Will Humble Health Equity, Public Health Law, Social Determinants, Wills Blog

AZPHA Public Health Policy Committee Meeting to Recommend Whether We Oppose HCR2060

The Legislature passed HCR2060 along party lines last week. The measure asks voters to approve a hodgepodge of new laws like empowering local law enforcement to enforce federal immigration laws. That authority comes with vague limits on how they would make that decision. HCR2060 also gives law enforcement civil immunity for apprehending persons they believe crossed at other than a port of entry.

It prohibits people from submitting false documents when applying for public benefits or employment, and hikes penalties for manufacture, sale of and possession of fentanyl.

We’ve scheduled a Public Health Policy Committee meeting for next Friday at 2pm to have the committee discuss whether they recommend to the Board whether to oppose HCR2060 – which will be on the November ballot.

We’ll include the committee’s recommendation in the June 21 Board meeting for a final decision. The SOS extended the deadline to submit arguments in the Publicity Pamphlet to July 3 – so we have time (the former deadline was June 20).

Note: The state constitution requires that all ballot propositions be of a ‘single subject’ See: AZ Single Subject Rule. HCR2060 is being challenged in court for violating this rule, which I believe it clearly does.

Last month our AZPHA Board of Directors 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 our Arguments:

See also: RHC-Presentation-2024-Ballot-Measures

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. The portal is open through July 2.

Will Humble Air Quality, Climate Change, Public Health Law, Wills Blog

The Arizona Corporation Commission Part V: ACC Election Important for AZ Public Health

The Arizona Corporation Commission plays a crucial role in influencing public health through its regulatory decisions on utilities like electricity, gas, and water. These decisions have far-reaching impacts on the social determinants of health, affecting everything from air quality to the economic well-being of Arizonans.

One significant area of impact is utility rates. The ACC’s approval of rate increases for utilities such as Arizona Public Service and Southwest Gas directly affects household finances, particularly for low-income families.

For instance, recent approvals of rate hikes have led to increased annual revenues for these utilities, but also higher utility bills for consumers. Higher utility costs can strain household budgets, reducing funds available for essentials like food, healthcare, and education, which are all critical components of overall health​.

The ACC’s energy policies significantly impact air quality and, consequently, public health. When the ACC supports renewable energy initiatives, it promotes cleaner air by reducing reliance on polluting fossil fuels. Renewable energy sources like solar and wind help cut down on harmful emissions, leading to fewer respiratory issues, cardiovascular diseases, and other health problems associated with air pollution​​.

Conversely, decisions that favor traditional energy sources can lead to poorer air quality and higher healthcare costs due to increased rates of pollution-related illnesses. This underscores the importance of regulatory decisions and the commissioners elected to the ACC, as their policies can either enhance or hinder public health outcomes​.

We recently wrote a four-part series describing the ways in which the decisions Arizona Corporation Commissioners influence public health.

Overall, the ACC’s regulatory choices ripple out into the broader social determinants of health, highlighting the need for informed voting and advocacy to ensure that the Commission prioritizes the well-being of all Arizonans.

The November Election

The 2024 Arizona Corporation Commission election will be held on November 5, 2024. Three of the five seats on the Commission are up for election in November – so this year presents a real opportunity to shift the commission away from protecting utilities and other businesses – focusing it more on their public health role.

Republicans currently hold 4 seats on the board, while Democrats hold just 1. Lea Márquez Peterson (Republican) is running for re-election, while James O’Connor ( R) and Anna Tovar (D) are not.

While a primary election will be held this summer, it won’t really matter, because each party is nominating just 3 candidates.

On the Republican side, we will see Rene Lopez, Lea Marquez Petersen and Rachel Walden on the November ballot. Democrats on the November ballot will be Ylenia Aguilar, Jonathon Hill and Joshua Polachek.

The 3 vote getters among the six candidates on the Nov ballot will earn a 4-year term on this important public health body.

