Prevention

Maricopa County Seeking Hepatitis A Intervention Strike Team Volunteers 

AHCCCS Policy Change Assisting the Response

Maricopa County is part of a statewide hepatitis A outbreak mostly affecting folks experiencing homelessness, substance use and/or recent incarceration. 229 people have been reported with the disease and more than 80% have been hospitalized. The Maricopa County Department of Public Health is working with community partners to vaccinate the people at highest risk...  both to protect them from getting sick and to stop the disease from spreading further.  

The public health response consists of: 1) vaccinating everyone in the county jail system for the next 8 months; 2) deploying vaccination and service strike teams (with other organizations); and 3) partnering with cities and parks to go to homeless encampments and offer vaccination in Strike Teams.

They're recruiting volunteer healthcare providers and screeners (no healthcare experience needed) for the vaccine outreach events. If you're interested in volunteering, please contact PHVolunteer@maricopa.gov.

In addition, AHCCCS now covers medically necessary covered immunizations for people 19 years of age and up when the vaccines are administered by AHCCCS registered providers through county health departments. Immunizations are covered even if the AHCCCS registered provider isn't in the member’s health plan network. The list of covered vaccinations includes (but isn't necessarily limited to) Hepatitis A & B and Measles.

Policy changes like this make a big difference in the effectiveness of public health interventions like the ones associated with this Hep A outbreak - and they also sets up a system that will be better able to prevent future outbreaks.

New USPSTF Recommendations for HIV Will Have a Powerful Public Health Impact

Ever since the passage of the Affordable Care Act, a prevention model of health has been increasingly weaving its way into the fabric of traditional models of care.  That's because the ACA expanded the role of preventive services in the US health care delivery system via various incentives. 

For example, the “Category A & B” preventive services that are recommended by the United States Preventive Services Task Force (USPSTF) are now included (at no cost to consumers) in all Qualified Health Plans. In addition, many employer-based and state Medicaid programs routinely cover Category A & B services once they're recommended by the USPSTF. 

The USPSTF is an independent, volunteer panel of experts in prevention and evidence-based medicine. The Task Force works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services such as screenings, counseling services, and preventive medications.

The Task Force analyzes priority preventive health services and assigns the a letter grade (an A, B, C, or D grade or an "I Statement") based on the strength of the evidence and the balance of benefits and harms of the preventive service.

Currently, the USPSTF recommends 51 Category A & B Preventive Health Services - which include things like screening tests, counseling, immunizations, and preventive medications for adults, adolescents, and children. 

The preventive services that have an A or B grade are presented in alphabetical order and by the date they were recommended on the Task Force website.

This month they added 2 new recommendations related to HIV: 

You can browse the USPHS website and check out the preventive services that they have evaluated but got a lower grade. Most of the services are broken down by age, gender and other risk factors.

Arizona Policies, Resources and Recent Investments are Addressing Rural Healthcare Workforce Shortages

Healthcare workforce shortages often contribute to health disparities in rural AZ.  That’s because rural communities tend to have fewer physicians, nurses, specialists, and other healthcare workers…  and at the same time face higher rates of chronic disease, mental illness, and obesity than urban areas. Having enough healthcare personnel in shortage areas can contribute to those health disparities. 

Additionally, health care providers working in shortage areas can experience isolation from their peers and burnout from seeing a greater number of patients and working longer hours than those in non-shortage areas.

A critical element to ensuring an adequate healthcare workforce is to improve the reach of provider recruitment programs, which can build a strong and diverse healthcare workforce that represents the population served. 

This year was particularly successful at the Legislature as they approved an additional $750K for the state loan repayment program (bringing the total budget to $2.75M) as well as more resources for rural Graduate Medical Education ($1.6M for rural Graduate Medical Education -$5.5M w the federal match)  - which can be use to bolster graduate training in rural AZ (this GME training is really important because it’s a key factor in where a provider practices over the course of her or his career- improving rural networks). There was also an additional $750K that was invested in the North Country GME program.

Arizona Primary Care Office

Arizona is fortunate to have an effective Primary Care Office program at the ADHS’ Bureau of Women and Children’s Health along with public policies that have been passed in the state legislature that help to improve the state program’s effectiveness. 

Our in-AZ resources to improve workforce capacity and access to care in rural and underserved AZ include the Arizona State Loan Repayment Programs, J-1 Visa Waiver Program, and at the national level, the National Health Service Corps and Nurse Corps.

