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

Hobbs Implements State Agency Hiring Freeze via a ‘Head Count Cap’

Governor Hobbs has ordered a hiring freeze for new state employees and instructed her department heads to send her a plan this week to cut $1.2 billion in spending out of their current and coming year budgets. That’s a 4% cut for the remainder of this fiscal year and a 2% reduction for next year.

The letter reportedly sets out a “headcount cap” for agencies like the Ducey administration did that will allow agencies to replace employee losses but not to fill currently vacant posts.

It’s unclear at this point how strict the hiring freeze will be and how easy it will be to get exemptions.

Editorial Note: ADHS desperately needs exemptions from the new policy for their licensing division, which is responsible for ensuring quality care in assisted living, skilled nursing, behavioral health facilities and the like. We have written extensively about the poor history the agency had during Christ and Herrington’s tenure – with a core reason for the poor performance the lack of inspectors. A hiring freeze would devastate their efforts to get licensing back on track.

Same goes for staffing at the Arizona State Hospital.

I’ll give another week or two to the administration before we begin advocacy to protect licensing and the state hospital from this new hiring freeze which would definitely jeopardize care at the Arizona State Hospital damage the Department’s ability to improve their licensing division’s performance.

See: Licensing & Regulating Care Facilities: A Root Cause Analysis of Arizona’s Failure to Protect Vulnerable Persons & Pathway to Redemption


More oversight is needed at the Arizona State Hospital, critics say

How The Republic reported on resident harm in senior living facilities

Report: The Arizona State Hospital lacking staff, treatment options

The AZ Corporation Commission & Public Health (Part II): Clean Energy

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 important ways.

Last week we covered how the Commissioners have been using their authority to regulate electricity monopolies and how those decisions affect the social determinants of health.  This week we’ll cover how Commissioners decisions impact Arizona’s ability to limit carbon emissions.

Commissioners Set Stage Slash Rooftop Solar Buyback Rates

The “Value of Solar” rates set by the Corp Comm back in 2017 determine how much APS needs to pay home-based rooftop solar generators for their extra electricity. Those criteria were carefully set in 2017 after a multi-year evaluation by commissioners and staff.

Since then, folks have been using that formula to figure out what the return on their investment for the power they generate on their house.

That is all up in the air now that the Commission is reevaluating those rates – most likely to reduce them.

Back in October 2023 the Corp Comm voted (3-2) to open a new legal case to re-evaluate rooftop solar export rates – setting the stage for a future reduction in buyback rates. 

Commissioners Nick Myers, Jim O’Connor and Kevin Thompson voted to open the Value of Solar docket. Lea Márquez Peterson and Anna Tovar against the move.

Central to the issue is the 10% annual reduction in how much utility companies must pay residential solar panel owners for extra energy produced by their home system that is then returned to the grid and sold to other customers.

The decision also reopens discussions about the 10-year export rate effective period and a grandfathering policy for net metering customers.’  Corporation Commission reopens debate over rooftop solar buyback rates

The Commissioners haven’t yet cut the export rates for current and future solar producing customers, but the stage is now set for the newly elected commission in 2025 to decide whether to slash existing and future solar customer export rates.

Note: the Value of Solar agreement in 2017 included very bad provisions like the elimination of ‘net metering’ of APS customers.

Rate Increases for Solar Power Generating Homeowners

Back in February, the Commission rubber stamped APS’ request to add a monthly charge of $2.50 to $3 for residential customers with rooftop solar systems, reducing the incentives for folks to install rooftop solar systems on their houses.

After pushback from consumers and rooftop solar advocates the Corp Comm recently granted a rehearing on whether an APS rate hike that included an added fee for solar customers is “just and reasonable”.

Attorney General Mayes also stepped in and argued the added charge on solar customers was “discriminatory” given both solar and non-solar customers receive power uniformly, and the decision generally violated customers’ due process rights.

“In this rate case, APS did not request an additional charge for residential solar customers at any point, nor did any party propose one,. No party had any reason to introduce evidence to refute the factual basis for the surcharge because no party had requested, briefed, or discussed the possibility of such a charge at any time prior to the close of the administrative record.”

The Corp Comm says the upcoming rehearing would be limited to “whether the rate should be higher or lower; whether the GAC rate constitutes an alleged discriminatory fee to solar customers and whether omission of the GAC is discriminatory to non-solar customers.”

Grid Access Charge Rate Schedules: Fixing a Just and Reasonable Rate of Return

Commissioners Scrap Clean Energy Standards

The Arizona Corporation Commission also killed carbon-free energy rules that were under consideration for years after watering down the plan which would have incentivized solar, energy efficiency and other clean power sources.

The changes that weakened what had been the requirements for electric companies to meet clean energy standards – turning them into “goals” rather than mandates.

_______

After you scratch the surface, it’s easy to see that who you vote for in the upcoming Corporation Commission race can have a big impact on policies to encourage more solar investment in Arizona… with the stage now set for an even more hostile policy environment.

