State Legislature Is In Full Swing: Here are the Bills We’re Tracking and Taking Positions On

Our Public Health Policy Committee has taken our first look at the bills that have been proposed so far and taken positions on about 35 of them. Just a few of them have been heard in their committees so far. We will continue to track and evaluate our positions on them as they go through the system and get amended. 

We will likely add new bills to our track list, and as bills languish or die, we will refine the list to focus on our A-list items. I’ll be down at the Senate Appropriations committee this week for sure, and maybe a couple others.

Public Health Emergency

SB1009 – state of emergency; executive powers OPPOSED but evaluating

Beginning on the first day of the next governor’s term, this new law would cap the length of a Governor’s public health emergency declaration at 30 days but allows the Governor to extend the state of emergency for up to 120 days in 30-day increments. Terminates a state of emergency after 120 days, unless extended by the Legislature. Allows the Legislature to extend the state of emergency as many times as necessary in up to 30-day increments.

HB2022  health emergencies; treatment; vaccinations; repeal OPPOSED

This bill eliminates public health emergency authority that currently allows the ADHS Director to mandate vaccinations in exposed persons in some circumstances

Vaccines

HB2029  vaccinations; evidence of immunity; prohibitions OPPOSED

Prohibits government entities from requiring a COVID vaccine as a condition of employment. Also prohibits them from contracting with any private business that requires vaccination. Has an conditional exemption for healthcare institutions.

HB2043 employer liability; COVID-19 vaccine requirement OPPOSED

Makes employers liable for damages if the employer denies a religious exemption and requires a person to receive a COVID-19 vaccination and significant injury results from receiving the vaccine.

HB2064  DHS; school immunizations; exclusions. OPPOSED

Prevents ADHS Director from ever adding COVID19 or HPV vaccines to the list required for school attendance

HB2065 school immunizations; nonattendance; outbreak OPPOSED

Removes that ability to exclude unvaccinated students from school during a school outbreak

HB2086 DHS; school immunizations; exclusions OPPOSED

Prevents ADHS Director from ever adding COVID19 or HPV vaccines to the list required for school attendance

HB2191 – school immunizations; DHS; exclusions OPPOSE

Prohibits ADHS from adding HPV, COVID-19 or anu vaccine that is just emergency use authorized to list of vaccines required for school attendance.

HB2452  – antidiscrimination; employment; vaccination status OPPOSED

Prevents ‘discrimination’ against anybody because of the vaccination status

Family Planning

SB1044 contracts; grants; exclusions; sex education OPPOSED

Prohibits ADHS from contracting with any entity that ‘provides or promotes abortion’ on their Personal Responsibility Education Program (PREP) or the Sexual Risk Avoidance Education Grant Program (SRAE) grants. Adds Title X (if ADHS ever applies for that again).

Criminal Justice

HB2033 juvenile offenders; monetary sanctions; repeal SUPPORT

Removes statute relating to court-ordered fees and fines for juveniles, except for victim restitution and specific driving under the influence offenses. Appropriates $2,531,000 from the state General Fund for costs relating to juvenile treatment services and court services.

Food Insecurity

HB2060 – supplemental nutrition assistance program; eligibility SUPPORT

Expands Supplemental Nutrition Assistance Program (SNAP) eligibility to individuals with felony drug convictions. Requires specified individuals who are eligible for SNAP to comply with probation conditions.

Housing

HB2606 – school districts; housing facilities; teachers SUPPORT

permits all school districts to leverage district-owned property and facilities toward the development of housing for staff.  Current statute limits these “teacherages” to rural and tribal communities.  This bill would expand these abilities to urban and suburban districts.  It’s a technical change to existing statute, but should have promising health, educational and economic impacts.

Maternal and Child Health

HB2111 appropriation; healthy families program SUPPORT

Appropriates $10 million from the state General Fund in FY 2023 to the Department of Child Safety for the Healthy Families Program.

HB2113 developmental disabilities; Down syndrome SUPPORT

Automatically qualifies persons with Down Syndrome for AHCCCS’ Long Term Care program (they currently need to go through a qualification process).

HB2311 – school health program; appropriation SUPPORT

Requires school districts (and charters) to have evidence-based school health programs. Provides funding for such programs.

Tobacco

HB2125 electronic smoking devices; retail licensing SUPPORT

This is the ‘good’ tobacco control bill. Has a host of evidence based interventions including retail licensing with proper enforcement.

SB1245  tobacco; vapor; alternative nicotine; regulation OPPOSED

Regulates tobacco products but in a bad way that isn’t evidence based. It preempts local jurisdictions from doing more than state law. Includes a tobacco license though, with weak enforcement. Would be managed by the LLC.

