AZPHA’s Potential Positions on November Ballot Propositions: Part 3 – Open Primaries

Every cycle the Arizona Secretary of State generates a publicity pamphlet to help educate voters ahead of the general election. The pamphlet includes arguments in support of and against citizens’ initiatives and legislative referral. It’s a feature of the Clean Elections voter initiative from several years ago. The publicity pamphlet is a key educational resource for voters to use before voting.

As Arizona’s independent voice for public health, we’ve played a key role in helping voters to understand the public health implications of the various ballot measures. One way we do that is to send arguments for and against ballot propositions focusing on the good and bad public health impacts. Last cycle AZPHA placed arguments for or against 4 of the 10 ballot propositions.

This cycle the window for getting arguments filed is May 20th – June 20th. The arguments are posted in order they are received so it’s a good idea to get arguments early so voters see our stuff first.

There are already 6 ballot measures set for the 2024 ballot (not including the upcoming voter-driven Arizonans for Abortion Access). Three have direct impacts to public health / public health policy and a 4th will the AZ for Abortion Access initiative.

Our Public Health Policy Committee will be recommending arguments for the publicity pamphlet to our Board of Directors for consideration at our May 17 Board Meeting. If approved, I’ll be authorized to submit our arguments for the publicity pamphlet.

Anybody can turn in an argument. Simply write up an argument (300-word limit) and submit it to the General Election Ballot Measure Argument Portal along with the $75 fee. Portal is open from May 20 to June 20.

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See a summary and our draft argument FOR the Arizona Eliminate Partisan Primaries Amendment
See Our Draft Argument (For)

This voter-driven amendment would eliminate partisan primaries and replace them with an electoral system where individuals may vote for the candidate of their choice, regardless of the party affiliation of the voter or the candidate.

AZPHA’s Potential Positions on November Ballot Propositions: Part 2 – Signature Distribution Requirement for Voter Initiatives

Every cycle the Arizona Secretary of State generates a publicity pamphlet to help educate voters ahead of the general election. The pamphlet includes arguments in support of and against citizens’ initiatives and legislative referral. It’s a feature of the Clean Elections voter initiative from several years ago. The publicity pamphlet is a key educational resource for voters to use before voting.

As Arizona’s independent voice for public health, we’ve played a key role in helping voters to understand the public health implications of the various ballot measures. One way we do that is to send arguments for and against ballot propositions focusing on the good and bad public health impacts. Last cycle AZPHA placed arguments for or against 4 of the 10 ballot propositions.

This cycle the window for getting arguments filed is May 20th – June 20th. The arguments are posted in order they are received so it’s a good idea to get arguments early so voters see our stuff first.

There are already 6 ballot measures set for the 2024 ballot (not including the upcoming voter-driven Arizonans for Abortion Access). Three have direct impacts to public health / public health policy and a 4th will the AZ for Abortion Access initiative.

Our Public Health Policy Committee will be recommending arguments for the publicity pamphlet to our Board of Directors for consideration at our May 17 Board Meeting. If approved, I’ll be authorized to submit our arguments for the publicity pamphlet.

Anybody can turn in an argument. Simply write up an argument (300-word limit) and submit it to the General Election Ballot Measure Argument Portal along with the $75 fee. Portal is open from May 20 to June 20.

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Below is a summary and a draft argument AGAINST the Arizona Signature Distribution Requirement for Initiatives Amendment
See Our Draft Argument (Against)

This proposition (referred to the ballot by the legislature) adds a new signature distribution requirement to get citizen initiatives on that ballot. It would require organizers of future voter initiatives to gather 10% of votes cast for governor from each of the 30 legislative districts in order to qualify for the ballot. For constitutional amendments voters would need to collect 15% from each legislative district.

Future voter initiatives designed to address public health threats (such as the Arizona Abortion Access Act), the Smoke Free Arizona Act, the Predatory Debt Collection Protection Act and the voter initiative that expanded Medicaid to 100% of poverty would be MUCH harder time making it to the ballot if voters approve this measure.

AZPHA’s Potential Positions on November Ballot Propositions: Part 1 – Emergency Authority

Every cycle the Arizona Secretary of State generates a publicity pamphlet to help educate voters ahead of the general election. The pamphlet includes arguments in support of and against citizens’ initiatives and legislative referral. It’s a feature of the Clean Elections voter initiative from several years ago. The publicity pamphlet is a key educational resource for voters to use before voting.

