- Arizonans can get a 30% Tax Credit when you install a solar system. That means you can get
back 30% of the cost of your system AND benefit from using your own power!
- Arizonans can get a 30% tax credit for installing batteries that charge up with your rooftop solar
- Arizonans can get a $7,500 tax credit when buying a new electric vehicle, $4,000 for a used EV
- Arizonans can get a 30% tax credit on chargers for your electric vehicle
- Most Arizonans qualify for a $4,000 rebate on breaker box upgrades to support your transition
to solar power
- Arizonans qualify for an $8,000 rebate when buying a heat pump, the best kind of air
conditioner for the desert (certain income requirements apply)
- Arizonans qualify for a $1,750 rebate when buying a heat pump water heater
- Most Arizonans can get a $840 rebate on electric stoves, ranges, and ovens- to accelerate your
kitchen’s energy efficiency
The ‘Vaccines for Children’ Program Is Critical to Maintaining Childhood Vaccination Rates… but Provider Participation Has Plummeted During the Ducey Administration
The Vaccines for Children Program makes sure kids whose parents can’t afford vaccines can still get them. Funding for VFC comes via CMS to the CDC, who buys vaccines at a discount and distributes them to states. States then distribute them to physicians’ offices & clinics that take part in the VFC program. The Arizona Department of Health Services manages the VFC program in our state.
Doctor’s offices and clinics are required to be enrolled as a VFC provider by ADHS in order to take part in the Medicaid program… so, the number of providers enrolled in VFC has a direct impact on the adequacy of a state’s care network for kids enrolled in Medicaid (AHCCCS).
Arizona’s VFC Provider Network Decreased Dramatically During the Ducey Administration
Arizona has a big problem that that you may not have heard much about: Providers have been dropping out of the VFC program in droves large part because of ADHS’ over-regulation of the VFC program (although industry consolidation has also played a role).
Arizona lost 50% of its VFC providers during the Ducey administration, going from 1,200 providers in 2015 to only 600 today
Why the decline? If you talk to providers who left VFC over the last few years, many will tell you they quit because of the administrative hassles that have been imposed on them by the state (ADHS not AHCCCS). At the top of the list of grievances is ADHS’ punitive practice of financially punishing providers with wastage rates over 5%.
Even though pediatric providers lose money by participating in the VFC program, the ADHS has been fining them for replacement doses if they had a 5% or higher wastage rate (see this letter to AZAAP members regarding the ADHS policy)
See Arizona’s Vaccines for Children (VFC) Program Requirements
How Does Arizona’s VFC Enrollment Compare to the Rest of the US?
Not good. Arizona has 6 VFC providers per 10,000 Medicaid eligible kids, while the national average is 24 providers per 10,000 Medicaid kids… meaning Arizona only has a quarter of the number of VFC providers per Medicaid kid compared with the national average. Many people believe that the declining immunization rates among AZ kids are in part due to a thinning network of VFC providers in Arizona.
Hopefully there will be new leadership coming to the ADHS in a few months – and perhaps that person will reverse the erosion in VFC participation that occurred during the Ducey administration. Maybe she or he will even alter their policies to encourage (rather than discourage) participation in VFC (and by extension, improve the pediatric Medicaid network).
The next ADHS director should start by engaging stakeholders like the Arizona Academy of Pediatrics, Arizona Academy of Family Physicians, the Arizona Partnership for Immunizations & AHCCCS and do a root-cause analysis of the decline in participation and then create and implement a plan to reengage providers in taking part in VFC.
The group should also decide whether the ADHS is actually the best place to manage the VFC program or whether it belongs over at AHCCCS.
A Fox News commentator that goes by the name of Tucker something created a bunch of controversy last week when he repeatedly claimed that CDC will be requiring the COVID vaccine for school attendance, which if course is preposterous. Vaccine requirements for school attendance is a decision that is made by states, not the CDC.
He based his claim on CDC’s Advisory Committee on Immunization Practices statement last week that they’re recommending updates to the CDC’s childhood and adult immunization schedules to include COVID19 vaccine boosters (which has nothing to do with requiring the vaccine for school attendance).
Vaccination requirements for school attendance are set by the ADHS under statutory authority in 15-871, 15-872, 15-873, and 15-874 which gives ADHS rulemaking authority to establish the list of required vaccines – which are posted in the AZ Administrative Code in R9-6-702.
