Sober living fraud allegedly continuing in Arizona – Arizona PBS
Five things to know about the legality of abortion in Arizona
Are extreme heat and wildfire smoke major disasters? – Los Angeles Times
Arizona has some of the dirtiest air in the nation. How to fix it
New claims against Arizona over Medicaid fraud total $2.3 billion
Governor approves ‘magic mushroom’ research, Molly therapy in Arizona
US Tools to Fight Extreme Heat Debated as FEMA Pressured to Act
The US Surgeon General recently declared firearm violence a public health crisis. While this is not a declaration of a public health emergency and federal agencies won’t get any additional regulatory authority from the declaration, it nevertheless underscores the urgent need to address the devastating impact of firearms on public health across the United States. The landmark report highlights that firearm-related deaths have reached unprecedented levels, with an alarming increase in homicides and suicides linked to gun violence.
The Surgeon General’s advisory emphasizes the role of public health in mitigating this crisis. It calls for a multi-faceted approach, including better data collection, enhanced mental health services, and robust community engagement to reduce firearm-related injuries and deaths. Importantly, it advocates for evidence-based policies such as universal background checks, safe storage laws, and interventions targeted at high-risk individuals.
This announcement aligns with findings from our comprehensive report which outlines the characteristics of the gun violence crisis in Arizona and offers effective policy interventions.
The AZPHA report identifies key issues, including the proliferation of firearms, lack of regulation, and the significant toll on communities, particularly among vulnerable populations such as children and minorities. In Arizona, the situation is particularly dire, with firearm deaths surpassing the national average.
Indeed, firearms are the leading cause of death among kids 0-19 in Arizona, surpassing car crashes and poisonings (e.g. fentanyl).
Our report recommends policies like expanding background checks, implementing extreme risk protection orders, and promoting community-based violence prevention programs. These interventions are crucial for reducing the burden of firearm violence and protecting public health. Our hope is that the 2025 legislature will be open to considering and passing some of the foundational evidence-based laws that are known to reduce deaths like child access prevention laws.
This declaration from the Surgeon General is a welcome call to action, urging policymakers and communities to recognize gun violence as a pressing public health issue and to work collectively towards effective solutions.
Note: This report is an ‘Advisory’ rather than a full Surgeon General’s Report. Advisories provide recommendations for how the issue should be addressed. Surgeon General full reports by contrast are landmark publications. For example, in 1964, a Surgeon General Report concluded that cigarette smoking was a cause of lung cancer. That report and more than a dozen follow-ups sparked national efforts that helped cut smoking rates.
Last week the Arizona Corporation Commission exempted a 200-megawatt power plant expansion in Mohave County from environmental review. The exemption, granted to UniSource Energy Services (associated with Tucson Electric Power), allows the company to avoid the usual environmental scrutiny.
How did they do it? They split their 200MW project into four 50-megawatt units. The Commission bought their argument that, because each individual building (on the same parcel) is less than the 100-megawatt threshold, they don’t have to go through the normally required environmental review.
Their clever maneuver not only bypasses essential environmental regulations but also sets a potentially troubling precedent for future power projects.
Utilities are now invited to design projects in smaller segments to stay under the regulatory radar and avoid environmental reviews, posing a risk to both the environment and public health.
This decision reinforces how important it is to elect Commissioners with a commitment to public health and the environment. More to come in our series highlighting the links between who you vote for in the Corporation Commission races and public health.
The Arizona Corporation Commission & Public Health: Part IV – Air Quality
The Arizona Corporation Commission & Public Health: Part V: ACC Election Important for Public Health
Governor Hobbs vetoed Senate Bill 1570 this week, a proposal that would have directed ADHS to create a system to regulate & license psilocybin-assisted therapy centers.
SB1570 would have allowed persons who wanted to try mushrooms as a therapy for things like PTSD, depression, and hospice care to get it in a regulated environment. Right now, they can’t because the DEA has classified it as a Schedule I substance.
Had Hobbs signed the bill, it would have opened the door to psilocybin (commonly known as magic mushrooms) for therapeutic use in a controlled, therapeutic setting.
Unlike ketamine (which is legal for medical use and has shown efficacy in treating severe depression), psilocybin’s Schedule I classification means the federal government believes it has no accepted medical use and a high potential for abuse, severely limiting its availability for research and therapeutic purposes.
See: Biden Administration to Reschedule Cannabis Under the Controlled Substances Act
During legislative committee hearings this session, numerous advocates highlighted the growing body of evidence suggesting that psilocybin (mushrooms) can provide significant relief for individuals suffering from things like PTSD, depression and hospice care (where conventional treatments have failed).
For now, psilocybin will remain inaccessible for many who might receive help from it, and people seeking relief through mushrooms will continue to have no legal way access the substance for medical use (in Arizona).