Access to Care

HB2144 – health insurance coverage; biomarker testing SUPPORT

Requires health insurance plans to begin covering biomarker testing. Important bill as emerging therapies rely on biomarker testing to target therapies. Medicaid is included!

HB2155 – health information organizations; research; disclosures SUPPORT

Makes deidentified health information more available for research.

HB2161 parental rights; schools; educational records OPPOSE

Expands statutory parental rights regarding the upbringing, education, health care and mental health of a parent’s minor child.

Special Needs & Disabilities

HB2382 – appropriation; health programs; disabilities SUPPORT

Appropriates $1 million to ADHS for grants to statewide organizations dedicated to “promoting evidence based, inclusive health programs for people with intellectual and developmental disabilities”.

HB2157 supplemental appropriations; community-based services SUPPORT

(Cleared House Appropriations 11-1) Appropriates $1,440,732,800 of expenditure authority and $30,121,100 from the Children’s Health Insurance Program (CHIP) Fund in FY 2022 for home and community-based services and funding formula requirements.  This will leverage $1.5B in mostly American Rescue Plan Act funds over the next 2 years to improve Home and Community Based Services for folks in their Long-Term Care Program (ALTCS).

$1B will go for badly needed investments to promote and stabilize access to supportive services, and workforce retention/ consistency to improve member outcomes ($1B)

Clean Energy & Climate

SB1132 – municipal bonds; environmental; prohibition OPPOSED

Prohibits the use of municipal bonds for any project that is “green”. Defines anything green as basically anything to do with climate change, carbon emissions, or clean energy. Excludes other pollutants regulated by ADEQ.

HB2403– appropriation; ADE; electric school buses SUPPORT

Appropriates $1.5M for a pilot program for electric school buses

SB1150 electric vehicles; pilot program; appropriation SUPPORT

Appropriates $500K from the General Fund to the Arizona Department of Administration (ADOA) for the Electric Vehicle-Ready Homes Pilot Program.

SB1151 – charging station; pilot program; appropriation SUPPORT

Appropriates $500K from the General Fund to ADOA to establish the Electric Vehicle Charging Station Pilot Program.

SB1152 – zero emission vehicles; plans SUPPORT

Requires ADOT to work in coordination with ADOA and ADEQ to develop a Zero Emission Vehicle Plan.

SB1153  state zero emission vehicle fleet SUPPORT

Requires state agencies to buy zero emission vehicles when they buy new cars (when feasible).

SB1154 transportation electrification study committee SUPPORT

Establishes the Transportation Electrification Study Committee

Women’s Health

HB2534 diapers; feminine hygiene; exemption SUPPORT

Exempts feminine hygiene products from sales taxes.

SB1164 – abortion; gestational age; limit OPPOSE Thursday in judiciary

Except in a medical emergency, prohibits physicians from performing an abortion after 15 weeks gestation as measured starting on the 1st day of the last menstrual period. Punishes the doctor with a felony and unprofessional conduct on her or his license. No exemptions for rape etc.

SB1272 AHCCCS; postpartum care; eligibility; appropriations  SUPPORT

(Being heard in Senate Appropriations 2/1/22) Allows AHCCCS to pursue eligibility for postpartum care for members for 1 year post-delivery up to 161% of federal poverty limit. Expanded eligibility currently ends at delivery. Still requires CMS approval.

Violence and Firearms

SB1123 disruption; educational institution; concealed weapon OPPOSED

Prohibits the governing board of any university, college, or community college from prohibiting the possession of a concealed weapon by a concealed weapon permit holder, or the transportation or storage of a firearm.

State Agency Administration

SB1175 – noncustodial federal monies; appropriation OPPOSE

The legislature would need to appropriate federal funds that come through grants- including for example the maternal and child health block grant, WIC, SNAP, and many others.

Behavioral Health

SB1210 mentally ill; transportation; evaluation; treatment SUPPORT

Stops the current practice of requiring that a police officer attend behavioral health ambulance transports.

SB1162 opioid prescriptions; intractable pain; exceptions Neutral but evaluating

Exempts patients with perioperative surgical pain, intractable pain or chronic intractable pain from statutory opioid prescription dosage restrictions.

Arizona Blows Through the 26,000 COVID Death Mark in the Absence of Mitigation from Governor Ducey and Interim Director Herrington

View Dr. Joe Gerald’s Weekly Epidemiology & Hospital Occupancy Report

Arizona blew through the 26,000 COVID death mark this week. Weekly death totals in the upper-300s, mid-400s are likely for several more weeks. Arizona still stands in 2nd place in COVID deaths per capita, trailing only Mississippi.