As Arizona’s independent voice for public health, we’ve played a key role in helping voters to understand the public health implications of the various ballot measures. One way we do that is to send arguments for and against ballot propositions focusing on the good and bad public health impacts. Last cycle AZPHA placed arguments for or against 4 of the 10 ballot propositions.

This cycle the window for getting arguments filed is May 20th – June 20th. The arguments are posted in order they are received so it’s a good idea to get arguments early so voters see our stuff first.

There are already 6 ballot measures set for the 2024 ballot (not including the upcoming voter-driven Arizonans for Abortion Access). Three have direct impacts to public health / public health policy and a 4th will the AZ for Abortion Access initiative.

Our Public Health Policy Committee will be recommending arguments for the publicity pamphlet to our Board of Directors for consideration at our May 17 Board Meeting. If approved, I’ll be authorized to submit our arguments for the publicity pamphlet.

Anybody can turn in an argument. Simply write up an argument (300-word limit) and submit it to the General Election Ballot Measure Argument Portal along with the $75 fee. Portal is open from May 20 to June 20.

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Below is an analysis and Draft Argument AGAINST the Arizona Emergency Declarations Amendment
See Our Draft Argument (Against)

This proposition (referred to the ballot by the legislature) ends states of emergency and emergency powers after 30 days unless the legislature extends the emergency powers granted to the governor. Emergencies related to floods and fires are exempt.  I’m crossing my fingers that the next governor serving during a public health emergency will use that emergency authority as intended. If approved, this ballot referral would severely restrict that future governor’s ability to save lives.

The AZ Corp Commission & Public Health (Part III): Southwest Gas

At first glance, the Arizona Corporation Commission might seem like it has pretty much nothing to do with public health. But when you scratch the surface just a little, you’ll discover that the Commission does in fact influence public health.

In our first piece we discussed how the Commissioners’ rubber stamping of APS rate increases over the last couple of years is harming the social determinants of health. Last week we wrote about how recent Commissioner decisions are disincentivizing rooftop solar.

This week we’ll cover the Commission’s regulation of methane gas monopoly rates and how that impacts the social determinants of health.

  • Just last year (2023), Southwest Gas and its shareholders were celebrating the “largest revenue increase in company history,” thanks to the company’s back-to-back rate hikes on customers in 2022 and 2023 in Arizona. Like we discussed in week one – those rate increases disproportionately impact the budgets of low-income Arizonans.
  • While many Arizonans struggle to pay their bills, gas utility executives are getting rich. Southwest Gas reaped $54.3 million in record revenue in Arizona, while its executives pulled in huge salaries. For example, President and CEO Karen S. Haller made more than $4.3 million in 2022, while former CEO John P. Hester took in more than $6 million
  • Now Southwest Gas is asking the Commission for another large rate increase – its third increase in three years on Arizona customers. The utility is seeking a $125 million increase to its revenues, a nearly 12% increase.
  • They’re also asking Commissioners to allow it to charge ratepayers $385K each year to support their membership to trade associations, including the American Gas Association, a special-interest group that has organized legislative attacks on electrification, including in Arizona.
  • On top of that, Southwest Gas is continuing to seek a subsidy, known as a “line extension allowance,” forcing customers to pick up to pay for new gas lines to commercial and residential properties for wealthy developers. 

Utility regulators (elected Corporation Commissioners) should be protecting consumer interests, but recent history shows they’ve been on the side of utility executives and shareholders rather than everyday Arizonans.

My point with this post is that the elected Commissioners in the Arizona Corporation Commission can have a substantial impact on the social determinants of health – especially when they defer to well-heeled utility executives instead of their constituents.

If you care about the social determinants of health – and I know you do – make sure you do your homework vetting candidates to decide whether you think they’ll have the backs of utility executives and investors or ordinary Arizonans.

Maricopa County Launches 2024 Heat Relief Efforts

Maricopa County Public Health investing in community support to prevent another record-breaking year of heat deaths

In response to the largest number of heat-related deaths since tracking began, Maricopa County Department of Public Health is ramping up its heat response efforts for 2024 to expand the Maricopa County Heat Relief Network.