Our state Primary Care Office also manages data collection regarding healthcare provider shortage areas (HPSAs) and information like Primary Care Area Statistical Profiles as well as maps and a host of additional data resources.

UA Center for Rural Health

We also have terrific programs at the UA Center for Rural Health which has rural health programs like the Rural Hospital Flexibility Program (AzFlex), the Small Rural Hospital Improvement Program (AzSHIP), Arizona First Responders Initiative (FR-CARA), The Rural Health Professions Program (RHPP), Workforce Data & Analysis (CRHWorks), Arizona Rural Recruitment and Retention Network (Az3RNet), Students Helping Arizona Register Everyone (SHARE), the Prescription Drug Overdose Program, and Health Insurance Assistance.

Arizona Area Health Education Centers

Arizona also has a unique system of AZ Area Health Education Centers that are established under state law (voter approved) “… enhance access to quality healthcare, particularly primary and preventive care, by improving the supply and distribution of healthcare professionals through educational partnerships between academic and community organizations in rural and urban medical underserved areas.” 

The Program has a state office at the UA and several local AHECs that promote community and educational partnerships to enhance access to quality health care with an emphasis on the needs of rural and urban underserved communities and populations. Their missions also include educational programs in partnership with academic institutions, communities, health care agencies, and other organizations that promote the health of Arizona residents.

Arizona Rural Health Association

We're also fortunate to have the Arizona Rural Health Association (AzRHA) in our state doing advocacy for rural health.  The AzRHA was established in 1994 as an independent organization after serving as the Advisory Committee of the University of Arizona Rural Health Office (RHO) for many years. While AzRHA continues to serve as the RHO advisory body, its functions have been expanded to cover many areas involving advocacy for rural healthcare programs.

Access to healthcare is an essential component of health and wellness. By providing financial incentives for clinicians to practice and train in rural areas and by collecting data on provider shortages and using that data to make policy adjustments, Arizona is increasingly poised to make measurable improvements in rural networks as a result of this year’s legislative session decisions.

Yuma County Captures 2019 Spotlight Award

Blue Cross Blue Shield of Arizona and fitness icon Jake “Body by Jake” Steinfeld have teamed up to shine a light on people and programs that are making Arizona healthier. The 2019 Spotlight Awards honor leaders across our state who are inspiring health and wellness in their communities, where it matters most.

WINNERS:

Business of the Year: Chicanos Por La Causa
City of the Year: City of Phoenix
County of the Year: Yuma County
Tribal Nation of the Year: Tohono O’odham
School District of the Year: Tempe Elementary School District #3
School of the Year:  Brunson-Lee Elementary

Washington State Eliminates the Personal Exemption for MMR

Washington’s Governor also signed a new law this week that will eliminate the “personal exemption” that parents can sign to exempt their kids from school and pre-school vaccination attendance requirements. 

Interestingly, the new law just eliminates the personal exemption for the MMR (measles, mumps, rubella) vaccine.  The personal exemption option will still be available for the other school-required vaccines.  The new law will be effective before the start of this year’s school season.

Washington lawmakers overcame strong lobbying by anti-vaccine groups who mobilized hundreds of supporters, who telephoned and sent emails to lawmakers, and turned out in large numbers for the hearings.

As is often the case, a protracted outbreak created the political will to pass the measure.  Earlier this year Washington declared a  state of emergency after officials reported 25 measles cases. The cases continued to climb – and so far 78 measles cases have been confirmed in Washington and neighboring Oregon.

As is the case in AZ, Washington has seen a consistent increase in the number of kids whose parents have exempted them from vaccination school enrollment requirements.  In fact, Washington’s exemption rate for Kindergarteners is 4.7%.  Arizona’s exemption rate is even worse than Washington’s- as the exemption rates for Kindergarten went up this year to 5.9%.

It’s only a matter of time before Arizona has a Washington/Oregon style outbreak.  Most likely it’ll be in a place like Yavapai County- which has the state’s lowest immunization rates.  There’s a good chance it’ll start when an unvaccinated Arizonan returns from Europe with measles and spreads it within their community.

How Much Compromise is Too Much?

That’s the basic question regarding a bill that is progressing that would move the buy age for tobacco products including e-cigarettes to 21 – but would also pre-empt existing and future local regulation of tobacco products (including e-cigs).

