Will Humble Climate Change, Wills Blog

Arizona & the Bipartisan Infrastructure Investment and Jobs Act

Back in November 2021 congress passed and the president signed a $1.2 trillion spending bill called the Infrastructure Investment and Jobs Act. You might know it better as the bipartisan infrastructure bill.

Over the next several years Arizona is set to receive billions of dollars for infrastructure development including projects that address energy efficiency, electric grid improvements, broadband expansion, workforce development and more.

The funding presents an opportunity for Arizona to work with communities in all corners of the state to continue ensuring resiliency in the state’s economy, improve energy efficiency and convert to carbon free energy sources.

Arizona began implementing the Act during the previous administration with the establishment of the Infrastructure Investment and Jobs Act (IIJA) Task Force.

The Task Force is made up of state agency directors or their staff, tribe leadership and subject-matter experts. Their direction is to maximize the opportunity for Arizona communities to receive discretionary grant funding for Arizona infrastructure projects.

Areas of focus include:

  • Broadband
  • Infrastructure Workforce Development
  • Cybersecurity
  • Healthy Forests
  • Energy 
  • Water

The infrastructure law funding is distributed very differently than the American Rescue Plan Act. Under ARPA, governors were given wide latitude to decide where ARPA funds should be allocated. By contrast, the infrastructure act is far more board based, competitive and governors aren’t the decision-maker in terms of cutting checks.

Rather than making funding decisions, the IIJA Task Force is charged with writing letters of support, helping search for grant opportunities, technical assistance with grant criteria and helping with grant writing and data collection.

The Task Force also tracks progress and performance of grant applications of Arizona IIJA funding opportunities (which run through 2026).

The IIJA Task Force has a program manager (Cindi Ptak). The Task Force has representatives from several entities (many of which have had senior leadership changes in the last few months):

  • Governor’s Office
  • ADOT
  • ADEQ
  • ADWR
  • Water Infrastructure Finance Authority
  • ADES
  • Department of Forestry and Fire Management
  • ADOA
  • Arizona Commerce Authority
  • Governor’s Office of Homeland Security
  • ADoH
  • Governor’s Tribal Liaison

I can’t find any minutes of meetings that the Task Force may have had nor do I see a schedule of future meetings. Perhaps once the legislative session ends the Task Force will meet and the executive director will provide more information about the IIJA Task Force. Here is the website for the IIJA Task Force (which is pretty primitive still): IIJA Task Force — Information and Resources

You can track federal spending in Arizona through USAspending.gov

Here’s a good map out of the Bipartisan Infrastructure Law (BIL) Maps Dashboard and state-by-state fact sheets: FACT SHEET: White House Highlights Infrastructure Progress in Every Corner of the Country, Updates State-by-State Fact Sheets

Here are the climate, clean energy, and electric vehicle projects with direct Arizona links that have been funded so far via the Bipartisan Infrastructure Bill: Bipartisan Infrastructure Bill Impacts in AZ through May 5 2023

Will Humble Early Childhood, Wills Blog

Social Media & Public Health

Message from the Surgeon General: Social Media and Youth Mental Health

The US Surgeon General came out with a report this week outlining several categories including:

  • Negative impacts on kids
  • Social media can expose children to content that presents risks of harm
  • Social media use can be excessive and problematic for some children

The report offers some interventions described as “A Way Forward” outlining some actions that can be taken to make social media safer and healthier for youth (and includes a bibliography of references).

For example:

  • Policymakers can take steps to strengthen safety standards and limit access in ways that make social media safer for children of all ages, better protect children’s privacy, support digital and media literacy, and fund additional research.
  • Technology companies can better and more transparently assess the impact of their products on children, share data with independent researchers to increase our collective understanding of the impacts, make design and development decisions that prioritize safety and health.
  • Parents and caregivers can make plans in their households such as establishing tech-free Zones that help protect sleep and better foster in-person relationships, teach children and adolescents about responsible online behavior, and model that behavior, and report problematic content and activity.
  • Children and adolescents can adopt healthy practices like limiting time on platforms, blocking unwanted content, being careful about sharing personal information, and reaching out if they or a friend need help or see harassment or abuse on the platforms.
  • Researchers can further prioritize social media and youth mental health research that can support the establishment of standards and evaluation of best practices to support children’s health.