The Network was initiated in 2005 by the Maricopa Association of Governments and is comprised of public, private and non-profit volunteer organizations that all come together with one goal: reduce the number of heat related deaths in Maricopa County.

This year MCDPH is coordinating cooling and respite centers throughout the County along with ensuring that Maricopa County residents know how to access these centers.

In response to this assessment, MCDPH has developed a robust plan to support the community:

  1. Intergovernmental Agreements (IGAs) with Phoenix, Glendale, Chandler, Mesa and Tempe. In partnership with these large cities, cooling and respite centers will be available to those needing to get out of the heat. At least one heat relief site in each city will be open until 7 p.m. Monday through Friday and open on at least one weekend day. 
  2. Partnership with 2-1-1. MCDPH has contracted with AZ 2-1-1 to staff their call center with community health workers or promotoras that speak English and Spanish to help residents find cooling and respite centers, water and other heat relief support like utility assistance and A/C repair and replacement from 9 a.m. to 7 p.m. daily.
  3. Partnership with large organizations providing cooling and respite centers. MCDPH will also be contracting with larger non-profits providing heat relief center support to ensure that cooling and respite centers are staying open until at least 7 p.m. and on weekends throughout the county whenever possible.

MCDPH has invested in its workforce to support climate and health. It has hired a Climate and Health Program Manager, as well as a Heat Relief Coordinator to focus specifically on supporting the county’s heat relief site infrastructure. This work is in addition to MCDPH’s robust surveillance to track heat-related deaths, which it has done since 2006.

Every year since 2016, Maricopa County has set a new record in the number of heat-related deaths confirmed. To break this tragic streak, it will require everyone to play a role, and at the center of this is the Heat Relief Network.

Oral Arguments in the Petersen v. Hobbs ‘Director Nominations’ Case Delayed Until May 20

After the shenanigans in early 2023 at the “Director’s Nominations” Committee it became clear that Governor Hobbs nominees to lead state agencies wouldn’t be getting a fair shake from the Committee or the Senate.

We posted a blog back then arguing that the Governor should use loopholes in the statute to get her nominees onto more stable ground: Time to Play Hardball with Agency Director Nominations? Here’s a Playbook

Hobbs ended up going with Option 3 from that blog post as outlined in Governor Hobbs Letter to Senate President Petersen. Hobbs first withdrew the 13 nominations of the agency directors that she had previously sent to the Senate.

The statutes about senate confirmation requirements are sufficiently vague and provide loopholes that gave Team Hobbs options to provide stability and governance options. See: 38-211 – Nominations by governor; consent of senate; appointment 

See: Senate committee doesn’t ‘vet’ nominees. It sabotages them

She then appointed a guy named Ben Henderson as the Interim Director for each of the agencies. Mr. Henderson proceeded to name the person who had previously been nominated to be director to the title of Executive Deputy Director.

State Senate President Petersen sued Governor Hobbs in Maricopa County Superior Court a few months ago. Several briefs have been filed by both parties, and Judge Blaney had scheduled the first round of oral arguments in court last week but later delated oral arguments until Monday, May 20: Civil Court Case Information: Petersen v. Hobbs

Maricopa County Superior Court CV2023-019899

My sense is this case will ultimately be appealed to the Arizona Supreme Court – so it may be several months to more than a year before we have a final resolution in this important policy matter. However, if the State Senate flips or ends in a 15-15 tie or if Dems take control of the chamber things could change rapidly and the case could end up being dismissed once a new Senate president is sworn in.

Note: The Chair of the Director Nominations Committee, Jake Hoffman, was recently indicted by an Arizona Grand Jury on numerous serious felony charges. Nevertheless, Senate President Hoffman has not removed Hoffman from his Director Nomination and Government Committee perches.

See: Governor Katie Hobbs Pulls Nominees from Partisan Political Circus Created by Extremist Jake Hoffman

Governor Signs Repeal of the Near Total Ban on Abortion Care: AzPHA’s Draft Voter Initiative Argument

You undoubtedly know that both the legislature narrowly passed and the governor signed a bill repealing the near total abortion ban that was originally passed during the first territorial legislature in 1864.  It’s unclear when the repeal will actually take effect – most likely around October 1 (90 days after the end of the legislative session).