AzPHA has been a long-time supporter of legislative changes to move the tobacco buy age to 21 from the current 18. There is a ton of medical and population-based evidence suggesting that moving the buy age to 21 would be an effective tool for reducing the number of people addicted to nicotine and tobacco – saving many lives.  Tobacco smoking remains the number one preventable cause of premature death (although obesity is expected to overtake tobacco in the next few years).

Our preference has always been to implement a “tobacco 21” law that would cleanly move the buy age for tobacco and e-cigs to 21.  Clean in the sense that the bill would do just that- and not impair cities, towns, universities etc. ability to be more restrictive.

A great example of that is Senator Carter’s SB 1363 which would have cleanly moved the buy age for both e-cigs and tobacco to 21.  We wholeheartedly supported that bill.  Sadly, it never even got a hearing in the Senate because it was assigned to the Commerce Committee instead of Health Committee- and the Commerce Chair didn’t hear the bill.  So, a couple of months ago it looked like a tobacco 21 bill was dead again this session.

Then, last month, along comes a “strike all” amendment to SB 1147 by Senator Allen which also would raise the buy age to 21 but also includes a pre-emption clause preventing any other jurisdiction from implementing tobacco or e-cig control measures that aren’t included in the 1147 bill and that aren’t covered in the Smoke Free Arizona Act. 

The preemption pieces would effectively open up currently tobacco free campuses to anyone over the age of 21 and would allow for vending machines containing e-cigarettes and conventional tobacco in areas where kids could have access to them.  Here are examples of what the pre-emption clause of 1147 would:

Void Phoenix, Tempe and other cities' zoning boundaries for tobacco retailers that prohibit the sale of tobacco products within 1,320 ft of a school, park, day care facility, among others public places.

Remove local prohibitions on tobacco marketing and advertisements on or near public property, such as near schools, bus stops, park benches.

Eliminate licensing requirements for retail tobacco establishments.

Allow tobacco vending machines in liquor stores where minors can enter without anyone verifying their age. Currently, some cities only allow vending machines in bars that ID customers to ensure they’re 21 and specialty clubs that require membership. 

On the penalty side- SB1147 would create new criminal penalties on those 18-21 rather than primarily placing the penalties on the establishments that sell to people under 21.

The challenge for organizations like ours when deciding whether to support or oppose SB 1147 is to weigh whether the benefit of the 21 buy age intervention is outweighed by the downside posed by the pre-emption.

To be honest- when I read SB1147 for the first time (after the amendments) I was on the fence about whether we should support the bill.  It sure was tempting to get T-21 finally into state law.  But in the end, we decided to stick with the rest of the public health community and oppose the bill for good reasons- because the pre-emption pieces and the fact that the bill doesn’t classify e-cigs with tobacco products really move the balance of the bill as a negative. 

Maybe in the next couple of years we can get a bill that won't have pre-emptions, would have a more balanced set of penalties, and would include e-cigs in the definition of tobacco products.

So that’s the reason for the title of this piece.  How much compromise is too much compromise- and as a secondary thing- how patient should one be to hold out for a clean intervention.  

I have no doubt that we will eventually get a clean T-21 bill through the legislature.  The question is how many years it’ll take.  Hopefully not as many as it took to get the hands-free cell phone law that was just passed and signed.  That took too many years.  Way too many.

SB 1147 is being heard on Monday in the House’s Committee of the Whole and it could even go to a 3rd read the same day (the Committee of the Whole is the last chance to amend measures in either chamber before bills go to the floor for a 3rd read- which is the floor vote).  Even if it passes the House this week it’ll still need to go back to the Senate because it’s a strike all bill.

New Study Shows Positive Economic Impact from SB1354

It’s been clear from the start that SB 1354 - the most important access to care bills this year- would do a great deal both in the short-term by boosting the primary care loan repayment program and really enhance graduate medical education residencies over the coming years (important because where a practitioner does her or his residency greatly influences where they ultimately practice).  Arizona’s primary care physician shortage is one of the worst in the nation (meeting only 42% of the state’s needs).

The public health merit of a bill is often not enough to carry the day – especially when a financial appropriation is involved- because the return on investment matters too.  Fortunately, the Arizona Hospital and Healthcare Association and the Arizona Rural Health Association commissioned a study to measure how SB 1364 would affect the economy and patient access to care.

