).  When a bill clears the House or Senate (having a 3rd reading with a recorded vote of the body) it’s transmitted to the other body of the legislature (the switchover). At that point, it gets 1st and 2nd read and assigned to a committee (s). Then it’s up to the chair to schedule the bill.

If heard, then it gets voted on and gets thru that body. If there are no changes, it’s sent back to its original body who then transmits it to the Governor. If there are changes the bill, goes back to the originating body to decide if they accept the changes. If they do, they’ll be a final read and recorded vote before transmitting to the Governor. If they don’t agree then it goes to conference committee. It can be a “simple” conference where the choice is the House or the Senate version. Most are free conference committees in which there are 3 members per body who serve.

Conference committees usually don’t take testimony.  The meetings are open but there’s usually only announcements from the floor to know when the group meets.  If there’s finally agreement, it goes back for acceptance of the conference report and a final vote by each side before it goes to the Governor.

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Lots of action last week with lots of 3rd read floor votes in the Senate. The House isn’t as far along in finishing 3rd reads.  This week we'll mostly be watching the 3rd Read votes.  We'd really like to get the hand free cell use bill, the syringe services bill, the GME bill and the e-cigarette smoke free AZ act bill through their chambers this week. Here's our document with all the particulars on bills this week.

Public health can breathe a little sigh of relief now that the Governor made it clear that he doesn’t   intend to sign any bill that would lower vaccination rates. We're already gambling with the lives of infants, people with disabilities, and immune optimized folks because of the erosion in our immunization rates and any of the 3 anti-vaccine bills this year (HB 2470, HB 2471, or HB  2472 would have done just that. 

We need public health policy decisions that improve vaccination rates, not decisions that put vulnerable people at even more risk.  With the Governor’s statements this we can now focus more of our efforts on the other (mostly good) public health policy bills out there.

 

Bills that Passed through the House or Senate

Access to Care & Healthcare Workforce

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

Passed the Senate 27-3.  This bill would expand 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.  This priority bill was passed by the Senate this week and has been transferred to the House. Note that since this bull would have a needed appropriation it will need to be included in the final state budget.

SB 1089Telemedicine 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. Requires that coverage for telemedicine healthcare services if the service is covered when delivered in-person.   This bill would be good for access to care especially in rural Arizona which is why we’re supporting it. Passed 30-0.

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.  The current regional centers include: 1) Eastern Arizona AHEC; 2) Greater Valley AHEC; 3) Northern Arizona AHEC; 4) Southeast Arizona AHEC; and 5) Western Arizona AHEC/Regional Center for Border Health.  This bill adds an area health education center that would focus on tribal areas and the Indian health care delivery system. Passed 30-0.  

SB 1355 Native American Dental Care

Passed Senate 25-5.  Requires AHCCCS to seek federal authorization to reimburse the Indian health services and tribal facilities to cover the cost of adult dental services.

** Kids Care: The Kids Care Reauthorization bills have all languished in their chamber of origin, however, we have good reason to believe that reauthorizing Kids Care including the appropriation needed to pay the state match (10%) will be negotiation in the state budget bills.

 

Licensing & Vital Records

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

Passed the Senate 30-0. 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. 

 

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

Passed the Senate 30-0. 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)

 

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

This bill will make 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.   Passed the Senate 30-0.

Tobacco & Nicotine

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 30-0.

Surveillance & Social Determinants

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

Passed House 46-13.  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 46-13 and has moved over to the Senate.

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

Requires ADHS to annually compile a report on veteran suicides beginning January 1, 2020. The data in the report would be shared across the public health system and with the VA and will hopefully include surveillance results that are actionable to prevent veteran suicides.

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

This bill would require the Child Fatality Review Team subcommittee on maternal mortality to make recommendations on improving information collection. Passed the Senate 30-0.

Bills that Still Need to Have a Final (3rd Read) First Chamber Vote

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.  Violations are a civil $ 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. We’re signed up in support of this bill.  This bill still needs to go to Committee of the Whole and get a Senate 3rd read.

HB 2718 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.  Approved by the International Affairs Study Committee this week.  Did not receive a hearing in Rules yet, we’ll work with stakeholders to get it heard in Rules.

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

This bill appropriates $50M from the General Fund to AHCCCS, UA Health Science Center, ADHS and the to address the state-wide shortage of physicians and nurses.  The bill has several elements with a rural focus. Elements include $20M for Graduate Medical Education in critical-access hospitals and community health centers in rural areas and $4M for the ADHS’ health practitioners loan repayment system. Many elements will be very good for access to care in rural AZ.  Bill still needs a final vote in the Senate and of course – since it’s a money bill it’ll need to go through the budget process.