Governor Hobbs’ veto statement focused on her concern about the potential risks and the lack scientific backing for its therapeutic use.
Meanwhile, magic mushroom research will continue using $5M in funding from last fiscal year under the oversight of Arizona’s new Psilocybin Research Advisory Council. Perhaps that research will provide the governor with the data she’s looking for to change her mind about mushroom’s potential therapeutic uses.
Hobbs felt differently about SB1677 and signed that measure, which would approve MDMA (ecstasy/molly) for treatment of PTSD in Arizona IF the FDA approves the drug (like psilocybin, MDMA is currently a Schedule I drug). The FDA is expected to make that decision this fall.
SB1677 also authorizes workers’ compensation coverage for MDMA (ecstasy/molly) treatment for firefighters and law enforcement under certain conditions (after FDA authorization).
See also: Governor approves ‘magic mushroom’ research, Molly therapy in Arizona
Friday, July 12, 2024 9-10am
Arizona’s 2024 legislative session saw the passage of about a dozen laws that will be good for public health and state government accountability – especially in the areas of behavioral health and licensing of care facilities.
There were also many missed opportunities – mostly in the areas of behavioral healthcare and care home assurance accountability. Some detrimental bills were successfully vetoed or blocked.
The budget saw across the board modest cuts for many agencies and sweeps of several professional license funds.
The legislature also placed 11 measures on the November ballot. AZPHA will be opposing 7 of them. Voters are likely to place an additional two propositions on the ballot.
This session will cover the Bills, the Budget and the Ballot Measures. Below is a PowerPoint summarizing what we’ll be covering in this webinar.
Will Humble, MPH
Executive Director
Arizona Public Health Association
Arizona’s 2024 legislative session officially ended last week with the passage and signing of a FY2025 fiscal year budget. The session saw the passage of about a dozen laws that will be good for public health and state government accountability – especially in the areas of behavioral health and licensing of care facilities. There were also many missed opportunities – mostly in the areas of behavioral healthcare and care home assurance accountability.
Some proposed detrimental bills were successfully vetoed or blocked, and there was a concerted push towards improving mental health services and expanding access to healthcare for underserved communities. These measures are crucial steps forward in addressing the state’s long-standing health disparities
The budget saw across the board modest cuts for many agencies and sweeps of several professional license funds.
The legislature also placed 11 measures on the November ballot. AZPHA will be opposing 7 of them. Voters are likely to place an additional two propositions on the ballot: One updating the law around abortion care and another that would eliminate partisan primaries. AZPHA is supporting both of those measures.
The session underscored the critical role of public advocacy in shaping health policy, as community organizations and health professionals continue to fight for the resources and policies needed to protect and promote public health in Arizona.
Below is a PowerPoint summarizing the session from a public health point of view – including the bills, the budget and the ballot propositions. The presentation includes links to each of the laws, bills and propositions.
The Arizona Legislature is required by the state constitution to adopt a balanced budget for each fiscal year (Article IV, Section 20, Part 2). That provision says the legislature needs to pass a General Appropriations Act (called informally a feed bill) which has appropriations for the different state departments, state institutions, public schools and interest on public debt.
This year’s “feed bill” is HB2897 and includes the primary budget provisions for state departments and agencies and focuses just on appropriations without including substantive law changes.
Statutory changes needed to reconcile the appropriations made in the feed bill and other changes are put into separate budget bills, called Budget Reconciliation Bills. Most years have a “Health BRB”, but this year there was just a Health Care BRB and a Human Services BRB, as there weren’t any changes needed in state law for ADHS to implement the budget (except for the provisions relating to the Arizona State Hospital in the Health BRB (see HB2903 below).
You can click on the links below for those BRBs to do a deeper dive.
The main ‘feed bill’ gave the ADHS a ‘lump sum’ reduction in their budget of about $719K. Interim Director Cunico has the discretion about what state fund to tap to cut. She has many options… let’s hope she’s thoughtful and doesn’t pull those funds from a critically important service.
Any of you with ADHS special line-item funding should be asking the Director what she intends to cut and explain why it shouldn’t be your program and why before it’s too late. Here is that Feed Bill: HB2897
There were a few other details in the feed bill as well including:
A few funds were exempted from reverting to the general fund including:
Our public health policy committee met last week and recommended that our Board (who meets next Friday) oppose both the “Secure the Border Act” (HCR 2060) and the “Arizona Legislative Ratification of Rules that Increase Regulatory Costs Measure” (SCR1012).
You can review the measures (which will be on the November ballot) above. Below you’ll see some draft language that the Board will review next Friday. If approved by the Board, arguments will be sent to the Voter Publicity Pamphlet on behalf of our members. Note: This is just rough draft language.
