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Special Session Produces Opioid Intervention Product

Last week’s Special Session of the Legislature produced a robust new law that includes a host of new interventions to address Arizona’s opioid epidemic.  Here’s a link to the official document that describes the final new law.

Various pieces go into effect at different times, so all the provisions won’t be implemented all at once.  Some things have an expiration date.  For example, the Good Samaritan component of the law expires on July 1, 2023.

The new law has over 90 provisions that impact prescribing and dispensing practices, criminal prosecution, drug drop off locations, educational programs and a new fund to assist with treatment.  If you’re interested, the best thing is to examine it in detail.

This was a textbook example of solid public health policy development that included enhanced surveillance and analysis, a literature review, research of best practices, stakeholder input, and bipartisan consultation that resulted in a consensus bill.  It’s not perfect (for example it doesn’t decriminalize needle exchange) but it’s a testament to good public policy-making.

 

New Bills this Week

Before we get to the committee agendas for this week- here are a couple of new bills that were proposed.  AzPHA supports both of them.

SB 1445 AHCCCS Dental care, pregnant women

This is a priority Bill for AzPHA.  It would provide oral health coverage for pregnant women who receive their health insurance coverage through AHCCCS.  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.

HB 2443  Medical services purchase, premiums

The Bill would essentially allow Arizonans that don’t normally qualify for Medicaid to buy Medicaid health insurance.  It would ask AHCCCS to write the rules and regulations for the program including setting a premium that ensures people buying in would pay full freight.  If approved, it would allow people to buy in beginning on October 1, 2019.  The bill is also contingent on CMS approval.

 

Committee Hearings this Week

Now that the Special Session is finished, the various House and Senate committees are back in full swing.  Several of the priority public health bills that we’re following are progressing through the system. 

Below is a summary of the committee hearings… I’ve pasted a quick summary of the Bills that are being heard this week.  After that is a listing of the other bills that haven’t been heard in their committees yet.

Remember to stay engaged and voice your opinion via the www.azleg.gov commenting system. I gave a summary of how to sign up for the system in my policy update 2 weeks ago.

Tuesday

House Commerce, Tuesday, 1/30 @ 2 pm, HHR 1

HB 2064 Medical marijuana; packaging; labeling              

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’re supporting this bill.

 

Wednesday

Senate Government, Wednesday, 1/31 @ 2 pm, SHR 109

SB 1420 medical marijuana; inspection; testing; appropriation

This Bill 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.

 

House Judiciary & Public Safety, Wednesday, 1/31 @ 2 pm HHR 4

HB 2038 Drug overdose review teams; records                

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.

Thursday

House Health, Thursday, 2/1 @ 9 am, HHR 4

HB 2084 Indoor tanning; minors; restricted use

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.

HB 2109 Tobacco possession; sale; age; signage                

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 2197 Health professions, workforce data

This Bill 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 2228 Annual waiver, applicability

This Bill 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

This Bill 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. 

 

Public Health Related Bills Waiting in the Wings

House Bills

HB 2071 Rear-facing car seats         

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.  This Bill cleared the House Transportation & Infrastructure Committee last Wednesday.

HB 2208 Prohibition, photo enforcement

This Bill 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 cleared the House Judiciary and Public Safety Committee last week.

HB 2127 Children’s health insurance program

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 KidsCare if the federal government drops its contribution level.  This one cleared the House Health Committee a couple of weeks ago.

HB 2389  Syringe access programs; authorization

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. No hearings scheduled yet.

 

HB 2222 Feminine hygiene products, requirements

This Bill would require the Arizona Department of Corrections to offer female inmates an unlimited supply of feminine hygiene products free of charge. We signed up in support.

 

Senate Bills

SB 1007  Motorcycle operation; riding between lanes          

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 if they’re wearing a helmet.  We decided to take a position against this one in our Public Health Policy Committee last week.

SB 1022    DHS; homemade food products            

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.

SB 1083 Schools; recess periods

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 1245 Snap Benefit Match

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.  We’ve signed up in support of this Bill.  It hasn’t been scheduled for a committee hearing yet.

SB 1250 Food Producers, Ordinances

This Bill would make it clear that cities, towns and counties can’t restrict food producers including community gardens from producing food products with some exceptions and inspection authority.

Thanks… and check out our upcoming Spring Conference “Together for Tomorrow: Protecting Arizona’s Children at www.azpha.org.