It would certainly be nice if the harmful effects of exposure to social media lends itself to simple and effective interventions. Sadly, that is not the case – and as the full report points out – there’s no simple intervention that’s easy to implement fore this public health problem.

Will Humble State Legislature, Wills Blog

Legislative Week in Review

Allie Bones – Governor Hobbs’ Chief of Staff since she took office resigned last week. The governor is expected to name her next chief of staff after the long holiday weekend. Look for Chad Campbell to be the new chief – that’s just a hunch – I don’t have any inside info.

Republican leaders of the House and Senate Health Committees (Shope, Montenegro) convened a two-day forum of a “Novel Coronavirus Southwestern Intergovernmental Committee. I went to the first couple of hours on the first day and quickly discovered that it’s a poor use of my time, so I left. I’ll spare you the details, but if you want to know more read this: Senate COVID hearing light on facts, heavy on misinformation.

The Governor signed nine bills last week including a continuation of AHCCCS and a new database of health professionals who’ve had their licenses revoked. She vetoed 22 bills – including limits on the use of student pronouns, a higher bar to get  unemployment benefits, bad changes to elections procedures, and SB1234, which would have forbid the use of any photo enforcement of traffic laws throughout the state -including photo red lights.

Governor Hobbs has signed 160 new laws and vetoed 94.

The House and Senate are still adjourned for two more weeks. The only thing scheduled next week is a Director Nominations Committee meeting for Martin Quezada for the Registrar of Contractors  Wednesday.

Will Humble Professional Development, Wills Blog

Maricopa County Public Health COVID-19 Video

On January 26, 2020, Maricopa County confirmed its first case of COVID-19. Within weeks, it was a public health emergency. This video tells the story of the county’s response over the first 2 years.  Four million people in an area nearly the size of Vermont. 

The Maricopa County Communications Office brings you news, insight, and curiosities from the heart of Phoenix and the 9,200+ square miles encompassing it. This is what is happening in your County, right here on YouTube: https://www.youtube.com/watch?v=TrWnrae_yUA&feature=youtu.be

Will Humble Firearm Safety, Public Health, Wills Blog

AzPHA’s Firearm Violence Report Featured in “The Nation’s Health”

AzPHA’s landmark report of firearm violence epidemiology and intervention evidence review is featured in the June edition of the American Public Health Association’s monthly newspaper The Nations Health

The article discusses how the AzPHA Board of Directors identified firearm violence as a top priority and how our affiliate followed through by publishing our comprehensive report.

The piece does a nice job answering ‘why’ we felt compelled to write the report and our hope that the work will translate into policy action by implementing some evidence-based foundational laws that have been proven to reduce firearm injury and mortality.

Any good policy intervention starts with surveillance and an evidence review, and we decided to do that…   to fill that gap. Any good Affiliate should think of themselves as a conduit for policy change and face the kinds of issues where there is resistance at the state level in terms of the governor.

Also from the article: ‘Making the report a reality was no easy task. The public health impact of firearm violence was not a priority for state agencies during the administration of former Arizona Governor Doug Ducey. A lack of buy in at the state level kept the health department from leading on gun violence prevention, but as a nonprofit organization, AZPHA is able to advocate for causes that might challenge the direction taken by state agencies.’

See the full article in The Nation’s Health: June 2023

Will Humble Uncategorized

Legislative Update: Second ‘Spring Break’

The House & Senate worked one day last week (Monday) and then promptly recessed until Monday, June 12.

The Legislature also took final votes on many of the remaining bills still in process, but most of them were hyper-partisan and can expect to meet with Governor Hobbs’ well-used veto stamp in the coming days. AZPHA is urging the governor to veto SB1234 – which would eliminate photo enforcement of traffic laws, although because that bill was modified in the House it is going back to the Senate again before it would hit Hobbs’ desk.

