State Legislature

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.

New AZ Public Health Laws Take Effect Friday

State legislators passed several new laws that will influence public health last session- but almost all of them won’t take effect until Friday (August 3). The Legislature has developed a report that report that summarizes all of this year’s bills. The health-related bills are on pages 99-108.  Here’s a snapshot:

  • HB 2088 will require school districts to: 1) develop intervention strategies to prevent heat-related illnesses, sudden cardiac death, and prescription opioid use; 2) notify parents when kids are bullied; and 3) tell parents if a student is suspected of having a concussion.  An ADHS concussion training & management report is due at the end of 2018.

  • HB 2196 will limit ambulance certificate of necessity (CON) hearings to 10 days unless the Administrative Law Judge determines that there’s an extraordinary need for more hearing days.  Hearings had previously gone on for many weeks or even months.

  • HB 2197 requires AZ health licensing boards to collect certain data from applicants (beginning January 2020).

  • HB 2228 directs AHCCCS to exempt tribal members from work requirement waiver requests (more on this later in the update).

  • HB2235 will set up a new licensed class of dental professionals called a Dental Therapist.  The next step is for the AZ Board of Dental Examiners to develop the scope of practice and license regulations.

  • HB 2323 authorizes contracted nurses to provide emergency inhaler medication in case of respiratory emergencies (takes effect this semester).

  • HB 2324 charges the ADHS with implementing a voluntary certification for Community Health Workers. The next steps are for the ADHS to establish the advisory committee and begin the Rulemaking to set up the certification process.

  • HB2371 sets up statewide licensure for food trucks. The licenses will have reciprocity in all county health and environmental service departments.

  • SB 1083 will require public schools (K-3) to have at least 2 recess periods beginning this semester.   Grades 4 and 5 will be required to have 2 recess periods beginning August 2019.

  • SB 1245 will develop a produce incentive program within the Supplemental Nutrition Assistance Program within ADES.

  • SB 1389 requires the ADHS to develop an HIV Action Plan.

  • SB 1465 requires the ADHS to adopt rules and license sober living homes.  It also allows them to contract with a third party to assist with licensure and inspections. They have a 2-year exemption from the regular rulemaking process.

  • Note: SB 1001 - The Arizona Opioid Epidemic Act was in a Special Session and became law several months ago. 

Ballot Measure Analysis Hearing Wednesday Morning

There will be several voter initiatives and some referendum issues for us to vote on in November. We don’t exactly know which measures will make it to the ballot yet because the Secretary of State is still validating the signatures etc. and there are some lawsuits challenging some of the measures too.

If you’ve read your voter publicity pamphlet in the past, you’ll remember that there's an analysis of each ballot measure. The analyses are really important because they convert the statutory language into normal language- and many voters use them in their decision-making.  It’s important that they be objective and accurate.

The language for the Analyses are prepared by the Arizona Legislative Council and evaluated by Council of Legislators, who consider and adopt or amend the draft analyses. ARS 19-124 governs the process.  The analyses are supposed to "... include a description of the measure and shall be written in clear and concise terms avoiding technical terms whenever possible.  The analysis may contain background information, including the effect of the measure on existing law...". 

The Legislative Council is holding a hearing this Wednesday (July 25, 2018) at 9:00 A.M., in House Hearing Room #3 to consider adopting (or amending) the draft analysis language for the Stop Political Dirty Money Amendment (draft analysis); the Clean Energy for a Healthy Arizona Amendment (draft analysis); the “Protect Arizona Taxpayers Act” (draft analysis); and the Invest in Education Act (draft analysis). 

I won’t be able to make it but I’m hoping some of you can take some time and attend.

CHW Rulemaking, Opioid Epidemic Ends and Various CEU Opportunities

Community Health Worker Certification Rulemaking

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

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

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

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

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

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

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

 

Opioid Public Health Emergency Executive Order Ends

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

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

 

Aligning Health and Early Childhood Learning

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

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

 

Legislative Session Webinar Posted

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

 

CDC’s Learning Connection

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

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

 

Free Continuing Education from MMWR and Medscape:

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

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

 

Free Continuing Education Training for Opioid Prescribers offered by UA

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

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

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

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

 

Dr. Bob’s Travelogue

I’ve gotten a couple more Travelogues from Dr. Bob in the last couple of weeks.  He’s been living for the last couple of months just outside of London. He's writing some entertaining travelogues- with a splash of public health of course. Take a few minutes when you're on a comfortable couch and enjoy Travelogue 1 & 2: Getting Settled and Travelogue 3: Nutrition. Here’s Interlude from last week and this new one Hoof Beats.

Legislative Session Wrap-up & Farm Bill Stuff

Arizona’s Legislative Session in the Books

Well, the 2018 Legislative Session is in the books.  All in all, it was a good year for public health at the state level.  Several more good public health-related bills were signed today including:

HB 2324 Voluntary Certification for Community Health Workers

HB 2088 Public Health Guidelines in Schools

HB 2235 Dental Therapy Licensure

SB 1245 SNAP- Fruits and Vegetables

HB2371 Statewide Food Truck Licensing 

I’ll be doing a free Webinar about the legislative session Thursday May 17 at noon with the UA Center for Rural Health & the UA Telemedicine Program. Visit the AZ Telemedicine Program’s Website to register. 

Here's a link to a PowerPoint that summarizes the Victories, Missed Opportunities, Disappointments, and things that were in the final budget that link to public health. It's the ppt that I'll be using during the webinar on Thursday.

 

US Farm Bill: An Opportunity to Leverage Policy to Reduce Obesity

You’ve probably heard about the “Farm Bill” at one point or another.  While it’s called the Farm Bill- it’s not just about farms. It’s the bill that sets the food and agricultural budget and policy for the US. The bill impacts farming livelihood, and also determines how food is grown and which foods are grown.  It was last reauthorized by Congress in 2014 and Congress is now working on a new reauthorization.
 
The 2014 Farm Bill  (the  Agricultural Act of 2014) included some changes and reforms to the Supplemental Nutrition Assistance Program (SNAP or food stamps) and the Commodity Supplemental Food Program.  In Arizona, SNAP benefits help put food on the table for more than one million people each month, with more than half of the benefits going to kids and teens.

The 2014 Farm Bill did a few things that promoted healthier options by requiring SNAP retailers to provide healthy choices. The ’14 law also provided grant programs to encourage people that receive SNAP benefits to buy more fruits and vegetables, provide funding for loan programs for healthy food retailers, and create opportunities for schools to add different kinds of vegetables as part of school menus.

We’re hoping that Stakeholders like us can better leverage the Farm Bill to improve healthy eating this time around now that we have a member of our delegation on the Agriculture Committee.  Arizona District 1 Congressman Tom O'Halleran is on the House committee. 

Back when I was at the ADHS we worked with ASU on a report to provide information to Congress about how SNAP could be leveraged to improve healthy eating.  The full report has the details but here are a few of the concepts in the evidence review:

  • Improving access to healthy food by establishing guidelines requiring SNAP vendors to carry more healthier options

  • Establishing nutrition standards for foods that qualify for purchase using SNAP benefits.  Right now, SNAP benefits can be used for basically any retail food no matter how unhealthy it is (alcohol can’t be purchased with SNAP benefits). 

  •  Making changes to the SNAP education program to incorporate evidence based public health practices to bring about sustained changes in participant behavior.

Rather than strengthen the food quality requirements, the bill currently being debated by the House Agriculture Committee would expand the existing SNAP work requirements.  Right now, SNAP requires childless adults between 18 and 49 who don’t have disabilities to work or be in work training to qualify. The draft legislation would expand the work requirement to include adults up to 59 and people who care for children older than 6. The draft bill also would set tighter time frames for recipients to find work and stiffen the penalties if they don’t.

SNAP recipients covered under the work requirement would have to document that they are working or getting job training for 20 hours a week. The first time an individual doesn’t comply with that requirement would trigger a loss of benefits for a year. Failing to comply again would result in being locked out of SNAP for three years.

The proposed changes would increase state costs by requiring states to collect monthly information from most SNAP users about their hours worked, their hours of participation in work programs, and the reasons they may not be working in a work program. 

The APHA has set up a way that you can Contact your representative today and urge them to include nutrition standards for foods to qualify for purchase under SNAP and also to comment about the new proposed work/work training requirements.

 

Sonoran Prevention Works Scores Syringe Access Grant

Sonoran Prevention Works received a $125,000 grant from the Vitalyst Health Foundation  to support advocacy and education for syringe access programs – a proven harm reduction strategy in response to the opioid crisis and rising hepatitis-C and HIV infection rates. They’ll be partnering with the University of Arizona College of Medicine Tucson and Creosote Partners to destigmatize syringe access programs and understand the comprehensive needs of people who inject drugs.

The Maricopa County Sheriff's Office will also work with Sonoran Prevention Works to implement a needle stick prevention program and to educate law enforcement on injection drug use. These partnerships will work to support policy change that treats substance use as a public health issue.

Arizona's 2018 Legislative Session in the Books

Well, Arizona’s legislative session ended last week, so you’re spared my impossibly long policy updates.  You can visit this PowerPoint to dive into the good things, bad things, and the missed opportunities this year.  It’s still a draft summary of the Session because the Governor hasn’t taken action on several bills (voluntary certification of community health workers, public health measures in schools, dental therapy, food truck licensing, and fresh produce in SNAP). BTW- Let me know if you see anything I've left out of the draft powerpoint so I can update it before my Webinar next week

I’ll be doing a Webinar about the legislative session on Thursday May 17 at noon in conjunction with the UA Center for Rural Health & the UA Telemedicine Program.  Visit the AZ Telemedicine Program’s Website to register.