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

Includes e-cigarettes in the definition of tobacco products and smoking for the purposes of the Smoke Free Arizona Act.  Allows smoking in retail stores that sell electronic smoking devices exclusively and have an independent ventilation system.  Because the Act was voter approved- this modification to the law will require a 3/4 majority of both houses.  This bill still needs to go to Committee of the Whole and get a Senate 3rd read.

SB 1456 Vision Screening- AzPHA Position: Yes

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.  This bill still needs to go to Committee of the Whole and get a Senate 3rd read.

HB 2471 Informed Consent (Barto) - AzPHA Position: Opposed

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.  Bill is likely dead but we’re remaining vigilant and will work with Stakeholders like TAPI to hold it back in the House.

HB  2472 Vaccinations- Antibody Titer (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.   Bill is likely dead but we’re remaining vigilant and will work with Stakeholders like TAPI to hold it back in the House.

HB 2470 Vaccination Religious Exemptions (Barto) - AzPHA Position: Opposed

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.  Bill is likely dead but we’re remaining vigilant and will work with Stakeholders like TAPI to hold it back in the House.

Good Bills that are Effectively Dead

Unless a miracle happens- this is the last time you’ll see me mention the bills below in my policy updates

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)

Legislative Update- Week of February 25

We’re roughly at the 1/3 to the halfway point in the legislative session now.  This coming week the only committees meeting are the Appropriations committees.  Lots of floor activity this upcoming week and then onto the delight of seeing how the Senate deals with House bills and how the House deals with Senate bills. 

The action this week will be in the Republican and Democratic Caucus meetings, the Committee of the Whole (in which the whole membership of a legislative house sits as a committee and operating under informal rules) and Third Read- which is the final tallied vote. You can follow the Third Read votes this week at www.azleg.gov.

The Appropriations committees will meet this week- but the public health bills with dollars attached have already been heard in the Approps Committees except for SB1399 (the School Health Pilot Program) which is being held at the Stakeholder and Sponsor request until procurement issues get resolved.

Leila Barraza, Senator Carter and I did a webinar this week on the UA Telemedicine system summarizing the legislative session so far.  You can click here to view webinar or view the Presentation Slides.

Here’s this week’s bill summary in spreadsheet format.

Bills Heard in Committee Last Week

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

Includes e-cigarettes in the definition of tobacco products and smoking for the purposes of the Smoke Free Arizona Act.  Allows smoking in retail stores that sell electronic smoking devices exclusively and have an independent ventilation system.  Because the Act was voter approved- this modification to the law will require a 3/4 majority of both houses. The Striker was Approved by the Senate Health and Human Services Committee last Wednesday.

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.  Approved by the Senate Transportation Committee this week.  Floor vote next.

SB1399 School Health Pilot Program (Pace) AzPHA Position: Yes

This bill charges 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.  Appropriates $9.5M for planning, implementing, and evaluating the pilot.  Approved by the Senate Education Committee this week.  Appropriations Committee next.

HB 2470 Vaccination Religious Exemptions (Barto) - AzPHA Position: Opposed

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.  Approved 5-4 by the House Health & Human Services Committee this week.  Floor vote next.

HB 2471 Informed Consent (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.  Approved 5-4 by the House Health & Human Services Committee this week.  Floor vote next.

HB  2472 Vaccinations- Antibody Titer (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.   Approved 5-4 by the House Health & Human Services Committee this week.  Floor vote next.

HB 2597School Safety Plan Task Force (Hernandez) AzPHA Position: Yes

This well-researched bill came out of a workgroup established by students at Mountain View High School. It takes a proactive approach to prevent school violence.  The Bill asks schools to develop plans to outline how teachers and staff will respond to crisis situations, how they respond to warning signs of emotional or behavioral distress among students, partnerships with agencies to refer students to support services, and what services they’ll provide after a violent incident.  Approved by both the House Education and Public Safety Committees this week.  Floor vote next.

HB 2718 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.  Approved by the International Affairs Study Committee this week.  Floor vote next.

 

Bills that Have Passed a Chamber

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. Unanimously passed in the full Senate and was transmitted to the House 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. Unanimously passed in the full Senate and was transmitted to the House this week.

SB 1174 Tribal Area Health Education Center

The 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.  The current regional centers include: 1) Eastern Arizona AHEC; 2) Greater Valley AHEC; 3) Northern Arizona AHEC; 4) Southeast Arizona AHEC; and 5) Western Arizona AHEC/Regional Center for Border Health.  This bill adds an area health education center focusing on the Indian health care delivery system. Approved by the Senate. Passed out of the Senate by a vote of 30-0.