See: Do Red Light Cameras Save Lives? The Evidence Says YES

SB1710, which would extract the Arizona State Hospital from ADHS and report to a 5-member Board starting January 1, 2025 remains in limbo in the House, where it needs to go through Committee of the Whole and then a final floor vote. Whether it will make it through the process remains unclear.

Governor Hobbs vetoed one of the worst bills of the session last week, HB2545. Veto Letter HB2545. That bill would have limited the ability of the Governor to declare a public health emergency to 7 days. Extending the emergency would require 2/3 vote of the legislature. Extensions could last just 1 week, and the legislature would need to extend them every week with a 2/3 vote.

A rumor is circulating suggesting that the Legislature will remain perpetually in session, something that has never happened before. I think that’s hogwash because most bills don’t become effective until 90 days after the end of session…  and majority members are anxious to see bills that Hobbs did sign go into effect.

Will Humble Behavioral Health, Medicaid, Wills Blog

Stunning Medicaid Fraud Uncovered in AZ

No doubt you’ve heard about the massive fraud and human trafficking scheme that went on for the last several years in Arizona. Governor Hobbs & Attorney General Mayes led a press conference last week where they laid out the big picture of what they discovered had happened during the Ducey Administration.

Operators or associates of the sham healthcare centers picked up people who are unhoused, low-income, alone or intoxicated, and transported them to residential centers after promising to provide food, housing, and access to care. Perpetrators were mostly targeting Native Americans on reservations & in urban areas. 

The bottom line is that operators of fraudulent sober living homes and residential behavioral health facilities have for years been raking in taxpayer dollars from AHCCCS by recruiting Native Americans to enter the facilities and billing for treatment that was never provided. 

The fraud was made possible by a fee-for-service reimbursement mechanism inside AHCCCS’ American Indian Health Plan that allows providers to bill for services they say they provided rather than the more mainstream capitated system the rest of AHCCCS uses.

AHCCCS failed to either recognize that the fraud had been going on for years- or knew about the fraud but took little coordinated action. At the press conference Mayes said attorneys in the AG’s office during the Brnovich era had uncovered cases of abuse and raised concerns with AHCCCS but that Brnovich and Ducey didn’t uncover the full extent of the problems. 

AHCCCS payouts for outpatient behavioral health services increased more than 10-fold from 2019 to 2022 – going from $53M in FY 2019 to $668M in 2022. How in the world claims could expand 1,000% in 3 years and not be flagged for scrutiny is dumbfounding – especially for an agency that has cost-containment literally in its name.

Perhaps Attorney General Mayes said it best: “I don’t think it is too much to say that this is one of the biggest scandals in the history of the state of Arizona… our office estimates that it is in the hundreds of millions of dollars – it could go higher than that”.  

As an initial intervention, AHCCCS has suspended future payments to Medicaid 100 behavioral health providers because of the fraudulent billing activities. The Arizona Attorney General’s Healthcare Fraud and Abuse Section, the Federal Bureau of Investigation, the US Department of Health and Human Services, the US Attorney’s Office, and the Internal Revenue Service are also looking into this widespread and tragic disaster.

AHCCCS (now under new management) says the suspensions are the first step and that that this action is just the beginning of multi-agency investigations. They also announced some first step actions to prevent further fraud and trafficking like:

  • Reviewing existing claims and setting specific rates for current billing that pay a percentage of the total billed amount instead of a standard rate;
  • Creating a trend report of all providers registering for the at-risk provider types and closely monitoring any billing anomalies;
  • Creating system reporting to flag concerning claims (volume, services per day, services for minors) for review prior to payment;
  • Setting billing thresholds to deny claims for multiple services that should not be billed on the same day, and more; and 
  • Moving three behavioral health provider types to the high-risk category for new applicants and revalidating providers.