In the coming weeks we’ll dive into the details of each candidate’s priorities to see how each matches up with public health priorities.

_________________

AZPHA Draft Letter to AZ Corporation Commission Candidates

July xx, 2024

Dear [Candidate’s Name],

I hope this letter finds you well. I’m writing to you as the Executive Director for the Arizona Public Health Association highlight our organization’s priorities related to the Arizona Corporation Commission (ACC) and to seek your commitment to policies that promote public health, environmental sustainability, and economic equity as you campaign for the November 2024 election.

The ACC plays a pivotal role in shaping Arizona’s economic and environmental landscape by regulating utility rates and services. Recently, we have witnessed significant rate increases from Arizona Public Service (APS) and Southwest Gas (SW Gas).

These rate hikes have far-reaching consequences on the social determinants of health, especially for our most vulnerable populations. Rising utility costs can lead to difficult choices between paying for utilities and other essentials such as food, housing, and healthcare, exacerbating health disparities among low-income families, seniors, and individuals with chronic health conditions.

The AZPHA is deeply concerned that the routine approval of these rate hikes undermines the well-being of Arizona residents. The 2022 APS rate increase, for example, was a substantial burden on many households, and the 2023 SW Gas rate hike followed suit.

These increases are not just numbers on a bill; they translate to real sacrifices and hardships for families across our state. We urge the ACC to adopt a more critical stance on rate increase proposals, ensuring that any approved increases are justifiable and do not disproportionately burden those already struggling to make ends meet.

It is essential to evaluate the impact of rate increases through a public health lens, considering how financial stress and energy insecurity can deteriorate health outcomes.

In addition to protecting consumers from unjust rate hikes, the ACC has a pivotal role in steering Arizona towards a sustainable energy future.

The AZPHA believes that the commission should be more proactive in incentivizing clean energy development and protecting our environment. Arizona, with its abundant sunshine, has tremendous potential for solar energy. Prioritizing investments in renewable energy not only mitigates climate change but also reduces pollution-related health issues, such as respiratory and cardiovascular diseases.

Moreover, clean energy initiatives can stimulate economic growth by creating green jobs and reducing energy costs in the long term. By supporting policies that favor renewable energy and energy efficiency, the ACC can ensure a healthier environment and a more resilient economy for all Arizonans.

Initiatives like expanding rooftop solar programs, enhancing grid storage capabilities, and promoting energy efficiency measures are crucial steps towards a sustainable future. Additionally, the ACC should consider the health implications of energy production and prioritize reducing emissions from fossil fuels.

As you campaign for a position on the ACC, we urge you to consider these priorities. Commitment to fair utility rates and clean energy development aligns with the broader goal of improving public health and reducing health disparities. Your leadership on these issues can make a significant difference in the lives of Arizona residents.

Thank you for your attention to these critical matters. We look forward to your response and to the possibility of working together to create a healthier and more sustainable Arizona.

Sincerely,

 

Will Humble, MPH

Executive Director, Arizona Public Health Association

Director, Arizona Department of Health Services (2009-2015)

 

 

 

Will Humble Medicaid, Wills Blog

Report Outlines Recommendations to Prevent Future Medicaid Fraud in Arizona

In April 2023, AHCCCS contracted with Berry Dunn, to analyze AHCCCS data, identify trends, and make recommendations on what they should do to prevent future Medicaid fraud moving forward. The audit focused on AHCCCS’ claims and enrollment processes.

View the Report

Berry Dunn made 25 programmatic recommendations. AHCCCS says they’ve implemented 20 of the 25 recommendations and is in the process of implementing another five.

AHCCCS Sober Living Fraud Website

As Stephanie Innes points out in her story last week (see: Audit on big Arizona Medicaid fraud focuses on processes, not people) the report: “… does not name any individuals responsible for ongoing fraud against the agency but rather name process and procedural issues to help prevent abuse in the future.”

