Assurance & Licensure

In the News

Opioid Use Disorder Treatment Medications

Earlier this week AHCCCS announced that they've accepted the recommendations of their Pharmacy and Therapeutics Committee and will be adding an additional buprenorphine medication (sublingual) to their preferred formulary list and a streamlined prior authorization process for a long acting injectable medication (effective 10/1). Here's the story from the Republic and the Cap Times.

Hacienda Healthcare Enforcement Action

The ADHS issued a Notice of Intent to Revoke the license of a Hacienda Healthcare on Friday (here's the story from the Republic). Apparently, a patient at the facility had larvae on a stoma, prompting the investigation. As you'll recall, the facility previously had not been required to have a license - until SB1211 was passed and signed. The Governor signed the law with an emergency implementation clause (making it immediately effective) on 4/24/19.

A survey was conducted on 4/23 & 4/24 (that found no deficiencies) and the facility was apparently issued a license on 4/26. According to the news report staff from 3 state agencies (ADHS, AHCCCS, and ADES) are monitoring the facility and working on an investigation.

Legislative Session Wrap Up

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

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

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

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

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

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

Legislative Update: May 6, 2019

Legislative Update

We're moving full force into the budget negotiations process now. By all accounts it looks to be a more deliberative process than in years past because of the tight party affiliation margins and the disconnect between the executive budget priorities and those of the legislature. It's likely that we'll have at least a few more weeks before a final budget is complete- and it might even go into June this year. 

Public Health Bills Signed by the Governor

SB 1165 now HB 2318 Hands Free Cell Requirement 

This bill was a long time coming- but were on the precipice of having this good public policy finally happen- all that's left is for the Gov to sign it. It will prohibit using a hand-held cell phone while driving.  There are some common-sense exemptions for example if the person is using it hands free etc.  It'll change driving behaviors and save lives.

Violations are a civil money penalty (no driving points) with the first offense being between $75- $150 and the 2nd offense between $150 and $250.  The bill would provide a state overlay so the cell phone use laws would no longer be different from jurisdiction to jurisdiction. Warnings for a year and a half - and then the penalties kick in.


SB 1247 Residential Care Institutions

This good bill will require more robust staffing background checks for facilities that provide services for children and will remove the “deemed status” designation for child residential behavioral health facilities. 

Under the old law law, facilities in this category (e.g. Southwest Key) can be accredited by a third party (e.g. Council on Accreditation) and avoid annual surprise inspections by the ADHS.  This intervention will provide more oversight to ensure background checks are done and that the facilities are compliant with state regulations. 

SB 1211 Intermediate Care Facilities

Like SB 1247, this bill closes a licensing loophole. This good bill will require more robust staffing background checks for facilities that provide services to people with disabilities at intermediate care facilities. 

These facilities would also require a license to operate from the Arizona Department of Health Services beginning on January 1, 2020.  Under current law these facilities (Hacienda de los Angeles and similar facilities run by the ADES are exempt from state licensing requirements).


SB 1040 Maternal Mortality Report

This bill was signed by the Governor this week.  The new law will establish an Advisory Committee on Maternal Fatalities and Morbidity.

It requires ADHS and the Committee to hold a public hearing to receive public input regarding the recommended improvements to information collection concerning the incidence and causes of maternal fatalities and severe maternal morbidity and complete a report (including recommendations) by the end of this year.

SB 1089 Telemedicine

This week the Governor signed this bill will improve healthcare access and help lower costs. With this legislation, any healthcare service covered in-person by a commercial insurer will also be covered when provided through telemedicine. Currently, Arizona law limits telemedicine coverage to a handful of medical services.

HB 2488 Veteran Suicide Annual Report (Lawrence)

Requires ADHS (starting this year) to complete an annual report on veteran suicides in Arizona that includes the number and rate of veterans who died by suicide, trends, an analysis of the years of potential life lost, a comparison of Arizona's resident veteran suicide rate to those of the nation, and the relative risk of suicide by race or ethnicity, age group, gender and region. 

The report is also supposed to analyze patterns of drugs, or combinations of drugs, that were used by Arizona's resident veterans when drug poisoning was the mechanism of suicide. The idea is to create the surveillance and data linkages needed to inform suicide prevention strategies based upon medical risk factors that significantly correlate to suicide.

