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I’ve asked them for an independent and objective review of statutes and rules several times and their analyses are complete, helpful and prompt (and free).
Public Health Journalism this Week
New bills proposed for psychiatric care of seriously mentally ill | 12news.com
Adults who rely on Arizona’s Medicaid program may get expanded coverage | KJZZ
Affordable Care Act enrollment hit record highs in Arizona, U.S. in 2023 (azpbs.org)
Emergency rooms in Arizona hospitals are extremely busy. Here’s why (azcentral.com)
Why is ban sought for menthol cigarettes? What Arizonans need to know (azcentral.com)
Arizona sober living scandal may have cost taxpayers $2 billion-plus (azcentral.com)
Full Health & Human Services Committee Agendas this Week
The health committees in the House and Senate have full agendas for the first time this legislative session. House Health meets Monday at 1:30pm and Senate at 1:30 Tuesday.
We’ve signed up in support of several bills in both committees next week. Several more aren’t in our wheelhouse and we haven’t taken a position. The bills that are bold are ones we’re supporting. The two that are in underlined are the bills I’ve selected to speak about at the podium this week.
Arizona Legislative Session Underway: Here’s Our Advocacy Approach
Let Legislators Know What You Think: Here’s How
Senate HHS (Tuesday 1:30pm Jan 30)
SB1020 | newborn screening; Duchenne muscular dystrophy | Shope |
SB1048 |child fatality review teams; duties | Shope |
SB1076 |marijuana funds; uses; enforcement | Shope |
SB1085 | pharmacists; independent testing; treatment | Shope |
SB1086 |assisted living facilities; referral agencies | Shope |
SB1100 | Arizona state hospital; private entity | Miranda | Neutral
SB1101 |appropriations; secure behavioral health facilities | Miranda
SB1154|dental board; dental hygienists | Shamp |
SB1163 |homeopathic medicine; integrated medicine; qualifications | Shamp
SB1178 |hospital interconnectivity; appropriation | Gowan |
SB1191 |developmental disabilities; Prader-Willi syndrome| Wadsack
|
House HHS (Monday 1:30pm Jan 29)
| HB2033 |department of health services; rulemaking | Cook |
| HB2050 |board of psychologist examiners | Bliss |
| HB2054 |SNAP eligibility; probation compliance | Dunn |
| HB2093 |emergency services; prudent layperson; definition | Parker B |
| HB2111 |licensed facilities; transfer; sale; prohibition | Willoughby |
| HB2112 |insurance coverage; hearing aids; children | Willoughby |
| HB2116 |fatality review; information; access | Willoughby |
| HB2137 infants; toddlers; developmental delays | Willoughby |
| HB2187 |health professionals; title use; prohibitions | Parker B |
| HB2402 |DCS; investigations; interviews; recording | Gress |
| HB2450 |remote pharmacies; pharmacy technicians; training | Montenegro |
| HB2451 |marijuana; advertising; restrictions | Montenegro |
| HB2454 kinship foster care; hearings; reports | Montenegro |
Note: Vitalyst put together this terrific compilation of categorized public health related bills this week. Rather than recreate their work I decided to just link to it above. Really good summary from Ana Roscetti.
Governor Hobbs Proposes Budget: Proposal Includes Investments in ADHS Licensing and Transparency Measures
Governor Hobbs has proposed a $16 billion budget, a decrease from last year’s $17.8 billion state spending plan. The economists at the JLBC think the deficit for the next two years is $1.7 billion, nearly twice the amount Hobbs’ $900 million estimate. The Governor’s Office estimates Arizona will pull in $823 million more revenue than the JLBC thinks the state will. The JLBC estimates baseline spending will decrease $1.5 million in the next fiscal year due to the cessation of one-time spending in last year’s budget.
Hobbs proposed cutting about $1 billion from the budget in a mix of cuts, sweeps and clawbacks and delays including clawing back $770 million in existing funding:
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- $419 million in transportation projects, like the I-10 widening in the West Valley.
- $188 million for capital projects, including state corrections department repairs.
- $163 million in operating expenses, like the Prescott Rodeo and Arizona Department of Education.
- Sweep $282 million in funds from 44 agencies.
For the next fiscal year, the governor proposes cutting $737 million, including:
- $413 million in ESA cost.
- $300 million of planned funding for long-term water projects.