Note: Three of the five Arizona Corporation Commission seats are up for election in November — those of Republicans Jim O’Connor and Lea Marquez Peterson and Democrat Tovar, who has announced she will not run again.

Last week we saw how the Corporation Commission impacts the social determinants of health by how they use their authority to scrutinize monopoly utilities electricity rate increases: Corporation Commission reopens debate over rooftop solar buyback rates

This week we covered how they can use their authority to either encourage or discourage carbon emission reductions (discourage mostly).

Next week we’ll look at the way the Corporation Commission has been rubber-stamping rate increases for another monopoly utility (and harming the social determinants of health): Southwest Gas.

Valleywise Health’s Dr. Michael White Honored by Becker’s Hospital Review

AzPHA member and Valleywise Health Executive Vice President and Chief Clinical Officer, Dr. Michael White has been recognized by Becker’s Hospital Review in its 2024 national list of “180 Hospital and Health Systems Chief Medical Officers to Know.” He was one of 2 Arizona chief medical officers recognized.

Dr. White is Chair of the Governing Board of the Creighton University Arizona Health Education Alliance, a partnership that includes Valleywise Health, District Medical Group, and Dignity Health St. Joseph’s Hospital and Medical Center.

In addition to his leadership roles, Dr. White is a practicing interventional cardiologist, using his top-tier medical credentials as a senior member of the cardiology team at Valleywise Health.

Dr. White is board certified in internal medicine, cardiovascular diseases, and interventional cardiology. He received his Bachelor of Science degree in biology from Creighton University. Dr. White received his medical degree from the Creighton University School of Medicine, where he also completed a residency in internal medicine and a fellowship in cardiovascular disease.

He completed a fellowship in interventional cardiology at Duke University in Durham, North Carolina. Dr. White earned his MBA degree from Creighton University in 2019.

Abortion Care Cessation Date in AZ: June 8

From the Arizona Republic’s Stephanie Innes: When does Arizona’s abortion ban take effect? Here’s what to know

“The earliest that Arizona’s 1864 near-total abortion ban could take effect is June 8, Arizona Attorney General Kris Mayes wrote Friday in a letter to medical providers.

Healthcare providers may continue providing abortions under the current law at least until June 8, Mayes wrote. Current law allows abortions up until 15 weeks gestation and makes an exception for medical emergencies.

The 1864 law, which the Arizona Supreme Court upheld on April 9, is a near-total ban that prohibits abortions in all circumstances, including rape and incest, with the only exception being to save the life of the mother.

“Absent any additional litigation or action by the legislature, the status quo remains in place concerning abortion law in our state until June 8,” Mayes said in a written statement. “My office continues to explore all legal options available to prevent the 1864 near-total abortion ban from taking effect.”

AZAG Mayes’ April 18 Letter to Providers Regarding the Legality of Abortion Care

The State of Adolescent Health in Arizona: A Status Report

As part of its commitment to lead the charge of advocating for youth, the Arizona Alliance for Adolescent Health developed this comprehensive report – The State of Adolescent Health in Arizona: A Status Report. Crucial data indicators across Health & Wellness, Education & Workforce Development, Environment & Climate, Economic Wellbeing, and Family & Community, describe the state of adolescent health in Arizona. 

The array of indicators in this report provides a unique snapshot of the health status of Arizona’s youth. Additionally, they offer a mechanism to track changes, which aids in policy and program planning, analysis, and evaluation. The aim of this report is to inform and guide initiatives that will contribute to positive and fair outcomes for all youth across the state. View the report here.

Click here for more information on The Alliance and how to become a member. You can view the report in its entirety below. To receive a printed copy, click below and fill in your mailing address. To receive an electronic copy, click below and fill in your email.

Get a Printed Copy

Get an Electronic Copy

Cochise County Healthcare Workforce Community Forum

Cochise County Healthcare Workforce Community Forum Tickets, Fri, May 3, 2024 at 8:30 AM | Eventbrite

The Regional Healthcare Workforce Community Forum brings together healthcare professionals, educators, industry leaders, workforce professionals, and economic development teams to discuss and strategize solutions to the challenges facing the healthcare industry, with a particular focus on training and development and educational programs and pathways.

Objectives/Outcomes

Develop and grow a regional healthcare workforce coalition that can find assets and solve complex issues through collaboration.

Audience

  • Healthcare Employers/Professionals
  • Educational Institutions/Programs
  • Community Organizations with training and development programs
  • Workforce Development Programs
  • Economic Development Entities

Event Schedule

Friday, May 3rd, 2024

  • Continental Breakfast and Registration: 8:30 am – 9:00 am
  • Regional Healthcare Workforce Community Forum: 9:00 am -1:00 pm
  • Networking Lunch: 12:30 pm – 1:00 pm

Location

Cochise College, Douglas Campus, Room #101 in the 100 Building

4190 Az 80 Douglas, AZ 85607