However, that doesn’t mean that the persons who oversaw AHCCCS’ American Indian Health Plan (former Assistant Director Markay Adams and former Deputy Director Shelli Silver) are off the hook (Ms. Silver is retired & Ms. Adams is in senior leadership at Blue Cross Blue Shield of Arizona).

The criminal investigation by the Attorney General is still underway. One has to believe that the AG investigators are examining emails and other internal AHCCCS records to determine whether this crisis was facilitated by former staff criminal misconduct.   

You can contact the AHCCCS Office of Inspector General with questions about fraud [email protected].

Will Humble Medicaid, Social Determinants, Wills Blog

Investigative Journalists Uncovering New Details About Unchecked Medicaid Fraud During the Ducey Administration

Arizona has been grappling with a significant Medicaid fraud and human trafficking crisis, particularly targeting Native Americans. The fraud primarily involved behavioral health providers exploiting lax AHCCCS staff oversight of the fee-for-service American Indian Health Plan.

Lax staff oversight allowed unscrupulous operators to enroll as Medicaid providers without proper oversight. Some providers even forged signatures of licensed healthcare professionals to submit fraudulent claims.

One of the major issues was the manipulation of billing codes. During the Ducey administration AIHP reimbursed up to $1,400 per day for addiction treatment services. Fraudulent operators exploited this high reimbursement rate by billing for services that were either not provided or grossly inflated. This led to a surge in Medicaid payouts, straining the system and costing taxpayers hundreds of millions of dollars.

The impact on Native American communities has been devastating. Many individuals seeking help for addiction were lured away from their homes under false pretenses, only to be abandoned once the fraudulent providers were shut down. This has led to an increase in homelessness and a lack of access to legitimate healthcare services for those most in need.

Arizona Republic journalists Stephanie Innes, Arlyssa Becenti, Richard Ruelas, Lane Sainty and others have been investigating the fraud and human trafficking for more than a year, trying to get public records requests filled and piecing together the factors and lax staff oversight that led to this tragic and expensive crisis.

I encourage you to read the developing series on azcentral below:

Arizona Republic Series: A SOBERING SCANDAL

The victims | Timeline | Inside the scam | Arizona’s failure | Rebuilding trust

___________________________

 

Will Humble Wills Blog

Public Health Journalism this Week

Audit on big Arizona Medicaid fraud focuses on processes, not people (azcentral.com)

How AZ leaders missed warning signs of Medicaid sober living fraud (azcentral.com)

Court rules Gov. Hobbs broke law to circumvent nomination process | Arizona Capitol Times (azcapitoltimes.com)

Judge rules against Arizona governor in agency director dispute | Daily Independent (yourvalley.net)

Katie Hobbs’ workaround to GOP nomination blockade rejected by judge (azcentral.com)

Judge rules against Arizona governor in agency director dispute | Daily Independent (yourvalley.net)

Hobbs illegally bypassed the Senate when appointing agency directors, judge rules  (azmirror.com)

Gov. Katie Hobbs and the Senate president need to grow the heck up (azcentral.com)
Will Humble Professional Development, Public Health Law, Wills Blog

Petersen v. Hobbs: The Clash Over Director Nominations is Jeopardizing State Agency Effectiveness

Judge Blaney ruled for senate president Petersen in the Petersen v Hobbs case. The case, Petersen v. Hobbs, centers on the governor’s strategy to circumvent the Senate’s approval process for her nominees.

Oral Arguments Monday in Petersen v. Hobbs Agency Director Nominations Case

Most of you will remember the behavior of the newly created Senate Director Nominations Committee. In a nutshell, the committee chair refused to hear most of Hobbs’ nominees and the ones that did get time before the committee faced partisan prosecutorial attacks rather than honest hearings.

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

Governor Hobbs eventually withdrew her nominations for several agency directors. She then appointed Ben Henderson as the interim director for multiple agencies, with previously nominated individuals being chosen as Executive Deputy Directors, allowing them to effectively lead the agencies without the formal title of director, thereby sidestepping the need for Senate confirmation.