What updating the recommended vaccine schedule does do is help clinicians by streamline clinical guidance for healthcare providers by including all currently licensed, authorized and routinely recommended vaccines in one document.
See the current recommended CDC vaccine schedule: Immunization Schedules | CDC
ACIP meets 3 times each year to discuss vaccine recommendations. They consider:
- How safe and effective the vaccine at a specific age
- The severity of the disease the vaccine prevents
- How many people get the disease if there is no vaccine
- How well the vaccine helps the body produce immunity to the disease
The final vaccine recommendations include:
- Number of doses of each vaccine,
- Timing between each dose,
- Age when infants and children should receive the vaccine, and
- Precautions and contraindications (who should not receive the vaccine).
CDC sets the immunization schedules based on ACIP’s recommendations. The childhood and adolescent schedules are also approved by the American Academy of Pediatrics, the American Academy of Family Physicians, and the American College of Obstetricians and Gynecologists.
CDC wrote last week in a media release that the new guidance will be published in early 2023. CDC will continue to update and work with health departments, providers, and other partners over the coming months to ensure a smooth transition of the COVID-19 vaccination program from emergency response to a routine immunization program activity.
HRSA will be accepting applications through January 27, 2023. The RRPD program is a multi-year HRSA initiative to develop new, accredited and sustainable rural residency programs or rural track programs in family medicine, internal medicine, psychiatry, general surgery, preventive medicine, or obstetrics and gynecology, to support the expansion of the physician workforce and increase opportunities for residents to train in rural communities.
HRSA will award 15 grants of up to $750,000 each to support the start-up costs of creating new rural residency programs (e.g., accreditation, faculty development, resident recruitment, etc.)
Is your organization ready for CHW Voluntary Certification? One way to prepare is to get your training program approved by AzCHOW. The training program approval process ensures that CHW training programs prepare CHWs to understand the 10 Core Competencies and work to the fullest extent of their skills and abilities. You can read more about training program approval using the resources on the AzCHOW website:
- Training Program Review Guidelines: learn about the requirements for training program approval and how to apply
- Step by step guide to training program approval: if you aren’t sure if your organization is ready for training program approval, this guide is for you! It supplies detailed instructions about how to prepare your program and ensure that it has all of the components required for approval.
- CHW Training Program Approval Informational Meeting Recording: this webinar covers the basics of training program approval and what organizations need to know
Technical aid is available. They can meet with your organization to provide support and recommendations to prepare for CHW training program for approval. You can schedule a first meeting with Katy Tucker at firstname.lastname@example.org.
For a picture of how CHWs can fit into a continuum of care, take a look at this report from the NAU Center for Health Equity Research in collaboration with the UA Prevention Research Center (AzPRC) which provides insight into innovative strategies for integrating, sustaining and scaling of the CHW workforce within Medicaid (AHCCCS).
The Center for Health Equity Research at NAU through funding from the ADHS and in collaboration with the UA Prevention Research Center (AzPRC) wrote a report which provides insight into innovative strategies for integrating, sustaining and scaling of the CHW workforce within AHCCCS.
The report provides direct insight to this pathway via conversations with health plan leadership including topics on:
- Current and Projected Utilization
- Roles, Competencies and Skills
- Recruitment and Training
- Financing and Payment Models
- Healthcare and Workforce Policy
The report found that Arizona health plan leaders recognize that Community Health Workers can play a significant role in improving patient outcomes and reducing system costs for health care. Many health plan leaders already actively support their contracted provider networks to better integrate and finance CHWs to meet HEDIS measures.
The research team found that health plan leadership expects that the new Arizona Complete Care Contracts will fundamentally expand the need for CHWs and the core competencies, roles and skills as plans expand their services and seek creative approaches to meeting membership medical and non-medical needs.
The report sheds light on important next steps toward building CHWs into the care network. Congratulations and thanks to AzPHA member Dr. Samantha Sabo, Louisa O’Meara, and Katie Castro for their work on this important roadmap document.
Community Health Workers are frontline public health workers who have a trusted relationship with the community and facilitate access to a variety of services and resources for community members. Building CHWs into the continuum of care has been proven to both improve health outcomes and reduce healthcare costs… especially when it comes to preventing and self-managing chronic diseases.