 

FDA Finally Implementing ACA’s Menu Labeling Requirement

You might have noticed that more and more restaurants and fast food places are starting to put calorie and other nutrition information on their menus.  That’s not a coincidence or accident- they’re implementing the menu nutrition labeling requirements in the Affordable Care Act.  Section 4205 of the ACA requires restaurants with 20 or more locations to post calorie content information for standard menu items directly on the menu and menu boards.  Vending machine operators with 20 or more machines are also required to disclose calorie content for certain items. 

Nutrition clarity is a real opportunity for public health change.  Not only will the new labels give the public key information to help them make better decisions about what they buy for themselves and their families- it’ll give pause to restaurants before they label their menus- giving them an opportunity to change ingredients to lower calorie counts.  It may even spur a trend away from super-sizes and toward more appropriate and reasonable serving sizes.  With 32% of the calories consumed in the US tied to eating outside the home- this is an important opportunity. 

Anyway, the FDA announced this week that they’re finally implementing the requirements that were established by the ACA.  Another evidence-based policy intervention brought to you by the Affordable Care Act.

 

CMS Denies Kansas’ Request for 3-year Lifetime Medicaid Eligibility

This week the Centers for Medicare and Medicaid Services Administrator denied Kansas’ request to impose a 3-year lifetime limits on Medicaid eligibility. 

Her decision bodes well for us in Arizona- at least when it comes to lifetime coverage limits (although CMS is poised to almost certainly approve AZ’s work/work training request).  Arizona law requires AHCCCS to annually ask CMS for permission to require work (or work training) and income reporting for “able bodied adults” and a 5-year lifetime limit on AHCCCS eligibility (with some exceptions).

A few months ago AHCCCS turned in their official waiver request asking permission to implement those requirements.  The AHCCCS Director recently postponed the negotiation process of the lifetime limit request to expedite approval of the work requirements.  See his letter here.  Word on the street is that AHCCCS expects approval of the work requirements in June.

 

Mid-year Federal Budget Cut Request

This week the White House submitted a special message to Congress requesting they rescind $15B bill in budget authority from the current fiscal year. The proposal includes unobligated balances from prior-year appropriations and reductions to budget authority for mandatory programs.

Below are selected programs proposed for rescission by the Administration that may impact public health programs. For more information, view the entire rescission proposal here.

  • Children’s Health Insurance Fund: The proposal would rescind $5B in amounts made available by the Medicare Access and CHIP Reauthorization Act of 2015 to supplement the 2017 national allotments to states, including $3B in unobligated balances available on October 1, 2017. 

  • Child Enrollment Contingency Fund: The proposal would rescind $2B in amounts available for the CHIP Contingency Fund, of which there were $2.4B available. The Contingency Fund provides payments to states that experience funding shortfalls due to higher than expected enrollment. 

  • Centers for Medicare and Medicaid Innovation (Innovation Center): The proposal would rescind $800M in amounts made available for FY11-19 for the Innovation Center, of which there were $3.5B available on October 2017. The Innovation Center was created to test innovative payment and service delivery models to reduce program expenditures under Medicare, Medicaid, and CHIP while preserving or enhancing quality care.

 

Speak for Health: Fund Public Health in 2019

As Congress begins its work on the FY 2019 appropriations process, Speak for Health and tell our members of Congress  to reject the proposed cuts to important public health programs in the president's budget proposal and instead to prioritize public health by building upon the important increased investments in public health provided by Congress in FY 2018.

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Most of you know Dr. Bob England, who's been on the AZ public health scene for the last 30 years including 12 years as the Director of the Maricopa County Public Health Department.  You know that he's a terrific cartoonist.  But did you know he's an engaging travel writer?

Bob's been living for the last couple of months just outside of London.  He's been writing some terrifically entertaining travelogues- with a splash of public health of course. Take a few minutes when you're on a comfortable couch and enjoy Travelogue 1 & 2: Getting Settled.  Here’s Travelogue 3: Nutrition. Enjoy.

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If you haven’t yet become a member of AzPHA please consider joining our team!

Here’s information about our Individual & Organizational Memberships

Medicaid Network Adequacy: A Key to Access to Care

AHCCCS is rolling out new integrated care contracts on October 1, and most members will be receiving services for both acute and behavioral care from these managed care organizations.  One of the keys to making sure that members have access to a health care provider when they need it is for AHCCCS to make sure each managed care organization has an adequate network of contracted providers.  After all, having health insurance isn’t much good if there’s no place for you to get care in your area or if the doctors are booked and you can’t get an appointment.  That’s where “network adequacy” comes in.

AHCCCS sets their network adequacy standards in what’s called their “AHCCCS Contractors Operations Manuals”, or ACOMs for short.  From now through May 28, 2018 AHCCCS is accepting public comment on their proposed ACOM manuals for network expectations for the integrated care contracts that start on October 1.

Geographic Standards

One of the keys is to make sure that there are providers reasonably nearby Medicaid members.  ACOM 436- Minimum Network Requirements will set the expectations for geographic access to care. It’s pretty long as you’ll see if you click on the link.  But here are a couple examples of the key proposed standards that are out for public comment. 

For kids, they propose requiring their contracted managed care organizations to ensure that 90% of members live within 10 miles or 15 minutes of a primary care provider in Maricopa and Pima counties.  For all other counties, they’re proposing that 90% of members lives within 30 miles or 40 minutes of a primary care provider.  For kids dental in Maricopa & Pima counties, they’re proposing requiring their contractors to make sure that 90% of members live within 15 minutes or 10 miles of a provider.  For the other counties, they’re proposing that 90% of members live within 40 minutes or 30 miles of a provider.

The Manual also proposing a process for managed care organizations ask for an exemption from the standards based on outlined reasons and the criteria by which they’ll consider approving the exemptions.  Those of you that are well versed in these aspects of access to care can comment on the proposed standards and the exemption criteria through May 28 at this web link.

Appointment Wait Time Standards

Another Manual that’s out for public comment is about how long it takes to make an appointment to see various kinds of providers.  That one is called ACOM 417, Appointment Availability, Monitoring and Reporting.

The 417 Manual proposes that routine primary care appointments be set within 21 calendar days of the member’s request.  For more urgent appointments, the proposal is for “… as expeditiously as the member’s health condition requires but no later than 2 business days of request”.  For Specialty provider referrals the proposal is “… as expeditiously as the member’s health condition requires but no later than 3 business days from the request”.  For routine specialty care appointments it’s within 45 calendar days of referral.  For dental provider appointments it’s “… as expeditiously as the member’s health condition requires but no later than 3 business days of request, and for routine care appointments within 45 calendar days of request

They’re also proposing a process for managed care organizations ask for an exemption from the standards based on outlined criteria.  They also outline the criteria by which they’ll consider approving the exemptions.

Those of you that are well versed in these aspects of access to care can comment on the proposed standards and the exemption criteria through May 28 at this web link.  We’ll talk this over with our Public Health Policy Committee and turn in comments sometime in May.  Let me know if you want to get onto our Policy Committee Basecamp and I’ll sign you up.

 

FDA Pursuing E-Cigarette Interventions

Last week the FDA announced several interventions to better regulate e-cigarette makers.  It’s no secret that e-cigarettes have become wildly popular with kids.  E-cig makers have become increasingly crafty in attracting kids to use their products- which often have high nicotine levels.  Some of the new products look like a USB flash drive- making it easier for them to sneak into what are supposed to be tobacco product free-areas.  Many fall under the JUUL Brand but also “myblu” and “KandyPens”.

The strategies that FDA announced last week include: 1) an “undercover” investigation into retailers that are selling these JUUL products to kids and issuing warning letters and other enforcement actions; 2) raising concerns with eBay regarding their listing of JUUL products on their website; 3) contacting manufacturers like JUUL Labs and requiring them to submit like documents like their product marketing strategy, research on the health, toxicological, and behavioral or physiologic effects of the products; and 4) enforcement actions focused on companies that are marketing products in ways that are misleading to kids.

Time will tell whether these strategies make a difference- but one thing is clear- we’ll continue to be in a long-term battle with companies that will continue to creatively find new ways to addict America’s youth to their nicotine products.

 

Legislative Session Update

There wasn’t much action on the public health bills we’re working on and tracking last week. Unless you’ve been out of town or on vacation you know that pretty much all last week was absorbed with the debate about weather and how to fund increases for K-12 schools.  There were huge peaceful marches on the Capitol on both Thursday and Friday.  The Legislature adjourned early last week.

The Governor has proposed increasing teacher salaries by 20% by the year 2020. The teachers are looking for a more robust commitment for all other school staff and a dedicated revenue stream to support the investment.  The Governor proposes paying for the increase in several ways- in part by increasing the assessment on hospitals to help pay for Medicaid, and in part by decreasing planned funding for things like provider increases for programs that serve people with disabilities (because of the increase in the minimum wage).  The plan assumes state revenue will increase by 4.8% per year over the next 3 years (over the last 3 years it’s increased by between 3 and 4% per year). 

Late last Friday afternoon the Governor issued a media release stating that an agreement had been reached with the legislature on a way to fund the 20% by 2020 idea, but the media release didn’t explain how it would be paid for.  Here’s the latest information that I have- but of course this could change when the actual proposal comes out later this week. Robert Robb from the Republic had the most digestible explanation of the plan that I’ve been able to find.

The phased-in cost of the teacher pay increase is $580M. The phased-in school-assistance portion is $370M (a total of $950M).  Maintaining all other state programs over that period is about $850M and that’s without any population increase or inflation.  At 4.8% revenue growth per year (the past 3-year average is between 3 and 4%) there’d be a $150M deficit in 2020 even if there were no increases in spending anywhere else in state government.  If revenue growth were less than 4.8%, there’d be a bigger deficit.  If revenue increases average more than 4.8% things might be OK.  If there’s a recession, we’d be in big trouble. 

