Legislative Update: Week Three

Things are still moving slowly at the legislature by historical standards. The House Health Committee held its first meeting of the year last week with an abbreviated agenda and the Senate Health Committee didn’t even meet. 

The rumors circulating are that the Legislature will send a continuation budget to Governor Hobbs this next week even though they know she’ll veto such a proposal. Experts in the process say that would be risky because Governor Hobbs could line-item veto the budget, which would force the Legislature to live with last year’s bipartisan budget for any agency the Governor approves.

If the Legislature attempts to pass a continuation budget next week, it is also speculated that committee milestone deadlines will need to be extended because of the slow start over the last three weeks and many, many bills haven’t been heard in committee yet.

Tuesday’s Senate Health Committee Agenda doesn’t really have any blockbuster bills on it. We are signed in for SB1088 – Good Samaritan; drug overdose; extension – which would remove the sunset provision currently in place protecting folks from tort liability exposure when helping someone having an opioid overdose episode.

House Health on Monday has a more robust Agenda. We’re signed up in support of 3 bills, against one, and neutral on one. None rise to the level of asking to speak on the bills at the podium. You can look at our tracking spreadsheet to see the status of the various bills.

Hobbs Establishes Independent Prison Oversight Commission

Executive Order 6 | Office of the Arizona Governor

Governor Katie Hobbs announced an additional executive order as part of her First 100 Days Initiative… establishing an Independent Prison Oversight Commission to improve accountability (and transparency) in Arizona’s corrections system. The yet to be appointed team is tasked with issuing a preliminary report by November 15, 2023 with initial findings and objective recommendations.

The Commission will inspect prison facilities and records, talk with staff and inmates to independently and objectively assess mental health and medical care, drug treatment programs, and accessibility to basic necessities such as nutrition, medicine, sanitary products and sufficient number of qualified staff.

This is a management best-practice and welcome intervention for a very troubled correctional system in Arizona. 

Musings from the President: The Year Ahead by Kelli Donley Williams, AzPHA President

Have you paused recently before answering the standard dinner party question, “What do you do for a living?” Prior to the pandemic, I had no hesitation in proudly saying without concern, “I work in public health.” But on a recent vacation, when asked this question multiple times a day, I tried variations that wouldn’t lead to dark conversations about vaccine deniers, the horrors of American politics, or predictions on the next disease coming our way.

(For the record, vaccines are the best life-saving public health tool ever, with seat belts perhaps coming in second. I rarely want to talk about politics, much less with strangers. And finally: I have no idea! Alas, my public health degree didn’t come with a crystal ball.)

By the end of the trip, I had reevaluated, dodging any invasive follow up questions. Instead, I told anyone who looked my way, “I work in public health!” And, I’d like to encourage you to do the same, with pride and joy for our field.

Yes, we are slowly emerging from a global pandemic where communication about public health strategies and advancements was unclear at best. And yes, unfortunately millions have died from COVID since 2019. However, imagine what our community and state would look like today if our public health work force hadn’t shown up and done their very best?

I had the chance to volunteer with the public health corps at Maricopa County Health during the first round of vaccines. I watched public health workers and retirees volunteer in droves to drive around the county, working long, thankless hours to get vaccines in the arms of the willing. They did so at risk to their own health and wellbeing. They did so when the call came, regardless of the time of day or weather. They did so because they remembered that working in this field is not about the individual, but about the greater community need.

We before me is the ultimate public health tenant. I watched these heroes in action, and it refilled my professional sails. What an honor to be part of this field, to work and walk alongside each of you.

In 2023, our association will be focused on three primary areas: increasing public health infrastructure, including workforce; health equity; and firearm safety. I hope to see you at our February conference and to share more details about each of these. And further, I hope you’ll find new ways to get involved with AzPHA this year. Join the book club, be a mentor, attend a Friday “conversations and coffee” to hear what colleagues in another corner of Arizona are working on.

Join us. Together, we can improve the public health in Arizona!