 

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Will Humble

Executive Director, AZPHA

 

Opioid Special Session this Week

The Governor called a Special Session of the Legislature this week to facilitate the passage of a series of statutory changes to address Arizona’s Opioid epidemic. The Bill (called HB 2001 in the House) tackles a wide range of issues as identified in ADHS’ September 5 report.  Some of the interventions include:

• Limiting the first-fill of opioid prescriptions to 5 days for opioid naïve patients and limiting dosage levels to align with federal prescribing guidelines (exemptions are included for cancer, trauma or burn patients, hospice or end-of-life patients, and those receiving medication assisted treatment for substance use disorder);
• Expanding access to Naloxone for law enforcement or corrections officers;
• Increasing oversight mechanisms, and enacting criminal penalties for manufacturers who defraud the public about their products;
• Enhancing continuing medical education for all professions that prescribe or dispense opioids;
• Enacting a Good Samaritan law to allow people to call 911 for a potential opioid overdose;
• Requiring e-prescribing;
• Requiring all pharmacists to check the Controlled Substances Prescription Monitoring Program prior to dispensing an opioid or benzodiazepine; and
• Identifying gaps in and improving access to treatment, including for uninsured or underinsured Arizonans, with a new $10 million investment.

The Bill is moving rapidly and received a pass recommendation from the House Health Committee on Tuesday. The expedited process and the Stakeholder meetings that were included during its development will likely result in quick passage and approval. AzPHA has signed up in support of the measure.

 

AHCCCS Proposes Ending “Prior Quarter Coverage”

Under Medicaid law, states are required to provide coverage beginning 3 months prior to the person’s application if the person would have been eligible during those months. Medicaid covers unpaid medical bills incurred during that time. 

The retroactive coverage ensures that enrollees aren’t hit with medical bills for the 3 months before they applied for Medicaid if their income was so low that they would have been Medicaid eligible. It also provides an incentive for doctors and hospitals to treat uninsured Medicaid eligible people because they’ll be paid for the services once the person is enrolled. 

AHCCCS is proposing a Prior Quarter Coverage Waiver Amendment asking CMS’ permission to stop covering “prior quarter” coverage. The public has until February 25 to comment on the proposal.  Written comments can be sent to [email protected].

You may want to think about framing your comments by urging CMS to require a 6 month or 1-year limit on the waiver and make final approval conditional upon an evaluation of the impact on hospitals’ and community providers’ uncompensated care burden as well as the effect on consumer medical debt and gaps in coverage prior to enrollment.

 

Federal Budget Deal Includes CHIP

The (temporary) federal budget bill that was passed and signed this week included a 6-year extension of the federal Children’s Health Insurance Program (called KidsCare in AZ).

Importantly, the federal contribution rate of 100% will stay in place until October 1, 2019.  When AZ approved the KidsCare program a couple of years ago- it was contingent on the fed’s continuing to pay 100% of the costs for the program. Under the current statute, if the federal contribution drops the program would be automatically frozen.

HB 2127 would remove the trigger that automatically freezes the KidsCare program if FMAP (the federal contribution) drops below 100% and allow the state to freeze it if costs are more than the state or federal allotment. 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.

 

AZ Legislative Update

Last week I covered the Bills relating to public health that had been proposed as of last week.  Here are the new bills from this week:

 

SB 1245 Snap Benefit Match

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.  We’ve signed up in support of this Bill.  It hasn’t been scheduled for a committee hearing yet.

 

SB 1250 Food Producers, Ordinances

This bill would make it clear that cities, towns and counties can’t restrict food producers (including community gardens) from producing food products with some exceptions and including inspection authority. 

 

HB 2208 Photo Enforcement

This bill would prohibit cities and other jurisdictions from having photo enforcement for red light running and speeding.  While nobody likes getting a ticket in the mail, the data suggest that photo enforcement saves lives and prevents injuries (especially photo red lights).  We’ve signed up in opposition to the bill.  SB 2208 will be heard in the House Judiciary and Public Safety Committee on Wednesday afternoon.

 

Bills Being Heard in Committee this Week

 

HB 2324 Community Health Workers; Voluntary Certification

This Bill (which is a priority for AzPHA) is being heard in the House Health Committee on Thursday, January 25.  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.

 

HB 2084 Indoor tanning; minors; restricted use

This Bill will be heard in the House Health Committee on Thursday.   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.

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Yuma County Gets Grant to Combat Childhood Poverty

The National Association of Counties has selected Yuma County to be part of the Rural Impact County Challenge: National Effort to Combat Childhood Poverty.  The program is a partnership between the National Association of Counties and the Robert Woods Johnson Foundation’s County Health Ranking and Roadmaps Program.  

Yuma County is part of a cohort of 11 communities selected nationwide to participate.  A link to the program can be found here: http://www.naco.org/resources/programs-and-services/rural-impact-county-challenge-national-effort-combat-rural-child.