You can see how important it is to get the revenue stream right.  If revenues and expenses are unbalanced, the increases for schools and teachers will absorb all other funds and there won’t be anything available to address public health or social determinant priorities and might even force reductions in other state services like health care and public health. 

 

Medicaid Changes Partially Support the Teacher Salary Proposal

There are a couple of “efficiency items” that the Governor identified within our Medicaid program that will partially pay for some of the teacher salary increase.  One relates to the assessment on hospitals that pays the state portion of the Medicaid expansion deal that was reached a few years ago.  The other is a proposed change to eliminate something called “prior quarter coverage”.

Hospital Assessment

One item listed as an “efficiency savings” to help pay for the teacher salary proposal increase the hospital assessment, which pays for Medicaid expansion, by $35 to $39M.  The Governor has proposed moving behavioral health services for childless adults to the same funding stream as acute care (tobacco taxes and the hospital assessment pay for acute care coverage for childless adults and those covered through Medicaid expansion).  The assessment on  hospitals would increase by 12% from $287 million to $326M.

Prior Quarter Coverage

Back on January 1, 2014 AHCCCS began covering people that qualify for Medicaid for the 3 months prior to their eligibility date.  So, if a person applying for AHCCCS qualifies during any portion of three months immediately preceding the month in which the member applied for AHCCCS coverage, they’ll reimburse providers for covered services.  They’ve submitted a waiver request to CMS to stop this practice.  In FY 2017 they spent a total of about $21M for prior quarter coverage- so stopping the practice would save about $11 - $12M in state funds. This waiver is in the hands of CMS right now.

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Here’s a snapshot of where the various bills we’re working on are in the system. 

HB 2038 Drug overdose review teams; records (Signed into Law)

HB 2071 Rear-facing car seats (Stalled in Senate)

HB 2084 Indoor tanning; minors; restricted use (Now called SB 1290 as Striker) 

HB 2127 Children's health insurance program (Now called SB 1087 as Striker)

HB 2197 Health professions, workforce data (Ready for Senate Floor Vote)

HB 2208 Prohibition, photo enforcement (Effectively dead)

HB 2228 Annual waiver, applicability (Signed by Governor)

HB 2323 Schools; inhalers; contracted nurses (Ready for Senate Floor Vote)

HB 2324 Community health workers; voluntary certification (needs Senate floor vote)

HB 2389 Syringe access programs; authorization (Basically dead)

HB 2484 local food tax; equality (Signed by Governor)

SB 1022 ADHS; homemade food products (Signed by Governor) 

SB 1083 Schools; recess periods (Signed by Governor)

SB 1245 Snap Benefit Match (Needs Rules Committee & Budget Line)

SB 1261 Texting while driving (Now HB 2159 traffic violations; traffic survival school)

SB 1420 Medical marijuana; inspection; testing; appropriation (Needs House Rules)

SB 1445 AHCCCS Dental care, pregnant women (Needs House Rules Committee)

SB 1377 Dental therapy, licensure, regulation (Failed in House now HB2235 in Senate)

SB 1389  HIV; needs assessment; prevention signed by the Governor last week.

SB 1394 Abortion reporting (Signed by Governor)

SCR 1005 Voter Initiative Sunset (striker in the House)

 

Public Health-related bills signed so far:

HB 2038 Drug overdose review teams; records was passed and signed.  Once it takes effect later this year, law enforcement agencies will now be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request. 

HB 2228 Annual waiver, applicability was signed by the Governor.  It’s good. It will direct AHCCCS to exempt tribes from their directed waiver request that asks for CMS permission to implement work requirements for some Medicaid members.  The recently submitted Waiver request includes an exemption for American Indians, however, this would place the exemption into statute.

HB 2323  Schools; inhalers; contracted nurses was signed by the Governor.  This bill adds contracted nurses to the list of people who are authorized to provide emergency inhaler medication in case of respiratory emergencies. Some charter and independent schools don’t employ nurses directly but engage them through contracts.

HB 2484 local food tax; equality, which will ban Arizona cities and counties from taxing sugary drinks as a public health intervention.

SB 1022  DHS; homemade food products ADHS will be required to establish an online registry of food preparers that are authorized to prepare "cottage food products" for commercial purposes. Registered food preparers would be required to renew the registration every three years.

SB 1083 Schools; recess periods was passed and signed!  Beginning next school year K-3 will need to have at least 2 recess periods. Grades 4 and 5 will need to have 2 recess periods the year after that.

SB 1389  HIV; needs assessment; prevention was signed by the Governor last week.  It requires the ADHS to establish and implement an HIV Action Program. 

SB 1394 Abortion reporting was passed by the House and signed by the Governor.  It will require the ADHS to collect and report additional data regarding abortions that are performed in AZ.

____

Federal Work Requirement Executive Order

Last week the President issued an Executive Order to the US Departments of Health and Human Services, Agriculture, and Housing charging them with reviewing the eligibility regulations for all of their public assistance programs (e.g. Medicaid, Medicare, SNAP, WIC, Section 8 Housing etc.) and check to see whether they have work requirements.  

If they don’t currently have work requirements, the Order charges them with determining whether the current law would allow them to do so.  Then, in 90 days, they’ll need to turn in a list of policy recommendations to “strengthen existing work requirements for work-capable people and introduce new work requirements”. The Order is of course more complex than I’ve described here- but you can read the whole thing here.

BTW: we expect AHCCCS' directed waiver that will require many (about 200,000) AZ Medicaid members to meet their work/school/community engagement requirements starting 10/1 to be approved any day now.

 

Phoenix Complete Streets

If you live or work in Phoenix, click here to send an email to the City Council members asking them to adopt and implement the Complete Streets Design Guidelines. Please be sure to send your email before the council meeting this Wednesday, April 18, and feel free to share this call to action with Phoenix friends. 

The Complete Streets Advisory Board recommended these design guidelines to the Council in 2015, but weren’t given the opportunity to vote and adopt them. It is now more than two years later, and we need your help to urge them to adopt the guidelines and move forward in protecting everyone who walks, bikes, uses public transportation, and drives on our streets. Thank you to Pinnacle Prevention for the heads up about this.

Send an email with one click!

 

Legislative Session Update

A Bill Called SB 1519 protective orders; schools; appropriations was proposed late last week by Senator Smith. It contains many of the things outlined by the Governor a few weeks ago related to firearms, schools and protection orders. The centerpiece is something called a “Severe Threat Order of Protection” which outlines a process to restrict firearm access for people who are a danger to themselves or others. The process is complicated and outside my area of expertise, so I’m trying to learn more about the proposal.  There are also measures that would require AHCCCS to develop and post suicide prevention training.  A statewide school safety hotline would also be established.

There’s no provision in the bill for comprehensive background checks or restrictions on things called “bump stocks” which makes guns fire quicker. Here’s a link to the introduced version of the bill.  You might need to sit down with somebody with a legal background if you really want to understand it. 

Hardly any organizations or persons are signed up either for or against the bill so far, and no hearing has yet been set in the Senate (It’s assigned to the Commerce and Public Safety Committee).  There’s no mirror bill in the House at their point.  Stay tuned.

SB 1445 AHCCCS Dental care, pregnant women is in the home stretch.  It’s cleared the full Senate but still needs a House Rules hearing and a floor vote. It will require some appropriation (to provide oral health coverage to pregnant Medicaid members)… so much of the discussion right now is about how much it would cost.

The direct cost to the state is estimated to be a little less than $268K.  However, the Joint Legislative Budget Committee believes that it could have secondary costs. Their thinking goes like this: some pregnant Medicaid enrollees that are not yet receiving prenatal care will discover that there is an oral health benefit and that the hygienist or dentist would inform their health plan of their pregnancy. These women would then switch their eligibility category to one with a higher state match rate (and presumably begin receiving prenatal care- which if it happened would be a good thing).  

Their analysis assumes that 25% of the estimated 5,000 pregnant women currently enrolled in the expansion population will switch their eligibility to the pregnant category generating a $3.7M refinancing cost because of the dental benefit.  It just seems to me that it’s unlikely that women that aren’t getting prenatal care from an OBGYN will present to a dentist or hygienist for a cleaning.  I can see it if they have a toothache, but that would likely be from the existing emergency dental benefit- not this new proposed preventative oral health benefit.  We’ll see what happens during the upcoming budget process.

HB 2324 Community health workers; voluntary certification is in the home-stretch.  It succeeded in the Senate’s Committee of the Whole (a voice vote) but wasn’t brought up for a final vote in the Senate as we had hoped (called 3rd Read) last week.  We hope to get on the Senate 3rd Read (final floor vote) calendar this week.

HB 2389 Syringe access programs; authorization basically looks dead for this year. The bill that passed the House was great- providing clear decriminalization of needle exchange programs (needle exchange programs are technically a class 6 felony right now).  The version that passed the Senate only decriminalizes syringe exchange programs when and where the ADHS declares a public health emergency because of the rapid spread of infectious diseases. 

It went to a Conference Committee this consisting of Rivero, Navarrete, Udall, Borelli, Brophy McGee, and Mendez… but Wednesday, Brophy McGee was replaced with Petersen, basically killing the House version- and the bill was dropped from the Conference Committee agenda- basically killing it.  Honestly, the Senate version of the bill wouldn’t have helped public health much if it all. Maybe next year.