- $4 million from the House and Senate budgets, combined.
- $3 million from the Governor’s Office budget, including $1 million from the Missing and Murdered Indigenous People Task Force.
ADHS Licensing Program Investments
Hobbs made several proposals to improve ADHS’ healthcare licensing system after a series of articles in the Arizona Republic highlighting the impact that the lack of investment in and poor leadership at ADHS licensing programs during the Ducey Administration had – as well as the scathing Auditor General Reviews.
Governor Hobbs proposes an increase of $24.8 million in ADHS’ licensing programs including $1.9 million ongoing and $157,500 one-time to add 16 employees to follow up on complaints, general inspections, and enforcement. She’s also proposing $500K ongoing and $900K one-time to fund improvements to AZCARECHECK to improve transparency.
There’s also $500K earmarked for an independent assessment of AZ’s network of services for persons with a serious mental illness, and $485K for ADES Ombudsmen and $271K ongoing for an ombudsman for the AZ State Hospital.
The budget also includes a $10M item for AHCCCS to get more people to join behavioral health quality improvement initiatives.
AZPHA 2024 Conference Addressing Arizona’s Opioid Crisis: Registration & Sponsorship Opportunities Open!
2024 AzPHA Annual Conference:
Addressing Arizona’s Opioid Crisis
Desert Willow Conference Center
4340 E Cotton Center Blvd, Phoenix, AZ 85040
Thursday, February 29, 2024
8:30am – 4:30pm
View Our Final Conference Agenda
Over 40 Arizona public health professionals presenting with lots of opportunities for in-person networking! Special guests include Arizona Attorney General Kris Mayes, AHCCCS Executive Officer Carmen Heredia, and U.S. Department of Health and Human Services Region IX Administrator Dr. Jeffery Reynoso.
Register Today!
Sponsorship Opportunities
Title Sponsor
Silver Sponsor
Bronze Partner
Legislative Session Kicks Off In Earnest this Week: Our Positions on Bills So Far
The legislative session kicked off on paper last week – but this upcoming week is really the first set of committee hearings, including the first hearings of the Health and Human Services Committees.
The House Health committee will meet on Mondays at 2pm. Senate Health and Human Services will meet Tuesdays at 2pm. There are only four bills posted in each committee this week. We’ve signed up in support of a couple bills being heard this week including SB1037 which would allow adult Medicaid members to use their $1000 annual dental benefit for more tha just emergency procedures.
On the House side, we’ve signed in against HB2183 which would entitle parents with the right to receive from a health care entity equivalent access to any electronic portal or other health care delivery platform for their minor child.
While that might sound reasonable, we believe it would pose a risk to kids who are being abused – making even more difficult to get treatment – especially those being sexually abused. Also, other teenagers who are sexually active may be discouraged from seeking treatment if they know their parents have access to their medical records – causing unaddressed infections and increasing the spread of STIs.
AZPHA has taken positions on about 40 bills so far. A short synopsis of where we are on these bills is below:
| House | ||
| Bill # | Description | Position |
| HB2002 | power plants; transmission lines; definition | No |
| HB2003 | replacement lines; structures; commission hearings | No |
| HB2004 | utilities; electronic filings; corporation commission | No |
| HB2005 | Arizona power authority; DWR cooperation | No |
| HB2130 | counties; maximum acreage; energy production | No |
| HB2131 | residential utility consumer office; businesses | No |
| HB2133 | solar panel disposal fund | No |
| HB2035 | insurance; claims; appeals; provider credentialing | Yes |
| HB2041 | school safety program; mental health | Yes |
| HB2042 | food preparation; sale; cottage food | N/A |
| HB2051 | joint training; surveyors; providers | Yes |
| HB2079 | food handler certificate; volunteers; limits | Yes |
| HB2081 | cremation | Yes |
| HB2183 | parental rights; medical records | No |
| HB2111 | licensed facilities; transfer; sale; prohibition | Yes |
| HB2112 | insurance coverage; hearing aids; children | Yes |
| HB2130 | counties; maximum acreage; energy production | No |