The result of the independent economic impact study found that the SB 1354 investments would have a “significant positive economic impact” to the state and expanded patient access to care over the next ten years.

The report found that the bill would enable hospitals across the state to increase the number of post-graduate physician residents they train and found that increasing the number of physician residents at three rural hospitals alone would result in 845 new high- paying jobs and $911 million in economic output over ten years.  Additionally, the bill lessens the issue of physicians leaving Arizona after graduation because they are unable to secure the limited amount of in-state residency positions.

Almost 75% of medical students who finish post-graduate training in Arizona stay in Arizona. This means state funding for physician residencies will move the needle on the state’s physician shortage and be a game-changer for rural communities.

The bill sailed through the Senate but stalled in the House - as the Rules Committee never heard the Bill (and that committee is no longer meeting).  But- portions of the bill or even the whole bill could be included in the final budget as what’s called a Budget Reconciliation Bill or BRB.

More Bad about AZ's Immunization Rates

School Vaccination Rates Drop Again this School Year

At the core – vaccines are really about community protection.  Our public health system depends on a solid network of providers that are available to vaccinate kids for all the nasty infectious diseases that have plagued humanity for millenia.  Vaccinating yourself and your kids is more about community protection than personal protection. It’s a social contract that we have with each other to keep all of us healthy.

We need just about everybody to participate in our shared social contract to vaccinate in order to get the herd immunity.  When communities have herd immunity, those who can’t be vaccinated and folks with weakened immune systems will still be protected because the viruses can’t circulate.  Measles needs a 95% community vaccination rate to achieve herd immunity.

As a means to maintaining herd immunity, Arizona law (ARS-872 & ARS-873) requires that all children attending school or child care have certain vaccines unless they're exempted by a doctor for medical reasons or by a parent for personal reasons.  

Each year, schools (6th grade, kindergarten, and child care/preschool) are supposed to turn in data about the vaccine exemptions in their school to the ADHS.  

There's bad news again in this year's report- continuing a multi-year trend toward higher exemption rates (worse vaccination rates). For the current school year:

  • 6th grade exemption rates went from 5.4% last year to 6.1% this year

  • Kindergarten exemption rates went from 5.4% to 5.9% 

  • Child care exemption rates increased from 4.3% percent to 4.5%

This year's results can be found on the ADHS' Immunization Coverage Level page.  You can check out individual school exemption rates on the Arizona School Vaccine Exemption Spreadsheet.

There are some pretty discouraging results in this year's results. For example, only 27% of Yavapai County schools (12/44) have herd immunity among 6th graders. Coconino County is only at 33% on the same measure (6/18). As in previous years, charter schools tend to have higher exemption rates than public schools. Lots of data to dive into in the spreadsheet. 

Arizona School Vaccine Exemption Spreadsheet

Sadly, several bills that would have improved rates weren't even heard in committee this year like HB 2162 which would have removed the personal exemption and HB 2352 which would have required schools to post on their school's immunization rates.

However, several bills were heard that would have eroded immunization rates even further including SB 1115, HB 2471, HB  2472, SB 1116, and HB 2470.  Fortunately those bills appear to be dead for this year- but may very well return.

Today's National Public Health Week Topic: Violence Prevention

Gun violence is an epidemic in America. On this second day of National Public Health Week — which has a daily theme of “Violence Prevention” — about 100 Americans will be killed with guns, and hundreds more will be injured.  That's just today.

Beyond gun violence, 1 in 4 U.S. women experience intimate partner violence, 1 in 6 has been the victim of rape or attempted rape, and hundreds of thousands of children experience abuse and neglect. Yet violence is preventable with the right research, resources and policies.

In support of today’s NPHW theme, urge policymakers to pass commonsense measures to reduce gun violence and provide research funding on par with the nation’s gun violence epidemic. Learn about ways to help make your community safer for all, such as using trauma-informed services to identify victims of violence and calling on law enforcement officials to treat all people with dignity, respect and fairness.

Also remember (see below) that we have some free upcoming free Mental Health First Aid Certification Opportunites for AzPHA Members.

For more on Tuesday’s NPHW theme and ways to take action, read our Violence Prevention fact sheet and help spread the word on social media. And join APHA and the Coalition to Stop Gun Violence for a gun violence prevention Twitter chat at 4 p.m. ET today. Use the hashtag #PublicHealth4GVP to join in.