AzPHA Annual Conference: Don’t Miss Out – Registrations Filling Fast

Addressing Health Disparities:
Building Infrastructure & Engaging the Next Generation of Public Health Leaders

View Our Agenda

Desert Willow Conference Center
4340 E Cotton Center Blvd, Phoenix, AZ 85040
Thursday, February 23, 2023
8:30am – 4:30pm

Register Here

Maricopa County Department of Public Health is Offering Free Scholarships to AZPHA Members:Use Scholarship Code AZHD2023 When Registering

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See Our Sponsorship Opportunities and View Sponsorship Benefits in Our Sponsorship Packet

Righting Arizona’s ‘Vaccines for Children’ Ship

The U.S. Vaccines for Children Program makes sure kids whose parents can’t afford vaccines can still get their kids vaccinated. Funding for VFC comes via the CDC, who buys vaccines at a discount and distributes them to states. States 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 to take part in the Medicaid (AHCCCS) 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 AHCCCS.

Arizona lost 50% of its Vaccines for Children providers during the Ducey administration, going from 1,200 providers to 600…  reducing access to childhood vaccines & harming AHCCCS network capacity

Why the decline? Anecdotally, providers who left VFC over the last few years say they quit because of the administrative hassles imposed on them by the state during the Ducey administration (ADHS not AHCCCS). At the top of the list of grievances is ADHS’ punitive practice (during Director Christ’s tenure) of financially punishing providers with wastage rates over 5% making participation financially difficult (see this letter to AZAAP members regarding the former ADHS policy).

Arizona now 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 the declining immunization rates among AZ kids are in part due to a thinning network of VFC providers in Arizona.

The Ducey-era ADHS never conducted an analysis to determine why so many providers have stopped participating in VFC during the Ducey administration. Thankfully, the Arizona Partnership for Immunization is now partnering with the OMNI Institute to figure out why so many have quit so we can right the VFC ship.

They’ve developed this Childhood Vaccine Provider Survey for medical provider offices that administer vaccines to children to collect data that can be then used to develop interventions to reverse this troubling trend. The survey takes 10-15 minutes to complete depending on your answers. Responses will be combined with other providers’ responses and no identifying information will be included in any report. Here’s the link to the Childhood Vaccine Provider Survey

The results of this landmark report can then be used to conduct interventions that either reverse Ducey administration VFC policies, change ADHS operational procedures, inform staffing changes, or explore moving VFC to AHCCCS. But…  good results depend on good participation – so please get the word out!

Participate in the Survey

Related: Childhood Vaccination Rates Continue to Drop In the 2021-2022 School Year

State Legislature Off to a Slow Start

By late January the state legislature is usually in full swing with jam packed committee agendas and a bewildering number of bills to go through. That’s not the case this year. House and Senate Health Committee meetings have been routinely canceled or not scheduled at all – and committee agendas are pretty light with just a few bills.

Maybe that’s because about half of the state legislature is new this year and members are still getting their sea legs. I’m not sure. 

Anyway – that’s good for at least right now, because we’re busy getting ready for our annual conference on February 23. We’re just about to get our agenda set and expect to announce that early next week. 

The Senate Health committee is scheduled to meet on Tuesdays from 2-4pm…  but Senate Health isn’t meeting this week. House Health is scheduled for Mondays from 2-4pm. They are meeting this week, but it’s a pretty light agenda.

I expect most of the action in House Health to be about HB2284; homelessness; housing; facilities. That bill would dictate how the Arizona Department of Housing should allocate funds for individuals experiencing homelessness. The drama is all about the details. 

It would require ADOH to use the money for parking areas that have access to potable water, electric outlets and bathrooms sufficient to serve that parking area and camping facilities. 

Importantly, it requires ADOH to spend money on those things before spending monies on permanent housing for individuals experiencing homelessness. It also prohibits people experiencing homelessness from camping and storing personal property anywhere except those designated areas. Here’s a more detailed review of the bill from Leg Council: HB2284 Discussion

It took us awhile to take a position on the bill because there are lots of pieces to it and it’s a bit out of my wheelhouse. A few of our Public Health Policy Committee members did some research and determined that the bill, as is, would do more harm than good – and we’ve signed up in opposition to the bill (although I don’t plan on speaking in Committee about it tomorrow).

The other bill we’re tracking with action so far is HB2001, which would exempt ADHS from the Administrative Procedures Act (that law provides the requirements for agency rulemakings). ADHS would be exempt only if the proposed rules reduce a regulatory burden without jeopardizing health and safety and don’t increase costs to the persons regulated. The public would have a minimum of 15 days to comment on the rules.

That bill passed through the House Health Committee 9-0. We signed up neutral on that bill. While I trust that Director Cullen will use the additional authority wisely and for good public health purposes, I’d like to see the exemption time limited to ensure that a future administration doesn’t use that authority to dismantle health and safety regulations at the Department. Hopefully that bill will be amended to limit it to just 3 years or something like that.