Voice Your Opinion this Legislative Session

As the leading public health professionals in the state, it’s important that you engage in public health policy development. After all, we’re the people that have first hand knowledge about the public health implications of the decisions that our elected officials make.

The good news is that it’s easier than ever to voice your opinion. Our state legislature has a transparent way to track bills through their www.azleg.gov website. The site allows you to track when bills are being heard in committee and provides an opportunity for you to express your support, opposition, or neutrality from your home or office.  

The main URL to bookmark in your computer is http://www.azleg.gov - which is the State Legislature's official website.  It got an overhaul last year making it easier to work with.

If you have the number for a bill you're interested in following, simply go to the upper right corner of the http://www.azleg.gov website and punch in the numbers. Up pops the bill including its recent status, committee assignments and the like. 

The dark blue tabs provide more detailed info about the bill.  For example, the “Documents” tab displays the actual language of the bill including the most recent versions.

You'll see that bills have committee assignments on the Bill Status pages. You can easily check the committee agendas each week on the website too.  Go to the "Committee Agenda" and pull up the agenda for the committee you’re interested in.  

Most of the bills we've been following and advocating for or against have been assigned to either the House Health Committee or the Senate Health and Human Services Committee.  This year the House Health Committee meets on Thursdays at 9 am. The Senate Health & Human Services Committee meets Wednesdays at 2 pm.

I’m encouraging all of you to weigh in for and against bills when you believe that it’s in the best interests of public health to do so. It’s straightforward.

First you need to create an account with an e-mail address and a password. You’ll need to go down to one of the kiosks in the House or Senate to set up your account and password- but after that you’ll be able to sign in for or against bills from your home or office. If you don’t want to use your work email address you can use a personal e-mail.

Once your account is set up, you can sign in support or against any bill at the Azleg’s My Bill Positons site at https://apps.azleg.gov/RequestToSpeak/MyBillPositions 

Even if you don’t have an account, you can click on each bill and find out who has signed in for or against or neutral on the bill.  Just go to the tab over each bill that says "RTS Current Bill Positions" and you’ll see who has signed in support or against each bill. Sometimes you'll see our name up there (AzPHA)

Legislative Update

All the legislative committees have big long agendas this week – as the deadline for bills to be head in their house of origin committees is rapidly approaching.  So, this will be a busy week. 

Our policy interns Tim Giblin and Annissa Biggane have been doing a great job tracking all the bills that we’re signed up for and against and monitoring amendments and the like. Here’s their detailed summary of all the various public health related bills and where they are in the system right now.

We have an Action Alert this week regarding some bills that will have a detrimental effect on vaccination rates- so please follow through on that this week- you can see more about that below.

Bills to Be Heard in Committee This Week

Monday

HB 2597  School Safety Plan Task Force (Hernandez) AzPHA Position: Yes

This well-researched bill came out of a workgroup established by students at Mountain View High School. It takes a proactive approach to prevent school violence.  The Bill asks schools to develop plans to outline how teachers and staff will respond to crisis situations, how they respond to warning signs of emotional or behavioral distress among students, partnerships with agencies to refer students to support services, and what services they’ll provide after a violent incident. This important bill will be heard in the House Education Committee on Monday, February 18 at 2pm.  We’re signed up in favor of the bill.

 

Tuesday

SB1399  School Health Pilot Program (Pace) AzPHA Position: Yes

This bill charges 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.  Appropriates $9.5M for planning, implementing, and evaluating the pilot.  This important bill will be heard in the Senate Education Committee on Tuesday, February 18 at 2pm. We’re signed up in favor of the bill and I’ll be speaking in Committee.

 

Wednesday

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.  Will be heard in Senate Transportation Wednesday at 9 am.  We’re signed up in favor of the bill and I’ll be speaking in Committee.

 

Thursday

HB 2471 Informed Consent (Barto) - AzPHA Position: Opposed

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. Hearing will be Thursday, February 21 at 9 am in the House of Representatives Health and Human Services Committee.  We’re signed up opposed to the the bill and I’ll be speaking in Committee.

 

HB  2472 Vaccinations- Antibody Titer (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.   Hearing will be Thursday, February 21 at 9 am in the House of Representatives Health and Human Services Committee.  Hearing will be Thursday, February 21 at 9 am in the House of Representatives Health and Human Services Committee.  We’re signed up opposed to the bill and I’ll be speaking in Committee.