Also today, as part of APHA’s NPHW celebrations, the Association will host a webinar at 3 p.m. ET with the Aetna Foundation and U.S. News & World Report on the recently released Healthiest Communities ranking. RSVP for the event now.

Join APHS tomorrow for the 9th annual #NPHWchat hosted by @NPHW (RSVP here), and on Thursday for NPHW Student Day activities. Don’t forget to check our calendar of local NPHW events to see what’s happening in your community.

_______________________

Free Mental Health First Aid Certification Opportunities for AzPHA Members

AzPHA is delighted to announce that we’re partnering with Crisis Response Network to provide our members a free opportunity to become certified in Mental Health First Aid.  We’ll have 3 separate opportunities in the next few months to take the 8-hour (one day) Mental Health First Aid course in which you’ll learn risk factors and warning signs for mental health and addiction concerns, strategies for how to help someone in both crisis and non-crisis situations, and where to turn for help.

When you take a course, you’ll learn how to apply the Mental Health First Aid action plan in a variety of situations, including when someone is experiencing:

  • Panic attacks

  • Suicidal thoughts or behaviors

  • Nonsuicidal self-injury

  • Acute psychosis (e.g., hallucinations or delusions)

  • Overdose or withdrawal from alcohol or drug use

  • Reaction to a traumatic event

Upon completion of the one-day course you’ll receive a three-year certification.  It’s a terrific opportunity to build your public health skill set while enhancing your professional credentials.

We’re offering the free Mental Health First Aid course on:

If you have any questions or concerns please reach out to Shelby Graves at Shelby.Graves@CrisisNetwork.org.

Arizona’s New Oral Health Plan Published

The Arizona State Oral Health Action Plan 2019-2020 Workgroup released the Arizona 2019-2022 Oral Health Action Plan this week.  The report articulates goals, delivers recommendations, and identifies strategies to improve the oral health of all Arizonans. It incorporates strategies gathered over three years of collaboration with health care stakeholders, state and regional oral health coalitions, educational institutions, professional associations, and grassroots organizations. This plan offers solutions to address the tremendous burden of preventable oral diseases that affect individuals across the lifespan by collaboratively creating a new blueprint to improve oral health and overall health.

The goals and objectives address four cross-cutting systems of care: Policy, Care, Community, and Financing.  The goal and objectives for each category begin on page 18 of the Report.  Recommendations include:

Policy—using data and stories to educate, advocating for Medicaid dental coverage for pregnant women, increasing the number of Arizonans with optimally fluoridated water, and establishing a state oral health surveillance plan;

Care —ensuring an adequate, diverse, and culturally competent workforce, incorporating oral health as an essential component of overall health and well-being through integrated inter-professional systems, and encouraging, supporting, and tracking inter-professional educational models of care;

Community—maintaining a statewide network of champions and leaders for oral health advocacy and planning, supporting evidence-based prevention and early detection programs, and implementing and disseminating consistent and uniform messaging; and  

Financing—financing oral health as an important component of overall health, funding and expanding oral health prevention, and sustaining financial support to improve health outcomes.

As is the case with any plan- the real key is translating the plan goals and objectives into public policy via administrative advocacy (policy interventions by state agencies), legislative advocacy (policy interventions like SB 1088 which would provide preventative oral health care for pregnant Medicaid members), by working with systems of care to improve inter-professional collaboration and by influencing policies by payors to drive better outcomes (e.g. teledentistry).

Measles & Mumps Cases in AZ

Arizona Has Lost Community Immunity in Many Places

In the last 2 weeks AZ public health officials have identified and confirmed cases of measles and mumps.  The mumps cases (2) were found in the SE valley and are under investigation by Maricopa County Public Health folks. Another mumps case has been confirmed in Cochise County.  The measles case was found in Tucson in a 12 month old- and appears to have been acquired after travelling to Asia. That case is being investigated by Pima County public health epidemiologists.

The basic detective work will include looking for susceptible contacts and conducting interventions to control the spread. Kids don't get the MMR vaccine until their first birthday, so infants are at high risk of getting the disease if they're exposed... so that group along with unvaccinated contacts (whether for medical or choice reasons) will be among the high priority contacts to identify.  You can see the investigation and control measures for both illnesses in Arizona's communicable disease rules (Pages 34-39).