HB 2228 Annual waiver, applicability was passed by the Senate and transmitted to the Governor.  It will direct AHCCCS to exempt tribes from their directed waiver request that asks for CMS permission to implement work requirements for some Medicaid members.  The recently submitted Waiver request includes an exemption for American Indians, however, this would place the exemption into statute.

SB 1394 Abortion reporting was passed by the House and signed by the Governor.  It will require the ADHS to collect and report additional data regarding abortions that are performed in AZ.

_______

Here’s a snapshot of where the various bills we’re working on are in the system. 

HB 2038 Drug overdose review teams; records (Signed into Law)

HB 2071 Rear-facing car seats (Stalled in Senate)

HB 2084 Indoor tanning; minors; restricted use (Now called SB 1290 as Striker) 

HB 2127 Children's health insurance program (Now called SB 1087 as Striker)

HB 2197 Health professions, workforce data (Ready for Senate Floor Vote)

HB 2208 Prohibition, photo enforcement (Effectively dead)

HB 2228 Annual waiver, applicability (Sent to Governor)

HB 2323 Schools; inhalers; contracted nurses (Ready for Senate Floor Vote)

HB 2324 Community health workers; voluntary certification (Needs Senate floor vote)

HB 2389 Syringe access programs; authorization (Effectively dead)

HB 2484 local food tax; equality (Signed by Governor)

SB 1022 ADHS; homemade food products (Signed by Governor) 

SB 1083 Schools; recess periods (Passed and Signed)

SB 1245 Snap Benefit Match (Needs Rules Committee & Budget Line)

SB 1261 Texting while driving (Now HB 2159 traffic violations; traffic survival school)

SB 1420 Medical marijuana; inspection; testing; appropriation (Needs House Rules)

SB 1445 AHCCCS Dental care, pregnant women (Needs House Rules Committee)

SB 1377 Dental therapy, licensure, regulation (Failed in House now HB2235 in Senate)

SB 1394 Abortion reporting (Signed by Governor)

SCR 1005 Voter Initiative Sunset (striker in the House)

 

Public Health-related bills that have been passed and signed so far:

HB 2038 Drug overdose review teams; records was passed and signed last week.  Once it takes effect later this year, law enforcement agencies will now be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request. 

HB 2484 local food tax; equality, which will ban Arizona cities and counties from taxing sugary drinks as a public health intervention.

SB 1022  DHS; homemade food products ADHS will be required to establish an online registry of food preparers that are authorized to prepare "cottage food products" for commercial purposes. Registered food preparers would be required to renew the registration every three years. 

SB 1083 Schools; recess periods was passed and signed!  Beginning next school year K-3 will need to have at least 2 recess periods. Grades 4 and 5 will need to have 2 recess periods the year after that.

SB 1394 Abortion reporting was passed by the House and signed by the Governor.  It will require the ADHS to collect and report additional data regarding abortions that are performed in AZ.

____

 

House Bills

HB 2038 Drug overdose review teams; records                

Passed and Signed

Law enforcement agencies will now be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request.  All information and records acquired by a Team are confidential and not subject to subpoena, discovery or introduction into evidence in a civil or criminal proceeding or disciplinary action.

 

HB 2071 Rear-facing car seats         

Stalled in Senate

This Bill would require kids under 2 years old to be in a rear-facing restraint system unless the child weights at least 40 pounds or is at least 40 inches tall.  We’ve signed up in support of this bill.  No action has yet been taken in the Senate so this bill is effectively dead.

 

HB 2084 Indoor tanning; minors; restricted use

Stalled in Senate- now SB1290 in House

This bill had been languishing in the Senate after passing the House by a 45-15 vote. Because of its lack of movement in the Senate it had appeared to be dead again this year.  However, this week it reappeared as a Strike All amendment in the House again as SB 1290.  It got a unanimous pass recommendation from the House Health Committee last Thursday- so was back in business but is now being held in House Rules. 

 

HB 2127 Children's health insurance program

Stalled in Senate- now SB 1087 in House

After passing the House, this bill had been languishing in the Senate and appeared dead.  However, it was resurrected this week in the form of SB 1087 and was passed again by the House Health Committee last Thursday.  It still needs another House floor vote before it goes back to the Senate again.  It would remove the trigger that automatically freezes the KidsCare program if FMAP (the federal contribution) drops below 100%.  

It allows the state to freeze it if costs are more than the state or federal allotment. The bill does not require the state to appropriate any money for a state share.  We’ve signed up in support of this bill because it provides a pathway to keep KidsCare if the federal government drops its contribution level. 

 

HB 2197 Health professions, workforce data

Ready for Senate Floor Vote

This bill is looking good and ready for a final Senate floor vote.  It would require AZ health licensing boards to collect certain data from applicants (beginning January 2020) to get better data about health professions workforce distribution and needs.  The data would be confidential.  Over the long-term this bill would be helpful in providing better data with which to improve the distribution and capacity of the public health workforce in Arizona.

 

HB 2208 Prohibition, photo enforcement

Died in Senate

This one would prohibit cities and other jurisdictions from having photo enforcement of red light and speeding violations.  While nobody likes getting a ticket in the mail, the data suggest that photo enforcement saves lives and prevents injuries (especially red-light photo enforcement).  We’ve signed up in opposition to the bill.  This bill passed the House 31-27 but stalled in the Senate.  Honestly, it looks dead.

 

HB 2228 Annual waiver, applicability

Transmitted to Governor

This would direct AHCCCS to exempt tribes from their directed waiver requests to CMS asking permission to implement work requirements for some Medicaid members.  The recently submitted Waiver request includes an exemption for American Indians, however, this would place the exemption into statute.

 

HB 2323  Schools; inhalers; contracted nurses

Ready for Senate Floor Vote

This bill adds contracted nurses to the list of people who are authorized to provide emergency inhaler medication in case of respiratory emergencies. Some charter and independent schools don’t employ nurses directly but engage them through contracts. Ready for a final Senate floor vote.

 

HB 2324 Community health workers; voluntary certification

Still needs Senate 3rd Read (Passed COW)

This succeeded in the Senate’s Committee of the Whole (a voice vote) but wasn’t brought up for a final vote in the Senate as we had hoped (called 3rd Read).  To get through COW, we supported an amendment to “grandfather” current CHWs who’ve worked for 6 months over 3 years as a CHW & to prohibit the state and subdivisions from offering preferential public contracts for voluntarily certified CHWs. We hope to get on the Senate 3rd Read calendar this week.

 

HB 2389  Syringe access programs; authorization

Effectively Dead

The bill that passed the House was great- providing clear decriminalization of needle exchange programs (needle exchange programs are technically a class 6 felony right now).  The version that passed the Senate only decriminalizes syringe exchange programs when and where the ADHS declares a public health emergency because of the rapid spread of infectious diseases. The bill died in a conference committee.

Maybe next year.

 

HB 2484 local food tax; equality

Signed by Governor

The Governor signed this bill, which bans Arizona cities and counties from taxing sugary drinks as a public health intervention. The bill doesn’t specifically mention taxes on sugary drinks, but states that any tax on food needs to be uniform.  products must be uniform. Right now, there aren’t any Arizona cities or counties that are taxing soda and other sugary drinks, and this new law will ensure that it stays that was.  

 

Senate Bills

SB 1022    DHS; homemade food products            

Signed by Governor

ADHS will be required to establish an online registry of food preparers that are authorized to prepare "cottage food products" for commercial purposes. Registered food preparers would be required to renew the registration every three years. This is a sensible addition to the current cottage industry food law and we’ve signed up in support.

 

SB 1083    Schools; recess periods

Signed by Governor

This was passed and signed!  Beginning next school year K-3 will need to have at least 2 recess periods.  Grades 4 and 5 will be added the following year. This makes AZ a national leader in state school recess policy. A big shout out to AzPHA member Scott Turner and Christine Davis from Arizonan’s for Recess for their heavy lifting to make this happen!

 

SB 1245 Snap Benefit Match

Needs House Rules Committee and Budget Line Item

This Bill needs House Rules review before a House floor vote (and of course needs to make it through the budget process). This good Bill would appropriate $400K to ADES to develop a produce incentive program within the Supplemental Nutrition Assistance Program for members to buy Arizona-grown fruits and vegetables.  It would also provide matching funds to SNAP-authorized vendors as an incentive to participate in the fruits and vegetable program. 

 

SB 1261 Texting while driving

Now HB 2159 and Moving Again in House

This has been languishing for the last few weeks because it hasn’t been called up for a floor vote in the Senate.  Last week, the language from SB 1261 was added as an amendment onto HB 2159 traffic violations; traffic survival school.  This bill, with the addition of the texting language, is now in the House awaiting a final vote.  

This would prohibit drivers from “using a portable wireless communication device to read, write, or send an electronic message while driving” (unless the car is stopped).  The first violation would be a petty offense with a fine between $25 and $99.

 

SB 1377 Dental therapy, licensure, regulation

Stalled in House now HB 2235

This bill failed to get a Pass recommendation from the House Health Committee last week (5-4) and is now HB 2235 as a striker.  It would have set up a new licensed class of dental professionals called a Dental Therapist. Their scope of practice would be somewhat less than a DDS, but they could do some procedures like filling cavities. This has been a somewhat controversial bill as there are stakeholders of both sides that are quite passionate about their position on this Bill.  

 

SB 1394 Abortion reporting

Signed by Governor

This one would require the ADHS to collect and report additional data regarding abortions that are performed in AZ. The data would be collected and reported by providers and would include the reason for the abortion (economic, emotional health, physical health, whether the pregnancy was the result of rape or incest, or relationship issues etc.).