Protect Our Seniors: Vote NO on Proposition XXX
Arizona’s ballot Proposition xxx is an unnecessary and potentially harmful measure that will impede the effective governance of critical sectors, especially healthcare in senior care.
Arizona law already mandates that state agencies have statutory authority with guardrails before they enact regulations. Additionally, all final proposed state agency rules must receive final approval from the Governor’s Regulatory Review Council. This existing oversight ensures that any new regulations are carefully vetted and justified, balancing regulatory needs with public interests.
Approving Proposition XXX would add an added layer of bureaucracy by requiring new regulations to also be approved by the state legislature. This would significantly slow down the process of enacting essential regulations and might even halt necessary health and safety regulations altogether. The consequences for healthcare, particularly in senior care facilities, could be severe.
As highlighted in a detailed report by The Arizona Republic, there are already alarming instances of resident harm in Arizona’s senior living facilities, including abuse, neglect, and inadequate care.
The delay or inability to update regulations promptly under Proposition XXX could make matters even worse, leading to deteriorating conditions and insufficient safeguards for vulnerable Arizonans.
Without being able to implement new health and safety regulations or change fees to hire inspectors, senior care facilities may continue using outdated rules that fail to address current challenges, such as emerging health threats, evolving care standards, and needs due to population growth. This could lead to further neglect and mistreatment of residents, undermining their health and well-being.
Proposition XXX poses a significant risk to effective governance and public safety. It threatens to stifle regulatory development crucial for maintaining and improving care standards in Arizona, especially in the most vulnerable sectors such as assisted living and nursing homes.
Please reject this harmful proposition to ensure we protect our elders and people living with disabilities who need services in Arizona care facilities.
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Vote No on Proposition xxx ‘Secure the Border Act’
Proposition xxx (aka the ‘Secure the Border Act’) presents a troubling path for Arizona. This extreme proposition is an unfunded mandate that could lead to enormous costs for cities and counties in Arizona. This unfunded proposition burdens local law enforcement, courts, and the jail and prisons, and prevents them from prioritizing the public safety needs relevant to their communities.
This proposition also imposes unjust and excessive regulations on working immigrant families in Arizona. If you pass Proposition xxx, essential health and public services for many Arizona families could be denied, leading to worsening economic disparities and health inequities among Arizona’s communities.
In addition, this proposition has no protections against enforcement actions in sensitive locations like hospitals, schools, or places of worship. This proposition also has no protections for the elderly, children, or other vulnerable individuals.
Additionally, Proposition xxx would deepen existing divides and foster discrimination within our society. It would lead to unfair policing, harassment, and racial profiling, violating basic safeguards like due process that we all deeply value. Proposition XXX also provides immunity to law enforcement and government officials, meaning they can’t be held accountable by Arizonans.
By voting no on this proposition, we send a clear message: discrimination has no place in Arizona. Our neighbors should not be denied their basic rights.
Please vote no on Proposition xxx to stand for a fair future for all Arizonans.
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Last month our Board approved our Public Health Policy Committee’s recommendation to take a position on 5 of the ballot measures. Our ballot arguments have been completed and filed with the Secretary of State. Here are links to those Arguments:
The State House and Senate were uncharacteristically in session last Friday and yesterday mulling over a budget proposal reached by the senate president Petersen, speaker Toma and the Hobbs team. A lot of the discussion among members appeared to be behind closed doors and in caucus meetings. As I write this on Saturday afternoon there was not yet a final vote on the bills.
The bottom line is that our elected officials are trying to both balance the current fiscal year budget (which ends June 30) and develop what they think will be a balanced budget for the next FY.
One of the main ways they’re trying to do it is to claw back some of the spending from last fiscal year (to help erase the $729M current year deficit) and come up with ways to make up for the projected gap between spending and revenue for the coming fiscal year (an estimated $690M gap).
I say estimated because, while there’s relative certainty about spending (except for off the grid and out of control private school and homeschool voucher spending), the revenue side is really just a projection.
Opioid Fund Sweep
A point of major controversy in the negotiations is a plan to sweep $75M from AZ’s opioid lawsuit settlement fund to help fund the state prison system. It’s unclear whether that’s legal as the Attorney General is the Plaintiff in that suit – giving her rather than the legislature primary control of the money.
Agency Lump Sum Cuts
On the health side of things, I didn’t see anything that was a catastrophic cut. Yes – both AHCCCS and ADHS were slated to get about a 3.5% ‘lump sum’ cut to their operating budget, which for ADHS only amounts to about $700K. This is a manageable figure, as there are clever ways to switch staff funding sources and find unused other funds to contribute.