Gov. Katie Hobbs’ health director was sabotaged. So was Arizona

For the last several months, nearly all state agency directors have been making agency decisions and operational priorities without official confirmation.

The Senate sued in Maricopa County Superior Court, asserting that Hobbs’ approach undermines the legislative process and oversteps her executive authority.  This legal dispute not only affects current agency operations but also sets a precedent for how future administrations might handle similar conflicts.

Judge Blaney, in Maricopa County Superior Court ruled yesterday that while Hobbs was “arguably” within her powers to withdraw her nominees but that she didn’t have the authority call them deputy directors and still give them full authority as an official director.

See the Ruling

A secondary argument offered by the Hobbs legal team suggested Hobbs misused a state law allowing the appointment of deputy directors, saying that argument “… improperly elevates form over substance”.

However, Blaney’s ruling didn’t order Hobbs to turn in nominees to the Senate, saying he intends to hear arguments later this summer to resolve the conflict. A quote from the ruling says he will instead “… give these co-equal branches of government an opportunity to meet and confer in an attempt to reach a mutually agreeable resolution of this dispute.”

If Hobbs and Petersen can’t resolve the conflict themselves Blaney suggested he would impose a solution by mandamus, basically imposing a resolution.

Editorial Note: The timing of the ruling is actually good. Why? Because it gives the two an opportunity to each use their leverage during the budget negotiations to come up with a solution they can both live with. The sense of urgency to get a final budget may compel them both to come up with a compromise.

But, if they agree to a budget that doesn’t include at least a handshake agreement on director nominations, the case may actually go ahead to court for the resolution phase this summer.

With the Legislature out of session in just under a month, there will be no immediate problem for Hobbs – as 38-211 allows the Governor to wait to nominate agency directors until the 2025 legislative session begins in January.

The Senate may look quite different in January…  perhaps moving to a 15-15 tie, or out and out control of the Senate by the Democrats.

Either result would likely mean there’d be a new Senate President and elimination of the Director Nomination Committee, honest vetting of the nominees, and a more traditional confirmation process rendering the case moot.

Will Humble Family Planning, Public Health Law, Wills Blog

What is Direct Care Planning and Why is it Important?

Direct care planning is a game-changer for families dealing with healthcare. Think of it like having a detailed road map when you’re on a road trip—you know exactly where you’re headed and how to get there. For families, this means having a clear plan for their loved one’s care, making things way less stressful.

With direct care planning, everyone involved—doctors, nurses, family members—knows what’s going on and what the next steps are. It’s like a playbook that ensures everyone is on the same team and working towards the same goals. This clarity helps avoid mix-ups and ensures that the care is tailored to what your loved one really needs.

Plus, it helps you feel more in control and informed about the care process. Instead of feeling overwhelmed, you get to focus on supporting your loved one, knowing that there’s a solid plan in place. All in all, it’s about making healthcare smoother and more personal for everyone involved.

Completing advance care planning documents is a proactive, responsible step towards ensuring that your healthcare journey aligns with your personal values and wishes.

Why it matters: It helps you take control of the unpredictable, offering peace of mind to yourself and those you love.

Here are the five steps to help you with advance care planning:

  1. Think about what matters most in life.
  2. Talk with your doctor and loved ones.
  3. Fill out the documents.
  4. Share your wishes and your documents.
  5. Review and update your documents.

Use this guide from the Arizona Hospital and Healthcare Association to start your advance care planning today.

Will Humble Environmental Health, Injury Prevention, Wills Blog

Maricopa County Public Health Launches Heat Illness/Death Data Dashboard

Maricopa County Department of Public Health launched an interactive, online heat-related illness and death dashboard to help provide more accessible and timely data around countywide heat-related hospital visits and deaths.

The publishing of this tool coincides with a multi-partner, countywide heat preparedness and response effort already underway to prevent another summer of record-breaking heat deaths.

