Will Humble Opioids, Wills Blog

AzPHA Public Health Policy Update: January 24, 2018

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 publicinput@azahcccs.gov.

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.

Will Humble State Legislature, Wills Blog

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.

Will Humble Uncategorized, Wills Blog

Public Health Policy Update: January 10

Governor to Call Special Session on Opioid Epidemic

During his State of the State address yesterday the Governor suggested that he’ll call for a Special Session of the Legislature to address legislation to mitigate the opioid epidemic in AZ. He said a package of opioid legislation will be released the week of January 15 along with an Executive Order calling for a special session. 

The legislative proposals will likely be aligned with the ADHS’ September 5 opioid report which is robust and has many practical and specific recommendations.  

There are literally dozens of specific recommendations, but I picked out a few of the more interesting ones below:

  • Impose a 5-day limit on all first fills for opioid naïve patients for all payers;
  • Require pharmacists to check the CSPMP prior to dispensing an opioid;
  • Require 3 hours of opioid-related CME for all professions that prescribe or dispense opioids;
  • Establish an all payers claims database to establish better surveillance data;
  • Eliminate dispensing of controlled substances by prescribers;
  • Regulate pain management clinics to prohibit “pill mill” activities;
  • Establish enforcement mechanisms for pill mills and illegal opioid dispensing;
  • Enact a good Samaritan law to allow bystanders to call 911 for a potential opioid overdose; and
  • Urging AHCCCS to ask permission to pay for substance abuse treatment in correctional facilities.

For the full picture you can visit the Report which is quite impressive and a testament to the team that developed the report.

We’ll be closely following the Special Session and we’ll be advocating for proposals that are evidence-based and likely to make a difference.

 

AHCCCS Caps First Fill Opioid Prescriptions at 5 Days

AHCCCS issued a new policy that imposes “first fill limits” of 5 days for opioid prescriptions (the former limit was 7 days).  You can review the changes to the AHCCCS Medical Policy Manual 310-V, Prescription Medications-Pharmacy Services.

 

Federal Prosecutor Changes Medical Marijuana Guidance

The U.S. Department of Justice issued a memo last week that outlines the Administration’s federal marijuana enforcement policy. The memo basically directs U.S. Attorneys to enforce the Controlled Substances Act and to “follow well-established principles when pursuing prosecutions related to marijuana activities”.  It also reinforces “local control to federal prosecutors” regarding how to deploy Justice Department prosecutorial resources.

The memo ends the 2009 “Ogden Memo” policy that discouraged federal law enforcement and prosecutors from pursuing persons and organizations (e.g. dispensaries and cultivation facilities) in states where the drug is legal for medical and recreational use when people and organizations are acting in accord with their state’s laws.

The new policy could have implications for Arizona’s Medical Marijuana program.  With the issuance of this memo it’ll be up to Acting US Attorney for Arizona Elizabeth Strange to make decisions about what to do regarding persons that are in accord with the AZ Medical Marijuana Program but are in violation of the federal Controlled Substances Act.

 

Federal Comment Period on AHCCCS Work Requirement Request

A 2015 AZ law requires AHCCCS to annually ask CMS for permission to require work (or work training) and income reporting for “able bodied adults” as well as a 5-year lifetime limit on AHCCCS eligibility.

A few weeks ago AHCCCS turned in their official waiver request asking permission to implement the following requirements for certain adults receiving Medicaid services: 

  • A requirement to become employed, actively seek employment, attend school, or partake in Employment Support and Development activities (with exceptions);
  • A requirement to bi-annually verify compliance with the requirements and report changes in family income; and
  • Limit lifetime coverage for able bodied adults to 5 years (with exceptions).

The federal public comment period is open through February 5. You can review the AHCCCS waiver application and submit comments on the CMS website.  AzPHA will be submitting comments consistent with the letter that we submitted to AHCCCS back in February.

 

AzPHA Public Health Policy Committee

Our AzPHA Public Health Policy Committee will get into full seasonal swing shortly. Our first 2018 call will be on Monday January 22 at 11am.  

We discuss the various state bills that are under consideration (including budget bills) and talk about advocacy strategies.  We also talk about federal advocacy strategies.

Our Public Health Policy Committee has a Basecamp site where we post policy documents, bills, and research.  We also schedule our meetings through the Basecamp. 

Contact tiffany@azpha.org if you’re a member and you’d like to join our Public Health Policy Committee and/or get access to the Policy Committee Basecamp.

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