Here’s our bill tracking spreadsheet thus far. This list will grow substantially as the legislative session progresses.

Register Today: The Hertel Report 2023 Winter State of the State

Register Today: https://www.thehertelreport.com/product/2023-winter-state-of-the-state/

AZPHA Members Use Coupon Code AZPHA2023 for $15 Off at Checkout

2023 WINTER STATE OF THE STATE

Arizona healthcare leaders provide fresh insight and trends impacting our local managed care industry. Stakeholders and guest speakers from across the healthcare continuum will add to the conversation.

Register Here https://www.thehertelreport.com/product/2023-winter-state-of-the-state/

GUEST SPEAKERS

  • Dr. Charlton Wilson
  • Mark Stephan, MD & Seth Dubry, MD
  • Equality Health
  • Paul Rose
  • Chief Executive Officer of Western Asset Protection

Substantial Advancements in Addressing the Social Determinants of Health are Hallmarks of Governor Hobbs’ Budget

Governor Hobbs Releases 2023-24 Budget Proposal 

Governor Hobbs released her proposed budget last Friday. It reflects a governor who is committed to improve the social determinants of health and assist families. The budget makes critical investments to protect the health and wellness of all Arizonans. 

  • $463M and $115M in federal fund expenditure authority to utilize year three of federal funding given directly to AHCCCS and DES respectively for home and community-based services programs
  • $257M for AHCCCS program caseload growth and unwinding of federal Covid-19 policies
  • $150M deposit into the Housing Trust Fund to assist families and individuals who are currently or at risk of becoming unhoused
  • $50M General Fund set-aside for a refundable child tax credit for low-income families beginning tax year 2023
  • $24M to make feminine hygiene products tax exempt
  • $20M to expand the income eligibility cutoff for the KidsCare program from 200 percent of the federal poverty level to 300 percent of the federal poverty level
  • $16M to make permanent a sales tax exemption for infant diapers
  • $9.7M to address an Arizona State Hospital staffing shortfall
  • $11M to fully fund the adoption subsidy for adoptive parents, backfill federal funding, and implement the Positive Parenting Program
  • $6.1M in ongoing funding to augment existing Title X family planning dollars to provide expanded family planning services to low-income women, doubling the current amount provided to women in Arizona
  • $14M to reduce caseloads for Adult Protective Services
  • $4.4M to make permanent federal funds to increase Arizona Early Intervention Program (AzEIP) Provider Rates
  • $2.5M to expand the Healthy Families AZ program for voluntary home-visits to families that are at high risk of abuse or neglect, adding capacity for additional 300 families
  • $2.7M for Medicaid enterprise system modernization
  • $200,000 in ongoing funding for pregnancy services that are inclusive of all options and support personal choice

Of course, a budget proposal is just that, a proposal. The ultimate result will come later this spring after negotiations with the state legislature… but it certainly is nice to have an executive proposal that prioritizes evidence-based strategies to improving the health status of ordinary Arizonans.

AHCCCS Eligibility Redeterminations Start April 1; 25% (600K) of Currently Enrolled AHCCCS Members May Lose Eligibility 

The big federal omnibus bill signed by President Biden last week directs states to begin their Medicaid redetermination efforts starting on April 1, 2023. AHCCCS thinks about 600,000 of the 2.5 million currently enrolled AHCCCS members may lose eligibility over the coming year once redetermination happens.

The federal government gave states an extra 6.2% in federal contribution toward a state’s Medicaid costs in exchange for not disenroll people from Medicaid during the public health emergency. The omnibus bill phases out the 6.2% enhanced federal match. Beginning on April 1, the enhanced match will drop 5% and continue to drop each quarter until the enhanced match is eliminated on Jan. 1, 2024.

The bill didn’t end the public health emergency (in fact HHS just extended it until August 2023) but redetermination will now begin on April 1 rather than when the emergency expires.

Healthcare providers can help get the word out that AHCCCS members should ensure that their mailing address, phone number & email address are up to date on www.healthearizonaplus.gov and urge AHCCCS members respond to requests from AHCCCS for more information.

The State Medicaid Advisory Committee met last week and AHCCCS staff provided an overview and update on various projects including how they’ll be redetermining eligibility later this year.

AHCCCS has a “Return to Normal” webpage with more info including community and contractor resources.