HB 2470 Vaccination Religious Exemptions (Barto) - AzPHA Position: Opposed

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.  Hearing will be Thursday, February 21 at 9 am in the House of Representatives Health and Human Services Committee.  We’re signed up opposed to the bill and I’ll be speaking in Committee.

ACTION ALERT: Please contact the following Representatives and let them know that you oppose HB 2470, HB 2471 & 2472 as they will decrease immunization coverage and jeopardize herd immunity.

Please focus your attention on the lawmakers in bold- especially those of you that know them!

 

John Allen

jallen@azleg.gov

Nancy Barto

nbarto@azleg.gov

Kelli Butler

kbutler@azleg.gov

Gail Griffin

ggriffin@azleg.gov

Alma Hernandez

ahernandez@azleg.gov

Jay Lawrence

jlawrence@azleg.gov  

Becky A. Nutt

bnutt@azleg.gov

Pamela Powers Hannley

ppowershannley@azleg.gov

Amish Shah

ashah@azleg.gov


Bills Heard in Committee Last 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.  This bill passed through the Senate Health & Human Services this week and will be moving to the floor.

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 This Bill passed the Senate Health & Human Services this week and will be moving to the floor.

 

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.  This Bill passed through the Senate Appropriation Committee this week and will be headed to the floor next.

 

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

This bill would basically set up a quasi-regulatory program at the ADHS to 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.  This bill passed the House Health Committee by a 5-4 vote this week.

 

Bills that Have Passed a Chamber

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. Unanimously passed in the full Senate and was transmitted to the House 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.

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.

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.

Public Health Bills So Far

There aren't very many public health related bills proposed yet, but they're on the way.  Here's what we have so far:

SB 1009 Electronic Cigarettes, Tobacco Sales

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. 

HB 2024 Electronic Cigarettes. Smoke Free Arizona Act

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. 

SB 1040 Maternal Mortality Report

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.

The 2019 Legislative Session Underway 

This year's state legislative session began on Monday.  Here’s a PowerPoint with our 2019 Legislative Priorities.  Like other years, lots of things will come up during the session that we will support or be opposed to.  Our Public Health Policy Committee will share information and meet during the session as we prepare our positions and conduct our public health advocacy.

The party balance in the Senate will remain 17-13 while the balance in the House will be 31-29 (a much closer party balance than there has been in recent years).

The President of the Senate will be  Karen Fann (R) LD-1 and House Speaker will be  Rusty Bowers (R) LD-25.   The Senate Health and Human Service Committee will be chaired by Senator Kate Brophy-McGee (Sen. Heather Carter will be Co-chair).  The House Health Committee will be chaired by Representative Nancy Barto (Rep. Jay Lawrence is Vice Chair)

Senate Health & Human Services Committee

The Senate Health and Human Services Committee will meet this Session on Wednesday mornings at 9 am in Senate Hearing Room #1.  The Chair will be Senator Kate Brophy McGee with Senator Heather Carter as the Vice Chair.  Other committee members will be Tyler Pace, Rick Gray, Sylvia Allen, Rebecca Rios, Tony Navarette, and Victoria Steel.

House Health & Human Services Committee

The House of Representatives Health and Human Services Committee will meet this Session on Thursday mornings at 9 am.  The Chair will be Rep. Nancy Barto with Jay Lawrence serving as Vice Chair.  Other members are Representatives John Allen, Gail Griffin, Becky Nutt, Kelli Butler, Pamela Powers-Hannley, Alma Hernandez and Amish Shah.

Intermediate Care Facilities Like Hacienda de los Angeles are Exempt from State Licensing Requirements

By now you’ve heard the disturbing story of a 29-year-old resident of Hacienda de los Angeles who gave birth a couple of weeks ago. What’s troubling about the birth is that the mother was unable to give consent because of the nature of her medical condition. In short, it means she was raped and delivered a baby while under the care of Hacienda de los Angeles.

Quite honestly, it’s astonishing that the facility and its staff apparently failed to detect – or report -- the sexual assault or pregnancy until after the baby was born and in medical distress.  Arizona law (ARS 46-464) requires people that have responsibility to care for a vulnerable adult to report any abuse or neglect that they suspect.  Failure to report is a Class 1 misdemeanor.

With such resources now deployed with the various investigations including the Phoenix Police Department, we will eventually most likely learn whether Hacienda staff knew but did not report the pregnancy or whether the care being provided was such that staff did not discover the pregnancy until the woman gave birth.  

Arizona and local law enforcement officials are investigating the matter – but they may be impeded by this troubling fact: Hacienda de los Angeles isn’t required to have a state license (and doesn’t have one).