The evidence that Community Health Workers cut healthcare costs and improve outcomes was clear several years ago- but it’s been a multi-year process to put together the infrastructure to build them into Arizona’s healthcare network. Education and training the workforce was critical of course – but we also needed a process to credential CHWs so they could be reimbursed for their work through health insurance and Medicaid claims.
We also needed training sites that could supply the curriculum that builds the knowledge and skills. Finally, AHCCCS needs to embrace the use of Community Health Workers and authorize their reimbursement via claims and encounters.
That’s a lot of work… work that took several years requiring community groups working in tandem with state and county government, community colleges and academia to make it all happen. Luckily, we had the Arizona Community Health Workers Association (AzCHOW) to help provide that grassroots community input to help drive the process and facilitate development of the workforce.
How was AzCHOW able to do it? They got a big boost back in 2017 when the 2017 the Vitalyst Health Foundation provided AzCHOW with a $123K Innovation and Medical Assistance Grant.
AzCHOW’s work paid off with a big victory in May 2018 when then Representative Heather Carter worked super-hard to pass HB2324, charging ADHS with developing a voluntary certification process for CHWs. Sadly, that relatively simple rule package wasn’t a priority for then Director Christ and the responsibility for developing the rules languished for 4 years before the department established the certification process.
The ADHS rules prescribe the CHW scope of practice and core competencies; qualifications; standards for education and training programs; continuing education requirements, and criteria for granting, denying, suspending, and revoking a certificate; and set up and collect nonrefundable fees for certification as a community health worker. See the final regulations here.
Curriculum Development & Training
As AzCHOW and the rest of the system waited patiently for ADHS to finally get their certification rules finished AzCHOW continued to work with Central Arizona College and Scottsdale Community College to set up curricula to prepare the workforce for certification. For example, SCC started their 1st cohort of scholars in their Community Health Worker Program this fall. They even partnered with Mercy Care to provide $1,000 Scholarships.
- Step 1: Apply for admission to Scottsdale Community College
- Step 2: Fill out and return the CHW Program Application according to form instructions.
The prep work is just about done to really plug CHW’s into the care network – where they can begin reducing improving health outcomes and reducing costs at scale. ADHS finally finished their credentialing work and have promised to open the portal to apply for certification on November 8. Scottsdale Community College & Central Arizona College have training programs in place and AzCHOW has been prepping the workforce.
The next big step is to build a funding pipeline so CHWs can get reimbursed for their work. There are many CHWs and CHRs already working in the field – but they’re mostly being paid with administrative funds from AHCCCS’ contracted Managed Care Organizations. The real workforce scale-up will happen once AHCCCS contracted MCOs can start sending claims and encounters to AHCCCS for their work.
19 of the 22 tribes in Arizona employ CHRs. CHRs have traditionally been funded through the IHS system. CHRs currently make up roughly 30% of the CHW workforce in Arizona.
Fortunately, current AHCCCS totally gets the importance of building the CHW reimbursement pipeline and is working hard to make that happen. The first step is to amend their State Plan Amendment with the Centers for Medicare and Medicaid Services. At a very informative webinar last Friday, AHCCCS committed to turning in a State Plan Amendment before the end of 2022 and expect to get CMS approval by March of 2023. See the AHCCCS PowerPoint.
The SPA language is succinct: “Certified Community Health Workers (CHW) acting within their scope of practice as defined in state law may provide AHCCCS-covered patient education and preventive services.” Education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum, face-to-face with the patient (could include caregiver/family) each billed in 30 minutes increments.
- 98960- patient education & training for 1 patient for 30 minutes.
- 98961- for a group of two to four patients.
- 98962- or a group of five to eight patients.
It has taken many long years to build the infrastructure to use the skills of Community Health Workers at scale within Arizona’s healthcare network. Kudos to the network of hard-working and tenacious folks that have been working toward this goal over the last several years!
Last week the FDA proposed updated criteria for when foods can be labeled with the nutrient content claim “healthy” on their packaging. This proposed rule would align the definition of the “healthy” claim with current nutrition science, the updated Nutrition Facts label and the current Dietary Guidelines for Americans.