Meanwhile, as a result of the state Supreme Court’s decision awhile back, that very same territorial law is set to take effect at the end of June, meaning – unless something changes – there will be virtually no abortion care in Arizona during July, August and September. Beginning in October that care would be restored up to 15 weeks gestation.

Meanwhile, folks working on the Arizona Right to Abortion Initiative continue to be busy collecting signatures to place a constitutional amendment on the ballot that would place the right to abortion care in the state constitution.

AZPHA has a series of Resolutions in place (going back decades) AzPHA Resolutions on Women’s Reproductive Rights Go Back to 1938 and AZPHA will be supporting the Act.

Every cycle the Arizona Secretary of State generates a publicity pamphlet for the ballot to support voter education which is mailed to registered voters ahead of the general election. The pamphlet includes arguments in support of and against citizens’ initiatives and legislative referrals.

The publicity pamphlet is a key educational resource for voters to use while navigating the ballot, or before going to the polls.

AZPHA has a history of including arguments for and against ballot propositions focusing on the good and bad public health impacts that could occur to help inform voters. Last cycle AZPHA placed arguments for or against 4 of the 10 ballot propositions.

We’re working on arguments for up to 5 of the ballot measures that’ll be on the ballot – including the Arizona Right to Abortion Initiative. Below is a working draft of what we’ll be including in the voter guide: 

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Vote For Sexual & Reproductive Health Fairness

Vote Yes on Proposition xxx

We urge you to vote Yes on Proposition xxx because it helps ensure sexual and reproductive fairness for all Arizonans.

Arizona’s record of ensuring fair reproductive health policy equality is checkered. You’re no doubt familiar with the law from 1864 that criminalized abortion care has been repealed (for now).

While the Arizona Public Health Association is grateful for the sensible repeal of that territorial-era law, we also know a similar restriction could be revived at any time by the state legislature.

In fact, a resurrection of that territorial era abortion ban may be just a couple of legislative sessions away…  that is unless we change the Arizona State Constitution to protect abortion care by voting YES on the Arizona Right to Abortion Initiative (Proposition xxx).

A large body of published evidence shows policy restrictions on sexual & reproductive health care cause health inequality and harm public health outcomes. Public health evidence shows that unreasonable restrictions on access to abortion negatively affect the provision of care, the availability of patient-centered services and reproductive autonomy.

Policy solutions that center and promote sexual and reproductive health equality like Proposition XXX are essential for building fair reproductive health care.

We hope you’ll join us by voting YES on Proposition XXX & continue to help us strive for other evidence-based reproductive freedoms like:

  • Ensuring sexual & reproductive health care programs provide person-centered care;
  • Requiring all health insurance plans and programs to provide comprehensive coverage for all contraceptive options;
  • Ensuring patients have multiple options for accessing reproductive health care;
  • Strengthening federal Title X Family Planning; and
  • Removing restrictions that silo abortion care.

Access to abortion care with reasonable restrictions is also a core element in reproductive care fairness.

Please vote YES on Proposition xxx

USDA Improves Nutrition Standards for Free & Reduced Lunch Program

USDA finished changes to the nutrition standards they expect participating schools to follow who take part in the USDA’s free and reduced breakfast/lunch programs. Schools across our country are serving breakfasts and lunches to nearly 30 million children every day.

Healthy school meals are the main source of nutrition for more than half of these students and are an essential part of the educational landscape.

USDA says their new standards were”… shaped by a host of stakeholders, including parents, devoted teachers, school administrators, school nutrition directors, and industry leaders, and are informed by the latest Dietary Guidelines for Americans”.

Here are the top line changes that will be implemented over the next couple of years:

  • Reduced added sugars in school breakfasts;
  • Making it easier to offer healthy proteins at breakfast;
  • Scaling back sodium levels;
  • Incentivizing fruits and vegetables and whole grains;
  • Making it easier for schools to accommodate vegetarian diets and the cultural and religious food preferences of students.

To learn more about the updated school nutrition standards, please visit the USDA Food and Nutrition Service website.

 

Biden Administration to Reschedule Cannabis Under the Controlled Substances Act

What Are the Implications?

In a surprise move, Biden Administration insiders have signaled that a few executive branch agencies will be moving in unison to reschedule marijuana from what’s called a “Schedule I” drug to a Schedule III drug under the Controlled Substances Act.