 

SB 1420 Medical marijuana; inspection; testing; appropriation

Needs House Rules Approval

This would require the ADHS to set up testing standards for medical marijuana and begin enforcing the standards beginning in 2019.  We’re supporting this legislation.  It passed the full Senate last week and was given a Pass recommendation by the House Military, Veterans & Regulatory Affairs Committee this week.

 

SB 1445 AHCCCS Dental care, pregnant women

Needs House Rules and Floor Vote & a Budget Line Item

This unanimously cleared the House Appropriations committee last week.  We were hoping to get a Rules committee hearing next week, (Monday April 9) but it’s not on the agenda, sadly.  The big hurdle will be getting an appropriation to cover the state match into the budget.

 

SB 1470  Sunrise process; health professions

After a dramatic start, this bill looks like it will have a consensus ending.  The sunrise process bill stakeholders negotiated changes to the current scope of practice sunrise process that everybody seems to be able to live with.  It passed in House this week by a 59-0 vote. It’s now ready for the Senate to concur in the House’s amendment.

____________

 

Thanks to all of you that planned, sponsored, exhibited, presented, or attended our conference last week.  We still need to input the data from the evaluations- but we think it was a real success!

 

Mark your calendars for Wednesday, October 3, 2018 for our fall conference and annual members meeting.  Our topic will be about engaging public and behavioral health to improve outcomes.  It'll also commemorate our 90th anniversary!

 

 

AzPHA Public Health Policy Update: April 2, 2018

 

Legislative Session Update

SB 1083 Schools; recess periods passed in the House last week by a wide margin (57–1).  It was amended slightly from its original Senate version (giving grades 4 & 5 an extra year to implement).  It’s headed back to the Senate with the amendment.  District and charter schools would be required to provide at least 2 recess periods during the school day for pupils in grades K-5 if it passes. Good news.

SB 1445 AHCCCS Dental care, pregnant women unanimously cleared the House Appropriations committee this week!  The next stop is the House Rules committee (which shouldn’t be a problem).  It’ll then be ready for a House floor vote. The big hurdle will be getting an appropriation to cover the state match into the budget. We’re trying to get a closer estimate of what it’ll take for the state match.  Senator Yee is the sponsor- which is a good thing because she’s the Senate Majority leader and will be influential during the budget negotiations.

HB 2127 Children's health insurance program removes the trigger that would automatically freeze the KidsCare program if federal matching drops below 100%.  It was heard but not voted on in the Senate Appropriations committee last week.  The contents of the bill were struck onto SB 1087.  HB 2127 is now dead since it didn’t pass out of a committee in the Senate, but it’s still possible for SB 1087 to get voted out of the House and then it would need to go back to the Senate.

HB 2324 Community health workers; voluntary certification is up for a floor vote in the Senate this afternoon.  To smooth the pathway for final passage, we’re supporting an amendment to the original bill that would “grandfather” current CHWs who’ve worked for 6 months over 3 years as a CHW & to prohibit the state and subdivisions from offering preferential public contracts for voluntarily certified CHWs. If we pass this week in the floor vote (with the amendment) the bill get transmitted back to the House because of the amendment.

HB 2389 Syringe access programs; authorization passed the full Senate last week (22-8) but in a substantially weakened form. The original bill would’ve decriminalized needle exchange programs. The amendment only decriminalize programs when and where the ADHS declares a public health emergency because of the rapid spread of infectious diseases. The bill will now go back to the House to resolve the differences in the House and Senate forms.  Hopefully we can get the amendment removed.  If we can’t and it passes and is signed with the amendment it’ll have limited public health utility.

______

Here’s a snapshot of where the various bills we’re working on are in the system. 

HB 2038 Drug overdose review teams; records (Signed into Law)

HB 2071 Rear-facing car seats (Stalled in Senate)

HB 2084 Indoor tanning; minors; restricted use (Now called SB 1290 as Striker) 

HB 2127 Children's health insurance program (Now called SB 1087 as Striker)

HB 2197 Health professions, workforce data (Ready for Senate Floor Vote)

HB 2208 Prohibition, photo enforcement (Effectively dead)

HB 2228 Annual waiver, applicability (Needs Senate Rules Committee Approval)

HB 2323 Schools; inhalers; contracted nurses (Ready for Senate Floor Vote)

HB 2324 Community health workers; voluntary certification (Senate floor vote this week)

HB 2389 Syringe access programs; authorization (Passed Senate- going back to House)

HB 2484 local food tax; equality (Signed by Governor)

SB 1022 ADHS; homemade food products (Signed by Governor) 

SB 1083 Schools; recess periods (Passed House- going back to Senate)

SB 1245 Snap Benefit Match (Needs Rules Committee & Budget Line)

SB 1261 Texting while driving (Now HB 2159 traffic violations; traffic survival school)

SB 1420 Medical marijuana; inspection; testing; appropriation (Needs House Rules)

SB 1445 AHCCCS Dental care, pregnant women (Needs House Rules Committee)

SB 1377 Dental therapy, licensure, regulation (Failed in House now HB2235 in Senate as striker)

SB 1394 Abortion reporting (Ready for House Floor Vote)

 

Public Health-related bills that have been passed and signed so far:

HB 2038 Drug overdose review teams; records was passed and signed last week.  Once it takes effect later this year, law enforcement agencies will now be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request. 

HB 2484 local food tax; equality, which will ban Arizona cities and counties from taxing sugary drinks as a public health intervention.

SB 1022  DHS; homemade food products ADHS will be required to establish an online registry of food preparers that are authorized to prepare "cottage food products" for commercial purposes. Registered food preparers would be required to renew the registration every three years.

 

____

House Bills

HB 2038 Drug overdose review teams; records                

Passed and Signed

Law enforcement agencies will now be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request.  All information and records acquired by a Team are confidential and not subject to subpoena, discovery or introduction into evidence in a civil or criminal proceeding or disciplinary action.

 

HB 2071 Rear-facing car seats         

Stalled in Senate

This Bill would require kids under 2 years old to be in a rear-facing restraint system unless the child weights at least 40 pounds or is at least 40 inches tall.  We’ve signed up in support of this bill.  No action has yet been taken in the Senate so this bill is effectively dead.

HB 2084 Indoor tanning; minors; restricted use

Stalled in Senate- now SB1290 in House

This bill had been languishing in the Senate after passing the House by a 45-15 vote. Because of its lack of movement in the Senate it had appeared to be dead again this year.  However, this week it reappeared as a Strike All amendment in the House again as SB 1290.  It got a unanimous pass recommendation from the House Health Committee last Thursday- so was back in business but is now being held in House Rules. 

If it passes and is signed, tanning facility operators would be prohibited from allowing a person under 18 years of age to use a "tanning device" and tanning facilities couldn’t claim that using a tanning device is free from risk or has health benefits. We’ve signed on in support of this of course.

HB 2127 Children's health insurance program

Stalled in Senate- now SB 1087 in House

After passing the House, this bill had been languishing in the Senate and appeared dead.  However, it was resurrected this week in the form of SB 1087 and was passed again by the House Health Committee last Thursday.  It still needs another House floor vote before it goes back to the Senate again.  It would remove the trigger that automatically freezes the KidsCare program if FMAP (the federal contribution) drops below 100%.  It allows the state to freeze it if costs are more than the state or federal allotment. The bill does not require the state to appropriate any money for a state share.  We’ve signed up in support of this bill because it provides a pathway to keep KidsCare if the federal government drops its contribution level. 

HB 2197 Health professions, workforce data

Ready for Senate Floor Vote

This bill is looking good and ready for a final Senate floor vote.  It would require AZ health licensing boards to collect certain data from applicants (beginning January 2020) to get better data about health professions workforce distribution and needs.  The data would be confidential.  Over the long-term this bill would be helpful in providing better data with which to improve the distribution and capacity of the public health workforce in Arizona.

HB 2208 Prohibition, photo enforcement

Died in Senate

This one would prohibit cities and other jurisdictions from having photo enforcement of red light and speeding violations.  While nobody likes getting a ticket in the mail, the data suggest that photo enforcement saves lives and prevents injuries (especially red-light photo enforcement).  We’ve signed up in opposition to the bill.  This bill passed the House 31-27 but stalled in the Senate.  Honestly, it looks dead.

HB 2228 Annual waiver, applicability

Still Needs Senate Rules Committee

This would direct AHCCCS to exempt tribes from their directed waiver requests to CMS asking permission to implement work requirements for some Medicaid members.  The recently submitted Waiver request includes an exemption for American Indians, however, this would place the exemption into statute.

HB 2323  Schools; inhalers; contracted nurses

Ready for Senate Floor Vote

This bill adds contracted nurses to the list of people who are authorized to provide emergency inhaler medication in case of respiratory emergencies. Some charter and independent schools don’t employ nurses directly but engage them through contracts. Ready for a final Senate floor vote.

HB 2324 Community health workers; voluntary certification

Still needs Senate Floor Vote (this week)

This Bill is ready for a floor vote in the Senate, and we’re on the COW calendar in the afternoon of Monday, April 2.  To smooth the pathway for final passage, we’re supporting an amendment to the original bill that would “grandfather” current CHWs who have worked for 6 months over three years and prohibit the state or it's subdivisions from offering preferential public contracts for voluntarily certified CHWs.

This Bill is a top priority for us. It asks the ADHS to develop a voluntary certification program for community health workers. The rulemaking would include certification standards including qualifications, core competencies, and continuing education requirements.

HB 2389  Syringe access programs; authorization

Passed Senate in Weak Form- going back to House

This passed the full Senate last week (22-8) but in a substantially weakened form. The original bill essentially would have decriminalized needle exchange programs. One of the amendments from the Senate makes it so that needle exchange would only be decriminalized when and where the ADHS declares a public health emergency because of the rapid spread of infectious diseases. The bill will now go back to the House to resolve the differences in the House and Senate forms.  Hopefully we can get the amendment removed.  If we can’t and it passes and is signed as amended it’ll have limited public health utility.