Measles is more contagious than mumps- but both are easily spread (direct contact isn't needed to spread the virus).  Both are vaccine preventable diseases.  For measles (the most contagious disease), 95% of children need to be vaccinated to prevent spread.  

Whether these cases transition to an outbreak or epidemic will depend on where the index cases were prior to diagnosis, who was potentially exposed and the vaccination status of the contacts.  If the index cases were isolated or if they were in communities (or medical facilities) with vaccination rates above 95% it's unlikely that measles will spread beyond the first case. If they were among communities with lower vaccination levels, there's a good chance there will be more cases. Another wildcard will be whether there were potential infant contacts in doctors offices or clinics if potential exposures happened there.

Many parts of Arizona have vaccination levels lower than "herd immunity" levels, meaning that in many parts of the state we've lost community immunity.  Fortunately, Pima County has among the highest vaccination rates in the state, meaning there's a better chance of containing the disease.  Had the index case been from one of the many communities in AZ with much lower vaccination rates the risk would be higher. Of course- there are pockets of under vaccinated areas in every county- so many communities are at risk these days.  

Arizona is one of eighteen states that allows parents to opt out of vaccinating their child with a non-medical exemption Click this link to view the full report.  In fact, Maricopa County leads the nation in the highest number of non-medical exemptions.  

There are 30 Legislative Districts in AZ. You can click here to find out what District you live in so you can communicate with your elected officials about the importance of community immunity and ensuring they understand you support public policies that encourage immunizations.

BTW: there are science-based resources available to help parents make informative decisions about vaccines such as the CDC, Children’s Hospital of Philadelphia and TAPI.

More States Moving to Eliminate Non-Medical Exemptions (not in AZ)

There have been 127 cases of measles were confirmed in 10 states this year with outbreaks in Texas, Washington, and multiple jurisdictions in New York. The reported cases are centered primarily within communities where rates of children who are vaccinated against measles are below herd immunity (due to its high level of communicability, measles require a high rate of vaccination, between 95% to reach herd immunity).  

There are many communities in Arizona and across the country where the rates are much lower than 95%. For example, in Clark County, Washington (where a recent measles outbreak originated) the percentage of kindergarteners who received a vaccine for measles fell from 96% in 2004 to 85% in 2017.

Every state has vaccination requirements for kids starting school, and all states also have medical exemptions.  All but three states—California, Mississippi, and West Virginia—also allow non-medical exemptions (i.e., exemptions based on religious, philosophical, or personal beliefs).

Arizona currently has medical and religious exemptions for pre-school & medical and personal exemptions for public school attendance. HB 2070, which passed the House Health and Human Services Committee Thursday (5-4) would add a new religious exemption for public school.

Over the past 10 years, the number of non-medical exemptions has increased, especially in states that allow both religious and philosophical exemptions. Additionally, researchers have identified several areas in the US where large numbers of non-medical exemptions are granted, including in the Portland metro area, where Clark County, Washington, is located.

Some states are now beginning to do away with non-medical exemptions for school vaccination requirements.

In 2015, following an outbreak of measles at Disneyland, CA eliminated its non-medical exemptions (and immunization coverage recovered dramatically).  In California, vaccination rates rebounded substantially after the personal exemption was eliminated.  Vermont also eliminated its philosophical belief exemption in 2015 (but kept their religious exemption).

This year, a bill to remove the personal belief exemption for the MMR vaccine has passed the State of Washington's House of Representatives (HB 1638).  Many other states have also proposed eliminating non-medical exemptions, including Arizona (HB 2162 - which has not received a hearing), Iowa (HF 206), Maine (LD 798), Minnesota (SF 1520), and New York (S 2994 and A 2371).

Sadly, the bills that have received hearings in Arizona all work against improving our immunization rates, including HB 2470 Vaccination Religious Exemptions, HB 2471 Informed Consent, and HB  2472 Vaccinations- Antibody Titer.  All 3 Bills received Pass Recommendations in the Senate Health and Human Services Committee this week (by a 5-4 margin). They will likely be up for floor votes this week in the AZ House.

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.

Measles Outbreaks, Personal Exemptions, Parent Education & School Exclusions:

Interventions to Protect Kids & Stop the Spread of Disease

The Social Contract & Herd Immunity

At the core – vaccines are really about community protection.  Our public health system depends on a solid network of providers that are available to vaccinate kids for all the nasty infectious diseases that have plagued humanity for millenia.  Vaccinating yourself and your kids is more about community protection than personal protection. It’s a social contract that we have with each other to keep all of us healthy.