Within 2-3 weeks Arizona will have the distinction of being:

#1 in COVID deaths per capita (once we pass Mississippi)

#1 in increased all-cause mortality over baseline

The only state in which COVID19 is the leading cause of death

COVID-19 hospital occupancy continues its march upward in the face of no mitigation policy from Governor Ducey & Interim Director Herrington. Hospitals are burdened by >30% occupancy in general wards and in the ICU. Access to care continues to be restricted by both COVID-19 occupancy and staff shortages because of infections among healthcare workers (or their family members).

Arizona continues to have historic levels of community transmission attributable to Omicron and the lack of mitigation policies. Test positivity is incredibly high reminding us that test capacity, accessibility, and/or uptake is wholly inadequate.

As of January 23rd, new cases were being diagnosed at a rate of 1694 cases per 100K residents per week. Rates peaked last week at ~1967 cases per 100K/week, somewhat lower than some other states, perhaps due to less testing. The risk of Omicron infection will remain extremely high for many weeks. Remember, the CDC defines high community transmission as levels >100 cases per 100K residents per week. We’re a far cry from that!

View Dr. Joe Gerald’s Weekly Epidemiology & Hospital Occupancy Report

Join The Hertel Report for their State of the State

 2022 STATE OF THE STATE – The Hertel Report
 Friday, February 11 Breakfast Meeting 8 to 10:30am Phoenix Art Museum, Singer Hall or virtually.

Join the Hertel Report for their annual Arizona healthcare market update hosted and moderated by Publisher Jim Hammond. After breakfast and networking, this year’s panel of guest speakers will deliver the latest insight impacting managed care in Arizona. Prefer to attend virtually? 

Discussion will offer insight into national value-based trends including Arizona’s competitive community of accountable care organizations, value-based networks and direct contracting entities. Get the latest enrollment numbers and news from AHCCCS, take a deep dive into Arizona’s Medicare Advantage (MA) market and explore Arizona Marketplace trends. Arizona’s HIE will also share how better connecting providers across the state

Open Letter to Arizona Corporation Commissioners in Advance of the Clean Energy Rule Vote Tomorrow

Thank you for your service to the people of Arizona through your work on the Commission.
We write today on behalf of the 850 members of the Arizona Public Health Association, urging you to vote yes tomorrow on the Energy Rule package without amendments, particularly the 100% emissions-free electricity by 2050 standard.
 
We encourage you to adopt the draft Rule as the final Rule. We believe that the Rule, as proposed, is comprehensive and incorporates the essential core elements of good public health policy as it will reduce carbon emissions, address our climate crisis, help clean up our air, conserve our water, and improve the health of our communities.
The Commission’s Energy Rules went through a rigorous public input process as evidenced by several elements in the Rule. We are pleased that the Commission’s Energy Rules, which call for 100% carbon-free electricity, are not specific about which technologies need to be used to achieve the goals.
We believe this will lead to more efficient economic decisions over time which will keep rates down. Affordable utility rates are important so that working families have adequate resources to provide a healthy environment for their families.
Energy efficiency and renewable energy help control utility costs, create jobs, and build a cleaner energy future. Jobs created by energy efficiency and renewable energy are likely to pay a living wage and are in fields like installation and will be filled with Arizona residents.
We also support increased investments in distributed solar storage as this will provide residents more ways to save money on their utility bills putting them in a better position to provide resources to improve the health of working families.
Importantly, the Commission’s Energy Rules protect low-income communities at risk of local economic disruptions by including preferential siting of renewable energy projects in communities impacted by the early closure of coal-fired power plants.
There is also good evidence that the general public and specifically voters support clean energy and energy efficiency standards.
The Arizona Public Health Association supports the Commission’s Energy Rules which were developed after years of study, more than a dozen public meetings, thousands of written comments, and hundreds of hours of engagement by interested Arizonans like me.

Arizona Family Health Partnership is Recruiting for Cohort 4 of the Adolescent Champion Model

The Arizona Family Health Partnership (AFHP) is excited to continue supporting the incredible achievements of Adolescent Champions in Arizona. Ten clinics have earned certification as an adolescent-centered environment, ten more clinics are participating in our current cohort, and we are ready to onboard another 10 clinics for our fourth cohort!

The Adolescent Champion Model is centered on the Adolescent Champion team as an agent of change within the clinic to transform it into an adolescent-centered medical home.