HB 2484 local food tax; equality

Signed by Governor

Last week the Governor signed which will ban Arizona cities and counties from taxing sugary drinks as a public health intervention. The bill doesn’t specifically mention taxes on sugary drinks, but states that any tax on food needs to be uniform.  products must be uniform. Right now, there aren’t any Arizona cities or counties that are taxing soda and other sugary drinks, and this new law will ensure that it stays that was. 

The APHA has a Policy Statement on the topic that states in part that: Research has shown that “Sugar-sweetened beverages are price elastic: it is estimated that every 10% increase in price would decrease consumption by 10%. A recent study revealed that a penny-per-ounce tax would reduce consumption by 15% among adults 25–64 years of age and prevent 2.4 million diabetes person-years, 95,000 coronary heart events, 8,000 strokes, and 26,000 premature deaths.”

 

Senate Bills

SB 1022    DHS; homemade food products            

Signed by Governor

ADHS will be required to establish an online registry of food preparers that are authorized to prepare "cottage food products" for commercial purposes. Registered food preparers would be required to renew the registration every three years. This is a sensible addition to the current cottage industry food law and we’ve signed up in support.

SB 1083    Schools; recess periods

Passed House- going back to Senate again

This passed in the House last week by a wide margin.  It was amended slightly from its Senate version by giving grades 4 & 5 an extra year to implement.  It’s now headed back to the Senate with the amendment.  District and charter schools would be required to provide at least 2 recess periods during the school day for pupils in grades K-5 if it passes.  Good news.

SB 1245 Snap Benefit Match

Needs House Rules Committee and Budget Line Item

This Bill earned a Do Pass recommendation from the House Appropriations Committee 2 weeks ago and is now needs House Rules review before a House floor vote (and of course needs to make it through the budget process). This good Bill would appropriate $400K to ADES to develop a produce incentive program within the Supplemental Nutrition Assistance Program for members to buy Arizona-grown fruits and vegetables.  It would also provide matching funds to SNAP-authorized vendors as an incentive to participate in the fruits and vegetable program. 

This Bill would appropriate $400K to ADES to develop the infrastructure for a produce incentive program within the Supplemental Nutrition Assistance Program (SNAP) for members to buy Arizona-grown fruits and vegetables.  It would also provide matching funds to SNAP-authorized vendors as an incentive to participate in the fruits and vegetable program. 

SB 1377 Dental therapy, licensure, regulation

Stalled in House now HB 2235

This bill failed to get a Pass recommendation from the House Health Committee last week (5-4) and is now HB 2235 as a striker.  It would have set up a new licensed class of dental professionals called a Dental Therapist. Their scope of practice would be somewhat less than a DDS, but they could do some procedures like filling cavities. This has been a somewhat controversial bill as there are stakeholders of both sides that are quite passionate about their position on this Bill.  

SB 1394 Abortion reporting

Ready for House Floor Vote

This one would require the ADHS to collect and report additional data regarding abortions that are performed in AZ. The data would be collected and reported by providers and would include the reason for the abortion (economic, emotional health, physical health, whether the pregnancy was the result of rape or incest, or relationship issues etc.).  The bill was given a Do Pass recommendation last week by the House Judiciary & Public Safety Committee- although it was amended slightly by removing the requirement that physicians ask and report specifically why the woman is asking for the procedure.

SB 1420 Medical marijuana; inspection; testing; appropriation

Needs House Rules Approval

This would require the ADHS to set up testing standards for medical marijuana and begin enforcing the standards beginning in 2019.  We’re supporting this legislation.  It passed the full Senate last week and was given a Pass recommendation by the House Military, Veterans & Regulatory Affairs Committee this week.

SB 1445 AHCCCS Dental care, pregnant women

Needs House Rules and Floor Vote & a Budget Line Item

Last week SB 1445 AHCCCS Dental care, pregnant women unanimously cleared the House Appropriations committee this week!  The next stop is the House Rules committee (which shouldn’t be a problem). It would then be ready for a House floor vote. The big hurdle will be getting an appropriation to cover the state match into the budget. We’re trying to get a close to accurate estimate of what it will take.  Senator Yee is the sponsor- which is a good thing because she’s the Senate Majority leader and will be influential during the budget negotiations.

This is a priority Bill for AzPHA.  It would provide oral health coverage for pregnant Medicaid members.  The benefit would be limited to $1,000 and could be used for other than emergency dental procedures (beginning October 1, 2017 all adult Medicaid members became eligible for up to $1,000 in emergency dental services per year).  Lots of good public health reasons to support this one. 

SB 1470  Sunrise process; health professions

Passed Senate 21 – 9; being amended

SB 1470 would change the scope of practice system so that all a profession needs to do is prepare a written sunrise report right before the regular legislative session. It would allow the legislative standing committees (rather than Committees of Reference) to consider a sunrise proposal. During legislative session, long agendas and the fast pace limits the time to consider serious issues impacted by changes in scope of practice, including prescribing, complex health care procedures, complicated review, and reflection on curriculum, training and education.

We had a Public Health Policy Committee call last week and recommended to our Board that we take a position opposing the bill- which we did last week.  I testified that, rather than eliminating the pre-session hearings for scope of practice changes that they consider modifying the bill so that requests for new Scope changes go to the ADHS Director for a recommendation back to the Legislature. 

The Bill passed the House Government Committee last week.  There was reportedly a stakeholder meeting on the bill last week.  Still being Held in the House Rules Committee.

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Opioid Prescribing Continuing Medical Education

Beginning April 26, physicians will need to complete 3 credits/hours of opioid-related, substance use-related, or addiction-related continuing medical education each licensing cycle. The Arizona Center for Rural Health and Office of Continuing Medical Education (OCME) have developed free Arizona Opioid Prescribing Guideline courses to help facilitate compliance with this new requirement. The coursework offers modules on:

  • Safe Prescribing of Opioids for Pain Management
  • Safe and Effective Opioid Prescribing While Managing Acute and Chronic Pain
  • Managing Opioid Misuse Disorder in Pregnancy and Neonatal Care

These courses familiarize prescribers with current guidelines for opioid use and prescribing, as well as educate prescribers about non-opioid strategies for pain management. All courses offer AMA PRA Category 1 CreditTM. Access courses at: http://vlh.com/AZPRescribing.

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Remember to register for our April 11 Spring Conference:

Together for Tomorrow: Protecting Arizona’s Children

View Agenda | Sponsorship Packet

 REGISTER TODAY!

AzPHA Public Health Policy Update: March 6, 2018

Legislative Session Update

Good news.  Last week SB 1445 AHCCCS Dental care, pregnant women was passed by the Senate (27 – 3).  This Bill would provide oral health coverage for pregnant Medicaid members. It has moved on to the House and is assigned to the House Health Committee (which gave as similar bill a pass recommendation last year).  Because it involves money its also assigned to the House Appropriations Committee.  The benefit would be limited to $1000/year.  Lots of good public health reasons to support this one. 

There was more good news with the passage of SB 1245 Snap Benefit Match by the Senate (25 – 5).  It’s assigned to House Health and Appropriation Committees too.  This good Bill would appropriate $400K to ADES to develop a produce incentive program within the Supplemental Nutrition Assistance Program (SNAP) for members to buy Arizona-grown fruits and vegetables.  It would also provide matching funds to SNAP-authorized vendors as an incentive to participate in the fruits and vegetable program.  

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Committee Highlights this Week

 

Senate Health and Human Services Committee- 2 pm Wednesday March 7

HB 2324 Community health workers; voluntary certification

This Bill is a top priority for us. It asks the ADHS with developing a voluntary certification program for community health workers. The rulemaking would include certification standards including qualifications, core competencies, and continuing education requirements.  The good news is that it’s being heard this week (Wednesday afternoon) in the Senate Health & Human Services Committee.

The members of the committee are Nancy Barto, Katie Hobbs, David Bradley, Kate Brophy McGee, Kimberly Yee,  Judy Burges, and Rick Gray.  Please contact these members today and let them know you support voluntary registration of community health workers.  You can also sign in using the RTS system.  Here’s some sample language to use:

“Thank you for hearing HB2324 (community health worker voluntary certification) in your HHS Committee next week. Community health workers establish and maintain trust, enabling them to serve as a liaison between health/social services and facilitating access to services and work to provide high quality and culturally competent service delivery- important tools to reduce costs and improve outcomes- especially for chronic diseases like diabetes.

Voluntary certification is an important next step in better using the CHW workforce in AZ's managed care healthcare system.  While many providers currently employ and contract with CHWs, voluntary certification will provide an additional level of assurance that voluntarily certified CHWs meet a set of core competency requirements- allowing AZs provider network to elect to use this workforce to improve outcomes and reduce costs.”

 

HB 2197 Health professions, workforce data

This bill will also be heard in Senate Health and Human Services Bill Wednesday afternoon.  It would require AZ health licensing boards to collect certain data from applicants (beginning January 2020) to get better data about health professions workforce distribution and needs.  The data would be confidential.  Over the long-term this bill would be helpful in providing better data with which to improve the distribution and capacity of the public health workforce in Arizona.

 

Senate Government Committee - 2 pm Wednesday March 7

HB 2389  Syringe access programs; authorization

This important bill will also be heard Wednesday afternoon in the Senate Government Committee. It would decriminalize needle exchange programs.  It’s currently a felony to distribute needles to illegal drug users. Under this bill, persons, employees and volunteers operating within the scope of the law couldn't be charged or prosecuted for their activities. We’ve signed up in support of this bill because this type of program is evidence-based and reduces the spread of bloodborne diseases as well as engaging in intravenous drug users into treatment. 