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.

On the Governor’s Desk for Signature

 SB 1468 Suicide Prevention Training

This good bill is awaiting the Governor’s signature.  It will require school districts, charter schools, and Arizona teacher training programs to include suicide awareness and prevention training in their continuing education curricula.  It’ll require AHCCCS to make suicide awareness and prevention training available (fortunately some evidence- based tools curricula already exist).

Starting in the 2020 school year, school districts and charter schools would need to provide training in suicide awareness and prevention to school personnel in grades 6 to 12.  The bill also establishes requirements for suicide awareness and prevention training and specifically says that the training use evidenced-based training materials and instruct participants on how to identify the warning signs of suicidal behavior in adolescents and teens.

SB 1085 Association Health Plans (AzPHA Opposed)

This bill was passed by the House this week and is awaiting the Governor’s signature.  He’s sure to sign it. It basically provides a regulatory structure at the state level to regulate AHPs in AZ - serving to make them more available in Arizona. A primary concern for folks interested in public health and consumer protection is that AHPs don’t need to cover the essential health benefits, they can charge differently depending on gender and age. 

Additionally, we’re concerned that if an employer offers a “skinny” benefit plan that barely meets the definition of minimum value (and doesn’t include important essential health benefits) families could be prevented from benefitting from the subsidies that would otherwise be available to them on the Marketplace.

Back in August (at the direction of the President) the US Department of Labor issued a final rule that established criteria for determining when employers can join in an association and be treated as an employer sponsor of a group health plan.  The federal regulation loosens the rules for additional plans to come onto the market, allowing more small businesses including individuals who work for themselves to join these plans.  This bill will make these plans more available in AZ.

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.


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

CMS Updates Health and Safety Expectations

With all the news about the Hacienda Healthcare facility I thought I’d give an update about how facilities like Hacienda are regulated.  Hacienda was a special case because it was exempt from the state licensing requirements and wasn’t required to have a state license.  It did, however, need to be certified as meeting the federal standards of care.  CMS has an interest in ensuring quality care because they are the payers for many of the patients in skilled nursing facilities and the like.

In general, skilled nursing facilities are required to have a state license (and meet state licensing standards).  However, if the facility is accredited by a 3rd party like the Joint Commission or the Council on Accreditation, they can submit that certification to the ADHS and receive a license without an on-site inspection.  The Agency still has the authority to conduct complaint investigations, but will, in general not do annual surprise inspections not related to a complaint.

In addition to the state licensing standards, CMS requires that facilities that treat Medicare and Medicaid patients also be Certified as meeting their standards.  That compliance work is also done by the ADHS – under a contract between CMS and the ADHS.  CMS asks states to use what's called the States Operations Manual when they do the certification inspections. 

So, a typical skilled nursing facility for example, would need to meet the state standards as well as the CMS expectations (in order to get paid for Medicare and Medicaid patient services).  When we (ADHS) re-wrote the healthcare institution Rules back in 2013, we did our best to synchronize the ADHS rules and CMS certification expectations.

CMS certification guidance addresses violations of health and safety regulations that cause serious harm or death to a patient and require immediate action to prevent further serious harm.  Their guidance also provides inspectors with guidance on quickly identifying and handling these urgent situations. 

This week, CMS announced that they've updated their guidance to states with information clarifies what information is needed to identify immediate jeopardy cases across all healthcare provider types.  The new guidance is in Appendix Q of the State Operations Manual that federal and state inspectors use.  CMS also released some new administrative tools to help inspectors make sure they have the evidence needed to meet criteria for immediate jeopardy.

Because these changes affect all Medicare- and Medicaid-certified healthcare providers, suppliers, and laboratories, CMS is providing online training on this new guidance at and are the revised guidance and administrative tools.

This was CMS’ final statement about their new guidance: “Investigators will now have a clear framework to identify serious patient health and safety problems. Today’s guidance is just the beginning of upcoming efforts to strengthen oversight of healthcare settings. Expect to hear more from us on this issue. This is part of the agency’s broader initiative of ensuring safety and quality, and we look forward to continuing to work on this priority across all our programs.”