What is the Controlled Substances Act?

The Controlled Substances Act is the main federal law that regulates many aspects of controlled substances. Drugs or substances are examined for their medical (beneficial) use, potential for abuse, safety and the likelihood that people would become dependent on the substance.

Congress enacted the CSA way back in 1970 so drugs with a potential for abuse could be available for medical, scientific, and research purposes, while trying to prevent them from being diverted for illegal reasons like drug abuse and trafficking activities.

What is the DEA’s Role?

The CSA is mainly under the prevue of the Drug Enforcement Administration (DEA), not the Food and Drug Administration. The DEA is housed within the US Department of Justice…  which tells you their mission is really enforcement of laws regarding who can possess drugs rather than how drugs are licensed, prescribed, and filled.

The DEA uses the Controlled Substances Act language to classify drugs or substances with those characteristics into one of 5 categories – ranging from Schedule I (those with no medical use and potential for abuse and dependency) – to Schedule V. Schedule V drugs tend to have legit medical uses and a low risk of abuse and dependency.

DEA’s algorithm for classifying drugs is based on these criteria:

  • Its actual or relative potential for abuse
  • Scientific evidence of its pharmacological effect
  • The state of current scientific knowledge
  • Its history and current pattern of abuse
  • The scope, duration, and significance of abuse
  • What, if any, risk there is to the public health
  • Its psychic or physiological dependence liability
  • Whether it’s an immediate precursor of a controlled substance

Here are some examples of where drugs lie on the Schedule spectrum:

  • Schedule I: Marijuana, ecstasy, heroin, LSD, and peyote
  • Schedule II: Methamphetamine, cocaine, fentanyl, Vicodin, oxycodone, and Adderall.
  • Schedule III: Anabolic steroids, testosterone, and ketamine, Tylenol with codeine.
  • Schedule IV: Xanax, Ambien, Ativan, and Valium.
  • Schedule V: Cough suppressants.

Alphabetical listing of Controlled Substances

A lower schedule number corresponds to greater restrictions, so substances in Schedule I are subject to the strictest controls, while substances in Schedule V are subject to the least strict. Schedule I drugs, where marijuana has been since 1970, aren’t authorized for anything.

That classification is a primary reason why marijuana was an enforcement priority for the DEA for many years. That has changed over time as more and more states adopted medical marijuana laws followed by laws that make it available for recreational purposes.

How Fast will Rescheduling Happen?

The rescheduling of marijuana from Schedule I to Schedule III won’t happen overnight. There is a defined process that needs to happen first. This week’s announcements were just the first steps in the rescheduling process.

The first step of the Office of Management and Budget to sign off on rescheduling marijuana to Schedule III. HHS has already recommended that marijuana be moved to a lower Schedule. After the public comment period (and a review by an administrative judge) DEA could publish the final rule.

After it’s rescheduled, marijuana would still be subject to various rules for Schedule III drugs and there could still be federal prosecution of people who traffic in the drugs without permission. Presumably, the feds will continue to mostly avoid prosecuting people for marijuana possession in states with medical or recreational marijuana laws (like Arizona).

However, it’s unlikely dispensaries operating in states like AZ would meet the federal Schedule III production, record-keeping, prescribing and other requirements… so those will be enforcement matters for DEA to still figure out.

Researching Marijuana will Become a Lot Easier

Marijuana’s status as a Schedule I drug has made it really hard to conduct authorized clinical studies that involve administering the drug. That’s created a bit of a conundrum: we’ve needed more research on Cannabis for a long time, but its Schedule I status was a huge barrier to actually doing it. Those barriers will be largely removed after rescheduling, making marijuana much easier to research for clinical/medical purposes.

Banking and Taxation Issues

Dispensaries haven’t been able to deduct rent, payroll or various other expenses that other businesses can write off because marijuana is Schedule I. Under the tax code, dispensaries are considered traffickers of an illegal substance because of its Schedule I status. Once Cannabis moves to Schedule III dispensaries will be treated like any other business.

Marijuana’s Schedule I status has been locking dispensaries out of banking services (especially loans). Rescheduling may not immediately (or directly) affect dispensaries’ ability to access banks because the federally regulated institutions are wary of the drug’s legal status, but that should change with rescheduling. Dispensaries have been trying to get the SAFE Banking Act to fix that. Some say passing the Act won’t be necessary if DEA actually reschedules.

