March 2022 – Page 2 – AZ Public Health Association

March 16, 2022March 16, 2022

Will Humble State Legislature, Wills Blog

Learn How the Legislature Works: Listen to this Consumable Podcast

Master the policy process with Arizona Common Ground, an eight-episode educational podcast series that gives a behind the scenes glimpse of the state legislative system to familiarize the public health workforce on how health bills can become laws.

We thank one of our former interns, Krista R. Cardenas, MPH, for putting together this terrific series that is available as ARIZONA COMMON GROUND on Apple Podcasts

ARIZONA COMMON GROUND

By AzPHA Member Krista R. Cardenas, MPH

March 14, 2022

Will Humble Assurance & Licensure, Behavioral Health, Disease Control, Early Childhood, Environmental Health, Medicaid, Tobacco, Wills Blog

Late March Is a Critical Control Point at the State Legislature: Here’s the Public Health Status Report

The last 2 weeks of March is a critical control point of any legislative session. That’s because the deadline to hear bills in committee in the alternate chamber is the end of March (this year it’s March 25). If bills that passed through the chamber of origin aren’t heard in the other chamber by March 25, they’re generally dead (although there are some escape hatches).

There are several bills that we’re supporting that didn’t get on a committee agenda this week. Those bills will need to be on an agenda next week if they’re going to have a chance. For examples, see the several bills under the ‘social determinants’ category below and the bill that would change the governance model at the Arizona State Hospital (SB1716).

Likewise, there are several bad bills that have not yet made it on a committee agenda yet… and some of those bad bills may die on the vine if they aren’t heard next week.

Below is a summary list of the bills that we’re supporting and opposing. Notes in green indicate good bills that are being heard in a committee this week. Red denotes bad bills that are being heard this week. Yellow indicates that a good bill might be in trouble.

Here’s the spreadsheet tracker prepared by our cohort of interns from the UA College of Public Health (Priscila Ruedas, Danielle Brooke King, and Garret Tomlin). A detail summary of the bills is at the tail end of this email.

Bill Overview: Select Bills Progressing that AzPHA is Supporting

Maternal/Child Health

SB1272 AHCCCS; postpartum care; eligibility; Passed Senate 26-2; Passed House Health 8-1; House Appropriations this Wednesday

Access to Care

HB2144 health insurance coverage; biomarker testing Passed House 59-0; Senate Finance Hearing Wednesday

Special Needs

HB2157 supplemental appropriations; community-based services SIGNED

HB2113 developmental disabilities; Down syndrome Passed House 59-0; Senate Health Committee Wednesday

HB2382 appropriations, health programs, disabilities Passed House 48-11; Not assigned in Senate

HB2111 appropriation; healthy families program – Passed house 40-17; No Action in Senate Yet

Social Determinants

HB2060 supplemental nutrition assistance program; Passed House 44-15; No Action in Senate Yet

HB2484 forcible entry; detainer; filing fee Passed House 59-0; No Action in Senate Yet

HB2485 eviction dismissal; sealed records Passed House 50-8; No Action in Senate Yet

HB2033 juvenile offenders; monetary sanctions; repeal Passed House 58-1; No Action in Senate Yet

Tobacco

HB2125 electronic smoking devices; retail licensing – failed but on reconsideration for vote in 2 weeks

Environmental

SB1152– zero emission vehicles; plans Passed Senate 16-13. Assigned to House NERW

SB1154 transportation electrification study committee Passed Senate 16-13. Transmitted to House, no action yet

HB2226 fireworks use, limitations, prohibition Passed House 42-17. Passed Senate COM; Held in R Caucus

HB2255 fireworks use, limitations, prohibition Passed House. Senate Appropriations Tuesday at 2pm

State Hospital/Behavioral Health

SB1716 state hospital; governing board; governance Passed Senate 27-0; No Action in House Health Yet

SB1444 state hospital; administration; oversight Passed Senate; House Health this Week

SB1641 – health care institutions; civil penalties Passed Senate 28-0. Held in House Health

SB1162 opioid prescriptions; intractable pain; exceptions Passed Senate 27-0. No Action in House Health Yet

SB1210 mentally ill; transportation; evaluation; treatment; Senate 3^rd read Needed

Bill Overview: Select Bills Progressing that AzPHA Is Opposing

Vaccines/Disease Control

HB2086 ADHS; school immunizations; exclusions Passed House 31-28; Assigned to HHS

SB1298 government mask mandate; prohibition Passed Senate 16-12;

SB1009 state of emergency; executive powers Passed Senate 16-13; Passed House GE Committee

HB2453 mask requirement; prohibition Passed House 31-28. Passed Senate G Committee 6-4

HB2043 employer liability; COVID-19 vaccine requirement Passed House. Passed Senate Judiciary 6-4.

HB2616 mask mandates; minors; parental consent Passed House 31-28. Senate Government Committee Monday at 2pm

HB2161 parental rights; schools; educational records Passed House 31-28. Senate Education.