| HB2137 | infants; toddlers; developmental delays | Yes |
| HB2139 | medical records; minors; confidentiality; consent | No |
| HB2192 | energy projects; grazing operations; compensation | No |
| HB2221 | firearm purchases; waiting period; offense | Yes |
| HB2223 | sentencing; concealed weapons permits; surrender | Yes |
| HB2224 | TPT; exemption; firearm storage devices | Yes |
| HB2226 | nursing care institutions; advisory council | Yes |
| HB2228 | AHCCCS; complex rehabilitation technology | Yes |
| HB2230 | AHCCCS; outpatient services | Yes |
| HB2231 | nursing care institutions; medical directors | Yes |
| HB2233 | firearms; ammunition; storage; civil penalty | Yes |
| HB2238 | severe threat order of protection | Yes |
| HB2239 | firearm sales; permit verification; requirements | Yes |
| HB2240 | firearms dealers; firearms transfers; requirements | Yes |
| HB2249 | residential care institutions; inspections | Yes |
| HB2281 | solar royalties fund; county residents | No |
| HB2315 | assisted living facilities; ownership; employees | Yes |
| HB2468 | community fridge; liability; prohibition | Yes |
| HB2471 | rulemaking; legislative approval | No |
| HB2513 | AHCCCS; preventative dental care | Yes |
| HB2560 | sober living; behavioral health; licensure | Yes |
| Senate | ||
| SB1002 | drug paraphernalia; testing; analyzing; repeal | Yes |
| SB1002 | drug paraphernalia; testing; analyzing; repeal | Yes |
| SB1003 | prohibition; photo radar | No |
| SB1010 | vehicle mileage; tracking; tax; prohibitions | No |
| SB1013 | government investments; products; fiduciaries; plans | No |
| SB1014 | business; discrimination prohibition; social criteria | No |
| SB1019 | appropriation; health innovation trust fund | Yes |
| SB1024 | spina bifida, developmental disabilities | Yes |
| SB1028 | medical assistance; drugs; prohibited arrest | Yes |
| SB1037 | AHCCCS, comprehensive dental | Yes |
| SB1045 | public restrooms; feminine hygiene products | Yes |
| SB1067 | DCS; group homes; investigations | Yes |
| SB1066 | solar royalties fund; county residents. | No |
| SB1068 | secure behavioral health facilities; appropriations | Yes |
| SB1100 | Arizona state hospital; private entity | Neutral |
| SB1101 | secure behavioral health facilities; appropriations | Yes |
| SB1102 | civil reintegration unit; state hospital | Yes |
| SB1103 | state hospital; governing board; governance | Yes |
| SB1157 | influenza response plan; updates; review | Yes |
Several Bipartisan Bills to Focus on Improving Care for Persons with a Serious Mental Illness
The Arizona State Hospital is located on a 260 bed 93-acre campus in Phoenix providing inpatient psychiatric care to people with mental illnesses who are under court order for treatment. Treatment at ASH is considered “the highest and most restrictive” level of care in the state. Patients are admitted because of an inability to be treated in a community facility or because of their legal status.
The Civil portion of the hospital provides services to people civilly committed as a danger to self, danger to others, gravely disabled and/or persistently and acutely disabled. Forensic patients are court-ordered for pre- or post-trial treatment because of involvement with the criminal justice system due to a mental health issue.
The needs of patients at ASH can be complex and the patients are vulnerable, so it’s critical to ensure the facility uses best practice treatment and is following a rigorous set of regulations. To achieve fidelity to best practice standards, it’s critical that the governance structure ensures accountability and is free from conflicts of interests.
The existing governance structure is insufficient to ensure quality care is provided at ASH. The fundamental flaw is that ADHS both runs & regulates ASH.
The lack of independent regulation & oversight of the Arizona State Hospital results in poor accountability and can lead to unchecked substandard care when ADHS leadership soft-pedals regulatory oversight to give the appearance that the facilities are providing care that meets standards.
There is evidence that this occurred during the Ducey Administration. For example, in 2021, ADHS’ licensing division investigated multiple suicides and a homicide and concluded that no operating deficiencies led to those deaths. Suicides and homicides only occur when there are deficient practices.
