Travelogue #1 Getting Settled

Travelogue, Part 1

A week-and-a-half into this retirement thing, I felt it was high time to give an update to my buds left behind, especially those of you still working for a living.  How tiresome.  

So greetings from somewhere in the UK!  Actually, if you want to know where I am, you could try searching on a map for Belsize, which is in Chipperfield, which is in Rickmansworth, near London.  I say “near” London, because it appears so on a map, but feels a world apart. My daughter’s daily commute, starting from here on the northwest side of London, to a university also on the west side of London, is 2 hours each way!

When Dawn described “village life,” I had imagined an actual village, with shops and eateries and pleasant strolls among the villagers and such.  But no, this is an area of homes and farms and fields.  The only establishment of any sort that is walkable from here is the pub that lies almost immediately next door.  It goes without saying that we shall become well acquainted.

It is not that civilization is all that far — it is a mere 2 miles to a lovely area just as I had    imagined above, but you cannot walk there from here without trekking much of that distance on the pavement of the local “main drag,” which is a non-starter for reasons I shall soon explain.

My daughter rises to catch a cab precisely at 6 a.m. each day, takes it to a metro station some 4 miles away, and transfers her way to her destination, reversing the process and getting home after 6:00 each night.  This, despite the fact that she has a car, left here by her husband when he took his new job in Dubai.  She no longer drives, having learned that doing so is illegal, which she was originally given to believe was a technicality of sorts, having exceeded the year’s period during which her Arizona driver’s license could be used.  

This car, which was to have been our ticket to seeing the local environs, was itself left by a friend of Dawn’s at the aforementioned metro station, a mere 4 miles from here in Croxley Green.  After Dawn paid a few days’ extra parking fare, Nancy and I ventured via cab to the station on our third day here to retrieve the car.  We choose the middle of the day, far from any heavy traffic period, and set Nancy’s “maps” function.  I volunteered to drive.

Now, the roads in this part of the world are ancient, and have been modernized simply by having been paved at some point during the previous century.  Originally laid out for pedestrians, livestock, and the occasional cart, they are amply broad enough at all points for two bicycles to comfortably pass each other, with thick hedges, solid trees, or the random stone wall penning you in on each side. Down these paths hurtle mostly compact vehicles, careening around curves with obscured visibility, encountering each other head-on.  

Of course, I exaggerate.  There is at every point at least 2-to-3 inches between side-view mirrors, so long as at least one of the vehicles is literally scraping the hedges or polishing the granite curbs.  There is obviously an elaborate dance and sophisticated rules by which these vehicles alternate slowing or embedding themselves into the hedges to allow the other car to pass.  These rules are, however, beyond comprehension.

When in more civilized stretches through villages, rather than widen these suddenly busier streets, the locals compensate by allowing parking virtually anywhere, typically with one wheel over the curb, and the dance now includes indecipherable rules by which one lane of traffic or the other stops, far in advance of these blocks-long stretches of parked cars, to allow a caravan of opposing traffic to proceed.  Notification regarding whose turn it is to proceed is communicated via telepathy.

Every other intersection or so one finds a roundabout, a remarkably efficient mechanism by which to move traffic. This efficiency, of course, depends upon knowing what on earth one is doing.  One might think that being greeted by the “yield to traffic in the circle” sign would mean that one should yield.  That was certainly the assumption I made, to the consternation of the line of drivers behind me.  What it actually means is:  don’t enter the circle until you have enough room that the oncoming traffic has just enough space to brake so as not to crash into you.  

Doing all of this while on the wrong side of the road, sitting on the wrong side of the car, crossing traffic to make right-hand turns, and shifting our manual transmission with the wrong hand, provided me with an exciting new challenge on that 4 mile drive home.  

Admirably enough, I only ate the hedges 10 or 12 times during that initial drive home, whacked my left side mirror nearly off against a tree, and helpfully assisted in filling potholes with excess available rubber from our tires.  The best thing was the enlightenment that I inspired in Nancy, as I’ve never before heard her exclaim with such enthusiasm her appreciation for life in this world.

It’s good that I’ve retired early, as that brief drive took two years off my life.  Needless to say, Nancy has driven since, yet still infrequently, as each of those adventures takes another single year off what’s left.  Thus, we have been limited in our excursions, such as obtaining our SIM cards only a couple of days ago.  These provide us with new UK phone numbers, which I’ll list at the end of this communication, but which will do many of you no good whatsoever as there is no cell service here at all.  With WiFi, however, those of you with iPhones may FaceTime us, although please, unlike my mom, do remember that we are 7 hours later than Arizona time (and it will be 8 hours once every other part of the civilized world goes to daylight savings).

Wait, why again, you may ask, is my daughter, who is well-accustomed to driving here, no longer driving?  It is illegal to drive in the UK longer than a year unless you have a UK license.  At 500 pounds cost and with only a month to go, it’s not worth it.  She might still risk it and just drive anyway, but for an experience she and her husband had.  

Minding their own business driving one day, Anthony had to eat the hedges not to avoid an oncoming vehicle, but one that was literally flying through the air over their car, on a missile trajectory to collide with others.  Naturally curious about the outcome, they learned that the driver had been arrested for driving without a UK license after having lived here for more than a year.  Not planning on using her car to fly, yet wishing to avoid imprisonment, Dawn has chosen to pass.

We forayed out again today out of necessity, given our 6 pillowcases stuffed with laundry that we had to schlep to the laundromat.  “Wait,” you may say, “you’ve been gone barely a week.  How did you accumulate so much dirty laundry?”

Ah, that leads to the next part of the story.

Especially for those of you hoping to join us here at some point, I should describe our abode.  This is a quaint little row house type of cottage, converted from an 1850s carriage house.  It totals 700 square feet, I presume inclusive of the expansive 6-inch by 2-foot closet. Downstairs is a tiny but cute art-deco fireplace, which we are required to fire up at least every other night, reportedly to help control dampness.  And to light this fire we use? Why, good British coal.  I’m not kidding.  I’m making a fire with coal.  

Excuse me, I believe that’s Charles Dickens who has come calling at my door.

Upstairs are two bedrooms.  We have the larger one — the one with the expansive closet and a good foot or so space to circumnavigate the bed.  When we were planning our trip, Dawn messaged us that when we arrived we would have to make the bed.  “No problem,” we thought, until we arrived to find the bed in pieces leaning up against the wall. We had to “make the bed,” as in, follow the IKEA instructions to construct the thing.  But I find I can follow directions better when there are no words, but merely hieroglyphics to instruct me, along with the helpful corrections from Nancy.

The other bedroom neatly frames the other bed wall-to-wall, but it contains the sole bathroom.  That’s right, my midnight pee trips involve tiptoeing past my sleeping adult daughter, rendered more acceptable by the absence of her husband in her bed, at least until he comes for a weekend next month.

These bedrooms are accessed by the narrow, and I swear 60 degree elevation staircase.  This is no problem except for the fact that the first step down is immediately outside of both bedroom doors, rendering waking my daughter the least of my concerns during my slumbering pee trips.  On the bright side, I may not need a repeat bone scan to test the progress of my osteoporosis.  If, by the bottom of the stairs, I am still intact, I should be good to go.

It really is a sweet little cottage, but for the beast.  

As some of you may know, Dawn has for years had Belvedere, a well-behaved little Schnoodle.  For a year, Belvis became the office dog at Nancy’s workplace in Nevada.  But now that Belvis is a Brit, he no longer has the run of the place to himself.

You are no doubt familiar with the British obsession with royalty, and royal bloodlines that extend back as far as can be discovered.  Well, the same extends to pure bred dogs. Apparently, it’s not just the offspring of cross-breeding that have discounted value, but the parents themselves, having violated protocol by succumbing to the pleasures of the fur with a breed other than their own, lose value themselves. So when attempting to breed pure-breds, and two dogs with eyes for each other stray outside of their own kind, it is best to cover-up the transgression, and hustle off the newborns as quickly as possible.

Dawn and Anthony adopted such a puppy to add to their family.  Juniper is the product of an English Spaniel and, wait for it… a Weimaraner.  This 7 month-old puppy weighs some 40 pounds so far and feels like she outweighs me whenever she chooses to throw her weight around, which occurs roughly every 5 or 6 seconds.

First greeting me with her front paws seeming to reach my shoulders and a “kiss” not so much a lick as a nose plant into my face, she quickly presented me with the gift of my shoe, and we progressed from there.  Given the chance, every cushion on the couch will be sent flying, and the stuffing joins the toys scattered across everything.  I am treated to endless displays of WWE Wrestling matches between the dogs, and often am compelled to participate. This is basically non-stop unless Juniper gets hours of vigorous romping across nearby farmland, rain or shine (who am I kidding?  It is always raining, unless it’s sleeting). This serves to expend her energy nearly as much as mine.

Recognizing the advanced age of her father, Dawn has thoughtfully spared us from as much of this as possible, often walking the dogs alone, boarding both dogs during the day (a continuance of what she had been doing during the work day while she was alone), and enclosing them in a cage-like kennel for sleeping at night.

Each morning, perhaps half an hour after my daughter’s ‪6 a.m. departure, I am woken by Juniper’s “OMG I’ve got to poop right now!” whine.  Stumbling my way downstairs I generally get to the front door just in time for her to step a foot or two outside before depositing copious puppy diarrhea on the front walk, but alas, not always in time. Even if outside, my choice is then to ignore the deposits and have them ultimately tracked back in, or do my best to scrape it up.  

Both pooches then scamper upstairs, Belvis hoping to escape the madness and sleep with Nancy, Juniper hoping to touch every square inch of mattress around her before absconding with some article of clothing.  I can usually manage to calm the beast down for a few moments of dozing on the couch during the morning, but otherwise wrestle for a few hours until both dogs are off to doggie day care.

I am repeatedly and endlessly covered in dog slobber, tracked in mud, and who knows what those other fluids are. I thus have soiled more laundry than usual, leading to our aforementioned trip to the laundromat, which of course required another life-expending drive, parking the car on the sidewalk and moving it three times, and a host of laundromat cultural lessons.

So just to pique my early retirement experience, we combined both driving and Juniper into a single adventure this week when we drove the dogs to the vet.  Having just endured endless vaccines and other requirements to become British, Belvedere is required to repeat the process for the UAE.  Of course, Juniper has to do it, too.

Despite the white-knuckle life-shortening aspect of riding in the passenger seat while Nancy drives (much, much better than I do), I at least have been able to assist in navigation between bouts of loss of sphincter control.  But I could not do so while desperately wrestling the beast in the back seat to keep her from attempting to drive.  

Thankfully, on the drive over to the vet, Dawn’s father-in-law chauffeured us.  I was especially grateful upon our transmigration of the “magic roundabout,” which consists of a single large roundabout fed on all sides by 7 separate roundabouts, some of them one-way, some two-way, lanes of traffic crossing, and no stoplights involved.  Roundabouts here go clockwise, unless others are feeding a central roundabout, which must then travel counter-clockwise, whose outer ring of traffic travels in the opposite direction.  It’s indescribable, especially at rush hour.

At one point during the vet visit, I was left for 20 minutes or so to constrain Juniper in the car while Belvis was with the vet.  I mistakenly settled in for the usual wrestling match, until she caught me with a right hook that sent my glasses flying and myself wondering whether I still possessed lips.

Convinced I was now involved in MMA, I soon realized that Juniper could not abide even those rules as she landed several kicks which, as the British might describe it, were received “down low and full square.”

Nancy then drove home admirably through rush hour.  I am learning to just not look.

I remain alive, but not for long.  So those of you who want to join us here may need to hurry!

Dawn is leaving us ‪on March 12.  The only firm dates we have for others being here are for Bobbie and Jack, here ‪April 12 – May 5.  We can handle more than one at a time as we have a sleeper futon sofa, and there is a “summer house” in the back with electricity and heat, but no plumbing.  Thus, your late night pees may need to involve slogging through the mud before climbing the stairs and stepping past others sleeping.  Either that, or chamber pots.  😛  Or perhaps taking a cue from the dogs and watering the yard.

The easiest way to reach me is still through email:  [email protected] .

CHW Rulemaking, Opioid Epidemic Ends and Various CEU Opportunities

Community Health Worker Certification Rulemaking

The new law that authorizes the voluntary certification of community health workers will officially take effect on August 3 (HB 2324 Voluntary Certification for Community Health Workers). Voluntary certification can’t begin until the ADHS completes their Administrative Rulemaking (regulations) that’ll flesh out the details of the certification program including defining the core competencies, the criteria for establishing those competencies, continuing education requirements, the fee and other certification details. 

The first step in the Rulemaking process is for the ADHS to populate the 9 member advisory council to help inform the Rulemaking (the ADHS Director makes those appointments based on the criteria in the Session Law – the language at the end of the bill here).  After that, the agency needs to open the docket for the rulemaking and put draft rules out for public comment in what’s called the Arizona Administrative Register.

The public will then have a chance to comment on those initial draft regulations.  The ADHS will then consider those comments and file the final proposed rules with the AZ Secretary of State (here’s a summary of the rulemaking process on the SOS website).

Before the rules become effective- the agency needs to get final approval of the regulations by the Governor’s Regulatory Review Council (GRRC).  If GRRC approves the rules- they’d become effective and voluntary certification could begin.

Realistically- even if the ADHS starts right away and appoints the advisory council and they begin meeting this Summer and began writing the initial draft rules later this year, it could easily take a couple of years before they’d become effective- so it’s important to begin the process soon with initial advisory council meetings. 

You might be familiar with other agency rulemaking that have gone a lot faster than this.  That’s likely because those were probably “exempt” rulemakings, which provides several rulemaking short cuts including an exemption from the GRRC requirements.  Sadly, the CHW Rulemaking isn’t “exempt”.

The Rulemaking will be among the topics we’ll all be talking about at the AZCHOW Conference on June 21st and 22nd in Tucson.  Hopefully many of you will be able to make it.  AzPHA will be exhibiting at the conference.

 

Opioid Public Health Emergency Executive Order Ends

This week the Governor officially ended the emergency public health declaration that was signed via an Executive Order about a year ago.  Much has been accomplished over the last year including implementing legislation that improves prescribing practices and enhances emergency responses and increases access to treatment.  Of course- the work will go on.  The epidemic didn’t start overnight, and it surely won’t end overnight.  You can read the official end of the emergency declaration here.

Rep. McSally (R) is hosting a House of Representatives Border and Maritime Subcommittee hearing today (May 30) at 9:30 am at the UA College of Medicine Phoenix (Building 2) entitled: “An Unsecure Border and the Opioid Crisis: The Urgent Need for Action to Save Lives” featuring the Governor, various federal officials from the DEA, CBP, and DHS as well as Dr. Christ, Debbie Moak, and some people from faith-based organizations. You can see the panel line up here.  It looks like it’s an open meeting.

 

Aligning Health and Early Childhood Learning

Evidence shows how important early childhood education is in protecting people from disease and disability as an adult–  and that a child’s health impacts his or her ability to learn and succeed in school and later in life. Even with these known positive connections between early learning and wellness- health and education systems sometimes fail to align and provide opportunities to maximize health and early learning outcomes for children.

To address the disconnect between health and education, the HHS & US Department of Education outlined a set of recommendations for states and communities to align health and early learning systems. The recommendations emphasize the need for a comprehensive, seamless, and coordinated set of systems to support children, parents, and families.

 

Legislative Session Webinar Posted

The UA has posted my webinar from a couple of weeks ago that summarizes the legislative session from a public health perspective.  The whole thing is about an hour long.  You can check out the webinar on the UA Telemedicine Website.  Here’s the PowerPoint that I used.

 

CDC’s Learning Connection

The CDC has what they call a “Learning Connection” which connects public health professionals, including healthcare workers, to training opportunities and educational tools developed by CDC. Their Learning Connection also engages public health professionals around the world via social media messaging and a monthly e-newsletter.

The CDC Learning Connection: 1) features quality learning opportunities from CDC, other federal agencies, and federally funded partners; 2) keeps you up-to-date on the latest training through a free monthly e-newsletter; 3) offers access to thousands of training opportunities through CDC TRAIN — CDC’s online learning system; 4) connects you to information about CDC internships and fellowships; and 5) makes it easy to locate courses that offer continuing education. There are literally hundreds of courses one can take- mostly on-line and self-paced.

 

Free Continuing Education from MMWR and Medscape:

CDC MMWR and Medscape introduced a new FREE continuing education (CE) activity that describe trends and demographic differences in health outcomes and healthcare use for childhood asthma, based on a CDC analysis of asthma data from the 2001-2016 National Health Interview Survey for children 17 years and younger.

This activity is intended for pediatricians, pulmonologists, public health officials, nurses, and other clinicians caring for patients with childhood asthma. To access this FREE MMWR / Medscape CE activity visit https://www.cdc.gov/mmwr/cme/medscape_cme.html. If you’re not a registered user on Medscape, you may register for free or login without a password and get unlimited access to all continuing education activities and other Medscape features.

 

Free Continuing Education Training for Opioid Prescribers offered by UA

With the requirement of Arizona prescribers to complete 3 hours of opioid, substance use disorder, or addiction-related CME, the University if Arizona’s Center for Rural Health we offer Arizona based materials and continuing education opportunities including:

Free online CME vouchers worth $150: order vouchers by responding to this email. We can mail them to you in batches of 100 to 500. Please feel free to forward the listserv blast below and attached documents for your attendees.

Free Arizona Opioid Prescribing Guidelines printed copies: order at http://www.azdhs.gov/audiences/clinicians/index.php#clinical-guidelines-and-rx-guidelines-order

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I’m doing my best to populate the “upcoming events” part of our AzPHA website.  If you have an upcoming public health related event- please let me know and I’ll get it up on our website at: https://azpha.org/upcoming-events/

 

Dr. Bob’s Travelogue

I’ve gotten a couple more Travelogues from Dr. Bob in the last couple of weeks.  He’s been living for the last couple of months just outside of London. He’s writing some entertaining travelogues- with a splash of public health of course. Take a few minutes when you’re on a comfortable couch and enjoy Travelogue 1 & 2: Getting Settled and Travelogue 3: Nutrition. Here’s Interlude from last week and this new one Hoof Beats.

Ebola, Family Planning, Public Charge, & Medicaid Network Standards

Ebola Outbreak in Democratic Republic of the Congo

WHO Policy Body Concludes it’s Not a Public Health Emergency of International Concern (yet)

The Democratic Republic of the Congo’s (DRC) Ministry of Health has confirmed 45 cases of Ebola Virus Disease in the last few weeks. Most of them have been in the remote Bikoro health zone, but 1 case is in Mbandaka, a city of 1.2 million, which is bad because of the city’s size and because it’s next to the Congo river- a major transportation corridor for people and trade. Large cities that are also transportation hubs can serve as a distribution channel for the virus.

The WHO’s Emergency Committee met last week and heard about the DRC’s surveillance & interventions. The Committee concluded that “… the interventions underway provide strong reason to believe that the outbreak can be brought under control, including: enhanced surveillance, establishment of case management facilities, deployment of mobile laboratories, expanded engagement of community leaders, establishment of an airbridge, and other planned interventions.  In addition, the advanced preparations for use of the investigational vaccine provide further cause for optimism.”

The Committee concluded that “… the conditions for a Public Health Emergency of International Concern (PHEIC) have not currently been met.” They advised against travel or trade restrictions as interventions.  Despite not being classified as a PHEIC, resources are still available to the DRC from the WHO consistent with the WHO’s Emergency Response Framework

Activities include distribution of vaccine to Congo (4,000 doses so far and 3,000 more coming), cold chain resources, prepositioning of additional vaccine in Mali and support and treatment and surveillance staff from WHO & Medecins Sans Frontieres. They are using a ring vaccination strategy around cases and contacts.  Surprisingly I don’t see anything on the CDC’s website about the outbreak right now, but hopefully they’re engaged.

Let’s hope that the WHO Emergency Committee is right and the Ministry has the resources, expertise and logistical support they need to quickly identify cases and conduct the needed interventions to stop the spread before this becomes a regional or international epidemic like it did in 2014.  

 

HHS to Restrict Title X Family Planning Program

Last week the President announced that the US Department of Health and Human Services will be changing federal family planning programs (Title X) to “ensure that taxpayers do not indirectly fund abortions”.  The statement suggested that HHS would be shortly proposing regulations that would ban Title X family planning providers from referring patients to abortion clinics.

Title X was enacted almost 50 years ago to provide quality family planning care to those who may not be able to afford it on their own.  Federal funds through Title X already can’t be used for abortion services. The funds are dedicated to access to medically accurate comprehensive healthcare for low-income individuals and families. The reproductive healthcare and family planning services include contraception, cancer and STD testing as well as counseling and education and more.  Title X funding has contributed to the recent and significant decline in unintended and teen pregnancies as well as unplanned births and has reduced abortions.

I searched all over the HHS website and I can’t find the proposed rule change anywhere, so the proposed changes haven’t been released yet. We don’t know if they’ll propose an emergency rule (hitting Title X networks immediately) or go through a normal rulemaking process.  The normal process (including posting the proposed rule in the Administrative Register and a comment period) would be slower because the public would have the chance to comment, and comments would need to be reviewed before the rule could be finalized.

This has already been a chaotic year for Title X applicants for family planning service providers. It’s normally a 3-year funding cycle for Title X providers, but the Administration has changed that to a 1-year cycle- and applications for the coming year are due this Thursday (5/24).

If the proposed rule is the same one that was proposed by the Reagan Administration (and later rescinded by Clinton), it would prevent any provider from referring or providing information on abortion services.  We don’t know the fine points of the rule yet, and cannot speculate about its structure, but we will keep you updated as we learn more. 

 

AzPHA Comments on AHCCCS’ Network & Appointment Standards

AHCCCS is rolling out new integrated care contracts on October 1, and most members will be receiving services for both acute and behavioral care from these managed care organizations.  One of the keys to making sure that members have access to a health care provider when they need it is for AHCCCS to make sure each managed care organization has an adequate network of contracted providers. 

AHCCCS sets their network adequacy standards in what’s called their “AHCCCS Contractors Operations Manuals”, or ACOMs for short.  From now through May 28, 2018 AHCCCS is accepting public comment on their proposed manuals for network expectations for the integrated care contracts that start on October 1.

Our Public Health Policy Committee reviewed the proposals and submitted comments (available on my blog at https://azpha.org/). In short- we commented that we liked the fact that the new proposed network standards are more easily measured and therefore easier to ensure compliance.  We also encouraged them to ask the plans to contract with the county health departments for services like vaccinations, sexual transmitted disease testing and treatment, reproductive health, and tuberculosis prevention and control. 

We also asked that when Plans ask for and receive exemptions from the standards that the information be posted on enrollment websites so members have that info as they make enrollment decisions.  Anybody can comment on the proposed standards at this website before May 28.

 

Kaiser Family Foundation “Public Charge” Issue Brief

A few weeks ago I wrote about a change that the US Department of Homeland Security is mulling to allow the federal government to take into account the use of federal health, nutrition, and other non-cash public programs like Medicaid, the Children’s Health Insurance Program, and WIC when making a determination about whether someone is likely to be a “public charge.”  Under these changes, use of these programs by an individual or a family member, including a citizen child, could result in a person being denied lawful permanent resident status or entry into the U.S.

Such changes would apply to coverage provided to legal immigrants and their citizen children, leading to decreased participation in Medicaid, CHIP, Affordable Care Act marketplace coverage and other programs, even though they would remain eligible for them.

The Kaiser Family Foundation published a new issue brief this week that provides an overview of the 10.4 million kids in the U.S. that have a non-citizen parent (the parent is the person that would be affected by the changes).  Then issue brief presents different scenarios of disenrollment from Medicaid and CHIP to illustrate the potential effects on their health coverage and discusses the implications for their health.

How do Lava & Seawater Make Acid Mist?

I heard on the radio that when lava coming from the Kilauea volcano hits the ocean it’s forming an acid mist that’s dangerous to the lungs.  I got curious how the acid forms.  It turns out that the acid comes from 2 different sources.  About 30% of the acid is trapped in the molten lava as a gas and escapes when the lava cools fast in the ocean water. 

The bigger source (70%) is a chemical reaction in which the salt dissolved in the ocean (NaCl and H2O) – in the presence of super-hot lava- forms NaOH (sodium hydroxide) and HCl (hydrochloric acid).  Of course- it’s more complicated than that (a lot more complicated).  If you’re interested in the particulars you can check out this journal article.

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I’m doing my best to populate our “Upcoming Events” section of our AzPHA website.  If you have an upcoming public health related event- let me know and I’ll get it up on our website at: https://azpha.org/upcoming-events/

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Grand Canyon University is developing a Bachelor of Science in Public Health and they would like to gather input from the public health professional community to help inform the curriculum. Please take a few minutes to provide them some feedback on this Grand Canyon University Bachelor of Public Health Policy Survey

 

ADHS EMS Regulatory Services Section Chief Post Open

The ADHS Bureau of Emergency Medical Services and Trauma Systems is recruiting for a senior management position in the Bureau of EMS and Trauma System to lead a team of professionals in several functional areas including, statutory committee support, EMS and trauma data collection, system of care performance improvement analysis and reporting, EMS and trauma system initiatives, community paramedicine, and strategic planning and communication

Responsibilities include:

  • Supporting a diverse multi-cultural workforce that reflects the community, promotes equal opportunity at all levels of ADHS, and creates an inclusive work environment that enables all individuals to perform to their fullest potential free from discrimination

  • Assisting in policy and rule development with Bureau and Department leadership

  • Leading a highly motivated, professional team

  • Guiding, monitoring and ensuring success of numerous projects and deliverables

  • Creating and editing EMS and trauma-related reports and plan

  • Ensuring successful meetings of Governor and Director-appointed advisory meetings

  • Seeking out and sharing resources to enhance the Arizona EMS and trauma system

  • Traveling to a limited number of national, state or local meetings

Salary: up to $60,354   Apply Here

 

AzPHA Member Kelli Donley on Horizon Thursday RE Her Latest Book

AzPHA member Kelli Donley will be on Horizon this Thursday at 5:30pm (May 24) to talk about her newest book called COUNTING COUP. The book is about the Phoenix Indian School, and like her other novels, has a strong public health theme. Here’s a short description of her book, which you can order from Amazon:

Happily consumed with her academic career, Professor Avery Wainwright never planned on becoming sole guardian of her octogenarian Aunt Birdie. Forced to move Birdie—and her failing memory—into her tiny apartment, Avery’s precariously balanced life loses its footing. 

Unearthed in the chaos is a stack of sixty-year-old letters. Written in 1951, the letters tell of a year Avery’s grandmother, Alma Jean, spent teaching in the Indian school system, in the high desert town of Winslow, Arizona. The letters are addressed to Birdie, who was teaching at the Phoenix Indian School. The ghostly yet familiar voices in the letters tell of a dark time in her grandmother’s life, a time no one has ever spoken of. 

Torn between caring for the old woman who cannot remember, and her very different memories of a grandmother no longer alive to explain, Avery searches for answers. But the scandal and loss she finds, the revelations about abuses, atrocities, and cover-ups at the Indian schools, threaten far more than she’s bargained for. 

 

Most of you know Dr. Bob England, who’s been on the AZ public health scene for the last 30 years including 12 years as the Director of the Maricopa County Public Health Department.  Bob’s been living for the last couple of months just outside of London. 

He’s writing some entertaining travelogues- with a splash of public health of course. Take a few minutes when you’re on a comfortable couch and enjoy Travelogue 1 & 2: Getting Settled and Travelogue 3: Nutrition. Here’s the 5th installment: Interlude.  Back to the 4th Travelogue next week.

AzPHA Comments on AHCCCS’ Proposed Network Sufficiency and Appointment Standards

May 11, 2018

 

Thomas J. Betlach

Administrator,

Arizona Health Care Cost Containment System

801 E Jefferson Street

Phoenix, AZ 85034

 

Dear Administrator Betlach:

I write on behalf of the Arizona Public Health Association (AzPHA) – one of Arizona’s oldest and largest membership organizations dedicated to improving the health of Arizona citizens and communities. An affiliate of the American Public Health Association, our members include health care professionals, state and county health employees, health educators, community advocates, doctors, nurses and students.

Thank you for the opportunity to comment on your AHCCCS Contractors Operations Manuals for the upcoming October 1 Integrated Care Contracts.  We have reviewed the proposed 400 Series Manuals and have comments on ACOM 436 (Minimum Network Requirements) and 417 (Appointment Availability, Monitoring and Reporting).

ACOM 436 Minimum Network Requirements

We applaud the Administration for applying measurable and verifiable standards for geographic network adequacy.  We like the way the Administration is using a standard which includes a percentage of the members within both a discrete distance and time from a provider in the various categories. The percentages and distances for rural and urban areas seem reasonable.  We encourage you to keep these types of easily measurable and verifiable standards in the final ACOM 436.

County public health departments support medical homes especially in under-served areas.  Their core services include vaccinations, sexual transmitted disease testing and treatment, reproductive health, and tuberculosis prevention and control.  These are services that patients are not always able or willing to access in their medical home. When county health departments are not a network provider, this critical health care infrastructure component is unavailable to members which can gave a substantial negative impact on community and member health. Please require your new integrated managed care plans to include Public Health departments in their health care provider networks. 

This will ensure fairness in providing services to your members, provide revenue that enables county health departments to continue to serve their communities, and prevent taxpayers from paying twice for access to critical health services.

A key to making member choice meaningful requires contractors to be transparent about whether they are meeting Minimum Network Requirements.  When contractors are out of compliance with the ACOM 436 Standard(s), we encourage the Administration to require contractors to disclose on their websites, newsletters and other member communication materials which standards they have not complied with and/or have requested exceptions from so that Members can take that information into consideration as they choose plans. This disclosure standard may need included in ACOM 404 for compliance purposes. The information should also be added to the AHCCCS enrollment websites

ACOM 417 Appointment Availability, Monitoring, and Reporting

We applaud the Administration for applying statistical methods and measurable and verifiable standards for regulating appointment availability, monitoring and reporting. We like the way the Administration is using a standard which includes an explanation of how sample sizes meet a 95% statistically significant confidence level including the calculations used to confirm the confidence level.  We encourage the Administration to keep these criteria and the reporting template.

As with ACOM 436, we encourage the Administration to require contractors to disclose on their websites, newsletters, and other member materials which standards they have not complied with and/or have requested exceptions from so that Members can take that information into consideration as they choose plans. This disclosure standard may need included in ACOM 404 for compliance purposes. The information should also be added to the AHCCCS enrollment websites.

Sincerely,

 

Will Humble, MPH

Executive Director,

Arizona Public Health Association

Legislative Session Wrap-up & Farm Bill Stuff

Arizona’s Legislative Session in the Books

Well, the 2018 Legislative Session is in the books.  All in all, it was a good year for public health at the state level.  Several more good public health-related bills were signed today including:

HB 2324 Voluntary Certification for Community Health Workers

HB 2088 Public Health Guidelines in Schools

HB 2235 Dental Therapy Licensure

SB 1245 SNAP- Fruits and Vegetables

HB2371 Statewide Food Truck Licensing 

I’ll be doing a free Webinar about the legislative session Thursday May 17 at noon with the UA Center for Rural Health & the UA Telemedicine Program. Visit the AZ Telemedicine Program’s Website to register. 

Here’s a link to a PowerPoint that summarizes the Victories, Missed Opportunities, Disappointments, and things that were in the final budget that link to public health. It’s the ppt that I’ll be using during the webinar on Thursday.

 

US Farm Bill: An Opportunity to Leverage Policy to Reduce Obesity

You’ve probably heard about the “Farm Bill” at one point or another.  While it’s called the Farm Bill- it’s not just about farms. It’s the bill that sets the food and agricultural budget and policy for the US. The bill impacts farming livelihood, and also determines how food is grown and which foods are grown.  It was last reauthorized by Congress in 2014 and Congress is now working on a new reauthorization.
 
The 2014 Farm Bill  (the  Agricultural Act of 2014) included some changes and reforms to the Supplemental Nutrition Assistance Program (SNAP or food stamps) and the Commodity Supplemental Food Program.  In Arizona, SNAP benefits help put food on the table for more than one million people each month, with more than half of the benefits going to kids and teens.

The 2014 Farm Bill did a few things that promoted healthier options by requiring SNAP retailers to provide healthy choices. The ’14 law also provided grant programs to encourage people that receive SNAP benefits to buy more fruits and vegetables, provide funding for loan programs for healthy food retailers, and create opportunities for schools to add different kinds of vegetables as part of school menus.

We’re hoping that Stakeholders like us can better leverage the Farm Bill to improve healthy eating this time around now that we have a member of our delegation on the Agriculture Committee.  Arizona District 1 Congressman Tom O’Halleran is on the House committee. 

Back when I was at the ADHS we worked with ASU on a report to provide information to Congress about how SNAP could be leveraged to improve healthy eating.  The full report has the details but here are a few of the concepts in the evidence review:

  • Improving access to healthy food by establishing guidelines requiring SNAP vendors to carry more healthier options

  • Establishing nutrition standards for foods that qualify for purchase using SNAP benefits.  Right now, SNAP benefits can be used for basically any retail food no matter how unhealthy it is (alcohol can’t be purchased with SNAP benefits). 

  •  Making changes to the SNAP education program to incorporate evidence based public health practices to bring about sustained changes in participant behavior.

Rather than strengthen the food quality requirements, the bill currently being debated by the House Agriculture Committee would expand the existing SNAP work requirements.  Right now, SNAP requires childless adults between 18 and 49 who don’t have disabilities to work or be in work training to qualify. The draft legislation would expand the work requirement to include adults up to 59 and people who care for children older than 6. The draft bill also would set tighter time frames for recipients to find work and stiffen the penalties if they don’t.

SNAP recipients covered under the work requirement would have to document that they are working or getting job training for 20 hours a week. The first time an individual doesn’t comply with that requirement would trigger a loss of benefits for a year. Failing to comply again would result in being locked out of SNAP for three years.

The proposed changes would increase state costs by requiring states to collect monthly information from most SNAP users about their hours worked, their hours of participation in work programs, and the reasons they may not be working in a work program. 

The APHA has set up a way that you can Contact your representative today and urge them to include nutrition standards for foods to qualify for purchase under SNAP and also to comment about the new proposed work/work training requirements.

 

Sonoran Prevention Works Scores Syringe Access Grant

Sonoran Prevention Works received a $125,000 grant from the Vitalyst Health Foundation  to support advocacy and education for syringe access programs – a proven harm reduction strategy in response to the opioid crisis and rising hepatitis-C and HIV infection rates. They’ll be partnering with the University of Arizona College of Medicine Tucson and Creosote Partners to destigmatize syringe access programs and understand the comprehensive needs of people who inject drugs.

The Maricopa County Sheriff’s Office will also work with Sonoran Prevention Works to implement a needle stick prevention program and to educate law enforcement on injection drug use. These partnerships will work to support policy change that treats substance use as a public health issue.

Arizona’s 2018 Legislative Session in the Books

Well, Arizona’s legislative session ended last week, so you’re spared my impossibly long policy updates.  You can visit this PowerPoint to dive into the good things, bad things, and the missed opportunities this year.  It’s still a draft summary of the Session because the Governor hasn’t taken action on several bills (voluntary certification of community health workers, public health measures in schools, dental therapy, food truck licensing, and fresh produce in SNAP). BTW- Let me know if you see anything I’ve left out of the draft powerpoint so I can update it before my Webinar next week

I’ll be doing a Webinar about the legislative session on Thursday May 17 at noon in conjunction with the UA Center for Rural Health & the UA Telemedicine Program.  Visit the AZ Telemedicine Program’s Website to register.

 

FDA Finally Implementing ACA’s Menu Labeling Requirement

You might have noticed that more and more restaurants and fast food places are starting to put calorie and other nutrition information on their menus.  That’s not a coincidence or accident- they’re implementing the menu nutrition labeling requirements in the Affordable Care Act.  Section 4205 of the ACA requires restaurants with 20 or more locations to post calorie content information for standard menu items directly on the menu and menu boards.  Vending machine operators with 20 or more machines are also required to disclose calorie content for certain items. 

Nutrition clarity is a real opportunity for public health change.  Not only will the new labels give the public key information to help them make better decisions about what they buy for themselves and their families- it’ll give pause to restaurants before they label their menus- giving them an opportunity to change ingredients to lower calorie counts.  It may even spur a trend away from super-sizes and toward more appropriate and reasonable serving sizes.  With 32% of the calories consumed in the US tied to eating outside the home- this is an important opportunity. 

Anyway, the FDA announced this week that they’re finally implementing the requirements that were established by the ACA.  Another evidence-based policy intervention brought to you by the Affordable Care Act.

 

CMS Denies Kansas’ Request for 3-year Lifetime Medicaid Eligibility

This week the Centers for Medicare and Medicaid Services Administrator denied Kansas’ request to impose a 3-year lifetime limits on Medicaid eligibility. 

Her decision bodes well for us in Arizona- at least when it comes to lifetime coverage limits (although CMS is poised to almost certainly approve AZ’s work/work training request).  Arizona law requires AHCCCS to annually ask CMS for permission to require work (or work training) and income reporting for “able bodied adults” and a 5-year lifetime limit on AHCCCS eligibility (with some exceptions).

A few months ago AHCCCS turned in their official waiver request asking permission to implement those requirements.  The AHCCCS Director recently postponed the negotiation process of the lifetime limit request to expedite approval of the work requirements.  See his letter here.  Word on the street is that AHCCCS expects approval of the work requirements in June.

 

Mid-year Federal Budget Cut Request

This week the White House submitted a special message to Congress requesting they rescind $15B bill in budget authority from the current fiscal year. The proposal includes unobligated balances from prior-year appropriations and reductions to budget authority for mandatory programs.

Below are selected programs proposed for rescission by the Administration that may impact public health programs. For more information, view the entire rescission proposal here.

  • Children’s Health Insurance Fund: The proposal would rescind $5B in amounts made available by the Medicare Access and CHIP Reauthorization Act of 2015 to supplement the 2017 national allotments to states, including $3B in unobligated balances available on October 1, 2017. 

  • Child Enrollment Contingency Fund: The proposal would rescind $2B in amounts available for the CHIP Contingency Fund, of which there were $2.4B available. The Contingency Fund provides payments to states that experience funding shortfalls due to higher than expected enrollment. 

  • Centers for Medicare and Medicaid Innovation (Innovation Center): The proposal would rescind $800M in amounts made available for FY11-19 for the Innovation Center, of which there were $3.5B available on October 2017. The Innovation Center was created to test innovative payment and service delivery models to reduce program expenditures under Medicare, Medicaid, and CHIP while preserving or enhancing quality care.

 

Speak for Health: Fund Public Health in 2019

As Congress begins its work on the FY 2019 appropriations process, Speak for Health and tell our members of Congress  to reject the proposed cuts to important public health programs in the president’s budget proposal and instead to prioritize public health by building upon the important increased investments in public health provided by Congress in FY 2018.

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Most of you know Dr. Bob England, who’s been on the AZ public health scene for the last 30 years including 12 years as the Director of the Maricopa County Public Health Department.  You know that he’s a terrific cartoonist.  But did you know he’s an engaging travel writer?

Bob’s been living for the last couple of months just outside of London.  He’s been writing some terrifically entertaining travelogues- with a splash of public health of course. Take a few minutes when you’re on a comfortable couch and enjoy Travelogue 1 & 2: Getting Settled.  Here’s Travelogue 3: Nutrition. Enjoy.

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If you haven’t yet become a member of AzPHA please consider joining our team!

Here’s information about our Individual & Organizational Memberships

Medicaid Network Adequacy: A Key to Access to Care

AHCCCS is rolling out new integrated care contracts on October 1, and most members will be receiving services for both acute and behavioral care from these managed care organizations.  One of the keys to making sure that members have access to a health care provider when they need it is for AHCCCS to make sure each managed care organization has an adequate network of contracted providers.  After all, having health insurance isn’t much good if there’s no place for you to get care in your area or if the doctors are booked and you can’t get an appointment.  That’s where “network adequacy” comes in.

AHCCCS sets their network adequacy standards in what’s called their “AHCCCS Contractors Operations Manuals”, or ACOMs for short.  From now through May 28, 2018 AHCCCS is accepting public comment on their proposed ACOM manuals for network expectations for the integrated care contracts that start on October 1.

Geographic Standards

One of the keys is to make sure that there are providers reasonably nearby Medicaid members.  ACOM 436- Minimum Network Requirements will set the expectations for geographic access to care. It’s pretty long as you’ll see if you click on the link.  But here are a couple examples of the key proposed standards that are out for public comment. 

For kids, they propose requiring their contracted managed care organizations to ensure that 90% of members live within 10 miles or 15 minutes of a primary care provider in Maricopa and Pima counties.  For all other counties, they’re proposing that 90% of members lives within 30 miles or 40 minutes of a primary care provider.  For kids dental in Maricopa & Pima counties, they’re proposing requiring their contractors to make sure that 90% of members live within 15 minutes or 10 miles of a provider.  For the other counties, they’re proposing that 90% of members live within 40 minutes or 30 miles of a provider.

The Manual also proposing a process for managed care organizations ask for an exemption from the standards based on outlined reasons and the criteria by which they’ll consider approving the exemptions.  Those of you that are well versed in these aspects of access to care can comment on the proposed standards and the exemption criteria through May 28 at this web link.

Appointment Wait Time Standards

Another Manual that’s out for public comment is about how long it takes to make an appointment to see various kinds of providers.  That one is called ACOM 417, Appointment Availability, Monitoring and Reporting.

The 417 Manual proposes that routine primary care appointments be set within 21 calendar days of the member’s request.  For more urgent appointments, the proposal is for “… as expeditiously as the member’s health condition requires but no later than 2 business days of request”.  For Specialty provider referrals the proposal is “… as expeditiously as the member’s health condition requires but no later than 3 business days from the request”.  For routine specialty care appointments it’s within 45 calendar days of referral.  For dental provider appointments it’s “… as expeditiously as the member’s health condition requires but no later than 3 business days of request, and for routine care appointments within 45 calendar days of request

They’re also proposing a process for managed care organizations ask for an exemption from the standards based on outlined criteria.  They also outline the criteria by which they’ll consider approving the exemptions.

Those of you that are well versed in these aspects of access to care can comment on the proposed standards and the exemption criteria through May 28 at this web link.  We’ll talk this over with our Public Health Policy Committee and turn in comments sometime in May.  Let me know if you want to get onto our Policy Committee Basecamp and I’ll sign you up.

 

FDA Pursuing E-Cigarette Interventions

Last week the FDA announced several interventions to better regulate e-cigarette makers.  It’s no secret that e-cigarettes have become wildly popular with kids.  E-cig makers have become increasingly crafty in attracting kids to use their products- which often have high nicotine levels.  Some of the new products look like a USB flash drive- making it easier for them to sneak into what are supposed to be tobacco product free-areas.  Many fall under the JUUL Brand but also “myblu” and “KandyPens”.

The strategies that FDA announced last week include: 1) an “undercover” investigation into retailers that are selling these JUUL products to kids and issuing warning letters and other enforcement actions; 2) raising concerns with eBay regarding their listing of JUUL products on their website; 3) contacting manufacturers like JUUL Labs and requiring them to submit like documents like their product marketing strategy, research on the health, toxicological, and behavioral or physiologic effects of the products; and 4) enforcement actions focused on companies that are marketing products in ways that are misleading to kids.

Time will tell whether these strategies make a difference- but one thing is clear- we’ll continue to be in a long-term battle with companies that will continue to creatively find new ways to addict America’s youth to their nicotine products.

 

Legislative Session Update

There wasn’t much action on the public health bills we’re working on and tracking last week. Unless you’ve been out of town or on vacation you know that pretty much all last week was absorbed with the debate about weather and how to fund increases for K-12 schools.  There were huge peaceful marches on the Capitol on both Thursday and Friday.  The Legislature adjourned early last week.

The Governor has proposed increasing teacher salaries by 20% by the year 2020. The teachers are looking for a more robust commitment for all other school staff and a dedicated revenue stream to support the investment.  The Governor proposes paying for the increase in several ways- in part by increasing the assessment on hospitals to help pay for Medicaid, and in part by decreasing planned funding for things like provider increases for programs that serve people with disabilities (because of the increase in the minimum wage).  The plan assumes state revenue will increase by 4.8% per year over the next 3 years (over the last 3 years it’s increased by between 3 and 4% per year). 

Late last Friday afternoon the Governor issued a media release stating that an agreement had been reached with the legislature on a way to fund the 20% by 2020 idea, but the media release didn’t explain how it would be paid for.  Here’s the latest information that I have- but of course this could change when the actual proposal comes out later this week. Robert Robb from the Republic had the most digestible explanation of the plan that I’ve been able to find.

The phased-in cost of the teacher pay increase is $580M. The phased-in school-assistance portion is $370M (a total of $950M).  Maintaining all other state programs over that period is about $850M and that’s without any population increase or inflation.  At 4.8% revenue growth per year (the past 3-year average is between 3 and 4%) there’d be a $150M deficit in 2020 even if there were no increases in spending anywhere else in state government.  If revenue growth were less than 4.8%, there’d be a bigger deficit.  If revenue increases average more than 4.8% things might be OK.  If there’s a recession, we’d be in big trouble. 

You can see how important it is to get the revenue stream right.  If revenues and expenses are unbalanced, the increases for schools and teachers will absorb all other funds and there won’t be anything available to address public health or social determinant priorities and might even force reductions in other state services like health care and public health. 

 

Medicaid Changes Partially Support the Teacher Salary Proposal

There are a couple of “efficiency items” that the Governor identified within our Medicaid program that will partially pay for some of the teacher salary increase.  One relates to the assessment on hospitals that pays the state portion of the Medicaid expansion deal that was reached a few years ago.  The other is a proposed change to eliminate something called “prior quarter coverage”.

Hospital Assessment

One item listed as an “efficiency savings” to help pay for the teacher salary proposal increase the hospital assessment, which pays for Medicaid expansion, by $35 to $39M.  The Governor has proposed moving behavioral health services for childless adults to the same funding stream as acute care (tobacco taxes and the hospital assessment pay for acute care coverage for childless adults and those covered through Medicaid expansion).  The assessment on  hospitals would increase by 12% from $287 million to $326M.

Prior Quarter Coverage

Back on January 1, 2014 AHCCCS began covering people that qualify for Medicaid for the 3 months prior to their eligibility date.  So, if a person applying for AHCCCS qualifies during any portion of three months immediately preceding the month in which the member applied for AHCCCS coverage, they’ll reimburse providers for covered services.  They’ve submitted a waiver request to CMS to stop this practice.  In FY 2017 they spent a total of about $21M for prior quarter coverage- so stopping the practice would save about $11 – $12M in state funds. This waiver is in the hands of CMS right now.

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Here’s a snapshot of where the various bills we’re working on are in the system. 

HB 2038 Drug overdose review teams; records (Signed into Law)

HB 2071 Rear-facing car seats (Stalled in Senate)

HB 2084 Indoor tanning; minors; restricted use (Now called SB 1290 as Striker) 

HB 2127 Children’s health insurance program (Now called SB 1087 as Striker)

HB 2197 Health professions, workforce data (Ready for Senate Floor Vote)

HB 2208 Prohibition, photo enforcement (Effectively dead)

HB 2228 Annual waiver, applicability (Signed by Governor)

HB 2323 Schools; inhalers; contracted nurses (Ready for Senate Floor Vote)

HB 2324 Community health workers; voluntary certification (needs Senate floor vote)

HB 2389 Syringe access programs; authorization (Basically dead)

HB 2484 local food tax; equality (Signed by Governor)

SB 1022 ADHS; homemade food products (Signed by Governor) 

SB 1083 Schools; recess periods (Signed by Governor)

SB 1245 Snap Benefit Match (Needs Rules Committee & Budget Line)

SB 1261 Texting while driving (Now HB 2159 traffic violations; traffic survival school)

SB 1420 Medical marijuana; inspection; testing; appropriation (Needs House Rules)

SB 1445 AHCCCS Dental care, pregnant women (Needs House Rules Committee)

SB 1377 Dental therapy, licensure, regulation (Failed in House now HB2235 in Senate)

SB 1389  HIV; needs assessment; prevention signed by the Governor last week.

SB 1394 Abortion reporting (Signed by Governor)

SCR 1005 Voter Initiative Sunset (striker in the House)

 

Public Health-related bills signed so far:

HB 2038 Drug overdose review teams; records was passed and signed.  Once it takes effect later this year, law enforcement agencies will now be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request. 

HB 2228 Annual waiver, applicability was signed by the Governor.  It’s good. It will direct AHCCCS to exempt tribes from their directed waiver request that asks for CMS permission to implement work requirements for some Medicaid members.  The recently submitted Waiver request includes an exemption for American Indians, however, this would place the exemption into statute.

HB 2323  Schools; inhalers; contracted nurses was signed by the Governor.  This bill adds contracted nurses to the list of people who are authorized to provide emergency inhaler medication in case of respiratory emergencies. Some charter and independent schools don’t employ nurses directly but engage them through contracts.

HB 2484 local food tax; equality, which will ban Arizona cities and counties from taxing sugary drinks as a public health intervention.

SB 1022  DHS; homemade food products ADHS will be required to establish an online registry of food preparers that are authorized to prepare “cottage food products” for commercial purposes. Registered food preparers would be required to renew the registration every three years.

SB 1083 Schools; recess periods was passed and signed!  Beginning next school year K-3 will need to have at least 2 recess periods. Grades 4 and 5 will need to have 2 recess periods the year after that.

SB 1389  HIV; needs assessment; prevention was signed by the Governor last week.  It requires the ADHS to establish and implement an HIV Action Program. 

SB 1394 Abortion reporting was passed by the House and signed by the Governor.  It will require the ADHS to collect and report additional data regarding abortions that are performed in AZ.

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AZ Public Health Policy Update: April 23, 2018

Feds Overhaul Essential Health Benefit Options

The Affordable Care Act required all health insurance policies sold on the Exchange and in the small group & individual markets to cover as set of “essential health benefits”.   Each Governor selects their state’s essential health benefits by choosing among options like their state employee plan, a small group market plan etc.  Each state has 10 options to pick from.  Governor Brewer selected the state employee plan as Arizona’s benchmark and Ducey did the same a couple of years ago.  Not a bad choice, because the benefits are generally robust- except that since the state employee plan doesn’t cover abortion services the state benchmark doesn’t either (although non-Medicaid plans can elect to cover those services).

Last week the Centers for Medicare & Medicaid Services issued an annual “Notice of Benefit Payment Parameters for 2019“. It outlined a big change.  Beginning in 2019 CMS will be giving Governors a lot more flexibility in selecting their state’s essential health benefit package.  Instead of 10 options, states will be able to choose among any of the essential health benefit benchmark plans used by any other state.  The new rules could have a profound impact on health insurance access and benefits.

It remains to be seen whether our Governor will choose a different benchmark plan moving forward.  Here’s a list of the various states’ insurance benefits benchmark mandates: [EHBs by State]

Legislative Session Update

The Governor vetoed 10 bills last Friday – apparently to send a message to the legislature that he wants the “20% by 2020” teacher funding bill on his desk forthwith. 

Luckily, the Community Health Worker voluntary certification bill needed to go back to the House for a Final Read- or it’s quite possible that it would have been veto number 11.  He did veto a good bill HB 2089 which would have required school districts to develop guidelines, information and forms on the dangers of heat-related illnesses, sudden cardiac death and prescription opioid use.

Last week was a busy one for the bills that we’re working on, so this update will be long again.  Once the session is over my updates will get shorter, I promise!

SB 1389   HIV; needs assessment; prevention was signed by the Governor last week.  It requires the ADHS to establish and implement an HIV Action Program to: 1) complete a statewide HIV Prevention and Care Needs Assessment (Assessment) of target populations (by November 1, 2020); 2) identify community-based agencies that serve the HIV population and that are outside of the known HIV service system; 3) conduct outreach to increase community involvement in HIV prevention, education and stigma reduction; 4) develop a social media initiative to engage at-risk populations to be tested for HIV infection; and 5) analyze data from the Assessment annually to develop and implement HIV training and education initiatives.

SB 1445 AHCCCS Dental care, pregnant women cleared the full Senate but still needs a House Rules hearing and a floor vote. It’ll need an appropriation (to provide oral health coverage to pregnant Medicaid members)… so much of the discussion right now is about how much it would cost.

The direct cost to AHCCCS is estimated to be a little less than $268K/year.  However, the Joint Legislative Budget Committee (JLBC) believes that it could have secondary costs. Their thinking goes something like this: pregnant Medicaid enrollees that are not yet receiving prenatal care will discover that there’s an oral health benefit and will make a dental appointment. The hygienist or dentist will discover the pregnancy and inform their health plan about the pregnancy. At that point, their eligibility category would switch to one with a higher state match rate (and presumably begin receiving prenatal care- which if it happened would be a good thing). 

The JLBC analysis assumes that 25% of the estimated 5,000 pregnant women currently enrolled in the expansion population but not receiving prenatal care will, because of the new benefit, go to the dentist- causing their eligibility to change (to a category called SOBRA), generating a $3.7M refinancing cost. 

Honestly, it seems unlikely to me that women who aren’t getting prenatal care will present to a dentist or hygienist for a cleaning.  I can see it if they have a toothache, but any secondary cos from a dental emergency would be associated with last year’s emergency dental benefit – not this new (proposed) preventative oral health benefit.  We’ll see what happens during the upcoming budget process.

A new problem is that the effort to raise teacher’s pay is probably going to jeopardize many programs that may have otherwise been funded, like this one.  It’s still possible that this might happen- but it’s a lot less likely now because of the effort to raise teacher’s salaries 20% by 2020.

HB 2159 traffic violations; traffic survival school has been languishing for the last few weeks.  Last week the bill passed the House and has been assigned a Conference Committee to resolve the differences with the Senate version.  This would prohibit drivers from “using a portable wireless communication device to read, write, or send an electronic message while driving” (unless the car is stopped).  The first violation would be a petty offense with a fine between $25 and $99.

HB 2228 Annual waiver, applicability was signed by the Governor this week.  It’s good. It will direct AHCCCS to exempt tribes from their directed waiver request that asks for CMS permission to implement work requirements for some Medicaid members.  The recently submitted Waiver request includes an exemption for American Indians, however, this would place the exemption into statute.

HB 2235 dental therapy; regulation; licensure has had a long and somewhat bizarre trip through the legislature.  The original bill (SB 1377) would have set up a new licensed class of dental professionals called a Dental Therapist.  Their scope of practice would be somewhat less than a DDS, but they could do some procedures like filling cavities.  They could also practice anywhere.  The original bill passed the Senate but died in the House Health committee.  It came back to life a couple of weeks ago as what’s called a Strike Everything Amendment but stalled out again.  Then, this week, an amendment to the amendment was offered that seems to please everybody- and it passed the Senate 30-0.  It still needs to go back to the House, but it has a real chance now.

The Senate version limits dental therapists to only practicing at a Federally Qualified Community Health Center (or look-alike), or a nonprofit dental practice or organization that provides dental care to low-income and underserved individuals, or a private dental practice that provides dental care for CHC patients of record.  The amended bill also prohibits a dental therapist from performing nonsurgical extractions of permanent teeth unless under the direct supervision of a dentist.

The “school safety” bill called SB 1519 protective orders; schools; appropriations was proposed late last week by Senator Smith. Here’s a link to the introduced version.  It contains many of the things outlined by the Governor a few weeks ago related to firearms, schools and protection orders. A centerpiece is something called a “Severe Threat Order of Protection” which outlines a process to restrict firearm access for people who are a danger to themselves or others. There are also measures that would require AHCCCS to develop and post suicide prevention training and a statewide school safety hotline would also be established. 

There’s no provision in the bill for comprehensive background checks or restrictions on things called “bump stocks” which makes guns fire quicker. There are some other troublesome parts of the bill. 

Our folks in the Public Health Policy Committee (including AzPHA member Jean Ajamie who is a school safety expert) has been doing some analysis of the bill (you can see that stuff on our Committee Basecamp- let me know if you’d like to join that group). We haven’t taken a position yet- most likely we’ll remain neutral.  The bill passed the Senate Commerce and Public Safety Committee this week. Next week will be the Senate Rules Committee.  There’s no mirror bill in the House at their point.  Stay tuned.

HB 2323  Schools; inhalers; contracted nurses was signed by the Governor this week.  This bill adds contracted nurses to the list of people who are authorized to provide emergency inhaler medication in case of respiratory emergencies. Some charter and independent schools don’t employ nurses directly but engage them through contracts.

HB 2324 Community health workers; voluntary certification was passed by the Senate this week (24-6)!  It passed the Senate in an amended form (including a provision to ensure that state procurements don’t favor contracting with certified vs non-certified CHWs).  There are two important steps left.  Because the Senate amended the House bill, it needs to go back to the House where Rep. Carter will likely formally concur with the Senate changes.  Then it needs a “Final Read” vote in the House to formally agree with the amendments the Senate added.  Assuming it passes the House again, then it’s on to the Governor for his approval (hopefully) The Senate amendments got the Goldwater Institute to be neutral- so I think we’re in good shape for a signature.

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Here’s a snapshot of where the various bills we’re working on are in the system. 

HB 2038 Drug overdose review teams; records (Signed into Law)

HB 2071 Rear-facing car seats (Stalled in Senate)

HB 2084 Indoor tanning; minors; restricted use (Now called SB 1290 as Striker) 

HB 2127 Children’s health insurance program (Now called SB 1087 as Striker)

HB 2197 Health professions, workforce data (Ready for Senate Floor Vote)

HB 2208 Prohibition, photo enforcement (Effectively dead)

HB 2228 Annual waiver, applicability (Signed by Governor)

HB 2323 Schools; inhalers; contracted nurses (Ready for Senate Floor Vote)

HB 2324 Community health workers; voluntary certification (Senate floor vote this week)

HB 2389 Syringe access programs; authorization (Basically dead)

HB 2484 local food tax; equality (Signed by Governor)

SB 1022 ADHS; homemade food products (Signed by Governor) 

SB 1083 Schools; recess periods (Signed by Governor)

SB 1245 Snap Benefit Match (Needs Rules Committee & Budget Line)

SB 1261 Texting while driving (Now HB 2159 traffic violations; traffic survival school)

SB 1420 Medical marijuana; inspection; testing; appropriation (Needs House Rules)

SB 1445 AHCCCS Dental care, pregnant women (Needs House Rules Committee)

SB 1377 Dental therapy, licensure, regulation (Failed in House now HB2235 in Senate)

SB 1394 Abortion reporting (Signed by Governor)

SCR 1005 Voter Initiative Sunset (striker in the House)

 

Public Health-related bills that have been passed and signed:

HB 2038 Drug overdose review teams; records was passed and signed.  Once it takes effect later this year, law enforcement agencies will now be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request. 

HB 2228 Annual waiver, applicability was signed by the Governor.  It’s good. It will direct AHCCCS to exempt tribes from their directed waiver request that asks for CMS permission to implement work requirements for some Medicaid members.  The recently submitted Waiver request includes an exemption for American Indians, however, this would place the exemption into statute.

HB 2323  Schools; inhalers; contracted nurses was signed by the Governor.  This bill adds contracted nurses to the list of people who are authorized to provide emergency inhaler medication in case of respiratory emergencies. Some charter and independent schools don’t employ nurses directly but engage them through contracts.

HB 2484 local food tax; equality, which will ban Arizona cities and counties from taxing sugary drinks as a public health intervention.

SB 1022  DHS; homemade food products ADHS will be required to establish an online registry of food preparers that are authorized to prepare “cottage food products” for commercial purposes. Registered food preparers would be required to renew the registration every three years.

SB 1083 Schools; recess periods was passed and signed!  Beginning next school year K-3 will need to have at least 2 recess periods. Grades 4 and 5 will need to have 2 recess periods the year after that.

SB 1389  HIV; needs assessment; prevention was signed by the Governor last week.  It requires the ADHS to establish and implement an HIV Action Program. 

SB 1394 Abortion reporting was passed by the House and signed by the Governor.  It will require the ADHS to collect and report additional data regarding abortions that are performed in AZ.

____

House Bills

HB 2038 Drug overdose review teams; records                

Passed and Signed

Law enforcement agencies will now be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request.  All information and records acquired by a Team are confidential and not subject to subpoena, discovery or introduction into evidence in a civil or criminal proceeding or disciplinary action.

HB 2071 Rear-facing car seats         

Stalled in Senate

This Bill would require kids under 2 years old to be in a rear-facing restraint system unless the child weights at least 40 pounds or is at least 40 inches tall.  We’ve signed up in support of this bill.  No action has yet been taken in the Senate so this bill is effectively dead.

HB 2084 Indoor tanning; minors; restricted use

Passed House but Stalled in Senate- now SB1290

This bill had been languishing in the Senate after passing the House by a 45-15 vote. Because of its lack of movement in the Senate it had appeared to be dead again this year.  However, this week it reappeared as a Strike All amendment in the House again as SB 1290.  It has now passed the House and has been sent back to the Senate.

HB 2127 Children’s health insurance program

Stalled in Senate- now SB 1087 in House

After passing the House, this bill had been languishing in the Senate and appeared dead.  However, it was resurrected this week in the form of SB 1087 and was passed again by the House Health Committee last Thursday.  It still needs another House floor vote before it goes back to the Senate again.  It would remove the trigger that automatically freezes the KidsCare program if FMAP (the federal contribution) drops below 100%. 

It allows the state to freeze it if costs are more than the state or federal allotment. The bill does not require the state to appropriate any money for a state share.  We’ve signed up in support of this bill because it provides a pathway to keep KidsCare if the federal government drops its contribution level. 

HB 2197 Health professions, workforce data

Ready for Senate Floor Vote

This bill is looking good and ready for a final Senate floor vote.  It would require AZ health licensing boards to collect certain data from applicants (beginning January 2020) to get better data about health professions workforce distribution and needs.  The data would be confidential.  Over the long-term this bill would be helpful in providing better data with which to improve the distribution and capacity of the public health workforce in Arizona.

HB 2208 Prohibition, photo enforcement

Died in Senate

This one would prohibit cities and other jurisdictions from having photo enforcement of red light and speeding violations.  While nobody likes getting a ticket in the mail, the data suggest that photo enforcement saves lives and prevents injuries (especially red-light photo enforcement).  We’ve signed up in opposition to the bill.  This bill passed the House 31-27 but stalled in the Senate.  Honestly, it looks dead.

HB 2228 Annual waiver, applicability

Signed by Governor

This would direct AHCCCS to exempt tribes from their directed waiver requests to CMS asking permission to implement work requirements for some Medicaid members.  The recently submitted Waiver request includes an exemption for American Indians, however, this would place the exemption into statute.

HB 2323   Schools; inhalers; contracted nurses

Signed by Governor

This bill adds contracted nurses to the list of people who are authorized to provide emergency inhaler medication in case of respiratory emergencies. Some charter and independent schools don’t employ nurses directly but engage them through contracts.

HB 2324 Community health workers; voluntary certification

Needs Final Read in House

This was passed by the Senate this week (24-6)!  It was in an amended form (including a provision to ensure that state procurements don’t favor contracting with certified vs non-certified CHWs).  There are two important steps left.  Because the Senate amended the House bill, it needs to go back to the House where Rep. Carter will likely formally concur with the Senate changes, and then it needs a “Final Read” vote in the House to formally agree with the amendments the Senate added.  Assuming it passes the House again, then it’s on to the Governor for his approval (hopefully) The Senate amendments got the Goldwater Institute to be neutral- so I think we’re in good shape for a signature.

HB 2389 Syringe access programs; authorization 

Dead

This basically looks dead for this year. The bill that passed the House was great- providing clear decriminalization of needle exchange programs (needle exchange programs are technically a class 6 felony right now).  The version that passed the Senate only decriminalizes syringe exchange programs when and where the ADHS declares a public health emergency because of the rapid spread of infectious diseases.

It went to a Conference Committee this consisting of Rivero, Navarrete, Udall, Borelli, Brophy McGee, and Mendez… but Wednesday, Brophy McGee was replaced with Petersen, basically killing the House version- and the bill was dropped from the Conference Committee agenda- basically killing it.  Honestly, the Senate version of the bill wouldn’t have helped public health much if it all. Maybe next year.

HB 2484 local food tax; equality

Signed by Governor

The Governor signed this bill, which bans Arizona cities and counties from taxing sugary drinks as a public health intervention. The bill doesn’t specifically mention taxes on sugary drinks, but states that any tax on food needs to be uniform.  products must be uniform. Right now, there aren’t any Arizona cities or counties that are taxing soda and other sugary drinks, and this new law will ensure that it stays that was. 

 

Senate Bills

SB 1022    DHS; homemade food products            

Signed by Governor

ADHS will be required to establish an online registry of food preparers that are authorized to prepare “cottage food products” for commercial purposes. Registered food preparers would be required to renew the registration every three years. This is a sensible addition to the current cottage industry food law and we’ve signed up in support.

SB 1083    Schools; recess periods

Signed by Governor

This was passed and signed!  Beginning next school year K-3 will need to have at least 2 recess periods.  Grades 4 and 5 will be added the following year. This makes AZ a national leader in state school recess policy. A big shout out to AzPHA member Scott Turner and Christine Davis from Arizonan’s for Recess for their heavy lifting to make this happen!

SB 1245 Snap Benefit Match

Needs House Rules Committee and Budget Line Item

This Bill needs House Rules review before a House floor vote (and of course needs to make it through the budget process). This good Bill would appropriate $400K to ADES to develop a produce incentive program within the Supplemental Nutrition Assistance Program for members to buy Arizona-grown fruits and vegetables.  It would also provide matching funds to SNAP-authorized vendors as an incentive to participate in the fruits and vegetable program. 

SB 1261 Texting while driving

Now HB 2159 and Moving Again in House

This has been languishing for the last few weeks because it hasn’t been called up for a floor vote in the Senate.  Last week, the language from SB 1261 was added as an amendment onto HB 2159 traffic violations; traffic survival school.  This bill, with the addition of the texting language, passed the House and is headed back to the Senate and has been assigned a Conference Committee.

This would prohibit drivers from “using a portable wireless communication device to read, write, or send an electronic message while driving” (unless the car is stopped).  The first violation would be a petty offense with a fine between $25 and $99.

SB 1377 Dental therapy, licensure, regulation

Moving Again in Amended Form

This has had a long and somewhat bizarre trip through the legislature.  The original bill (SB 1377) would have set up a new licensed class of dental professionals called a Dental Therapist.  Their scope of practice would be somewhat less than a DDS, but they could do some procedures like filling cavities.  They could also practice anywhere.  The original bill passed the Senate but died in the House Health committee.  It came back to life a couple of weeks ago as what’s called a Strike Everything Amendment but stalled out again.  Then, this week, an amendment to the amendment was offered that seems to please everybody- and it passed the Senate 30-0.  It still needs to go back to the House, but it has a real chance now.

The Senate version limits dental therapists to only practicing at a Federally Qualified Community Health Center (or look-alike), or a nonprofit dental practice or organization that provides dental care to low-income and underserved individuals, or a private dental practice that provides dental care for CHC patients of record.  The amended bill also prohibits a dental therapist from performing nonsurgical extractions of permanent teeth unless under the direct supervision of a dentist.

SB 1394 Abortion reporting

Signed by Governor

This one would require the ADHS to collect and report additional data regarding abortions that are performed in AZ. The data would be collected and reported by providers and would include the reason for the abortion (economic, emotional health, physical health, whether the pregnancy was the result of rape or incest, or relationship issues etc.).

SB 1420 Medical marijuana; inspection; testing; appropriation

Needs House Rules Approval

This would require the ADHS to set up testing standards for medical marijuana and begin enforcing the standards beginning in 2019.  We’re supporting this legislation.  It passed the full Senate last week and was given a Pass recommendation by the House Military, Veterans & Regulatory Affairs Committee this week.

SB 1445 AHCCCS Dental care, pregnant women

Needs House Rules and Floor Vote & a Budget Line Item

This unanimously cleared the House Appropriations committee last week.  We were hoping to get a Rules committee hearing next week, but it’s not on the agenda, sadly.  The big hurdle will be getting an appropriation to cover the state match into the budget.

SB 1470  Sunrise process; health professions

After a dramatic start, this bill looks like it will have a consensus ending.  The sunrise process bill stakeholders negotiated changes to the current scope of practice sunrise process that everybody seems to be able to live with.  It passed in House this week by a 59-0 vote. It’s now ready for the Senate to concur in the House’s amendment.

Federal Work Requirement Executive Order

Last week the President issued an Executive Order to the US Departments of Health and Human Services, Agriculture, and Housing charging them with reviewing the eligibility regulations for all of their public assistance programs (e.g. Medicaid, Medicare, SNAP, WIC, Section 8 Housing etc.) and check to see whether they have work requirements.  

If they don’t currently have work requirements, the Order charges them with determining whether the current law would allow them to do so.  Then, in 90 days, they’ll need to turn in a list of policy recommendations to “strengthen existing work requirements for work-capable people and introduce new work requirements”. The Order is of course more complex than I’ve described here- but you can read the whole thing here.

BTW: we expect AHCCCS’ directed waiver that will require many (about 200,000) AZ Medicaid members to meet their work/school/community engagement requirements starting 10/1 to be approved any day now.

 

Phoenix Complete Streets

If you live or work in Phoenix, click here to send an email to the City Council members asking them to adopt and implement the Complete Streets Design Guidelines. Please be sure to send your email before the council meeting this Wednesday, April 18, and feel free to share this call to action with Phoenix friends. 

The Complete Streets Advisory Board recommended these design guidelines to the Council in 2015, but weren’t given the opportunity to vote and adopt them. It is now more than two years later, and we need your help to urge them to adopt the guidelines and move forward in protecting everyone who walks, bikes, uses public transportation, and drives on our streets. Thank you to Pinnacle Prevention for the heads up about this.

Send an email with one click!

 

Legislative Session Update

A Bill Called SB 1519 protective orders; schools; appropriations was proposed late last week by Senator Smith. It contains many of the things outlined by the Governor a few weeks ago related to firearms, schools and protection orders. The centerpiece is something called a “Severe Threat Order of Protection” which outlines a process to restrict firearm access for people who are a danger to themselves or others. The process is complicated and outside my area of expertise, so I’m trying to learn more about the proposal.  There are also measures that would require AHCCCS to develop and post suicide prevention training.  A statewide school safety hotline would also be established.

There’s no provision in the bill for comprehensive background checks or restrictions on things called “bump stocks” which makes guns fire quicker. Here’s a link to the introduced version of the bill.  You might need to sit down with somebody with a legal background if you really want to understand it. 

Hardly any organizations or persons are signed up either for or against the bill so far, and no hearing has yet been set in the Senate (It’s assigned to the Commerce and Public Safety Committee).  There’s no mirror bill in the House at their point.  Stay tuned.

SB 1445 AHCCCS Dental care, pregnant women is in the home stretch.  It’s cleared the full Senate but still needs a House Rules hearing and a floor vote. It will require some appropriation (to provide oral health coverage to pregnant Medicaid members)… so much of the discussion right now is about how much it would cost.

The direct cost to the state is estimated to be a little less than $268K.  However, the Joint Legislative Budget Committee believes that it could have secondary costs. Their thinking goes like this: some pregnant Medicaid enrollees that are not yet receiving prenatal care will discover that there is an oral health benefit and that the hygienist or dentist would inform their health plan of their pregnancy. These women would then switch their eligibility category to one with a higher state match rate (and presumably begin receiving prenatal care- which if it happened would be a good thing).  

Their analysis assumes that 25% of the estimated 5,000 pregnant women currently enrolled in the expansion population will switch their eligibility to the pregnant category generating a $3.7M refinancing cost because of the dental benefit.  It just seems to me that it’s unlikely that women that aren’t getting prenatal care from an OBGYN will present to a dentist or hygienist for a cleaning.  I can see it if they have a toothache, but that would likely be from the existing emergency dental benefit- not this new proposed preventative oral health benefit.  We’ll see what happens during the upcoming budget process.

HB 2324 Community health workers; voluntary certification is in the home-stretch.  It succeeded in the Senate’s Committee of the Whole (a voice vote) but wasn’t brought up for a final vote in the Senate as we had hoped (called 3rd Read) last week.  We hope to get on the Senate 3rd Read (final floor vote) calendar this week.

HB 2389 Syringe access programs; authorization basically looks dead for this year. The bill that passed the House was great- providing clear decriminalization of needle exchange programs (needle exchange programs are technically a class 6 felony right now).  The version that passed the Senate only decriminalizes syringe exchange programs when and where the ADHS declares a public health emergency because of the rapid spread of infectious diseases. 

It went to a Conference Committee this consisting of Rivero, Navarrete, Udall, Borelli, Brophy McGee, and Mendez… but Wednesday, Brophy McGee was replaced with Petersen, basically killing the House version- and the bill was dropped from the Conference Committee agenda- basically killing it.  Honestly, the Senate version of the bill wouldn’t have helped public health much if it all. Maybe next year.

HB 2228 Annual waiver, applicability was passed by the Senate and transmitted to the Governor.  It will direct AHCCCS to exempt tribes from their directed waiver request that asks for CMS permission to implement work requirements for some Medicaid members.  The recently submitted Waiver request includes an exemption for American Indians, however, this would place the exemption into statute.

SB 1394 Abortion reporting was passed by the House and signed by the Governor.  It will require the ADHS to collect and report additional data regarding abortions that are performed in AZ.

_______

Here’s a snapshot of where the various bills we’re working on are in the system. 