How is this possible?

Hacienda de los Angeles is classified as an intermediate care for persons with intellectual disabilities. Facilities in this class provide more intensive services than a residential group home for persons with intellectual disabilities but different services than a skilled nursing facility.

When I learned through the media of the assault and birth, I went to the ADHS’ AZ Care Check    website to look at the regulatory compliance record for the facility. I was puzzled when I discovered that the facility didn’t have an ADHS License number. They have an identifying number for their Certification to get paid by the Centers for Medicare and Medicaid Services (CMS) -- but no state license.

In digging deeper- I discovered that this class of facility doesn’t require a license from the ADHS.  They are specifically exempt. The exact statutory language is located in ARS 36-591(E) where it states that: “An intermediate care facility for persons with an intellectual disability that is operated by the division or a private entity is not required to be licensed under this section if the facility is certified pursuant to 42 Code of Federal Regulations section 483.400”.

That’s not to say that there’s no oversight of the facility.  There is. ADHS has conducted annual certification inspections under a contract from CMS every year for the last several years, and you can see that there are several deficiencies that have been identified (and corrected) over time.

What’s problematic is that the state has no direct regulatory authority over the facility because they’re not required to have a state license (if they’re CMS certified).  That means there’s no direct mechanism to compel compliance with state care regulations – because there’s no license to suspend, put on provisional status, or to revoke. 

With information that will be discovered in the coming days and weeks, the federal government could elect to decertify the facility and to no longer pay for services provided there, and/or our state Medicaid agency could decide to no longer approve placement of their members at the facility- but the state has no direct authority to compel compliance -- again, because there’s no state license to use as leverage to compel compliance with state licensing requirements.

Intermediate care facilities were exempt from state licensing requirements back in 1997 when HB 2247 was passed by the legislature and signed by Governor Hull.

Perhaps this case provides an opportunity for our state elected officials to re-examine the wisdom of exempting intermediate care facilities from having a state license.

What We Can Do to Prepare for a Post ACA Arizona 

A federal judge in Texas (Judge Reed O’Connor) dealt a blow to the Affordable Care Act late last week when he ruled in Texas v. Azar that the ACA is unconstitutional in its entirety- including the implementation of market reforms (e.g. protections for folks with pre-existing conditions), the health insurance marketplaces, and the expansion of Medicaid.

Fortunately, he didn’t issue an injunction ordering the Administration to stop implementing the law- so the ACA will remain the law of the land for now.

Back in February, 20 states (including Arizona) filed the lawsuit seeking to invalidate the 3 legs of the ACA stool: pre-existing condition exclusions, community rating, and guaranteed issue. 

The ACA prevents health insurance companies from: 1) denying someone health insurance because they have a preexisting condition -called the “guaranteed issue” requirement; 2) refusing to cover services that people need to treat a pre-existing condition- called “pre-existing condition exclusions”; and 3) charging a higher premium based on a person’s health status - called the “community rating” provision.

The U.S. Department of Justice isn’t defending the ACA because they agree with the plaintiff States.  In fact, the Justice Department has urged the court to strike down the law.  Luckily, several states including CA are defending the law.

The Plaintiffs (including AZ) argue that since the new federal tax reform law removed the financial penalty for not having health insurance, the ACA is now unconstitutional.  

So, Will the Supreme Court Uphold the ACA Again?

Last week’s ruling isn’t the last word. The case will certainly be appealed in the federal appellate court system and then to the US Supreme Court, which has a different cast of characters than it did when the ACA was originally upheld back in 2012 by a 5-4 vote.

Since then, Justice Gorsuch replaced Justice Scalia and Justice Kavanaugh replaced Justice Kennedy.  Both Scalia and Kennedy voted against the ACA- so not much on that score has changed.

Chief Justice Roberts voted with the majority that upheld the law.  His argument rested on the ACA’s link to the financial penalties for not having health insurance. But remember, the financial penalties for not having health insurance were removed from the IRS tax codes in last year's federal tax overhaul, pulling out the structure that Roberts used in his argument.

In the 2012 Ruling, Justice Roberts wrote that: “… the Affordable Care Act’s requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a taxbecause the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness.” 

Roberts rejected the Administration's argument that the federal government's authority to regulate interstate commerce provides the authority needed for the ACA to be constitutional (the Court struck down that argument 5-4).

The bottom line is that the ACA, including its protections for folks with pre-existing conditions, may very well be in jeopardy if Chief Justice Roberts views the ACA as fundamentally different now that the financial penalties for not having health insurance are gone.