The proposed rule would update the “healthy” claim definition to better account for how all the nutrients in various food groups contribute and may work synergistically to create healthy dietary patterns and improve health.
Under the proposed definition for the updated “healthy” claim, which is based on current nutrition science, more foods that are part of a healthy dietary pattern and recommended by the Dietary Guidelines would be eligible to use the claim on their labeling, including nuts and seeds, higher fat fish (such as salmon), certain oils and water.
To be labeled with the “healthy” claim on food packaging, the products would need to:
- Contain a certain meaningful amount of food from at least one of the food groups or subgroups (e.g., fruit, vegetable, dairy, etc.) recommended by the Dietary Guidelines.
- Adhere to specific limits for certain nutrients, such as saturated fat, sodium and added sugars. The threshold for the limits is based on a percent of the Daily Value (DV) for the nutrient and varies depending on the food and food group. The limit for sodium is 10% of the DV per serving (230 milligrams per serving).
For example, a cereal would need to contain ¾ ounces of whole grains and contain no more than 1 gram of saturated fat, 230 milligrams of sodium and 2.5 grams of added sugars.
FDA is also developing a symbol or icon that manufacturers could use to show that their product meets the “healthy” claim criteria. This will be a front-of-package (FOP) labeling system to quickly and more easily communicate nutrition information to empower consumers to make healthy decisions.
AzPHA Recommends YES on Props 209, 211, 308 & 310
Urges NO on Prop 128
AzPHA’s 501(c)3 nonprofit status prohibits us from taking positions on the candidates- but we can take positions on policy issues and the ballot propositions. We’ve taken a deep dive into the public health implications (direct & indirect) of all 10 ballot propositions and have taken positions on 5 of them.
AZPHA Recommends YES Votes on the Following Propositions
PROP 209: Predatory Debt Collection Protection Act
Summary: The measure makes multiple changes to state statutes on wage garnishment debt collection. It limits the interest rate on medical debt to 3%. It would protect more equity in homes, vehicles, household goods and bank accounts from being taken by creditors. It also limits the amount that can be garnished from wages to pay off debts.
Arguments for it: Medical debt causes many Arizonans to fall into bankruptcy. The standards for wage garnishment and asset collection are outdated. People shouldn’t lose their homes or vehicles because of predatory debt.
Who’s backing it: Arizona Public Health Association, Healthcare Rising Arizona (which receives support from the SEIU-United Healthcare Workers West), Arizona Students’ Association, Phoenix Workers Alliance, Neighbors Forward AZ, Democrats of Casa Grande
Who’s opposing it: Goldwater Institute, Arizona Chamber of Commerce & Industry, Arizona Free Enterprise Club, Tucson Metro Chamber, Greater Phoenix Chamber, Arizona Bankers Association
PROP 211: Voters’ Right to Know Act
Summary: Prop 211 would change state law to require political groups and people spending more than $50,000 to influence the outcome of an election to disclose the original donor of contributions over $5,000. It would also require real-time reporting of significant campaign spending and allow the Arizona Citizens Clean Elections Commission to enforce the provisions of Prop 211. Allows civil penalties for violations.
Arguments for it: “Dark money” is a corrupting influence on our democratic system and Arizona voters deserve to know who is funding political campaigns. Prop 211 will bring transparency and accountability to campaign messaging because voters will know who is paying for those ads. And it’ll stop regulated utility companies like Arizona Public Service from secretly funding the campaigns of their own regulators, as has happened in past elections.
Who’s backing it: Arizona Public Health Association, League of Women Voters of Arizona, former Phoenix mayors Paul Johnson and Terry Goddard
Who’s opposing it: Arizona Free Enterprise Club, Center for Arizona Policy Action
PROP 308: Tuition; Post-secondary Education
Summary: Prop 308 would change state law to allow all Arizona students, regardless of immigration status, to be eligible for financial aid and in-state tuition at Arizona universities and community colleges. Students must have graduated from an Arizona high school and been enrolled for two years. It would ask voters to repeal Prop 300 from 2006, which passed overwhelmingly at the time and barred non-citizens from receiving in-state tuition.
Arguments for it: Arizona students should be able to attend Arizona universities, regardless of immigration status. Undocumented students and Dreamers are a vital part of our economy. It’s good for business and it’s the right thing to do.