I say manageable because I lived through cuts far more drastic than this. For example, in early 2009 we were given a $20M lump sum cut and a few months later an addition $30M cut… so, while not desirable, a $700K cut is entirely manageable. Hopefully the agency leadership takes the funds from their operating budget and not other line items like their loan repayment program etc. That’s what we need to watch out for.
Drug Rebate Fund
AHCCCS got a similar percentage operating fund cut (manageable). The big contribution from AHCCCS in the negotiated proposal is a $33M sweep of their drug rebate fund. The drug rebate fund is seldom discussed, as AHCCCS has generally liked to keep the existence of the fund quiet, and for good reason.
AHCCCS collects rebates from pharmaceutical manufacturers based on the volume of drugs dispensed to Medicaid members. The beauty of the rebate fund and (and why previous AHCCCS didn’t discuss it much) is that it’s:
The legislature also worked through several languishing bills on Friday and Saturday include the one that will charge ADHS with developing a regulatory program for magic mushroom (psilocybin) service centers where people could receive the psychedelic in a medically supervised setting
I’ll write up a summary of the final budget once it’s passed and signed.
Arizona’s Vaccines for Children (VFC) program, designed to ensure kids from low-income families can get vaccinated, has hit a rough patch in recent years. Over the past few years, the state has seen a significant drop in participating providers, meaning it’s been getting harder and harder for parents to actually get their kids vaccinated.
Under the Ducey administration, the number of providers fell by 50%, leaving Arizona with only six VFC providers per 10,000 Medicaid-eligible kids, compared to the national average of 24 per 10,000.
Several issues have been at the heart of this decline. Providers have faced cumbersome ADHS administrative processes, like complicated vaccine ordering and returns, and difficulties integrating their systems with the Arizona State Immunization Information System.
Additionally, the program’s enforcement of strict policies, including restitution (fines), has been a major deterrent for many providers. These fines, coupled with accusations of fraud for administrative errors, created a punitive environment that many found off-putting, running many providers off the VFC program.
I’m happy to report that ADHS has finally begun making some changes to turn things around after several years of full court press administrative advocacy on the part of a constellation of stakeholders and county health departments
They’re working to stop the bleeding of VFC providers and hopefully eventually increase the number of VFC providers by streamlining the application process and offering more support to healthcare providers. A recent report by the Arizona Partnership for Immunization, in collaboration with the OMNI Institute, has laid out recommendations to address these challenges and improve the program.
See: An Assessment of the Facilitators and Challenges to Providing Vaccine)
This week ADHS Deputy Director posted a blog highlighting new measures aimed at expanding the provider network and simplifying processes. For instance, the department is pausing the enforcement of the contentious dose-for-dose restitution policy and implementing more provider-friendly approaches and updating their VFC Program Operations Guide. Policy changes include:
The Arizona VFC Program Operations Guide and a summary of the changes can be found on the Arizona VFC Home Page in the announcement box or on the VFC Operations Guide and Resources page.
AZPHA commends Ms. Sjolander’s leadership in trying to turn the ship around. These new policy changes (if implemented consistently), have a chance at rebuilding and enhancing Arizona’s VFC program and ensuring more children can access crucial vaccinations.
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The 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. ADHS manages the VFC program in our state.
Arizona lost 50% of its VFC providers during the Ducey administration – going from 1,200 to 600… reducing access to vaccine, lowering childhood vaccination rates and harming overall AHCCCS network capacity.
Maricopa County Department of Public Health contracted with The Arizona Partnership for Immunizations to study this issue and prepare a report describing the facilitators and challenges to participating in the VFC program from healthcare providers’ perspectives, as well as recommendations for reversing this course. TAPI hired OMNI Institute, a social sciences non-profit consultancy to conduct this assessment.
That report, entitled An Assessment of the Facilitators & Challenges Providing-Vaccine in Arizona was released in December 2023. The 96-page report has many findings. A common theme as presented in the Executive Summary:
“Respondents expressed frustration with the complexity surrounding ordering and returning vaccines, the challenges integrating practice electronic medical record systems with the Arizona State Immunization Information System and the administrative burdens regarding compliance and reconciliation.”
“When asked about the significant challenges/barriers to their continued participation in the VFC program, a common theme respondents raised was an adversarial tone in the enforcement of VFC policies and communications, with administrative errors (some of which stemmed from ASIIS) often being met with accusations of fraud and/or wastage. Many non-VFC providers pointed to administrative burdens, expensive charges to rectify incorrect dose counts, and a generally punitive tone from the VFC program as rationales for their non-participation.”
Protecting Public Health Authority & Advocacy Toolkit
This toolkit was created based on the technical assistance requests of APHA affiliates working to protect public health authority in their states. These resources can be shared with affiliate membership, advocates, and partners, or used to support affiliate activities. This toolkit is designed to equip users with resources they need to support an effective advocacy campaign to protect public health.