 

What Happens in AZ if the ACA Goes Away & How Can We Prepare?

It's easy to see how the ACA could end up being struck down in a couple of years once this case gets to the highest court. Gone would be the health insurance market reforms like protection for folks with pre-existing conditions, community rating pricing and guarantee issue as well as Medicaid expansion and the health insurance marketplaces.

Prior to the ACA, the standards to protect people with pre-existing conditions were determined at the state level.  Most states including AZ had very limited protections. Many insurers maintained lists of up to 400 different conditions that disqualified applicants from insurance or resulted in higher premiums.  35% of people who tried to buy insurance on their own were either turned down by an insurer, charged a higher premium, or had a benefit excluded from coverage because of their preexisting health problem.

Fortunately, Arizona is partially in control of our own destiny if the ACA is struck down. We couldn't do much about Medicaid rolling back to pre-ACA levels or the loss of subsidies on the Marketplace, but we could have some control over the market reforms like pre-existing condition exclusions, community pricing, and guarantee issue.

Several states have enacted their own laws to be consistent with the ACA market reforms. Several states (CT, HI, IA, IN, MA, ME, MD, MN, NE, NY, NC, ND, OR, SD, VA, VT) already have their own laws that incorporate some or all the ACA insurance market protections. Arizona could do the same. 

The good news is that we have time before the Texas v. Azar case makes it to the Supreme Court. A reasonable first step would be for the Governor to ask the Arizona Department of Insurance, the ADHS and AHCCCS to generate (or commission) a report outlining the real-life impact in Arizona in the event that the Texas v. Azar suit is ultimately successful. The report would also put forward options for state-based health insurance market reform laws that could be enacted to require things like prohibiting pre-existing condition exclusions.

Such a report would give the Arizona State Legislature an analysis with which to evaluate public policy options for state-based market reforms.

I know what you're thinking, it's impossible to pass these kind of market reforms in Arizona.  Maybe, but many thought that Arizona's expansion of our Medicaid system back in 2013 was impossible.

That case study shows that with the right kind of leadership on the 9th floor, anything is possible.

State Legislature Health Committees

Senate Health & Human Services Committee

The Senate Health and Human Services Committee will meet this Session on Wednesday mornings at 9 am in Senate Hearing Room #1.  The Chair will be Senator Kate Brophy McGee with Sen, Heather Carter as the Vice Chair.  Other committee members will be Tyler Pace, Rick Gray, Sylvia Allen, Rebecca Rios, Tony Navarette, and Victoria Steel.

House Health & Human Services Committee

The House of Representatives Health and Human Services Committee will meet this Session on Thursday mornings (no room named yet).  The Chair will be Rep. Nancy Barto with Jay Lawrence serving as Vice Chair.  Other members are Representatives John Allen, Gail Griffin, Becky Nutt, Kelli Butler, Pamela Powers-Hannley, Alma Hernandez and Amish Shah.

State Agency Budget Requests

Here’s a summary of some of the budget requests that were made by state agency directors for the upcoming fiscal year:

Department of Health Services

  • Seeks increased compensation for “key” positions to reduce turnover & vacancy rates.  No dollar figure is attached.

  • Requests an increase of $4.1 M lump sum from Health Licensing Fund & ongoing Radiation Regulation appropriation increase of $600,000 from Health Service Licensing Fund to cover administrative expenditures & ongoing growth & workload for Licensing Division.

  • Asks for $550,000 from the General Fund for an “administrative shortfall” at the Arizona State Hospital.

  • Requests $500,000 from the ADHS Indirect Fund for the public health emergency fund.

  • Seeks $200,000 from the Land Fund to pay for higher costs for services at the State Hospital for pharmacy, dietary, EHR, housekeeping, etc.

  • Asks for an appropriation increase of $600,000 from the Newborn Screening Fund to cover administrative costs.

  • Asking for a $240,000 in state general funds for the Behavioral Risk Factor Surveillance Survey (under a cooperative agreement with CDC).

 

AHCCCS 

  • Requesting a net increase of $44.7 M over the current year.

  • Seeks an overall acute capitation rate increase of 1.9% over the blended rates from the prior year

  • Asks for overall weighted capitation rate increase of 2.5% over baseline across all populations.

  • Anticipates the FMAP rate (federal matching rate percentage) for the acute traditional members of 69.48%

  • Includes a $7.9M dollar figure if state law is modified to prevent freezing KidsCare (because of the reduction in federal payments (FMAP) moving from the current 100% to 90% beginning October 1, 2019)

 

AZ Department of Economic Security

  • Requests $41.6 M in increased funding to help providers cover some of the costs that providers of services for folks with developmental disabilities to cover costs for the coming increase in the minimum wage next fiscal year. 