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The following public health related bills passed their committee of origin and have gone over to the other chamber. Some have been assigned to committees in the new chamber, but some haven't yet.  Where available, I've listed the committee assignments in the detail section below.  We’re keeping track of the hearing dates and times.

HB 2038 Drug overdose review teams; records                

HB 2071 Rear-facing car seats

HB 2084 Indoor tanning; minors; restricted use      

HB 2127 Children's health insurance program

HB 2208 Prohibition, photo enforcement (we’re against this one)

HB 2228 Annual waiver, applicability (tribes)

HB 2324 Community health workers; voluntary certification

HB 2389 Syringe access programs; authorization

SB 1022 ADHS; homemade food products            

SB 1083 Schools; recess periods

SB 1445 AHCCCS Dental care, pregnant women

SB 1377 Dental therapy, licensure, regulation

SB 1394 Abortion reporting

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Remember to stay engaged and voice your opinion via the www.azleg.gov commenting system.  Click the following links for: Request to Speak account registration form; a Step-by-step use of the Request to Speak platform; and to Locate your Elected Officials 

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House Bills

HB 2038 Drug overdose review teams; records                

Passed the House 57-0-2

Assigned to Senate Health and Human Services Committee

Under this proposed Bill, law enforcement agencies would be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request.  All information and records acquired by a Team are confidential and not subject to subpoena, discovery or introduction into evidence in a civil or criminal proceeding or disciplinary action.  We’re signed up in support of this one of course.

 

HB 2071 Rear-facing car seats         

Passed House 33-25-1

Assigned to HHS & Commerce and Public Safety Committees 

This Bill would require kids under 2 years old to be in a rear-facing restraint system unless the child weights at least 40 pounds or is at least 40 inches tall.  We’ve signed up in support of this bill.  Dual assigned in the Senate.

 

HB 2084 Indoor tanning; minors; restricted use

Passed House 45 - 15

Assigned to Senate HHS and Commerce & Public Safety Committees

Tanning facility operators would be prohibited from allowing a person under 18 years of age to use a "tanning device". Tanning facilities couldn’t advertise or distribute materials that claim that using a tanning device is free from risk or will result in medical or health benefits. We’ve signed on in support of this of course. Bummer that it's dual assigned in the Senate.

 

HB 2127 Children's health insurance program

Passed House 46-12-1

Assigned to HHS & Appropriations Committees

This removes the trigger that automatically freezes the KidsCare program if FMAP (the federal contribution) drops below 100%.  It allows the state to freeze it if costs are more than the state or federal allotment. The bill does not require the state to appropriate any money for a state share.  We’ve signed up in support of this bill because it provides a pathway to keep KidsCare if the federal government drops its contribution level. 

 

HB 2197 Health professions, workforce data

Passed House 60 – 0

Assigned to HHS and Commerce & Public Safety Committees

This would require AZ health licensing boards to collect certain data from applicants (beginning January 2020) to get better data about health professions workforce distribution and needs.  The data would be confidential.  

 

HB 2208 Prohibition, photo enforcement

Passed the House 31-27-1

Assigned to the Senate Transportation Committee

This one would prohibit cities and other jurisdictions from having photo enforcement of red light and speeding violations.  While nobody likes getting a ticket in the mail, the data suggest that photo enforcement saves lives and prevents injuries (especially red-light photo enforcement).  We’ve signed up in opposition to the bill.  This bill passed the House 31-27 last week and is moving on to the Senate Transportation Committee.

 

HB 2228 Annual waiver, applicability

Passed the House 58-0-1

Assigned to Senate HHS Committee

This would direct AHCCCS to exempt tribes from their directed waiver requests to CMS asking permission to implement work requirements for some Medicaid members.  The recently submitted Waiver request includes an exemption for American Indians, however, this would place the exemption into statute.

 

HB 2324 Community health workers; voluntary certification

Passed House 56 – 1 - 3

Assigned to HHS and Commerce & Public Safety Committees

This is a top priority for us. It would charge the ADHS with developing a voluntary certification program for community health workers.  The Department rulemaking would include certification standards including qualifications, core competencies, and continuing education requirements. We’ve signed up in support of this bill.

Members of the committee are Nancy Barto, David Bradley, Kate Brophy McGee, Judy Burges, Rick Gray, Katie Hobbs, and Kimberly Yee.  You can contact these members directly by email (here is the list) and you can also sign in using the RTS system.

 

HB 2389  Syringe access programs; authorization

Passed House 56 – 0 - 4

Assigned to the Senate Government Committee

This important bill will also be heard Wednesday afternoon in the Senate Government Committee. It would decriminalize needle exchange programs.  It’s currently a felony to distribute needles to illegal drug users. Persons, employees and volunteers operating within the scope of the law can’t be charged or prosecuted for their activities. We’ve signed up in support of this bill because this type of program is evidence-based and reduces the spread of bloodborne diseases as well as engaging in intravenous drug users into treatment. 

 

Senate Bills

SB 1022    DHS; homemade food products            

Passed Senate 30-0

Assigned to House Health Committee

ADHS would be required to establish an online registry of food preparers that are authorized to prepare "cottage food products" for commercial purposes. Registered food preparers would be required to renew the registration every three years. This is a sensible addition to the current cottage industry food law and we’ve signed up in support. Being heard in the House Health Committee this week (Thursday).  Should have no problems at all.

 

SB 1083    Schools; recess periods

Passed Senate 26-3-1

Assigned to and Passed House Education Committee 9-0 on Monday

District and charter schools would be required to provide at least 2 recess periods during the school day for pupils in grades K-5 if this passes.  We’ve signed in support of this bill because there is good evidence that opportunities for physical activity at school are associated with improved health, behavior, and academic achievement of students.  Here is a good evidence review from the CDC entitled The Association Between School-based Physical Activity and Academic Performance. Great couple of weeks for this bill.

 

SB 1245 Snap Benefit Match

Passed Senate 25 - 5

Assigned to House Health and Appropriation Committees

This Bill would appropriate $400K to ADES to develop the infrastructure for a produce incentive program within the Supplemental Nutrition Assistance Program (SNAP) for members to buy Arizona-grown fruits and vegetables.  It would also provide matching funds to SNAP-authorized vendors as an incentive to participate in the fruits and vegetable program.  It passed the Health and Human Services Committee and the Appropriations Committee. We’ve signed up in support of this Bill. Being heard in Senate HHS Wednesday.

 

SB 1261 Texting while driving

Passed Transportation Committee- Ready for a Senate Floor Vote

This would prohibit drivers from “using a portable wireless communication device to read, write, or send an electronic message while driving” (unless the car is stopped).  The first violation would be a petty offense with a fine between $25 and $99.  It has passed its committees and is ready for a floor vote, which hasn’t happened yet.  Not a good sign.

 

SB 1377 Dental therapy, licensure, regulation

Passed Senate 22 – 8

Assigned to House Health Committee

This would set up a new licensed class of dental professionals called a Dental Therapist. Their scope of practice would be somewhat less than a DDS, but they could do some procedures like filling cavities. This has been a somewhat controversial bill as there are stakeholders of both sides that are quite passionate about their position on this Bill. 

 

SB 1394 Abortion reporting

Passed Senate 17 - 13

Assigned to the Judiciary and Federalism, Property Rights & Public Policy Committees

This one would require the ADHS to collect and report additional data regarding abortions that are performed in AZ. The data would be collected and reported by providers and would include the reason for the abortion (economic, emotional health, physical health, whether the pregnancy was the result of rape or incest, or relationship issues etc.).

 

SB 1420 medical marijuana; inspection; testing; appropriation

Passed Senate 27 – 3

Assigned to House Military, Veteran and Regulatory Affairs Committee

This would require the ADHS to set up testing standards for medical marijuana and begin enforcing the standards beginning in 2019.  We’re supporting this legislation.  It passed the full Senate last week.

 

SB 1445 AHCCCS Dental care, pregnant women

Passed Senate

Assigned to House Health & Appropriations Committees

This is a priority Bill for AzPHA.  It would provide oral health coverage for pregnant Medicaid members.  The benefit would be limited to $1000 and could be used for other than emergency dental procedures (beginning October 1, 2017 all adult Medicaid members became eligible for up to $1000 in emergency dental services per year).  Lots of good public health reasons to support this one. 

 

SB 1470  Sunrise process; health professions

Passed Senate

Assigned to House Government Committee

To be honest- this bill has been flying under the radar at least with me.  If it passes and is signed it’d make huge changes to the health professions scope of practice system we use today. The current sunrise process is a collaborative, inclusive process that allows time for consideration and review of the complicated health care delivery proposals.  The current process requires a Committee of Reference hearing, which allows a consideration of a proposed scope change and its potential patient safety and care implications.

SB 1470 would change the scope of practice system so that all a profession needs to do is prepare a written sunrise report right before the regular legislative session. It would allow the legislative standing committees (rather than Committees of Reference) to consider a sunrise proposal. During legislative session, long agendas and the fast pace limits the time to consider serious issues impacted by changes in scope of practice, including prescribing, complex health care procedures, complicated review, and reflection on curriculum, training and education.

We haven’t taken a position on this yet- but we’ll talk about it on our Public Health Policy Committee call on Monday.  Seems like the risks outweigh the benefits on this one.

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Public Health Bills that Failed to Thrive

HB 2064 Medical marijuana; packaging; labeling              

Dead for now

This Bill proposes that medical marijuana dispensaries be prohibited from selling a marijuana product that’s packaged or labeled in a manner that’s "attractive to minors". Due to voter protection, this legislation requires the affirmative vote of at least 3/4 of the members of each house of the Legislature for passage.  Dead for now.