Who’s backing it: Arizona Public Health Association, Arizona Chamber of Commerce and Industry, Southern Arizona Leadership Council, Arizona Education Association, Aliento Education Fund, Valley Interfaith Council, Stand for Children, Local First Arizona
Who’s opposing it: Former Senate President Russell Pearce, the Arizona Republican Party, RidersUSA
PROP 310: Fire districts; Sales tax
Summary: Prop 310 would increase sales taxes by a tenth of a penny on the dollar to fund rural fire districts.
Arguments for it: Fire districts serve 1.5 million Arizonans and handle not only fighting fires but providing emergency medical services in car crashes along major parts of Arizona’s highway system. Fire districts are strapped for labor, equipment and resources, and 911 calls often take upwards of 30 minutes for a response.
Who’s backing it: Professional Fire Fighters of Arizona, Arizona Fire Chiefs Association, rural fire districts
Who’s opposing it: Arizona Free Enterprise Club, Arizona Republican Party
AZPHA Urges NO Vote on Prop 132
PROP 132: Initiatives; Supermajority vote
Summary: Prop 132 would amend the state Constitution to require a 60% vote to increase taxes at the ballot.
Who’s for it: Arizona Chamber of Commerce and Industry, The Goldwater Institute, Doug Ducey, Arizona Tax Research Association
Arguments against it: Lawmakers already need a two-thirds majority vote to pass any increases on taxes or to roll back tax credits and exemptions, and that supermajority requirement has hindered lawmakers’ ability to pass even common-sense tax increases. Bottom line: this proposition is designed to limit the voice of voters.
Who’s against it: Arizona Public Health Association, League of Women Voters of Arizona, Arizona Center for Economic Progress, Arizona Education Association
AZPHA is Not Taking an Official Position on Props 128, 129 & 309 but Our Executive Director Urges NO Votes
PROP 128: Voter Protection Act; Court Determinations
Summary: Prop 128 is a constitutional amendment that would allow lawmakers to bypass the Voter Protection Act to amend or repeal any ballot measure with any ‘illegal’ or unconstitutional language. (Currently, the Voter Protection Act bars lawmakers from repealing voter-approved laws, or from amending them, unless lawmakers can muster a three-fourths majority in both chambers and the changes “further the intent” of the voter-approved law.)
Who’s backing it: Arizona Free Enterprise Club, Arizona Chamber of Commerce and Industry, Center for Arizona Policy, Home Builders Association of Central Arizona
Argument against it: One single sentence or word in an initiative might be found unconstitutional or ‘illegal’, and the courts can already nullify just the unconstitutional or ‘illegal’ part and leave the rest. But if Prop 128 passes, lawmakers could then throw out the entire law, even though most of it is perfectly constitutional, which would shift power from the voters to the Legislature.
While the word ‘unconstitutional’ in the statutory language has a clear meaning, the word ‘illegal’ does not. The very purpose of a voter initiative is to change laws. For example, if Proposition 128 passes and there is a voter initiative in 2024 that constitutionally legalizes abortion could the courts decide the initiative is ‘illegal’ because it contradicts existing law?
Who’s opposing it: League of Women Voters of Arizona, One Arizona, Living United for Change in Arizona (LUCHA), Save our Schools Arizona, Sierra Club Grand Canyon Chapter, Will Humble
PROP 129: Initiatives; Single Subject
Summary: Prop 129 would limit initiatives to a single subject and require each provision be represented in the title. While lawmakers are barred from loading multiple subjects into a single bill, citizens writing initiatives are not, the Arizona Supreme Court has ruled.
Who’s backing it: Arizona Free Enterprise Club, Arizona Chamber of Commerce & Industry, Center for Arizona Policy Action
Arguments against it: It would eliminate initiative backers’ ability to combine forces for good-governance initiatives that touch on several aspects of the law. It would give the courts yet another technicality to use to ignore the will of the people. And the same rules shouldn’t apply to initiatives as lawmakers because passing a bill is a lawmaker’s job, but it costs citizens a lot of time and money to pass their own laws via initiative.