  • Pursues use of federal Child Care Development Block Grant of $55.8 M (OF) which would allow child care rates to increase from 2000 to 2010 market rate and serve an additional 5,000 children

2019 Legislative Session

The 2019 Legislative Session will begin on January 14.  The Session usually starts with a State of the State address by the Governor followed by a proposed executive branch budget. 

Here’s a PowerPoint RE 2019 Legislative Priorities that I put together.  Like other years, lots of things will come up during the session that we will support or be opposed to.  Our Public Health Policy Committee will share information and meet during the session as we prepare our positions and conduct our public health advocacy.

The party balance in the State Senate will remain 17-13; while the balance in the House will be 31-29 (a much closer party balance than there has been in recent years).

The President of the Senate will be  Karen Fann (R) LD-1 and House Speaker will be  Rusty Bowers (R) LD-25.  There will be 12 Senate committees and 20 House committees starting in January.  The Senate Health and Human Service Committee will be chaired by Senator Kate Brophy-McGee (Sen. Heather Carter will be Co-chair).  The House Health Committee will be chaired by Representative Nancy Barto (Rep Jay Lawrence as Vice Chair)

Senate Committees:

Appropriations: Sen. David Gowan (LD14), Chair

Commerce: Sen. Michelle Ugenti-Rita (LD23), Chair

Education: Sen. Sylvia Allen (LD6), Chair and Sen. Paul Boyer (LD20), Co-chair

Finance: Sen. J.D. Mesnard (LD17), Chair

Government: Sen. David Farnsworth (LD16), Chair and Sen. Sonny Borrelli (LD5), Co-chair

Health and Human Services; Kate Brophy McGee (LD28), Chair & Heather Carter, Co-chair

Higher Ed. & Workforce Dev: Heather Carter (LD15), Chair and Sen. J.D. Mesnard, Co-chair  

Judiciary: Sen. Eddie Farnsworth (LD12), Chair

Natural Resources and Energy: Sen. Frank Pratt (LD8), Chair

Rules: President-Elect Karen Fann (LD1), Chair  

Transportation and Public Safety: Sen. David Livingston (LD22), Chair  

Committee on Water and Agriculture:  Sen. Sine Kerr (LD13), Chair Sen. Frank Pratt (LD8), Co-chair

House Committees:  

Appropriations: Rep. Regina Cobb (LD5), Chair and Rep. Kavanagh (LD23), Vice Chair

Commerce: Rep. Jeff Weninger (LD17), Chair

County Infrastructure: Rep. David Cook (LD8), Chair

Education: Rep. Michelle Udall (LD25), Chair

Elections: Rep. Kelly Townsend (LD16), Chair

Federal Relations: Rep. Mark Finchem (LD11), Chair

Government: Rep. John Kavanagh (LD23), Chair

Health & Human Services  Nancy Barto (LD15), Chair and Jay Lawrence (LD23), Vice Chair

Judiciary: Rep. John Allen (LD15), Chair

Land & Agriculture: Rep. Tim Dunn (LD13), Chair

Military & Veterans Affairs: Rep. Jay Lawrence (LD23), Chair

Natural Resources, Energy & Water: Rep. Gail Griffin (LD14), Chair

Public Safety: Rep. Kevin Payne (LD21), Chair

Regulatory Affairs: Rep. Travis Grantham (LD12), Chair

Rules: Rep. Anthony Kern (LD20), Chair

Sentencing & Recidivism Reform: Rep. David Stringer (LD1), Chair

State & International Affairs: Rep. Tony Rivero (LD21), Chair

Technology:  Rep. Bob Thorpe (LD6), Chair

Transportation: Rep. Noel Campbell (LD1), Chair

Ways & Means: Rep. Ben Toma (LD22), Chair

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.

Some State Legislatures Tackling E-cigs

E-cigarette use by kids is growing across the nation including in AZ.  A couple of weeks ago the FDA Commissioner called out the manufacturers of electronic cigarettes for their clear efforts to market to teenagers and put them on notice that additional regulations could be on the way. 

All of you reading this have seen them around these days.  They have various looks.  For example- some of the most popular ones mimic USB flash drives so that they’re easily disguised adults (teachers and parents).  They even actually plug into an USB port for charging!

Almost all of them contain nicotine which is of course highly addictive, harmful to adolescent brain development, and a health danger for pregnant women. E-cigarette aerosol can also contain cancer-causing chemicals, heavy metals like lead, and volatile organic compounds. Evidence shows that even those without nicotine are harmful to the lungs.