HB2498COVID-19; vaccination requirements; prohibition. Passed House. Senate Government Committee Monday at 2pm

Tobacco

HB2145 electronic smoking devices; retail licensing – failed but on reconsideration for vote in 2 weeks

Social Determinants

HB2021 Drug Offenses, homicide, sentencing House Judiciary 10-0. Looks dead.

SB1164– abortion; gestational age; limit Passed Senate 16-13; Held in House ED

SB1123 disruption; educational institution; concealed weapon Looks dead

HB2811 unlawful abortion medication; offense Failed House 28-31

Government

HB2787 Maricopa county; new counties Passed House Government & Elections Committee 7-6. Looks Dead

SB1175– noncustodial federal monies; appropriation Passed Senate 16-13; Passed House Approps.

March 13, 2022March 13, 2022

Will Humble Disease Control, Public Health, Wills Blog

AzPHA Data Brief: 2020 Arizona Life Expectancy Decreased Substantially More Than the US Average

View Our March 7, 2022 Data Brief on 2020 Arizona Life Expectancy:

In December 2021, CDC announced that life expectancy in the US had declined by about 2 years in 2020 compared to 2019, the largest single year decrease in more than 75 years and reflects the excess deaths in 2020 directly or indirectly related to the Covid pandemic.

Our new AzPHA Data Brief entitled Declines in Life Expectancy in Arizona: 2020 vs. 2019, explores how Arizona compares with the U.S. overall with respect to the decrease in life expectancy in 2020 vs. 2019. We chose this topic because of our previous reports that found that Arizona:

Not surprisingly, our analysis finds that life expectancy in Arizona decreased by substantially more than the US average during 2020; 2.8 years in Arizona vs 2.1 years nationally.

The decrease in life expectancy was not uniform across demographics, with American Indians experiencing a decrease in life expectancy of about eight years.

Editorial Note: The reasons why Arizona’s 2020 life expectancy declined by substantially more than in the US overall are multifactorial, but the dominant reasons are the decisions made by Governor Ducey and former ADHS Director Christ during 2020 (particularly the lack of implementation and enforcement of mitigation measures like an enforced statewide face covering mandate and enforced mitigation in closed indoor environments like bars, restaurants and nightclubs).

For more on this topic be sure to read this article in the Arizona Republic by Stephanie Innes entitled: Why Is Arizona’s COVID-19 Death Rate So High?

March 7, 2022

Will Humble State Legislature, Wills Blog

Legislative Session Halftime Report

It was relatively quiet at the Arizona Capitol last week. Each chamber began the process of hearing the opposite chamber’s bills, Senate bills in House committees, and vice versa. AzPHA supported bill SB1272 which extends AHCCCS coverage to 12 months postpartum from its current 60 days, advanced out of the House Health Committee Monday. Like other bills that contain an appropriation, passing out of both chambers is just the first step in the process.

The next major session deadline is for those crossover bills to be heard in committee in the opposite chamber is Friday, March 25.

Last week’s Legislative Session highlight (from the point of view of good things) was the passage of HB 2157, which will significantly improve access to and the quality of home and community-based services for persons with disabilities. The American Rescue Plan Act provided Arizona up to $1.5B to enhance and improve community-based services for members of AHCCCS’ Long Term Care program (ALTCS).

AHCCCS had earlier developed their action plan to leverage those additional federal funds and CMS approved their plan back in January, but in AHCCCS needed legislative approval in order to implement the plan. Not that HB2157 has been passed and signed, they can begin implementation (once the statute kicks in).

Here’s a link to AHCCCS’ implementation 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)

Bill Overview: Select Bills Progressing that AzPHA is Supporting

HB2157 supplemental appropriations; community-based services SIGNED

SB1272 AHCCCS; postpartum care; eligibility; Passed Senate 26-2

HB2144 health insurance coverage; biomarker testing Passed House 59-0

HB2060 supplemental nutrition assistance program; Passed House 44-15

HB2484 forcible entry; detainer; filing fee Passed House 59-0

HB2485 eviction dismissal; sealed records Passed House 50-8

HB2113 developmental disabilities; Down syndrome Passed House 59-0

HB2382 appropriations, health programs, disabilities Passed House 48-11

HB2033 juvenile offenders; monetary sanctions; repeal Passed House 58-1

HB2811 unlawful abortion medication; offense Failed House 28-31

SB1716 state hospital; governing board; governance Passed Senate 27-0

HB2111 appropriation; healthy families program – Passed house 40-17

Bill Overview: Select Bills Progressing that AzPHA Is Opposing

HB2086 ADHS; school immunizations; exclusions Passed House 31-28

SB1298 government mask mandate; prohibition Passed Senate 16-12

HB2125 electronic smoking devices; retail licensing – failed but on reconsideration for vote in 2 weeks

Senate Health Wednesday

HB2086 ADHS; school immunizations; exclusions OPPOSE

HB2622 AHCCCS eligibility, DCS – SUPPORT

Requires AHCCCS or its designee, subject to the approval of the Centers for Medicare and Medicaid Services, to annually renew the eligibility of a person under 26 years of age and who was in the custody of DCS when the person turned 18 without requiring additional information from the person until they turn 26 years old.