The dashboard will help public health officials and other key stakeholders involved in heat response activities monitor health impacts of environmental temperature and help inform outreach and interventions needed to help residents stay safe from extreme heat.

It features:

  • Near real-time data on heat-related hospital visits in addition to data on heat-related deaths
  • Comparative data for heat-related deaths and hospital visits for 2023 and 2024
  • Patient characteristics by age, race, and sex to show who is at highest risk from heat and inform prevention efforts
  • Patient characteristics on housing status and substance use involvement in heat-related hospital visits and deaths

In addition to showing daily county-level heat-related illness and deaths reported, the dashboard also will feature daily maximum and minimum temperatures to help illuminate the impacts of extreme heat.

The dashboard is perfected for desktop viewing. MCDPH has prepared a guidance document to support users as they navigate different features of the dashboard.

In the coming weeks, the dashboard will include an interactive map that displays heat-related deaths by sub-county geography and information about the circumstances of each death, such as outdoor or indoor and whether air conditioning was available or not functioning in the home.

Will Humble Medicaid, Wills Blog

AHCCCS Launches Member Emergency Department & Inpatient Admissions Dashboard

AHCCCS quietly launched a couple of useful accountability tools last week that can also be used for research: their new Emergency Department Visits  and Inpatient Admissions Dashboards. Both data sets are populated with deidentified claims information among Medicaid members in AZ.

The Emergency Department Visits Dashboard allows users to explore and interact with AHCCCS member data pertaining to emergency department utilization. The data is broken down by ED Utilization, Demographic Comparison, and Primary Diagnoses.

The Hospital Inpatient Admissions Dashboard displays AHCCCS member data pertaining to hospital inpatient admissions. The dashboard allows users to explore and interact with the data in a more insightful and visual way, which better communicates trends and important information. This dashboard is broken down by Inpatient Admissions, Demographic Comparison, Primary Diagnoses, and Length of Stay.

So, why is this a big deal? For starters, transparency! These dashboards are a win for anyone who cares about where and how healthcare resources are being used. But remember – these are just dashboards…  they don’t provide the kind of detailed data that researchers would need to do detailed analyses – but they do provide bottom-line trend data.

Will Humble Professional Development, Wills Blog

Get Your Staff Training in this Summer with the Western Region Public Health Training Center

Summer is here, and with it comes a fantastic opportunity for health departments, managed care, and provider organizations to level up their staff training without breaking the bank. Enter the Western Region Public Health Training Center, your go-to hub for free, top-notch public health and management training.

Western Region Public Health Training Center Home: (arizona.edu)

WRPHTC offers a diverse range of training topics that cater to the needs of today’s public health & healthcare workforce. From epidemiology and community health to leadership and project management, there’s something for everyone. The best part? These training courses are completely free.

Health departments can benefit big time from their offerings. Your team can improve their insight into disease prevention, data analysis, and health promotion. The knowledge gained from these courses can directly impact the community by improving public health outcomes while providing employee engagement and professional development.

Managed care organizations can use the Center’s courses too. Training courses cover crucial topics like healthcare quality improvement, patient-centered care, and health equity. By empowering your staff with these skills, you’re not just enhancing their professional development; you’re also elevating the level of care provided to your members.

There are courses tailored to provider organizations too, with topics like clinical management, healthcare policy, and effective communication – transforming how your team interacts with patients and navigates the complex healthcare landscape. Training your staff in these areas can lead to better patient outcomes and a more efficient operation overall.

Training is available online, making it easy for your team to take part without the need to travel or disrupt their daily work schedules. This means you can integrate learning into the summer season, traditionally a slower period, allowing for maximum participation and minimal interference with day-to-day operations.

In short, the Western Region Public Health Training Center is a treasure trove of knowledge waiting to be tapped into.

Take advantage of these free training opportunities this summer and watch your organization thrive. Happy learning!

Visit: Western Region Public Health Training Center
1 … 11 12 13 14 15 … 23