E-cigs are now the most commonly used tobacco products among youth and young adults, with e-cigarette use growing 900% among high school students from 2011 to 2015.  In 2016, more than two million U.S. middle and high school students had used e-cigarettes in the past 30 days.

Middle aged e-cig users are quite different from younger users. Most middle aged e-cigarette users (aged 45 years and older) are either current or former regular cigarette smokers.  Less than 2% had never been cigarette smokers!  In contrast, among 18-23 year olds, 40% have never been regular cigarette smokers. A big concern is that many of these younger e-cig users will transition to actual cigarettes.

Some states have implemented legislative approaches to combat e-cigarette use. Pricing is among the most frequent interventions.  Raising the price of e-cigarette reduces demand just like for other tobacco products, especially for younger users- that tends to dominate the approaches. Legislation to increase the price of e-cigarette products fall into three categories: 1) price increases based on the current sales price; 2) pricing e-cigarettes and vapor products at the same rates as regular cigarettes; and 3) imposing a per milliliter (ml) price increase on liquid nicotine or consumable material.

 

Percentage Price Increases

Two states have established percentage price increases for e-cigarettes. Pennsylvania increased the price of e-cigarette products (i.e., the electronic oral device with heating coil, battery, etc., as well as the liquid or substance used in the e-cigarette) by 40%.  Minnesota increased the price of tobacco products including e-cigarette products by 95%.

Washington state introduced a bill that would raise the prices of vapor products by 60%. In New Mexico, an amendment was introduced to raise the price of e-cigarettes by 76% of the product value. This would be an increase from the current 25% set out in statute.

Legislators in New York recently introduced two bills (A011338 and S01089) to treat e-liquid cartridges as “tobacco products” and increase the price of cartridges by 75% of the wholesale price. A governor’s budget proposal in Rhode Island called for raising the price of e-cigarettes by 80% of the wholesale cost. Similarly, Kentucky proposed an amendment to increase the price of e-cigarettes by 15%.

 

Pricing Equalized to Cigarettes

California is adopting regulations to increase e-cigarettes prices equal to their Cigarette Distribution Tax ($0.10 per cigarette).  District of Columbia increased the price of vapor products equal with the rate imposed on a pack of 20 cigarettes.

 

Price Increases Per Fluid Amount

Six states increased prices of vapor products, liquid nicotine, or consumable material per fluid ml. Delaware (vapor products), Kansas (consumable material), Louisiana (vapor products and e-cigarettes), and North Carolina (vapor products) added $0.05 per fluid ml. Louisiana’s law increased the price of consumable nicotine liquid solution or other material containing nicotine that is depleted as a vapor product.

New Jersey passed legislation raising the price of nicotine liquid by $0.10 per fluid ml. West Virginia increased the price of e-cigarette liquid by $0.075 per ml.  Puerto Rico legislature approved a bill to increase the price of e-cigarettes by $3, nicotine cartridges by $0.05 for every millimeter of nicotine solution or any other substance in each nicotine cartridge, and vaporizers by $6 for every unit.

Legislation increasing the price of e-cigarettes, other electronic smoking devices, and e-liquids can encourage users to quit, seek and sustain cessation, prevent youth initiation, and reduce consumption among those who continue to use them. Many states have taken proactive steps to stem the tide using the fact that young people are price sensitive. Perhaps we’ll see some proposals from the Arizona State Legislature.  However, how successful the effort will be depends on the makeup and view of the next legislature and governor.

AzPHA Members Voting on New Resolutions

 

Three new Resolutions have been developed by our Resolutions Committee and have been forwarded by our Board for a vote of our Members. AzPHA Resolutions are important because our advocacy priorities are driven by Resolutions. AzPHA has dozens of Resolutions in place dating back to the 1930s. Our historic Resolutions are available on our Members Only site.  

Early resolutions focused on the importance of food safety regulations, tuberculosis prevention and treatment, tobacco control, family planning, and other contemporary public health issues. More recent Resolutions have focused on addressing the Opioid epidemic, certifying Community Health Workers, and regulating electronic cigarettes. 

Our AzPHA Members that are up to date on their dues and such are now electronically voting on the proposed Resolutions between August 28 and September 12, 2018.  Links to the proposed Resolutions are located below: 

Note: This voting is just open to AzPHA Members who are up to date with their dues.  Only members in good standing were sent the message with the voting link. Let me know if you believe that you’re an active member but didn’t get the email.  It went out on the morning of August 28 and was entitled “2018 AzPHA Election Announcement”