The time commitment is fairly minimal over the course of the 18-month program, and it offers an exceptional leadership opportunity for the Champions within the clinic. The program also provides opportunity for CME, MOC Part IV, QI project credit, and certification as an adolescent-centered environment.

Adolescent Champion health centers have shown significant improvement in adolescent patient satisfaction, staff perception of adolescent-centered care within their clinic, and provider comfort and confidence in caring for adolescents.

Check out their Champions!

  • Adelante Healthcare’s Mesa and Peoria Clinics
  • Banner University Medical Center Phoenix
  • Canyon Pediatrics Gilbert and Mesa Clinics
  • Chiricahua’s Mobile Unit and the Pediatric Center of Excellence
  • El Rio El Pueblo
  • Jewish Family and Children’s Services
  • Mariposa Nogales Clinic
  • MHC Oro Valley Pediatrics
  • Mountain Park’s Gateway and Maryvale Clinics
  • Native Health Central
  • NOAH Heuser Family Medicine
  • North Country’s 4th Street Flagstaff and Winslow Clinics
  • Phoenix Children’s Hospital
  • Valleywise Comprehensive Health Center
  • Wesley Community & Health Center

Interested clinics should connect by February 10th; Orientation Webinars are taking place on March 21st and 28th; implementation begins April 1st.   

Contact Adolescent Health Program Manager Tracy Pedrotti if you are interested in learning more: tpedrotti@arizonafamilyhealth.org or 602-688-6260. Thank you!

Center for Medicare & Medicaid Services Approves AHCCCS’ Home & Community Based Services Action Plan

Last week AHCCCS put out an under-stated media release announcing that CMS approved their Home and Community Based Services (HCBS) Spending Plan, which would use $1.5B in mostly American Rescue Plan Act funds over the next 2 years to improve Home and Community Based Services for folks in their Long Term Care Program (ALTCS). Even though this is mostly federal money (it will require some state match) implementing it will require approval of the Legislature and Governor.  We will play a role in trying to make that happen.

Here’s a link to their 30-page plan which is of course written in dense AHCCCS/CMS language – but the takeaway is that they would bump up the per member per month capitation rates by 10% and then have some performance expectations tied to those funds in areas like:

  • Promoting stabilization, access to supportive services, and workforce retention/ consistency to improve member outcomes ($1B)
  • Expanding access to care from a “well-trained, highly-skilled workforce” ($217M)
  • Supporting individual self-sufficiency by connecting members to technological tools and resources that promote independence ($96M)
  • Using new technology to promote care coordination and seamless communication ($74M)
  • Funding local initiatives and community-specific programming to improve member health ($62M)
  • Empowering parents and families to provide care and meet the needs of their kids ($27M)
  • Assessing member engagement and satisfaction to better understand needs, prevent abuse and neglect, and identify opportunities for improvement ($5M)
  • Creating tools that strengthen quality monitoring and prevent abuse and neglect ($3.2M)

AHCCCS’ spending plan has all the particulars for how they want to spend this money in the various categories, but the biggest category by far is the first bullet; to build the caregiver workforce.

The detail on the spending plan is for temporary payments to providers for sign-on bonuses, retention payments, mileage reimbursement, reimbursement for tuition or continuing education, reimbursement for childcare and/or enhanced insurance coverage. 

Because the money ends in March of 2024 “AHCCCS will establish appropriate criteria to ensure that provider recruitment and retention strategies do not create an expectation of ongoing benefits, given the time-limited nature of this funding opportunity“.

For more information about the spending plan and CMS’ response, please visit the AHCCCS ARPA webpage.

Arizona Has the 2nd Highest COVID-19 Death Rate Per Capita During the First 2 Years of the Pandemic

Dr. Gerald’s Weekly COVID-19 Epidemiology & Hospital Occupancy Report

As we pass the 2-year mark for the pandemic, Arizona is distinguished to have the 2nd highest number of COVID-19 deaths per 100,000 in the U.S., with a death rate of 348/100,000. Only Mississippi has a higher COVID death rate at 357/100,000.

Assuming current trends continue (and there’s no reason to believe they won’t- given the lack of interest in mitigation by Doug Ducey & Don Herrington), Arizona will have the highest per-capita COVID death rate in the entire U.S. by mid-February.  A dubious distinction indeed, and one that is mainly attributable to the decisions made by Doug Ducey, ADHS Interim Director Don Herrington, and former ADHS Director Cara Christ.