House Health Monday

SB1231 independent oversight committee; developmental disabilities SUPPORT

Directs DDD to allow the Committee up to 30 days to review new policies and major policy changes before DDD submits the policies or changes for public comment.

AzPHA Bill Tracking File

March 5, 2022March 5, 2022

Will Humble Disease Control, Wills Blog

Dr. Joe Gerald, MD, PhD Files His Final COVID-19 Epidemiological Report

View Dr. Gerald’s Final COVID Epidemiology Update (March 5, 2022)

Dr. Joe Gerald MD, PhD just published his final weekly epidemiology and hospital occupancy report. He’s been publishing these weekly for the last 2 years, providing the people of Arizona, journalists and policymakers refined data to inform their activities and to make policy decisions.

Dr. Gerald’s work has been essential and have been used to make policy and intervention decisions by county health departments, city governments, the judicial branch, K-12 schools, universities, community colleges, private businesses, non-profits, and private businesses & venues. His work has been essential for those of us doing advocacy.

Journalists across Arizona have used Dr. Gerald’s work to inform their reporting (helping them cut through the misinformation & spin coming from the governor, his staff & state health department directors). By doing so, his work was essential in keeping the people of Arizona to keep informed about what was really happening.

Dr. Gerald… the people of Arizona salute you!

_______________________________________________________

Here’s introductory information from Dr. Gerald summarizing his final weekly report:

Good afternoon, all…

We continue to experience rapidly improving COVID-19 conditions. Arizona should fall below the 50 cases per 100K residents per week threshold in mid-March. A few counties may lag behind, so there will be some geographic differences. All-in-all, nothing but good news on the short-term horizon. I think the next opportunities for trouble will be May/June with the summer heat disrupting social behaviors, then August with resumption of K -12 and universities, and most likely November/December with the typical respiratory seasonal pattern.

Of course, a new variant could arise as well. While new outbreaks are expected, my hope is that we’ll see more muted seasonal patterns but that is not guaranteed.

A few things from this week. We’re getting a better idea of what the new ADHS Dashboard is going to look like after the change to weekly updating. Could be some hiccups before things get ironed out. I noticed the tally of cumulative deaths does not seem to be updating. Also, there appears to be considerable hospital non-reporting (~15%). Since the change, the total number of ward beds is down about 1200 and the total number of ICU beds is down about 240. The COVID-19 count occupancy will be more impacted than the percent occupancy. If non-reporting becomes worse, then non-response bias could be an issue for the new CDC Community Levels. Just keep an eye on it.

We’re almost certain to see more COVID-19 deaths from October 2021 – March 2022 than we did in the same period last year despite much greater vaccination and acquired immunity (See report Appendix). As it turns out, mooning COVID-19 before it was done left us with our pants down. The lack of a concerted, consistent, organized, effective policies to achieve high levels of vaccine immunity and widespread adoption of mitigation practices led us to this grim milestone. Not surprising, but disappointing and disillusioning.

Relatively low third-dose booster uptake, low levels of prior infection, and waning vaccine immunity among the elderly may lead to higher than expected hospitalizations and deaths in the coming months. Not to a degree that will stress hospitals but rather a lingering tale of woe to this most recent pandemic wave. For those >50 years who haven’t obtained a third shot booster, I would recommend doing so even though conditions are improving.

I want to thank everyone for their support over the past 2 years. Some specific mentions include my colleague Patrick Wightman who has steadfastly manhandled the data from ADHS. Also, a shout-out to Rob Bailey and Tim Flood at ADHS who have organized and overseen the work of our tri-university modeling group. Without them, our reports would not have been possible. They have done an incredible job managing, integrating, and distributing the myriad of data streams. Much thanks!!

Also to my UA, ASU, and NAU colleagues who have done their own work plus providing me ideas/suggestions for my reports. Of course, locally – Terry Cullen and Francisco Garcia who have helped with data and insights from Pima County. To the ICU/critical care physicians at Banner University Medical Center who have allowed me to listen in to their twice weekly COVID-19 huddles and kept me apprised of workload and clinical trends. Also, thanks to the MEZCOPH IT and media relations folks who have helped distribute and archive these reports. I’m sure there are others – I apologize for not recognizing your contributions.

This is the last planned report – so thank you to my readers for allowing me some of your precious time each week. I’m going to give a bit more free time.

Joe

Joe K. Gerald, MD, PhD

Associate Professor of Public Health Policy and Management

The Mel and Enid Zuckerman College of Public Health

The University of Arizona

March 1, 2022March 1, 2022

Will Humble Disease Control, Wills Blog

AzPHA Weekly Legislative Update

Last week was “crossover week,” where the legislature holds very few Committee hearings and attempts to move as many bills as possible through the full chamber. At this point, any measures that haven’t received a hearing in committee in their chamber of origin can’t move forward unless the chamber suspends their own rules.

It is important to remember that no idea or bill is truly “dead” until sine die, as it can always be revived if the rules are waived. The House and Senate each heard over 200 bills in caucus this week and spent significant hours on the floor moving bills through the legislative process.

Here’s a synopsis of last week’s action.

Let’s start with the good stuff: