Will Humble State Legislature, Wills Blog

Legislative Session Halftime Update

This year’s legislative session is just about 1/2 over. Well, maybe not chronologically, but in terms of bills’ migration through the process. The budget will probably be done at the tail end of the session.

This year we’re focusing our advocacy in two main areas: policy interventions to improve the performance of ADHS’ assurance and licensure responsibilities and behavioral health. 

Of course, we’re signed up for a whole bunch of bills, both for and against, but we’re focusing more on the assurance and licensure and behavioral health areas.

In part, that’s because we need to spend less time fighting against bills that are clearly bad for public health because we have confidence that the governor will veto bad bills (during the previous administration we had to do a lot of defense because the former governor had a proclivity to sign bills even if they were harmful to public health.

Most of the bills that would help ADHS do a better job regulating care facilities are on track and doing well including:

• HB2111 licensed facilities; transfer; sale; prohibition – Prohibits the ADHS from acting on an application for licensure of a currently licensed health care institution while any enforcement or court action related to their license is pending. Passed House.

• HB2249–residential care institutions; inspections – Adds behavioral health residential care facilities to the list of places for which ADHS can’t accept accreditation in lieu of a compliance inspection (eliminates deemed status). Passed House.

•HB2653– assisted living care; reporting; monitoring; injury – Greatly enhances incident reporting requirements for assisted living facilities and establishes optional electronic monitoring options (with limitations). Requires staffing registry checks. Passed House Health 8-0.

• HB2764– long-term care; enforcement; memory care – Raises the cap on ADHS imposed civil money penalties to $1000 per patient per day. Requires ADHS to develop a separate certification for assisted living facilities or nursing care institution that wants to provide enhanced memory acre services to residents. Passed House Health 9-0

• SB1655 – health care institutions; regulation – Increases the cap on civil penalties for violation of health care institution statutes from $500 to $10,000. Establishes the Indigenous Peoples Protection Revolving Fund with money from civil penalties. Passed Senate Health 7-0 but died in Rules

The same goes for the bills that would improve the performance of our behavioral health system. Most are on track, but a couple have stalled out:

– SB1678– secure state mental health facilities – Makes it clear that secure residential behavioral health facilities are only for people receiving court ordered treatment. Passed Senate Health 7-0.

– SB1688: Arizona State Hospital; governing board; governance. Establishes the State Hospital Governing Board and transfers operational control of the Arizona State Hospital to an independent 5-member board – eliminating the conflict of interest in which ADHS both runs and ‘regulates’ ASH. Passed Senate Health 7-0

– SB1309 Mental health evaluations; information &SB1311Mental health; data; evaluation

•SB1309Expands information that’s needed for court ordered behavioral health evaluations to include more information about the proposed patient. It also specifies which individuals may provide informed consent on behalf of a proposed patient for a voluntary evaluation (Passed Senate Health 7-0)

•SB1311 Makes it clear that AHCCCS is responsible for monitoring, overseeing and evaluating other state agencies that provide mental health services. It also makes good changes to the procedures for mental health prepetition screenings and court-ordered evaluations. (Passed Senate Health 7-0)

2024 Legislative Session Working Powerpoint working draft
Will Humble Assurance & Licensure, Public Health, Wills Blog

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

Regulating facilities where Arizonans receive services is a key, one might say cornerstone, function of a state health department. When a state health department is doing a good job regulating facilities like nursing homes, assisted living centers, behavioral health facilities, outpatient treatment clinics and the like, journalists’ stories are generally about how a facility did poorly on an inspection and highlight agency enforcement actions.

It’s an altogether different story when an agency deprioritizes their assurance and licensure mission and journalists end up writing about how lax or even nonfeasant and agency becomes. When that happens, stories become not so much about noncompliant facilities, but about poor regulation and unchecked substandard care.

That’s precisely what happened toward the end of the Ducey Administration. On former Director Christ and Herrington’s watch, ADHS licensing programs continued to atrophy until the Arizona Auditor General exposed gross nonfeasance on the part of the agency.

See:

Following each of those reports, journalists weren’t writing about substandard facilities, but about substandard performance of the entire licensing and regulatory system.

That 2019 Arizona Auditor General Report found, among many other things, that ADHS (during the Director Christ/Herrington era) failed to investigate long-term care facility complaints. They even discovered Christ lowered the priority level of 98% of their open high priority nursing home complaints, giving the appearance they were making improvements (high risk complaints need to be done in 10 days vs months for the others).

A core reason why the agency failed the people of Arizona during the prior administration was its leadership (leadership which is now gone from state government). Among the reasons, perhaps THE CORE reason for their terrible performance was a hiring freeze that was imposed on ADHS by former Governor Ducey’s team.

Each agency received a ‘cap’ on the number of personnel they could have. That led agency directors (Christ/Herrington) to decide what jobs to fill and not fill as people retired or left the agency. A smart and ethical director would recognize that she or he should prioritize filling posts in clear core regulatory areas – like the positions responsible for regulating care facilities like nursing homes, assisted living centers and the like.

Sadly, filling those types of positions weren’t a priority for Christ or Herrington – and the agency became less and less effective at regulating care facilities over the course of time – resulting in the terrible outcomes identified in the Arizona Republic’s The Bitter End Series by Caitlin McGlade Melina Walling & Sahana Jayaraman: 

How The Arizona Republic reported on resident harm in senior living facilities
The Legislature Intervenes

The shocking Auditor General findings finally got the attention of the state legislature, and in 2022 they distributed an additional $1.6M for ADHS to hire licensing staff. Sadly (but not unexpectedly) Herrington failed to hire any staff with those funds.

House Committee on Abuse & Neglect of Vulnerable Adults Meets: Urges Policy & Operational Changes to Protect Vulnerable Adults

The attitude of the agency finally changed in early that things need to change with the departure of Herrington and the advent of the Hobbs administration.  Tom Salow, new chief of the Licensing Division, posted a blog that reflects a new attitude at the Agency committing to fix their problems rather than sweeping them under the rug as had occurred during the Ducey era.

See: A recent audit of the Long Term Care Licensing system shows room for improvement to address issues with complaint processing ADHS Blog

“There were significant changes to the ADHS Division of Licensing leadership team prior to the release of the 2022 Report. Our current leadership team agrees with the Auditor General that no excuses can justify the additional findings in the 2022 Report, and the failure to implement the recommendations from the 2019 Report. We recognize the importance of correcting these issues to help ensure the health and safety of the vulnerable populations that reside in Arizona’s LTC facilities.”

The Agency is now in the midst of a months-long effort to recruit, train and keep inspectors to fill the talent void left by the Christ and Herrington administrations – but the minimum qualifications are robust and the training time significant, and the process of filling badly needed positions hasn’t been fast.

In the meantime, legislators of both parties are acutely aware of the shortcomings of the department’s licensing performance (despite recent positive leadership changes and a culture that now embraces quality improvement rather than denying bad performance).

In this year’s budget, Governor Hobbs proposes to appropriate funds to add 16 employees to follow up on complaints, general inspections, and enforcement. However, even if those funds are appropriated, the Department would still need to increase their licensing fees to ensure a stable funding source for long-run success.

Legislators are rightfully frustrated by what they’re hearing from constituents and reading in the newspaper and are proposing several bills that would help the ADHS do a better job regulating institutions over the long run including:

  • HB2111 licensed facilities; transfer; sale; prohibition – Prohibits the ADHS from acting on an application for licensure of a currently licensed health care institution while any enforcement or court action related to their license is pending. Passed House Committees.
  • HB2249 – residential care institutions; inspections – Adds behavioral health residential care facilities to the list of places for which ADHS can’t accept accreditation in lieu of a compliance inspection (eliminates deemed status). Passed House 57-0.
  • HB2653 – assisted living care; reporting; monitoring; injury – Greatly enhances incident reporting requirements for assisted living facilities and establishes optional electronic monitoring options (with limitations). Requires staffing registry checks. Passed House Health 8-0.
  • HB2764 – long-term care; enforcement; memory care – Raises the cap on ADHS imposed civil money penalties to $1000 per patient per day. Requires ADHS to develop a separate certification for assisted living facilities or nursing care institution that wants to provide enhanced memory acre services to residents. Passed House Health 9-0
  • SB1655 – health care institutions; regulation – Increases the cap on civil penalties for violation of health care institution statutes from $500 to $10,000. Establishes the Indigenous Peoples Protection Revolving Fund with money from civil penalties. Passed Senate Health 7-0

But remember, even if all these new policy changes pass and are signed, real improvements will only come if ADHS continues to rapidly improve their processes and recruit, train, and retain inspectors. In short – they need to continue to dig out of the 8-year hole they were left by Christ & Herrington.

Will Humble Disease Control, Reproductive Health, Wills Blog

U.S. Syphilis Cases Reach Highest Rate Since the Pre-antibiotic era: Arizona has the 3rd Highest Rate of Congenital Syphilis in the U.S.

Syphilis cases increased 80% in the United States between 2018 and 2022, and rates are now comparable to those in the pre-antibiotic era. Arizona now ranks 5th highest in the nation for primary and secondary syphilis rates & 3rd highest in congenital syphilis.

Why syphilis in newborns in an ongoing crisis in Arizona (via Stephanie Innes, Arizona Republic)

“In Arizona, the problem is particularly acute. State data shows the number of babies born with syphilis went from 17 in 2016 to 219 last year, which was a nearly thirteenfold increase over seven years…. the number of babies who died from syphilis more than doubled from 14 to 32.”

 

If untreated, syphilis can seriously damage the heart and brain and can cause blindness, deafness, and paralysis. When transmitted during pregnancy, syphilis is particularly concerning- causing miscarriage, stillbirth, prematurity and even death shortly after birth. Babies that live can have:

  • Deformed bones
  • Severe anemia (low blood count),
  • Enlarged liver and spleen,
  • Jaundice (yellowing of the skin or eyes),
  • Brain and nerve problems, like blindness or deafness,
  • Meningitis

CDC’s recent Vital Signs report, Missed Opportunities for Preventing Congenital Syphilis — United States, 2022, showed that timely syphilis testing and treatment during pregnancy might have prevented almost 9 in 10 (or 88%) congenital syphilis cases in 2022.

Vital Signs: Missed Opportunities for Preventing Congenital Syphilis — United States, 2022 | MMWR

More than 37% of babies with congenital syphilis were born to persons who had received no prenatal care (national data). 

Among congenital syphilis cases, no or no prompt testing during pregnancy was the most often missed opportunity found among birth parents without documented prenatal care.

Innovative solutions like partnerships with retail health or pharmacies, STI express clinics, and setting up injectable syphilis treatment delivery programs can jump-start care for people.

In addition to improving access to prenatal care (and screening for syphilis among those who do have prenatal care), approaches to providing care outside of clinical settings (e.g., use of rapid tests & active case follow-up) are needed.

Screening for syphilis at encounters outside traditional prenatal care (e.g., emergency department, jail intake, syringe services program, and maternal and child health programs) might help find and treat persons with syphilis who might not otherwise receive adequate prenatal care.

National Overview of STIs, 2022 (cdc.gov)

Vital Signs: Missed Opportunities for Preventing Congenital Syphilis — United States, 2022 | MMWR (cdc.gov)

Perhaps an Executive Order is called for charging ADHS to use executive public health authority to coordinate enhanced surveillance & interventions identified in R9-6-381 (like specific directives to licensed healthcare institutions) and work with other sectors like corrections, ADES and AHCCCS to implement evidence-based interventions.

See also: Executive Order 2007-29: To Spend Money From the Health Crisis Fund on Syphilis Prevention and Education Campaign

Will Humble Professional Development, State Legislature, Wills Blog

This Week is the Last Opportunity for Bills to Get a Hearing in their House of Origin: Packed Agendas on Tap

This week is the final opportunity for bills to be heard in committee in their house of origin. Those that don’t make it through next week will likely be dead – although they could emerge as a strike amendment later. We’ve taken positions on the bills highlighted in Bold. I’ve asked to speak at the podium in committee on the bills related to behavioral health. Brief descriptions of each bill follow the graphs below:

House Health & Human Services Agenda – Feb 12, 2024
Bill Description Sponsor AZPHA Position
HB2035 insurance; claims; provider credentialing Cook Support
HB2068 behavior analysts; regulatory board Bliss None
HB2187 health professionals; title use; prohibitions Parker B None
HB2323 DCS; specialty medical evaluations Payne None
HB2361 DCS; removal of children Diaz None
HB2362 AHCCCS; undocumented individuals Sandoval None
HB2444 grievance process; payment methods; report Montenegro None
HB2446 dietitian nutritionists; licensure Montenegro None
HB2447 department of child safety; continuation Montenegro None
HB2449 mental health conditions; medications; prohibitions Montenegro None
HB2452 marijuana funds; uses; enforcement Montenegro Neutral
HB2453 AHCCCS; naturopathic physicians Montenegro None
HB2502 SNAP; mandatory employment; training Biasiucci Opposed
HB2503 SNAP; waivers; exemptions Biasiucci Opposed
HB2640 appropriations; services providers; reimbursement Martinez None
HB2653 long-term care; reporting; monitoring; injury Nguyen Support
HB2704 foster youth permanency project team Gress None
Senate Health & Human Services Agenda – Feb 13, 2024
SB1100 Arizona state hospital; private entity Miranda Neutral
SB1159 technical correction; home health agencies Shamp None
SB1212 vapor products; sales; directory Shope Opposed
SB1235 maltreatment oversight committee; establishment Shamp None
SB1262 marijuana; social equity licenses; enforcement Borrelli None
SB1407 employers; vaccines; religious exemption Shamp Opposed
SB1507 transitional training permittees; medical licensure Shamp None
SB1508 vulnerable adult system; study committee Shamp Support
SB1509 informed consent; signatures Shamp None
SB1511 insurance; gender surgeries; documentation Shamp None
SB1570 psilocybin services; regulation; licensure Shope Support
SB1580 DCS; parents’ rights; vaccinations Wadsack Opposed
SB1585 services providers; reimbursement Wadsack Support
SB1590 group homes; random drug screening. Wadsack None
SB1594 aggravated assault; dev disability; exception Wadsack None
SB1596 developmental disabilities; electro therapy Wadsack None
SB1598 transitional services; long-term care; appropriation Wadsack None
SB1609 AHCCCS; personal health information Wadsack None
SB1611 guardianship; independent medical evaluation Wadsack None
SB1618 developmental disabilities; treatment plans; billing Wadsack None
SB1619 nursing-supported group homes; preceptors Wadsack None
SB1628 sex-based terms; laws; rules; regulations Kerr None
SB1655 health care institutions; regulation Hatathlie Support
SB1664 DCS; tiered central registry; hearings Gowan None
SB1678 secure state mental health facilities Gowan Support
SB1682 state hospital; bed availability Gowan Support
SB1688 state hospital; governing board Gowan Support

HB2035 – Insurance Appeals, Credentialing – Support – This good bill sets up reasonable timeframes for when a health care insurer denies a health care service claim. Some insurers are not paying providers in a prompt way affecting their ability to care for patients. The bill also provides an appeal process with the Office of Administrative Hearings if their claim denial grievance is unresolved. Another good thing about the bill is that it will force insurers to finish provider credentialing from 100 to 45 calendar days. Some insurers aren’t credentialing providers promptly, also impacting care.

HB2502 & 2503 – SNAP Administration – Oppose: 2502 Unnecessarily requires ADES to require able-bodied adults under 60 to participate in a mandatory employment and training program to participate in SNAP unless the person meets the exempt criteria. Bill creates unnecessary bureaucracy with no proven return on investment and may be harmful to SDOH. 2503 Prohibits ADES from asking for a waiver for SNAP work requirements if 2502 becomes law.

HB2653 – Long Term Care Reporting – Monitoring – Support – Provides more accountability among long term care facilities including required reporting by the facility of abuse and neglect, reporting to Adult Protective Services and allowing for electronic monitoring in facilities with restrictions.

SB1100 – State Hospital, Private Entity – Neutral. Requires ADHS to go out to bid to private entities to run the Arizona State Hospital. Allows the department wide latitude to reject bids. ASH needs better governance but SB1688 is a better solution.

SB1407 – Employers, vaccines – Oppose – Requires employers who ask their staff to get the Hepatitis A&B, influenza or COVID vaccines to accept religious exemptions from their policy. Health care institutions are unable to question or reject the religious exemption. Bad for infection control at healthcare institutions.

SB1508 – Vulnerable Adult Care – Support – Establishes a study committee to examine safety net services and requirements to keep vulnerable adults safe. Has no authority, but the recommendations may be helpful in crafting future administrative and regulatory requirements.

SB1570 – Psychedelic Mushrooms – Support – Requires ADHS to license psychedelic mushroom therapy centers. Emerging evidence suggests these therapies can be helpful for some patients.

SB1585 – Service Provider Reimbursement – Support – Increases salaries for persons providing home and community-based services for folks with developmental disabilities. Still would need to be built into the budget.

SB1655 – Behavioral Health Group Homes – Support – Better regulates and provides added resident safeguards at licensed behavioral health group homes.

SB1678 – Secure Residential Behavioral Health Facilities – Support – Makes it clear that Secure residential behavioral health facilities (which don’t physically exist yet) are solely for persons receiving court ordered treatment.

SB1682 – State Hospital Admissions – Support – Makes it clear that the AZ State Hospital can’t consider county of residence when considering admissions. The Arnold v Sarn settlement agreement stipulates that ASH will only admit 55 persons from Maricopa County. This stipulation is harmful – as Arizona already has a dearth of secure settings for court ordered treatment for psychiatric illnesses.

SB1688 – State Hospital Governing Board – Support – Extracts the Arizona State Hospital from the ADHS. Establishes a badly needed independent governing board to be responsible for running the Arizona State Hospital. ASH Superintendent would report to the Board rather than the ADHS director. ADHS would then be free to regulate ASH without a conflict of interest. See: Fixing the Governance Flaw at Our Arizona State Hospital: A Primer

Will Humble Professional Development, Public Health, Wills Blog

Arizona Public Health Grant Opportunities

Grants List courtesy of the Vitalyst Health Foundation:

Due February 2nd: Community Foundation for Southern Arizona Local Journalism Initiative

NEW Due February 7th: Community Opioid Intervention Prevention Program – U.S. Department of Health and Human Services

Due February 9th: South32 Hermosa Community Fund Grant

NEW Due February 12: Section 811 Supportive Housing for Persons with Disabilities (Capital Advance) – U.S. Department of Housing and Urban Development (HUD)

Due February 13th: Innovative Coordinated Access and Mobility Pilot Program

Due February 14th: Grants for Expansion and Sustainability of the Comprehensive Community Mental Health Services for Children with Serious Emotional Disturbance

NEW Due February 15th: FY 2024 AmeriCorps VISTA Request for Concept Papers – AmeriCorps

NEW Due February 15th: Children, Youth and Families At-Risk Sustainable Community Projects – U.S. Department of Agriculture

Due February 15th: The Youth Homelessness System Improvement (YHSI) Grants

Due February 16th: Economic Mobility Focused on Needs of Individuals and Families – Bank Of America Charitable Foundation Inc. 

Due February 19th: Tortoise and Freshwater Turtle Fund 

NEW Due February 20th: Historic Preservation Fund – Tribal Heritage Grants – U.S. Department of the Interior

NEW Due February 20th: USDA Community Connect Program

Due February 21st: Strategic Prevention Framework – Partnerships for Success for Communities, Local Governments, Universities, Colleges, and Tribes/Tribal Organizations

Due February 21st: Strategic Prevention Framework – Partnerships for Success for States

NEW Due February 23rd: VA Supportive Services for Veteran Families Program – U.S. Department of Veterans Affairs

NEW Due February 23rd: VA Legal Services for Homeless Veterans and Veterans At-Risk for Homelessness Grant – U.S. Department of Veterans Affairs

NEW Due February 26th: Geriatric Workforce Enhancement Program – Bureau of Health Workforce, Health Resources and Services Administration

Due February 27th: Partners for Places

Due February 28th: The Gus Schumacher Nutrition Incentive Program – Produce Prescription Program

Due March 1st: Resilient Food Systems Infrastructure (RFSI) Grant

NEW Due March 8th: The Jandy Ammons Foundation

NEW Due March 10th: Regenerative Medicine Standards Curricula Development Program – U.S. Department of Commerce

Due March 21st: Fisher Service Award for Military Community Service

Due March 22nd: Community Research Partnership Fund

Will Humble Air Quality, Health Equity, Wills Blog

EPA Strengthens Public Health Protections w/ New Particulate Matter Standard: Maricopa County Now Likely Out of Compliance

Particulate matter isn’t just one pollutant. It’s a host of fine particles like road dust, suspended tire debris, diesel exhaust, fireplace smoke and industrial discharges in the air. You can see the bigger particles like smoke and soot, but the most harmful particles are the really small ones that you can’t see.

Particles bigger than 10 microns get stuck in your nose and throat but don’t make it into your lungs because they’re too big. Particles between 2.5 and 10 microns make it into the lungs – but mainly the upper bronchi.  Particles smaller than 2.5 microns make it deep into the lungs and are therefore more harmful.  Basically, the smaller the particle, the more harmful it is.

Many years ago, Congress passed the Clean Air Act, which gave EPA the responsibility to set air quality standards for a host of pollutants including particulate matter. State and local jurisdictions are responsible for complying with those standards.

That has been the driving force for various air quality policy interventions like vehicle testing and inspections, point source regulations (industry mostly), dust control requirements for construction sites, and even agricultural practice requirements.

Over the years, EPA has updated their standards using the best science available. Over that time, it has become more and more clear that focusing on regulating the finest particles (<PM2.5) provides the biggest public health benefit.

With that in mind, EPA has been revising their particulate matter standards over the last couple of years…  and yesterday announced new standards – strengthening the annual average air for PM2.5 from 12 micrograms per cubic meter (annual average) to 9 micrograms per cubic meter (annual average).

Once jurisdictions come into compliance, EPA estimates the change will prevent 4,500 premature deaths and 290,000 lost workdays (yielding up to $46 billion in net health benefits).

Along with strengthening the primary annual PM2.5 standard, EPA changed monitoring network design criteria to include a factor that accounts for proximity of populations at increased risk of PM2.5, advancing environmental justice by ensuring localized data collection in overburdened areas.

EPA has 2 standards for PM2.5 – the annual average standard, which EPA has revised from 12ug/m3 to 9ug/m3, and a 24-hour average standard, which EPA didn’t change. EPA also didn’t change the current primary 24-hour standard for PM10, which provides protection against coarse particles.

As a result of yesterday’s change – Maricopa and Santa Cruz Counties have moved from being compliant with EPA’s PM 2.5 standard to being out of compliance. Pinal County was already out of compliance with the former, more permissive standard.

National Annual PM2.5 Averages & Attainment Status (EPA)

 

County Avg Annual PM 2.5 value

 In Attainment w/new Standard (9ug/m3)?

La Paz County

 4.1 Yes

Maricopa County

10.5

No*

Pima County

 6.1 Yes
Pinal County 12.4

No
Santa Cruz County 10.2

 No*
Yuma County 8.9

Yes
* Counties moving from current ‘attainment’ status to ‘non-attainment’ under new annual average PM2.5 standard (9ug/m3)

A jurisdiction’s compliance status is important because those that don’t meet the standards need to come up with and implement plans and submit them to the EPA with the ways they will come into compliance.  For example, Maricopa County Air Quality Department will likely need to update their rules and regulations in order to meet the new standards for PM2.5. You can see their rules and regulations here – but beware- they are more than 800 pages long!

Will Humble Healthcare, Wills Blog

Medicare Releases Initial Salvo on Drug Pricing

For the last 20 years, all Americans have been getting ripped off by pharmaceutical companies. The heist began when a prescription drug benefit was added for Medicare enrollees (Medicare Part D). Drug company lobbyists made sure Congress wrote the law to prohibit Medicare from negotiating drug prices.

As a result, Medicare was (and actually still is) held hostage by drug companies and Medicare pays 300% more for prescription drugs than in Europe or Canada, and close to 10x higher than in developing nations. That means every American who gets a paycheck is paying way more than necessary for prescription drugs. We’re ALL being scammed (not just Medicare beneficiaries) because Medicare is financed with a regressive payroll tax.

The Inflation Reduction Act of 2022 finally included modest reform by allowing Medicare to begin negotiating the price of a handful (initially 10) of the thousands of drugs they cover in Medicare Part D.

Last week Medicare sent initial offers to manufacturers of the first 10 drugs selected for drug price negotiation to help bring down the price of these prescription drugs.  This is the first time ever that Medicare is not accepting the drug prices the pharmaceutical companies set. 

Below is the list of 10 drugs covered under Medicare Part D selected for negotiation for initial price applicability year 2026, based on total gross covered prescription drug costs under Medicare Part D and other criteria as required by the law. For example, any drug that was approved by the FDA less than 7 years ago can’t be negotiated.

 

Drug    Condition               Part D Cost $          # of Part D Users

Eliquis     Prevention of blood clots    $16,482,621,000         3,706,000

Jardiance Diabetes; Heart failure     $7,057,707,000           1,573,000

Xarelto    Prevention of blood clots    $6,031,393,000          1,337,000

Januvia   Diabetes                           $4,087,081,000             869,000

Farxiga   Diabetes; Heart failure        $3,268,329,000             799,000

Entresto  Heart failure                      $2,884,877,000             587,000

Enbrel    Rheumatoid arthritis            $2,791,105,000              48,000

Imbruvica Blood cancers                   $2,663,560,000              20,000

Stelara   Psoriasis; colitis                  $2,638,929,000              22,000

Fiasp      Diabetes                             $2,576,586,000            777,000

According to the HHS, the list of drugs above represents: “… the 10 drugs with the highest total Part D gross covered prescription drug costs after excluding from the ranked list of 50 negotiation eligible drugs any biologics that qualify for delayed selection as a result of there being a high likelihood that a biosimilar will enter the market within a specified time.”

The drug companies have filed several lawsuits to stop HHS from negotiating better prices. They’re hoping the courts will do what they could not get done in Congress: block Medicare from negotiating lower prices for seniors and families.

HHS Names 1st 10 Drugs Up for Negotiation Under Medicare – AZ Public Health Association (azpha.org)

‘Inflation Reduction Act of 2022’ Gets a C- for Cutting Prescription Drug Prices – AZ Public Health Association (azpha.org)

More Meaningful Prescription Drug Price Reform That Could Have Been – AZ Public Health Association (azpha.org)

Will Humble Professional Development, State Legislature, Wills Blog

AZPHA Positions on This Week’s Health & Human Services Committee Agendas

Next week will be another busy one for hearing public health related bills in the House and Senate Health Committees. We’ve been busy reading the bills that are up in committee next week and have made our decisions about what to support, oppose, be neutral on and the things to just leave alone for this week.

The two tables below list the full agenda of bills next week. The items in bold are the ones we’ve taken a position on. Between planning for the upcoming conference and trying to stay ahead of all the bills that are being proposed made for a super busy week for me!

Below the charts is a brief explanation of the bills we’ve taken a position on in the upcoming week.

House HHS Committee (Monday 1:30pm)

Bill   Name Sponsor AZPHA Position
HB2171 health care workforce council; fund Bliss No Position Yet
HB2279 behavioral health professionals; addiction counseling Gress No Position Yet
HB2323 DCS; specialty medical evaluations Payne No Position Yet
HB2424 licensed health aides Willoughby No Position Yet
HB2451 marijuana; advertising; restrictions Montenegro Yes
HB2452 marijuana funds; uses; enforcement Montenegro Neutral
HB2453 AHCCCS; naturopathic physicians Montenegro No Position Yet
HB2480 group homes; random drug screening Parker B No Position Yet
HB2494 nursing board; licensure; appropriation Bliss No Position Yet
HB2502 SNAP; mandatory employment; training Biasiucci No
HB2503 SNAP; waivers; exemptions Biasiucci No
HB2504 forced organ harvesting; insurance; prohibition Biasiucci No Position Yet
HB2520 community health centers; graduate education Peña Yes
HB2621 sovereign authority; border; health crisis Montenegro No Position Yet

Senate HHS Committee (Tuesday 1:30pm)

SB1036 social work compact Shope No Position Yet
SB1157 influenza response plan; updates; review Shamp No Position
SB1163 homeopathic medicine; integrated medicine; qualifications Shamp No Position Yet
SB1173 licensed professional counselors; compact Gowan No Position Yet
SB1209 hospitals; fentanyl testing Shope No Position Yet
SB1211 pharmacists; prescribing; naloxone; reporting Shope Yes
SB1212 vapor products; sales; directory Shope No
SB1233 chiropractic care; licensure; complaint investigations Shamp No Position Yet
SB1234 pharmacy board; virtual manufacturers Shamp No Position Yet
SB1235 maltreatment oversight committee; establishment Shamp No Position Yet
SB1238 obstetric services; rural communities; recommendations Shamp Yes
SB1250 AHCCCS; claims Shope Yes
SB1267 physical therapy assistants; students; supervision Shope No Position Yet
SB1269 dental hygienists; botox; continuing education Shope No Position Yet
SB1295 advanced practice registered nurses; compact Shamp No Position Yet
SB1309 mental health evaluations; information; consent. Miranda Yes
SB1311 mental health; oversight; data; documentation. Miranda Yes
SB1335 appropriation; older individuals; blind. Carroll No Position Yet
SB1361 sober living homes Carroll No Position Yet
SB1387 kinship foster care stipend; increase Alston No Position Yet
SB1388 temporary assistance; child only case Alston No Position Yet
SB1406 international medical licensees; provisional licensure Shamp No Position Yet

HB2451 support – This bill would add additional reasonable restrictions on how marijuana stores and dispensaries can advertise to ensure they aren’t targeting those folks under 21 years old. Needs supermajority.

HB2452 neutral – This bill explicitly allows ADHS to use excess marijuana funds to go to the attorney general’s office for enforcement, which is a good thing except the amount isn’t capped leading to a risk that community colleges could be shortchanged as a result.

HB2502 & 2503 oppose – These bills place unreasonable administrative restrictions on participants in the SNAP program as well as unnecessary administrative burdens on ADES.

HB2520 support – This bill would help community health centers to more efficiently stand up additional rural family medicine residencies.

SB1309 support – Ensures care coordination and gathering if history from family and natural supports. This is often not done, persons released and results in bad outcomes often hitting the news.

SB1311 support – Hopefully AHCCCS will inform connected state entities- licensing, DES etc. if they determine an agency is out of compliance. AHCCCS should facilitate quarterly meetings with state entities to review findings of established reports.

SB1211 support – Good bill that authorizes pharmacists to dispense naloxone (or any other opioid antagonist approved by the FDA) without a signed prescription and removes related reporting and rulemaking requirements.

SB1212 opposed. This one is being pushed by PM, Reynolds, Altria, and Juul as a barrier to entry for competitors (and increase their market share) which is actually kind of a who cares issue really. It also distracts from proven policies with proven public health benefits like SB1130 offers. If SB1212 some will suggest the bill is part of the youth tobacco problem when it really sin’t and use it as an excuse or reason to not pass SB1130. Also, FDA already maintains a list of all authorized e-cigarette products permitted to be on the market.

SB1238 support – Good bill that makes ADHS convene stakeholders to develop recommendations to ensure obstetrics and gynecology services are provided in low-volume, high-risk rural communities and report its recommendations.

SB1250 support – Prohibits AHCCCS contracted MCOs from denying a claim for payment because of the lack of prior authorization if AHCCCS has authorized the item or service. 

SB1309 support – Good bill that expands information that’s needed for court ordered behavioral health evaluations to include more information about the proposed patient. It also specifies which individuals may provide informed consent on behalf of a proposed patient for a voluntary evaluation.

SB1311 support – Makes it clear that AHCCCS is responsible for monitoring, overseeing and evaluating other state agencies that provide mental health services. It also makes good changes to the procedures for mental health prepetition screenings and court-ordered evaluations.

See the full list (60+) of AZPHA bill positions 

See 2024 Legislative Session Working Powerpoint working draft
Will Humble Uncategorized

Register Now: Hertel Report 2024 Winter State of the State

Join Arizona healthcare professionals at the 2024 Winter State of the State in Scottsdale to learn about the latest news on Arizona managed care from a panel of experts including the Publisher of The Hertel Report Jim Hammond. Enjoy breakfast and networking before a full morning conference featuring the latest news, data and trends relevant to our competitive and evolving healthcare landscape.

The conference includes The Hertel Report’s curated collection of the top healthcare stories, along with data, discussion and policy insight about Arizona’s busiest market segments:

  • Medicare Advantage
  • Marketplace
  • AHCCCS/Medicaid
  • Value-Based Care – ACOs, APMs

The Scottsdale conference includes everything you have come to expect from the State of the State, breakfast, a full conference program, data reference pages and a directory to support post-conference networking.

TOPICS & GUEST SPEAKERS

 

Moderated by Jim Hammond

Publisher of The Hertel Report

Medicare Enrollment

Paul Rose, Managing Partner
Western Asset Protection

Medicare Trends & Priorities
Dana Marie Kennedy, State Director
AARP – Arizona

Transforming Healthcare in Arizona
Jenn Barrett, VP of Behavioral Health Transformation
Arizona Council of Human Service Providers

Arizona Medicaid – AHCCCS Update
A representative from the Arizona Health Care Cost Containment System (AHCCCS) Office of the Director

CONFERENCE BASICS

What: 2024 Winter State of the State

When: Friday, February 16, 2024

  • 7am Networking & Breakfast
  • 8-10:30am Conference Program

Where: Orange Tree Resort, Scottsdale

Cost: $235 for AZPHA Members

 

REGISTRATION LINKS

Conference Information Link: https://www.thehertelreport.com/2024-winter-state-of-the-state-registration-is-open/

Registration Link: https://www.thehertelreport.com/product/2024-winter-state-of-the-state/

Use the AZPHA2024 Coupon at Checkout to Receive $15 Off admissi

Will Humble Professional Development, Public Health Law, Wills Blog

ASU Center for Public Health Law: Your Free Resource for Understanding Public Health Law

Together with AZPHA member Jen Piatt, JD, Center Co-director and Research Scholar, and Senior Legal Researcher Mary Saxon, the ASU Center for Public Health Law published a new SCOTUS Public Health Law Updates (“PHLU”), available online at the ASU Center for Public Health Law & Policy website.

The brief, 2-page document provides select synopses of cases, petitions, oral arguments, and other news before the U.S. Supreme Court with repercussions in public health law and policy (defined broadly to include constitutional and other laws affecting the health of populations and social determinants of health).

New editions of SCOTUS PHLUare posted online each month through the end of the Court’s current term in June 2024. Their summary and analyses of major SCOTUS public health law decisions selected for our annual end-of-the-term review is set for mid-July 2024. 

Note: The Center is a terrific free resource for public health practitioners ar all levels who need an independent review of what statutes and rules actually say. All you need to do is contact them on their website.

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).

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