 

HB 2109 Tobacco possession; sale; age; signage                

Sadly, dead for now

This Bill would prohibit furnishing a tobacco product to a person who is under 21 years of age. The definition of "tobacco product" is expanded to include "electronic smoking devices". We’ve signed up in support. It received a Do Pass recommendation from the House Health Committee three weeks ago but the Commerce chair hasn’t put it on the agenda, so it’s effectively dead for now. Kudos to Rep. Boyer for sponsoring this.

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APHA Legislative Update

On Feb. 9, President Trump signed the Bipartisan Budget Act of 2018. The new law raises the current spending caps for defense and nondefense discretionary spending in fiscal year 2018 and fiscal year 2019 by $165 billion and $131 billion, respectively. While APHA welcomed the increase in nondefense discretionary funding, the category of money that funds public health and other federal nondefense programs, the association is deeply disappointed that the bill also cut the Prevention and Public Health Fund by $1.35 billion over the next decade.

The bill used the cuts from the prevention fund in part to pay for reauthorizing community health centers, the National Health Service Corps and other expired health programs for two years. The bill also added an additional four years to the reauthorization of the Children’s Health Insurance program, bringing the total reauthorization for CHIP to 10 years. The bill passed the U.S. Senate by a vote of 71-28 and passed the House by a vote of 240-186.

After the bill passed, APHA issued a statement supporting the additional funding available for nondefense discretionary spending and urging Congress to work to ensure that some of the additional funding is directed to public health programs at the Centers for Disease Control and Prevention and the Health Resources and Services Administration.

The statement also expressed deep disappointment that Congress turned to cutting the prevention fund, a critical source of public health funding that currently makes up around 12 percent of the CDC’s entire budget. The Prevention Fund supports critical public health activities — including lead poisoning surveillance, vaccination initiatives and other programs — in every state and community across the country.

APHA members can send a message to their members of Congress urging them to ensure public health is adequately funded in FY2018.

AzPHA Public Health Policy Update: January 17, 2018

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.

The Arizona Community Action Association (ACAA) has created an alternative way for you to create an account.  You fill out this form granting the ACAA permission to create an RTS account on your behalf.  ACAA will create a default password for your account, which will need to be changed when you gain access to your account. 

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).

 

Public Health Bills So Far

The legislative session just started last week. We’re in the initial phases of digging into the bills that have been proposed so far.  There are still a few weeks left for lawmakers to propose new bills- but here’s a summary of the ones we’re tracking so far:

 

HB 2324 Community health workers; voluntary certification

SPONSOR: CARTER

This Bill would charge the ADHS with developing a voluntary certification program for community health workers.  The Department rulemaking would include certification standards including qualifications, core competencies, and continuing education requirements. We’ve signed up in support of this bill. 

 

SB 1010 Tobacco possession; sale; age; signage

SPONSORS: FARNSWORTH D, BOYER                 

This Bill would prohibit furnishing a tobacco product to a person who is under 21 years of age. The definition of "tobacco product" is expanded to include "electronic smoking devices". We’ve signed up in support of this bill.

 

HB 2071 Rear-facing car seats

SPONSOR: BOLDING                 

This Bill would require kids under 2 years old to be in a rear-facing restraint system unless the child weights at least 40 pounds or is at least 40 inches tall.  We’ve signed up in support of this bill.  It’s being heard in the House Transportation & Infrastructure Committee on Wednesday.

 

HB 2127 Children's health insurance program

SPONSOR: COBB

This Bill removes the trigger that automatically freezes the KidsCare program if FMAP (the federal contribution) drops below 100%.  It allows the state to freeze it if costs are more than the state or federal allotment. The bill does not require the state to appropriate any money for a state share.  

We’ve signed up in support of this bill because it provides a pathway to keep Kids Care if the federal government drops its contribution level.  This will be heard in House Health on Thursday.

 

HB 2389  Syringe access programs; authorization

SPONSOR: RIVERO

Under this Bill, organizations in Arizona may establish and operate a needle exchange program.  Persons, employees and volunteers operating within the scope of the law may not be charged or prosecuted for their activities. It’s currently a felony to distribute needles to illegal drug users.

We’ve signed up in support of this bill because this type of program is evidence-based and reduces the spread of bloodborne diseases as well as engaging in intravenous drug users into treatment.

 

SB 1083 Schools; recess periods

SPONSOR: ALLEN S

Under this Bill, district and charter schools would be required to provide at least 2 recess periods during the school day for pupils in grades K-5.  We’ve signed in support of this bill.

 

SB 1022    DHS; homemade food products

SPONSORS: FARNSWORTH D, KAVANAGH                 

Under this Bill, ADHS would be required to establish an online registry of food preparers that are authorized to prepare "cottage food products" for commercial purposes. Registered food preparers would be required to renew the registration every three years.  

This is a sensible addition to the current cottage industry food law and we’ve signed up in support.

 

HB 2040 Pharmacy board; definitions; reporting

SPONSOR: CARTER                 

This Bill proposes various changes to the Board of Pharmacy functioning including requiring a medical practitioner, pharmacy or health care facility that dispenses a controlled substance to submit the required informational report to the Board once each day. We’ve signed up in support.

 

HB 2038 Drug overdose review teams; records

SPONSOR: CARTER                 

Under this proposed Bill, law enforcement agencies would be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request.  All information and records acquired by a Team are confidential and not subject to subpoena, discovery or introduction into evidence in a civil or criminal proceeding or disciplinary action.  We’re signed up in support of this one.

 

HB 2084 Indoor tanning; minors; restricted use

SPONSOR: CARTER                

Under this proposal, tanning facility operators would be prohibited from allowing a person under 18 years of age to use a "tanning device". Tanning facilities are prohibited from advertising or distributing promotional materials that claim that using a tanning device is free from risk or will result in medical or health benefits. We’ve signed on in support of this.

 

SB 1007  Motorcycle operation; riding between lanes

SPONSOR: FARNSWORTH D                 

Under this proposal,motorcycle operators would no longer be prohibited from passing in the same lane occupied by the vehicle being overtaken and from operating a motorcycle between the lanes of traffic as long as they’re wearing a helmet.  

We haven’t taken a position on this yet.  Interesting that lane splitting would only be lawful if wearing a helmet.  Right now, only people under 18 are required to wear a helmet.  We’ll talk about this one in our public policy committee next week.

 

HB 2064 Medical marijuana; packaging; labeling

SPONSORS: LEACH                 

This Bill proposes that medical marijuana dispensaries be prohibited from selling a marijuana product that’s packaged or labeled in a manner that’s "attractive to minors". Due to voter protection, this legislation requires the affirmative vote of at least 3/4 of the members of each house of the Legislature for passage.  We’ll talk about this one in our public policy committee next week.

 

HB 2014  Marijuana; civil penalty

SPONSOR: CARDENAS                 

Under this proposal, possession, use, production, or transporting for sale an amount of marijuana weighing less than one ounce is subject to a civil penalty of up to $100, instead of being classified as a class 6 felony.  We’ll talk about this one in our public policy committee next week.

 

HB 2030  Pain treatment; dosage limit; prohibition

SPONSOR: LAWRENCE                 

Under this proposal, state or any other political subdivision would be prohibited from limiting the morphine milligram equivalents per day of a schedule II controlled substance that may be prescribed for pain management by a licensed health professional.  We’re likely to oppose this on (but we haven’t done so yet).  

We’ll take a position once we know the content of the upcoming opioid special session.

 

HB 2033  Drug overdose; good samaritan; evidence

SPONSOR: LAWRENCE                 

Under this proposal, a person who seeks medical assistance for someone (or themselves) experiencing a drug-related overdose and who needs medical assistance can’t be charged with possession or use of a controlled substance as a result of seeking medical assistance.  

We will likely support this bill- but like 2033, we’ll wait for the special session.

 

SB 1016  Duty to report; life-threatening emergency

SPONSOR: KAVANAGH                 

Under this proposed Bill, a person who knows that another person is exposed to or has suffered a life-threatening emergency is required to report the emergency and its location to a peace officer, fire department or other governmental entity responsible for public safety. Violations are a class 1 (highest) misdemeanor.  

This bill isn’t what appears to be on it’s surface because it’s effect would be to penalize those that do not call for medical assistance rather that providing an incentive to ask for assistance like HB 2033 would do.  We will likely oppose this bill.

 

Opioid Special Session?

There are rumors circulating about the Capitol that the Governor will call a Special Session next week to tackle bills related to the opioid epidemic.  The Special Session would be triggered by an Executive Order that would call for the session.  We’ll continue to track this and weigh in on the policy proposals that come out of the session.

 

Federal Budget Update

Last night, Rep. Frelinghuysen, chairman of the House Appropriations Committee, released the text of a Continuing Appropriations Act (H.J. Res 125). Fortunately, in this proposal, the Prevention and Public Health Fund isn’t used as an offset in this legislation. The bill includes the following provisions relevant to public health:

  • Federal Funding: The current continuing resolution expires this Friday, Jan. 19. This bill extends funding for the federal government through Feb. 16. 
  • Children’s Health Insurance Program (CHIP): Extends funding for the CHIP program through FY23, provides a 11.5% Federal Matching Assistance Percentage (E-FMAP) in FY20, and returns to the traditional pre-Affordable Care Act matching rate in FY21, FY22, and FY23. 

There are many people that follow the federal budget process closely that believe it’s likely that there will be a temporary federal government shutdown because of complex issues like immigration reform and a border wall.