An ongoing and regularly updated list of registered providers subject to payment suspension or termination is posted on the AHCCCS Office of Inspector General Provider Suspensions web page. See more information in the Provider Payment Suspensions Fact Sheet.

As providers are terminated, there will no doubt be persons in both licensed and unlicensed sober living homes at risk of abandonment. AHCCCS is working to ensure persons who were receiving services but may no longer be getting them have a way to get back to where they want to be or into an alternative legitimate care setting. This will be a lot of work.

What is ADHS’ Role?

ADHS licenses sober living homes, behavioral health residential facilities, and outpatient clinics. They are responsible for ensuring that licensed facilities comply with ADHS licensing rules – which focus on health and safety.

ADHS doesn’t pay for services provided and isn’t involved in the billing, but they do have statutory authority to ensure patients are treated properly. It remains unclear what the ADHS licensing division discovered or did during the 2019-2022 time period when this massive fraud and human trafficking scheme flourished.

ADHS posted a couple of useful blogs last week that cover their responsibilities to license and regulate sober living homes and residential behavioral health facilities. Rather than paraphrase…  it’s best to post a link so here goes:  How we license facilities that provide substance abuse recovery resources – ADHS Blog

Will Humble Emergency Management, Public Health, State Legislature, Wills Blog

State Budget in the Books w/ Some Public Health Gains: A Summary

The Legislature passed and the governor signed what turned out to be a bipartisan budget last week. The $17.8B budget was negotiated by House Speaker Toma, Senate President Petersen & Governor Hobbs.

Many members in both chambers expressed frustration that there hadn’t been a more collaborative process, but ultimately voted in support. In general, all of the Republicans voted for the budget as did 9 Democratic senators and 16 D representatives.

You can find a line-by-line analysis prepared by the Joint Legislative Budget Committee here and you can see the bill line items in the feed bill.

Both chambers are meeting today for floor calendar action (COW and 3rd Read). Word on the street is both chambers will break until Monday, May 22 after today.

One important thing on the calendar today are in Senate COW is HCR2039 governor; state of emergency, which would dismantle the Recovery phase of emergencies in Arizona. Calendars

Last-minute questions by Senator Bennett in a (R) caucus meeting highlighted the damage the measure would cause to emergency management if the voters would have approved it. Let’s hope it fails in what’s likely to be a final 3rd read vote Monday. If it passes, Governor is unable to veto it and it’ll be on the November 2024 ballot.

Ballot Referral Could Dismantle Arizona’s Emergency Management System

SB1234 is up for a final vote in the House this afternoon. That one would prohibit cities or counties from using photo enforcement technology to enforce speeding or red light running.  

Do Red Light Cameras Save Lives? The Evidence Says YES

Here’s a breakdown on what the final budget package looked like from a public health perspective.

Housing Trust Fund Gets Big Cash Infusion

The biggest public health benefit in the budget is an unprecedented infusion of $150M into the state Housing Trust Fund. That fund provides the AZ Department of Housing with its most flexible source of money and includes healthy match for federal housing funds. It can be used for affordable housing development, housing aid programs and money for homeless shelters, transitional housing, eviction prevention, rapid rehousing, and other innovative activities. The Dept of Housing will set those priorities in the coming months.

Kids Care Extended to 225% of FPL

The second biggest, good thing for public health in the budget was a more generous eligibility level for families to take part in KidsCare. The budget bill relaxed the eligibility level from 200% of the federal to 225%.  This is expected to expand access to health insurance for approximately 9,500 kids in FY24, and 12,000 in FY25.

No Medicaid Adult Dental Benefit

The biggest public health disappointment was the failure to include a preventive oral health benefit for adult AHCCCS members. A reasonable and inexpensive proposal to begin covering a limited dental benefit was not made a priority and wasn’t included in the negotiated agreement.

Adult Medicaid members will still be eligible for a very limited $1K/year emergency dental benefit – but nothing else. That’s about enough to cover a couple of pulled teeth, but that’s about it.