Summary of this week’s report by Dr. Joe Gerald:

Arizona is experiencing historic levels of community transmission attributable to the dominant Omicron variant. Test positivity is insanely high reminding us that test capacity, accessibility, and/or uptake is wholly inadequate. Transmission (cases) has likely peaked as you read this but expect high levels of hospital through February. The greatest burden on our health care system will remain in hospital wards and emergency departments.

As of January 16th, new cases were being diagnosed at a rate of 1896 cases per 100K residents per week. We can expect rates to peak ~2000 cases per 100K residents/week, somewhat lower than some other states perhaps due to less testing availability. Ideally, a peak would be indicated by declining case counts and test positivity. Hopefully, next week’s update will bring confirmation of both.

Even if Arizona is moving down the backside of the wave, it is still important that all adults who previously completed the 2-dose primary sequence to obtain a booster, particularly those 50+ years of age. The risk of Omicron infection will remain extremely high for many weeks. Remember, the CDC defines high community transmission as levels >100 cases per 100K residents per week. We’re a far cry from that!

COVID-19 hospital occupancy (wards) continues to increase but should moderate soon. Hospitals will continue to be burdened by >30% occupancy in general wards and in the ICU for several weeks yet. Access to care continues to be restricted by both COVID-19 occupancy and staff shortages owing to infections among healthcare workers.

Weekly COVID-19 deaths likely peaked at 530 deaths the week ending December 12th. However, weekly totals in the upper-300s, lower-400s are likely for several more weeks. So far, at least 25,502 Arizonans have lost their lives to COVID-19.

Federal No Surprises Act Protects Arizonans From Surprise Medical Bills

The No Surprises Act (backed by Sen. Mark Kelly) went into effect a couple of weeks ago. It was passed in Dec. 2020 as part of a larger COVID relief bill called the Consolidated Appropriations Act of 2021. It protects patients when they receive emergency care or scheduled treatment from doctors and hospitals that aren’t in their insurance networks and that they did not choose. From now on, Arizonans are only responsible for their in-network cost-sharing in these situations.

A pre-existing Arizona law from 2019 (Senate Bill 1441) only created an out-of-network claim dispute resolution process covering cost sharing of at least $1,000.

CMS recently released several new resources to assist with the implementation of the No Surprises Act. The documents include a series of frequently asked questions related to the federal independent dispute resolution process and notice of consent requirements and frequently asked questions related to the uninsured and self-pay good faith estimates.

Maricopa County Department of Public Health Issuing $12M in Health Disparity Grants

 Here’s Where to Learn More

The Maricopa County Department of Public Health is offering up to $12 million in health disparities grant funding to agencies, municipalities, and other organizations among 5 regions in Maricopa County.

The funding will be used to help develop and work through strategies and interventions that consider systemic barriers and potentially discriminatory practices. COVID-19 and the ripple effects of economic and school closures, job loss, isolation, etc. has meant that many families and individuals did not see healthcare providers for regular checkups, increasing the likelihood of undiagnosed or unmanaged chronic illnesses, oral health, mental health, etc. 

Funding must support Policy, System and Environmental changes that can impact the disparity gap for vulnerable and marginalized populations. Funds are not intended for direct services or direct financial distribution to the public. Funding will be awarded via 5 opportunities for the following regions:

Visit www.maricopahealthmatters.org to learn more about our regions and community health needs assessment data.

Attend the Virtual Pre-Bid Conference to learn more about this opportunity Monday, January 24, 2022 at 1:00pm Join Here. Questions go to Cheryl Bucalo, Procurement Officer @ (602) 506-6886 or Cheryl.Bucalo@Maricopa.gov

Journal Article of the Week: Clinical outcomes among patients infected with Omicron SARS-CoV-2 variant in southern California

Clinical outcomes among patients infected with Omicron SARS-CoV-2 variant in southern California

Results: Our analyses included 52,297 cases with Omicron and 16,982 cases with Delta infections, respectively. Hospital admissions occurred among 235 (0.5%) and 222 (1.3%) of cases with Omicron and Delta variant infections, respectively. The adjusted hazard ratios for any subsequent hospital admission and symptomatic hospital admission associated with Omicron variant infection were 0.48 (0.36-0.64) and 0.47 (0.35-0.62), respectively.

Rates of ICU admission and mortality after an outpatient positive test were 0.26 (0.10-0.73) and 0.09 (0.01-0.75) fold as high among cases with Omicron variant infection as compared to cases with Delta variant infection.

Conclusions: During a period with mixed Delta and Omicron variant circulation, SARS-CoV-2 infections with presumed Omicron variant infection were associated with substantially reduced risk of severe clinical endpoints and shorter durations of hospital stay.

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