For context read this article by Amy Silverman: Patient deaths at Arizona State Hospital raise questions about staffing levels, lack of oversight, this piece by Mary Jo Pitzl at the Arizona Republic and these important investigative stories by Stephanie Innes: Arizona State Hospital patients have died since 2015 and More oversight is needed at the Arizona State Hospital
AzPHA was a supporter of SB1710 during last year’s legislation because it was commonsense solution to governance problem that’s jeopardizing care at ASH by separating the operational functions of running ASH from the regulation of ASH. Sadly, there was a last second amendment that gutted all of the meaningful governance reform in that bill, and the Arizona Department of Health Services continues to both run and ‘regulate’ the Arizona State Hospital. See: Governance Reform of the Arizona State Hospital Goes Up in a Puff of Smoke
Fortunately, Senators Miranda and Shope continued to work with informed stakeholders, pursuing governance reform for our Arizona State Hospital. They even published a couple of op-eds in the Arizona Republic explaining their vision for improving care:
Arizona State Hospital Needs Independent Oversight, Isn’t Getting It
Arizona State Hospital needs reform. Here’s how to do it
That ‘off-season’ work bore some important fruit. A series of bills were just posted to the State Legislature’s website this afternoon with a set of bipartisan plans sponsored by Senator Miranda and several other legislators (of both parties) to improve services and governance of the Arizona State Hospital and other psychiatric care resources.
- SB1100 Arizona state hospital; private entity would direct the ADHS to go out to bid to identify a private entity who would operate the state hospital, removing the conflict-of-interest ADHS has by being responsible for both running and regulating the facilities.
- Another more desirable alternative is SB1688 (Gowan) state hospital; governing board; governance which would establish a 5-member Governing Board who would be responsible for hiring and managing the State Hospital Director. The state hospital would report to and serve at the pleasure of the Board. SB1688 got a unanimous (7-0) pass recommendation from the Senate Health Committee on February 13 and awaits a floor vote in the Senate.
- SB1102 civil reintegration unit; state hospital would provide a badly needed Civil Unit Reintegration Unit at the Hospital as outlined in ADHS’ Clinical Improvement and Human Resource Plan.
- Finally, SB1101 appropriations; secure behavioral health facilities would create and fund more secure residential treatment facilities for persons under a court order for treatment – a huge gap in the continuum of care – also identified as a gap in ADHS’ Clinical Improvement Plan.
AZPHA will be carefully following the progress of these bills and will be an active partner to help inform the debate as these important bills work their way through the legislative process this session.
Register Today for AZPHA’s 2024 Conference: Addressing Arizona’s Opioid Crisis
AzPHA Annual Conference
Addressing Arizona’s Opioid Crisis
Desert Willow Conference Center
4340 E Cotton Center Blvd, Phoenix, AZ 85040
Thursday, February 29, 2024 (Leap Day)
8:30am – 4:30pm
View Our Conference Agenda*
*Subject to invitation acceptance by presenters
Sponsorship Opportunities
Register Here!
Conference Topics Subject to Final Speaker Confirmation
- Opening Remarks by Arizona Attorney General Kris Mayes (confirmed)
- Closing General Session: AHCCCS Policy, Programs and Resources Targeting the Opioid Epidemic; Increasing Service, Support and Cross-sector Engagement –Catherine Dobler, Polly Knape, et.al. AHCCCS
- Rates & Trends of Opioid/Fentanyl Overdose Deaths in Arizona, 2003-2023: Implications for Public Health Policy – Allan Williams, PhD & Will Humble, AZPHA
- Statewide overdose surveillance: strategies from the overdose data to action program at the ADHS – Martín Celaya, MPH , ADHS & Charles Katz, PhD – Arizona State University
- Findings from a Mixed-Methods Needs Assessment of People Who Use Drugs — Maricopa County, AZ, April–June 2023 – Christina Mrukowicz – Maricopa County Department of Public Health
- Risks from opioid use during extreme heat- Marisa Domino – ASU, Center for Health Information and Research
- Collaborative problem solving in rural communities to address the opioid crisis – Rocio Torres – Arizona Center for Rural Health & Christy Crowley – Easter Seals
- Collaborative efforts in rural consortium of SUD/OUD partners to support youth and young adults along the US-Mexico border – Yara Castro & Tsion Meles Mariposa Community Health Center