Collaborative Care Initiative

There are a couple small scale things in the budget that are worth mentioning including a $1M line item that ADHS is getting to set up ‘collaborative care model’ templates to encourage formal collaborative arrangements among primary care physicians, care managers and a psychiatric consultant.

ADHS is supposed to ask for proposals from and enter into grant agreements with collaborative care technical assistance center applicants to supply technical aid to primary care physicians on providing behavioral health integration services through the collaborative care model.

Looks to me like this is set up to benefit a specific entity- but I’m not sure who.

Dementia & Alzheimer’s Disease

ADHS is also getting about $1.5M to coordinate a plan to deal with Alzheimer’s disease and dementia. They’re supposed to coordinate ‘support of policies and programs’ in the executive branch that relate to Alzheimer’s disease & dementia with the money.

The work is supposed to include a State Plan that ‘coordinates outreach programs and services between state agencies, local public health departments, tribal nations, educational institutions, and community groups to foster public awareness and education about Alzheimer’s disease and related forms of dementia’.

They’re also supposed to facilitate the ‘coordination of services and activities among the area agencies on aging, service providers, advocacy groups, legal services, emergency personnel, law enforcement, local public health departments, tribal nations and state colleges and universities’. Another responsibility includes incorporating early detection and risk strategies into existing public health programs.

ADHS is only getting $964K for all that work, which doesn’t seem very much compared to what they’re expected to do.

They’re also getting another $500K for an “education campaign to increase awareness of Alzheimer’s disease in rural and underserved urban areas”.  The language in the law is super specific and it’s pretty clear that this is an earmark for the Alzheimer’s Association.

Psilocybin (Magic Mushroom) Research Council

The budget also created a Psilocybin Research and Advisory Council that’s supposed to oversee competitive research grants (using the $5M appropriated) for ‘whole mushroom psilocybin clinical trials’ to evaluate the effects of whole mushroom psilocybin on treating a host of conditions.

Interestingly, the law didn’t give the money to the Arizona Biomedical Review Centre as would have been logical. Not sure why a separate entity was set up instead.

Budget Line-Item Breakdowns

Department of Health Services

  • Arizona State Hospital (ASH) Contracted Services $1,100,000
  • ASH Contracted Services One-time $6,000,000
  • ASH Video Security One Time $3,500,000
  • Alzheimer’s Research Ongoing $500,000
  • Dementia Services and Alzheimer’s State Plan non-lapsing through FY 2026 $964,100
  • Dementia Awareness GF One-time; non-lapsing $500,000
  • Psilocybin Research GF One-time $5,000,000
  • Collaborative Care Uptake Fund GF Onetime $1,000,000
  • Health Crisis Review and Wraparound Services GF One-time $5,000,000

AHCCCS

  • Arizona Health Care Cost Containment System KidsCare Expansion GF Ongoing; from 200% to 225% of the Federal Poverty Level $5,000,000
  • Critical Access Hospitals GF One-time $4,200,000
  • On-Call OBGYN Services GF One-time; non-lapsing $7,500,000
  • KidsCare Expansion OF Children’s Health Insurance Program Fund; ongoing $16,620,800
  •  

ADES

  • Adult Protective Services Backfill GF One-time $9,100,000
  • Produce Incentive Program GF One-time; non-lapsing; “Double Up Food Bucks” $5,462,600
Will Humble Wills Blog

MMWR: 2022 Mortality Data for the U.S.

Provisional Mortality Data — United States, 2022 | MMWR (cdc.gov)

Overall death rates and COVID-19–associated death rates decreased from 2021 to 2022 for most demographic groups compared with 2020, with the exception of certain age groups.

COVID-19–associated death rates increased for all persons aged <15 years. Although the overall and COVID-19–associated death rates decreased for persons aged ≥85 years from 2021 to 2022, rates remained higher for this group compared with all other age groups.

AzPHA member Allan Williams, Ph.D. ran the 2022 CDC Wonder data for AZ (below).

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