We need just about everybody to participate in our shared social contract to vaccinate in order to get the herd immunity.  When communities have herd immunity, those who can’t be vaccinated and folks with weakened immune systems will still be protected because the viruses can’t circulate.  Measles needs a 95% community vaccination rate to achieve herd immunity.

 

School Enrollment Requirements & Exemptions

To achieve herd immunity and prevent the spread of measles and other communicable diseases, every state including Arizona requires kids in public school to be vaccinated against a series of diseases, including measles.

All states allow an exemption from the required vaccines when it’s medically necessary.  Seventeen states (including Arizona) allow parents to exempt their kids from the requirements because of personal or philosophical beliefs (called personal belief exemptions).  BTW: HB 2162 would change that by removing Arizona’s personal belief exemption (it hasn’t been scheduled for a hearing).  States with a personal exemption option usually have lower vaccination rates than states without that option.

States also have authority to exclude kids that are unvaccinated from school during a vaccine preventable disease outbreak. In Arizona, ARS § 15-873(C) states that students “… who lack documentary proof of immunization shall not attend school during outbreak periods of communicable immunization-preventable diseases”.  The decision to exclude kids during an outbreak rests with the directors of the county health departments and school administrators and is prescribed in Arizona’s Communicable Disease Rules.

 

Immunization Rates Among AZ Schools

Arizona has many pockets in which our vaccination rates are below 95%, mostly in high income areas and among certain charter schools. One of our best sources of vaccine coverage data comes from schools and childcare centers- which are required to report their vaccination coverage and exemption rates for 19-35 month old’s, kindergartners, and 6th graders.

Public health agencies aren’t the only group of folks interested in school exemption rates. Many parents are interested in finding out whether their child’s school is has a high vaccination rate.  For the last several years, the ADHS has been posting the vaccination rates of schools across the state.

Last year exemption rates increased across all age categories. Exemptions rose from 3.9% to 4.3% for child care, from 4.9% to 5.4% for kindergarten and from 5.1% to 5.4% for 6th grade.  As is always the case, exemption rates were much higher in charter schools. Data for exemption rates and vaccine coverage rates by county and school are available on the ADHS website.  Note: updated exemption rates will be available in a couple of months.

 

Educating Parents

Arizona’s public health system has been doing some creative work to improve our immunization rates. One is an innovative on-line immunization education course that’s designed to serve as part of a potential new personal exemption process.  

Last year a pilot project was conducted recently at a dozen or so schools in Maricopa County to learn how to best implement an immunization education module, get feedback from school staff, and identify whether parents learned new information about vaccines using a pre-and post-knowledge assessment survey.

A new more robust pilot is planned for the 2019-2020 school year. The county health departments and the ADHS are partnering in the project.  At participating schools (hopefully as many as 125 schools), parents who want to exempt their kids from the school enrollment vaccination requirements will be asked to complete the Immunization Education Course first.  Upon completion, they’ll be able to download their school’s exemption form.

The online course is designed only for the use of Personal Beliefs Exemptions in grades K-12 at pilot program schools. It doesn’t change the process to request and obtain a Medical Exemption form or the Religious Beliefs Exemption form.

Hopefully the project will demonstrate positive results and will include an academic partner so the eventual results can be published and other states can learn from this important work.

We don’t have much time, though.  Vaccination rates are already below herd immunity levels for measles in many parts of the state, and all it'll take right now is a sentinel measles case in the right place at the right time and we’ll have a measles outbreak- maybe one as bad as the one happening right now in Washington state and across much of Western Europe.

CA Eliminated Personal Exemptions & Vaccination Rates Improved A Lot

California had also been struggling to maintain herd immunity vaccination rates- especially in higher income areas (just like us).  After trying a variety of interventions- and following a measles outbreak associated with Disneyland- the California Assembly passed & Governor Brown signed Senate Bill 277 (in 2015) which abolished personal exemptions in California.

The intervention worked.  In the following years, CA had sharp increases in vaccination rates among kindergarteners entering school. During the 2014–2015 school year the statewide kindergarten full-vaccination rate was only 90.4%. After implementing the new law, the kindergarten full-vaccination rate rose to >95% and has stayed there. 