Who’s opposing it: Arizona Education Association, One Arizona, League of Women Voters of Arizona, Will Humble
PROP 309: Voter Identification; Affidavit
Summary: Prop 309 would change state statutes to require voters who vote in person to show a photo ID, instead of multiple pieces of certain mail, like bank statements. For voters without a photo ID, the state would issue a free non-operating license for voting purposes. If receive a ballot by mail, you would have to write your birthdate, ID number and signature on a “concealed early ballot affidavit” before mailing it back or dropping it off at a polling place.
Who’s backing it: Heritage Action for America, Arizonans for Voter ID, Arizona Free Enterprise Club, Arizona Republican Party, Goldwater Institute, Arizona Women of Action, Election Transparency Initiative, America First Policy Institute
Arguments against it: It will impede people’s ability to vote by adding burdens and creating confusion. It will invade people’s privacy.
Who’s opposing it: Arizona County Recorders, Prescott Indivisible, League of Women Voters of Arizona, One Arizona, Defend Arizona Rights, Opportunity Arizona, Arizona Education Association, Living United for Change in Arizona (LUCHA), Chispa Arizona, Our Voice Our Vote Arizona, Mi Familia Vota, Will Humble
Asks DEA to Look into Rescheduling Marijuana’s Classification Under the Controlled Substances Act
Last week President Biden promised to use his executive authority to overhaul the way the federal government enforces marijuana possession laws and promised to pardon folks who have been previously convicted of possession of small amounts of marijuana under federal law.
The most immediate action appears to be pardoning prior federal offenses of simple marijuana possession. While most marijuana possession convictions are under state law, there are about 6,500 people with prior federal convictions for marijuana possession between 1992 and 2021 who may be denied housing, employment, or educational opportunities as a result.
This pardon will help relieve those collateral consequences. Biden asked his Attorney General Garland to develop the administrative process to issue the certificates of pardon.
The vast majority of marijuana convictions are at the state level. See: Expunging Cannabis Possession Convictions Made Easier in AZ
The president also asked the Drug Enforcement Administration to investigate rescheduling marijuana under the Controlled Substances Act. Congress passed the Controlled Substances Act decades ago – but left most of the details to the DEA, Justice Department, and HHS.
Those agencies have classified marijuana under ‘Schedule 1’ – the most restrictive category along with heroin and LSD. Marijuana is even classed higher than fentanyl, methamphetamine, and cocaine – drugs that do more public health damage than marijuana.
Schedule 1 and 2 drugs face the strictest regulations because they are considered to have no medical use. Schedule 1 drugs are effectively illegal for anything outside of research, and schedule 2 drugs can be used for limited medical purposes with the DEA’s approval because they are still considered to have a ‘high potential for abuse’. At Schedule 3 and beyond, both the FDA and DEA play a role in regulating the drug.
Here’s how the reclassification process will work. The Drug Enforcement Administration will officially ask HHS to review the medical and scientific evidence about marijuana’s scheduling. HHS will evaluate the drug based on 8 factors including its potential for abuse, the scientific evidence for a drug’s pharmacological effects, and the scientific evidence for a drug’s medical use.
HHS will then make a recommendation to the DEA, who will make the decision about whether and how to change the scheduling of marijuana.
Let’s imagine that DEA ends up changing marijuana to Schedule 2 or 3, and the FDA begins to have some authority to regulate marijuana. You might thing that rescheduling marijuana would have a big impact on enforcement of marijuana laws – either nationally or at the state level… but you’d be wrong because FDA approval or lack thereof has no bearing on the administration’s enforcement discretion.
Rescheduling would make it much easier to do research on marijuana, but rescheduling would really have little to no impact on enforcement of existing marijuana possession or trafficking laws at either the state or federal level and would have little effect on state regulation of medical or retail marijuana.
For a deeper dive visit: Clearing Up Misconceptions about Marijuana Rescheduling
Some examples of the drugs that are on each schedule:
- Schedule 1: marijuana, heroin, LSD, ecstasy, and magic mushrooms
- Schedule 2: cocaine, meth, oxycodone, Adderall, Ritalin, and Vicodin
- Schedule 3: Tylenol with codeine, ketamine, anabolic steroids
- Schedule 4: Xanax, Soma, Darvocet, Valium, and Ambien
- Schedule 5: Robitussin AC, Lomotil, Motofen, Lyrica, and Parepectolin