- Perceptions of overdose risks among persons who use illicitly manufactured fentanyl in Phoenix, Arizona – Raminta Daniulaityte & Kaylin Sweeney – ASU College Health Solutions
- From Stigma, to Hope, to Healing: Maricopa SHIFT: Safe, Healthy Infants and Families Thrive Clay Jones, M.Ed., IMH-E Maricopa County Department of Public Health
- A Citywide Approach to Opioid Response Planning – Nicole Witt, MPH & Yanitza Soto – City of Phoenix Public Health Advisor Office of Public Health
- A Tale of Two Cities: An Overview of Opioid Use Prevention Initiatives in Phoenix, AZ and Kansas City, KS – Jeffery Hanna, MPH, MSc & –Justin Zeien, MD, MPH Zeihan Prohealth Consulting, LLC
- Evidence to Action: Reducing Opioid Overdoses in Arizona through Medical and Pharmacy Practice Change- Beth Meyerson – Harm Reduction Research Lab, UArizona College of Medicine-Tucson
- Expanding MOUD Prescribers: How the Arizona State University Edson College of Nursing is addressing the Opioid epidemic – Ann Guthery PhD, PMHNP-BC & Matthew Martin– ASU
- The Yavapai County Connection Center: Serving recently incarcerated individuals, addressing the challenges of housing-employment-food insecurity, mental health needs, and substance abuse. James Tobin & Beya Thayer – Yavapai Community Health Services
- MCDPH Fellowship: Catalyst for Change in Maricopa County’s Correctional Health Services- Tori Osmundson Maricopa County Department of Public Health & Megan Baker – Maricopa County Correctional Health Services
- Access to treatment for incarcerated individuals experiencing opioid withdrawal in the Maricopa County, Arizona Jail System – Matthew Martin, PhD &Swetha Gansan, MS- ASU College of Health Solutions
- Using Overdose Data to Transform Care: What Data Matters- Amanda Sapp – Pima County Health Department
- Data to Action: Opioid Surveillance, Fatality Review, and Prevention Measures in State Public Health – Ginger Dixon & Mercedeh Reamer, MPH – ADHS
- From Overdose to Treatment & Recovery – Andy Sparks Director of Commercial Development at Integrative Strategies: Combining Medicine, Peer Support, and Care for Opioid Recovery – Riley Monahan & Barbara Lee – Crossroads
- Beyond Free Narcan. A Proposal for Meaningful Legislative Changes to Combat the Opioid Crisis – Hon. Gary E. Donahoe Judge of the Arizona Superior Court (ret.) & Jahanzeb Ali Khan, MD – Crossroads
- Perinatal Harm Reduction – Danielle Treiber Sonoran Prevention Works
- The Impact of Opioids on Maternal and Child Health and Strategies to Improve Outcomes in Arizona – Aubrianna Perez & Morgan Anderson – ADHS
- Public Health & Libraries Harm Reduction Partnership – Mark Person & –Kate DeMeester-Lane – Pima County Health Department
- Turning the Page on Opioids: Libraries as Community Partners – Dana Abbey Network of the National Library of Medicine, Engagement Specialist
- Saving Lives: Strategies and Successes of the City of Phoenix Naloxone Program – Yanitza Soto, MPH City of Phoenix Special Project Administrator Office of Public Health & Dominic Orso, MBA – Maricopa County Public Health
- Naloxone Leave Behind in Arizona – Julia Vinton & Adam Rodriguez– ADHS
ADHS Awards First Round of Justice Reinvestment Grants to Arizona Nonprofits
The Arizona Department of Health Services (ADHS) was charged with creating the Justice Reinvestment Program through the passage of Prop 207 (retail marijuana) in November 2020. The proposition legalized recreational marijuana use for adults 21 and older as well as created initiatives to increase safety and community resilience around arrest and incarceration, including the Justice Reinvestment Program.
The Office started by completing a statewide data and funding landscape analysis to decide which local communities were most impacted by drug enforcement, arrest, and incarceration. The analysis found priority communities across the state, where 18 listening sessions were held. Listening session participants expressed the following services would be beneficial for their communities:
- Neighborhood safety and community gathering infrastructure (such as parks, community centers, etc.)
- Cultural awareness training
- Accessible options for healthy food
- Affordable and accessible housing
- Stigma reduction and culturally proper health services
- Technology re-training for people who have been formerly incarcerated
- Positive youth development
- Substance use education and prevention
The Office of Health Equity then released a competitive grant application open to qualified Arizona nonprofits to support Justice Reinvestment programming this year.