By the way- a few months ago the Second District Court of Appeal in Los Angeles found that the CA law didn’t violate freedom of religion or the right to an education.

The court said that… “Compulsory immunization has long been recognized as the gold standard for preventing the spread of contagious diseases”.  The court said the new law was not discriminatory and was a valid measure to protect public health.  Just saying.

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.

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.

New Funding Opportunity Available for Arizona to Explore Strategies to Reduce Maternal Mortality

A couple of months ago (before the government shutdown happened) landmark federal legislation was passed and signed that will provide millions of dollars to help states determine why women are dying from pregnancy and childbirth at troubling rates.  

The new funding is great news because studies have found that at least half of childbirth-related deaths could have been prevented if health care providers had followed best medical practices to ensure complications were diagnosed and treated quickly and effectively.

The bill provides $12M in annual funding to the CDC to pass through to states with maternal mortality review committees and create committees in the 12 states that lack them.  Arizona has a committee in statute because of a law signed in 2011 - here's a link to the most recent report.

In order to qualify for funding, states need to demonstrate  that their “methods and processes for data collection and review use best practices to reliably determine and include all pregnancy-associated deaths and pregnancy-related deaths, regardless of the outcome of the pregnancy.” All indications are that the ADHS meets these CDC data standards and therefore would qualify for funding.

We and the Arizona Chapter of the March of Dimes will keep an eye out for the grant announcement and offer any assistance that the ADHS needs with their application for this important funding opportunity that can be used to save the lives of Arizona moms.

Recently Passed Federal Public Health Legislation

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

Improving Access to Maternity Care HR 315

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

Preventing Maternal Deaths Act of 2018 HR 1318

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

PREEMIE Reauthorization Act of 2018  S 3029

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

Agriculture Improvement Act of 2018 – The Farm Bill HR 2

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

State Offices of Rural Health Reauthorization Act: S 2278

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

The Action for Dental Health Act of 2018

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

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

PEPFAR Extension Act of 2018  HR 6651

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

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

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

Infrastructure for Alzheimer's Act S 2076

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

US Supreme Court Declines to Hear Appeal Regarding Reproductive Health

This week the US Supreme Court declined to hear a case that would have given them an opportunity to overturn a lower court ruling that found that Medicaid agencies can’t exclude providers offering preventive reproductive health services like annual health screens, contraceptive coverage and cancer screening because they also offer abortion services.  Lower federal courts had ruled that while states have broad authority to ensure that Medicaid health care providers are qualified, that power has limits. 

The case isn’t about elective abortion services per se (the Hyde Amendment from 1977 makes it clear that federal funds can’t be used to pay for abortions except in cases of rape, incest, or life endangerment). The question is whether providers can be excluded from Medicaid contracts for preventive services like annual health screens, contraceptive coverage and cancer screening because they also separately offer abortion services outside of their public dollar contracts. 

The Supreme Court’s decision to decline the case will have implications here in Arizona. In 2016, Governor Ducey signed a bill giving the director of the AHCCCS the power (at his or her discretion) to disqualify any provider that doesn’t fully segregate the public dollars they get and ensure that none of those funds went toward providing elective abortions- including overhead expenses like rent, lights and A/C.

While that law is still on the books (as ARS 36-2930.05), it hasn’t been implemented. After a lawsuit was filed back in '16, attorneys for AHCCCS agreed not to implement the law and stipulated that AHCCCS won’t try to cut family planning dollars from Planned Parenthood or any other organization because it hasn’t fully segregated out the costs of abortion services to the satisfaction of the director.  The implementation hold agreed to in the stipulation was until Rules (Administrative Code) could be adopted- which they estimated would take about 2 years.

In exchange, the attorneys for the providers agreed to drop their lawsuit challenging the legality of the measure until there are actual rules in place.  I checked on the AHCCCS and Secretary of State’s website and can’t find any Rules fleshing out the criteria- but I might have missed them.

In any event- the fact that the US Supreme Court this week declined to hear a case similar to Arizona’s suggests that- at least for now- the status quo remains...  and Arizona’s Managed Care Organizations that contract with AHCCCS are free to contract with Planned Parenthood or other providers even though they may not be segregating expenses as required in ARS 36-2930.05.Of course- that could change at any time if the Supreme Court changes their mind and agrees to hear a similar case in the future.