Likewise, dispensary customers will likely begin to be able to use credit cards to buy product – but that remains to be seen as it’s the bank and credit card company’s decision.

Dispensaries operating in states like AZ currently don’t meet the federal Schedule III production, record-keeping, prescribing and other requirements so they’d presumably need to come into compliance with those requirements to enjoy the banking (and tax) benefits. Some in the industry worry that the IRS and banks would only consider medical marijuana dispensaries to be in compliance with new regulations – meaning retail dispensaries wouldn’t enjoy tax and banking benefits of rescheduling.

Why? Because Schedule III drugs require a prescription to be issued and filled by a ‘practitioner’. Recreational buyers don’t have a prescription nor are dispensary agents likely to be considered practitioners.

Will Big Pharma Get Involved & Compete with Dispensaries?

Once marijuana is rescheduled, pharmaceutical companies can start applying for licenses from the FDA for drugs/medications that use Cannabis. Once approved, those drugs could become available in local pharmacies.

Theoretically big pharma might see rescheduling as an opportunity to get a piece of the Cannabis action by applying for licenses to sell things like edibles for therapeutic purposes…  think gummies with a combo of CBD & THC as a sleep aid as an example. Like other drugs – they’ll need to prove to the FDA that they’re safe and effective to get them approved.

Honestly though, drug companies tend to like to get patents and drug approvals for medicines that are unique and have no biosimilar competitors because they can charge much higher prices. There are a host of competing drugs containing marijuana in states that have medical and retail programs – so I think it’s unlikely pharmaceutical companies will get involved, but I could be wrong. There’s no way FDA is going to approve marijuana buds etc. – so there won’t be any new competition on that front.

CMS Establishes Minimum Staffing Standards for Long-Term Care Facilities

Centers for Medicare & Medicaid Services pay for a big chunk of the care at skilled nursing facilities via their Medicaid and Medicare programs. As such – they have a keen interest in making sure the care for the people they’re paying for is good.

For the last couple of years, they’ve been reevaluating their standards and expectations for facilities that serve folks via Medicare and Medicaid (nearly 1.2 million residents live in Medicare- and Medicaid-certified long-term care facilities paid for by CMS).

See: Medicare and Medicaid Programs: Minimum Staffing Standards for Long-Term Care Facilities and Medicaid Institutional Payment Transparency Reporting Final Rule (CMS 3442-F) | CMS

Last week, after reviewing 46,000 public CMS just established new rules that will a total nurse staffing standard of 3.48 hours per resident day. CMS is also finishing enhanced facility assessment requirements and a requirement to have an RN onsite 24 hours a day, seven days a week, to provide skilled nursing care. 

See: How The Republic reported on resident harm in senior living facilities

CMS will also require states (ADHS) to collect and report on the percent of Medicaid payments that are spent on compensation for direct care workers, and support staff, delivering care in nursing facilities and intermediate care facilities, for individuals with intellectual disabilities. 

They’ll be offering hardship exemptions in limited circumstances to the 3.48 hours of nursing per resident per day and 24/7 onsite RN requirements if they meet several geographic staffing unavailability, financial commitment to staffing, and good faith efforts to hire.

Enforcement is largely up to the state health departments who contract with CMS to do the certification inspections, in our case ADHS.

See Auditor General’s Office Produces Scathing Review of ADHS’ Nursing Home Complaint Investigations During the Director Christ Era &

 The Arizona Republic’s The Bitter End Series

Last week’s directive from Hobbs to agency directors ordering them to implement a hiring freeze (and send her a plan to cut 4% from their current-year spending and additional 2% cuts next FY) undercuts the department’s efforts to improve their performance.

Hobbs’ budget letter points to cuts, hiring freeze for Arizona government

Those moves cast an uncertain shadow on ADHS’ ability to hire and keep adequate staffing to ensure folks are receiving adequate care in licensed care facilities.

For now, I will give the administration the benefit of the doubt that ADHS Licensing (which lives mostly off licensing fees) and the Arizona State Hospital will be exempt from this new directive. For now, those positions in Licensing and ASH are still posted on AZ State Jobs