The awarded projects address all of the key focus areas outlined in the statute and in the community listening sessions and represent communities from across the state of Arizona. ADHS is proud to announce the following grant awardees:
- Northland Family Help Center
- Hushabye Nursery
- Axiom Community of Recovery
- Cihuapactli Collective
- Stuck Community Acupuncture, Inc
- Phoenix Indian Center
- Arouet Foundation
- Friendly House
- Jobs for Arizona’s Graduates (JAG)
- Persevere
- Constructing Circles of Peace
- Regional Center for Border Health, Inc. – Yuma
- Regional Center for Border Health, Inc. – Parker
- Arizona Democracy Resource Center
- Southern Arizona Legal Aid, Inc.
- The Bambi Fund
- Just Communities Arizona
- Our Sister Our Brother
Additional Justice Reinvestment funding will be made available in the near future. Earlier and new applicants are encouraged to apply. Visit the ADHS Office of Health Equity’s Justice Reinvestment Program page for updates.
Legislative Session Kicks Off Today with the Governor’s State of the State Address
Monday marks the beginning of the 2024 legislative session. Governor Hobbs will give her State of the State address in the House at 2pm on Monday. You can attend the speech live from the top floor of the House (take the stairs/elevator to the top floor and go to the Gallery’.
It’s usually pretty packed so your best bet is to watch it on Capitol TV. Several media outlets will no doubt be covering it live as well.
I expect the Governor to talk about statutory changes and resources needed to improve the performance of ADHS’ Licensing Division, who is responsible for assuring the health and safety of Arizonans residing in assisted living and skilled nursing facilities as well as medical facilities, clinics, residential group homes, sober living homes etc.
Look for proposals to:
- Hike the limit the ADHS can assess against facilities for noncompliance. Right now only fine facilities $500 for each violation.
- Give ADHS additional authority to revoke licenses for cause.
- Close some loopholes like the law that allows assisted living facilities to skip annual inspection if they have a clean inspection the year prior. She may even propose eliminating ‘deemed status’ licenses, although I doubt it.
- Appropriations to hire more licensure staff.
- Create a quality rating system for nursing homes, assisted living and long-term care facilities.
Editorial Note: When you hear these proposals take note that they are a DIRECT result of the series by reporters Caitlin McGlade, Sahana Jayaraman and Melina Walling focusing unaddressed senior living violence and sexually assaults and a piece about how senior living facilities are often understaffed, endangering workers and residents.
It’s possible the governor may mention mental health care as well given the solid series of stories via Stephanie Innes about AZ’s behavioral health system – especially the Arizona State Hospital: Arizona is in a mental health crisis. Here’s what needs to improve.
About 200 bills have already been filed in the House, but only about 40 in the Senate so far. Those numbers will go up into the several hundred range in the coming days as legislators file their bills. You can find the inventory of bills in both chambers on the AZLEG website here: Introduced Bills.
So far we’re tracking about 12 of the pre-filed bills. That will dramatically increase in the coming days.
| Bill # | Description |
| HB2042 | food preparation; sale; cottage food |
| HB2081 | cremation. |
| HB2111 | licensed facilities; transfer; sale; prohibition |
| HB2112 | insurance coverage; hearing aids; children |
| HB2130 | counties; maximum acreage; energy production |
| HB2137 | infants; toddlers; developmental delays |
| SB1002 | drug paraphernalia; testing; analyzing; repeal |
| SB1002 | drug paraphernalia; testing; analyzing; repeal |
| SB1003 | prohibition; photo radar |
| SB1024 | spina bifida, developmental disabilities |
| SB1028 | medical assistance; drugs; prohibited arrest |
| SB1037 | AHCCCS, comprehensive dental |
The days and times for the House and Senate Health & Human Services committees aren’t posted yet – but by this time next week you’ll be able to calendar those events.
Our Public Health Policy Committee has a discussion board on Basecamp and that’s also where we post information, research and documents related to public health policy. Let me know if you’d like to sign up for that Basecamp site at [email protected].
Our policy committee also has conference calls every other Friday at 2pm starting in mid January. Details are in our policy committee basecamp (email me at [email protected] to get access to the members policy committee Basecamp).
Arizona Legislative Session Begins Monday, January 8: Here’s Our Advocacy Approach
Let Legislators Know What You Think: Here’s How
Learn How the Arizona State Legislature Works by Listening to this Consumable Podcast