HB 2038 Drug overdose review teams; records (Signed into Law)

HB 2071 Rear-facing car seats (Stalled in Senate)

HB 2084 Indoor tanning; minors; restricted use (Now called SB 1290 as Striker) 

HB 2127 Children’s health insurance program (Now called SB 1087 as Striker)

HB 2197 Health professions, workforce data (Ready for Senate Floor Vote)

HB 2208 Prohibition, photo enforcement (Effectively dead)

HB 2228 Annual waiver, applicability (Sent to Governor)

HB 2323 Schools; inhalers; contracted nurses (Ready for Senate Floor Vote)

HB 2324 Community health workers; voluntary certification (Needs Senate floor vote)

HB 2389 Syringe access programs; authorization (Effectively dead)

HB 2484 local food tax; equality (Signed by Governor)

SB 1022 ADHS; homemade food products (Signed by Governor) 

SB 1083 Schools; recess periods (Passed and Signed)

SB 1245 Snap Benefit Match (Needs Rules Committee & Budget Line)

SB 1261 Texting while driving (Now HB 2159 traffic violations; traffic survival school)

SB 1420 Medical marijuana; inspection; testing; appropriation (Needs House Rules)

SB 1445 AHCCCS Dental care, pregnant women (Needs House Rules Committee)

SB 1377 Dental therapy, licensure, regulation (Failed in House now HB2235 in Senate)

SB 1394 Abortion reporting (Signed by Governor)

SCR 1005 Voter Initiative Sunset (striker in the House)

 

Public Health-related bills that have been passed and signed so far:

HB 2038 Drug overdose review teams; records was passed and signed last week.  Once it takes effect later this year, law enforcement agencies will now be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request. 

HB 2484 local food tax; equality, which will ban Arizona cities and counties from taxing sugary drinks as a public health intervention.

SB 1022  DHS; homemade food products ADHS will be required to establish an online registry of food preparers that are authorized to prepare “cottage food products” for commercial purposes. Registered food preparers would be required to renew the registration every three years. 

SB 1083 Schools; recess periods was passed and signed!  Beginning next school year K-3 will need to have at least 2 recess periods. Grades 4 and 5 will need to have 2 recess periods the year after that.

SB 1394 Abortion reporting was passed by the House and signed by the Governor.  It will require the ADHS to collect and report additional data regarding abortions that are performed in AZ.

____

 

House Bills

HB 2038 Drug overdose review teams; records                

Passed and Signed

Law enforcement agencies will now be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request.  All information and records acquired by a Team are confidential and not subject to subpoena, discovery or introduction into evidence in a civil or criminal proceeding or disciplinary action.

 

HB 2071 Rear-facing car seats         

Stalled in Senate

This Bill would require kids under 2 years old to be in a rear-facing restraint system unless the child weights at least 40 pounds or is at least 40 inches tall.  We’ve signed up in support of this bill.  No action has yet been taken in the Senate so this bill is effectively dead.

 

HB 2084 Indoor tanning; minors; restricted use

Stalled in Senate- now SB1290 in House

This bill had been languishing in the Senate after passing the House by a 45-15 vote. Because of its lack of movement in the Senate it had appeared to be dead again this year.  However, this week it reappeared as a Strike All amendment in the House again as SB 1290.  It got a unanimous pass recommendation from the House Health Committee last Thursday- so was back in business but is now being held in House Rules. 

 

HB 2127 Children’s health insurance program

Stalled in Senate- now SB 1087 in House

After passing the House, this bill had been languishing in the Senate and appeared dead.  However, it was resurrected this week in the form of SB 1087 and was passed again by the House Health Committee last Thursday.  It still needs another House floor vote before it goes back to the Senate again.  It would remove the trigger that automatically freezes the KidsCare program if FMAP (the federal contribution) drops below 100%.  

It allows the state to freeze it if costs are more than the state or federal allotment. The bill does not require the state to appropriate any money for a state share.  We’ve signed up in support of this bill because it provides a pathway to keep KidsCare if the federal government drops its contribution level. 

 

HB 2197 Health professions, workforce data

Ready for Senate Floor Vote

This bill is looking good and ready for a final Senate floor vote.  It would require AZ health licensing boards to collect certain data from applicants (beginning January 2020) to get better data about health professions workforce distribution and needs.  The data would be confidential.  Over the long-term this bill would be helpful in providing better data with which to improve the distribution and capacity of the public health workforce in Arizona.

 

HB 2208 Prohibition, photo enforcement

Died in Senate

This one would prohibit cities and other jurisdictions from having photo enforcement of red light and speeding violations.  While nobody likes getting a ticket in the mail, the data suggest that photo enforcement saves lives and prevents injuries (especially red-light photo enforcement).  We’ve signed up in opposition to the bill.  This bill passed the House 31-27 but stalled in the Senate.  Honestly, it looks dead.

 

HB 2228 Annual waiver, applicability

Transmitted to Governor

This would direct AHCCCS to exempt tribes from their directed waiver requests to CMS asking permission to implement work requirements for some Medicaid members.  The recently submitted Waiver request includes an exemption for American Indians, however, this would place the exemption into statute.

 

HB 2323  Schools; inhalers; contracted nurses

Ready for Senate Floor Vote

This bill adds contracted nurses to the list of people who are authorized to provide emergency inhaler medication in case of respiratory emergencies. Some charter and independent schools don’t employ nurses directly but engage them through contracts. Ready for a final Senate floor vote.

 

HB 2324 Community health workers; voluntary certification

Still needs Senate 3rd Read (Passed COW)

This succeeded in the Senate’s Committee of the Whole (a voice vote) but wasn’t brought up for a final vote in the Senate as we had hoped (called 3rd Read).  To get through COW, we supported an amendment to “grandfather” current CHWs who’ve worked for 6 months over 3 years as a CHW & to prohibit the state and subdivisions from offering preferential public contracts for voluntarily certified CHWs. We hope to get on the Senate 3rd Read calendar this week.

 

HB 2389  Syringe access programs; authorization

Effectively Dead

The bill that passed the House was great- providing clear decriminalization of needle exchange programs (needle exchange programs are technically a class 6 felony right now).  The version that passed the Senate only decriminalizes syringe exchange programs when and where the ADHS declares a public health emergency because of the rapid spread of infectious diseases. The bill died in a conference committee.

Maybe next year.

 

HB 2484 local food tax; equality

Signed by Governor

The Governor signed this bill, which bans Arizona cities and counties from taxing sugary drinks as a public health intervention. The bill doesn’t specifically mention taxes on sugary drinks, but states that any tax on food needs to be uniform.  products must be uniform. Right now, there aren’t any Arizona cities or counties that are taxing soda and other sugary drinks, and this new law will ensure that it stays that was.  

 

Senate Bills

SB 1022    DHS; homemade food products            

Signed by Governor

ADHS will be required to establish an online registry of food preparers that are authorized to prepare “cottage food products” for commercial purposes. Registered food preparers would be required to renew the registration every three years. This is a sensible addition to the current cottage industry food law and we’ve signed up in support.

 

SB 1083    Schools; recess periods

Signed by Governor

This was passed and signed!  Beginning next school year K-3 will need to have at least 2 recess periods.  Grades 4 and 5 will be added the following year. This makes AZ a national leader in state school recess policy. A big shout out to AzPHA member Scott Turner and Christine Davis from Arizonan’s for Recess for their heavy lifting to make this happen!

 

SB 1245 Snap Benefit Match

Needs House Rules Committee and Budget Line Item

This Bill needs House Rules review before a House floor vote (and of course needs to make it through the budget process). This good Bill would appropriate $400K to ADES to develop a produce incentive program within the Supplemental Nutrition Assistance Program for members to buy Arizona-grown fruits and vegetables.  It would also provide matching funds to SNAP-authorized vendors as an incentive to participate in the fruits and vegetable program. 

 

SB 1261 Texting while driving

Now HB 2159 and Moving Again in House

This has been languishing for the last few weeks because it hasn’t been called up for a floor vote in the Senate.  Last week, the language from SB 1261 was added as an amendment onto HB 2159 traffic violations; traffic survival school.  This bill, with the addition of the texting language, is now in the House awaiting a final vote.  

This would prohibit drivers from “using a portable wireless communication device to read, write, or send an electronic message while driving” (unless the car is stopped).  The first violation would be a petty offense with a fine between $25 and $99.

 

SB 1377 Dental therapy, licensure, regulation

Stalled in House now HB 2235

This bill failed to get a Pass recommendation from the House Health Committee last week (5-4) and is now HB 2235 as a striker.  It would have set up a new licensed class of dental professionals called a Dental Therapist. Their scope of practice would be somewhat less than a DDS, but they could do some procedures like filling cavities. This has been a somewhat controversial bill as there are stakeholders of both sides that are quite passionate about their position on this Bill.  

 

SB 1394 Abortion reporting

Signed by Governor

This one would require the ADHS to collect and report additional data regarding abortions that are performed in AZ. The data would be collected and reported by providers and would include the reason for the abortion (economic, emotional health, physical health, whether the pregnancy was the result of rape or incest, or relationship issues etc.).

 

SB 1420 Medical marijuana; inspection; testing; appropriation

Needs House Rules Approval

This would require the ADHS to set up testing standards for medical marijuana and begin enforcing the standards beginning in 2019.  We’re supporting this legislation.  It passed the full Senate last week and was given a Pass recommendation by the House Military, Veterans & Regulatory Affairs Committee this week.

 

SB 1445 AHCCCS Dental care, pregnant women

Needs House Rules and Floor Vote & a Budget Line Item

This unanimously cleared the House Appropriations committee last week.  We were hoping to get a Rules committee hearing next week, (Monday April 9) but it’s not on the agenda, sadly.  The big hurdle will be getting an appropriation to cover the state match into the budget.

 

SB 1470  Sunrise process; health professions

After a dramatic start, this bill looks like it will have a consensus ending.  The sunrise process bill stakeholders negotiated changes to the current scope of practice sunrise process that everybody seems to be able to live with.  It passed in House this week by a 59-0 vote. It’s now ready for the Senate to concur in the House’s amendment.

____________

 

Thanks to all of you that planned, sponsored, exhibited, presented, or attended our conference last week.  We still need to input the data from the evaluations- but we think it was a real success!

 

Mark your calendars for Wednesday, October 3, 2018 for our fall conference and annual members meeting.  Our topic will be about engaging public and behavioral health to improve outcomes.  It’ll also commemorate our 90th anniversary!

 

 

AzPHA Public Health Policy Update: April 9, 2018

AzPHA Spring Conference is Wednesday!

We’re looking forward to seeing many of you at our Conference on Wednesday: Together for Tomorrow: Protecting Arizona’s Children at the Desert Willow Conference Center. Here’s the Conference Program with all the particulars. Check in starts at 7:30 am with the agenda starting at 8:30 am (breakfast is provided). We hope many of you will stay for our hosted reception immediately following the conference!

New Immigration Rule Could Damage Public Health

The Department of Homeland Security Secretary Kirstjen Nielsen is in the final stages of proposing a new Rule that would require the Immigration and Naturalization Service (INS) to consider a much broader range of factors when determining whether immigrants or their U.S.-citizen children are using public benefits (using certain public benefits hurts applicant’s chances at changing their legal immigration status).

Currently, the INS uses information about whether applicants for legal permanent residency (and other immigration categories) receive cash assistance as a factor when considering applications. Applicants that receive have received cash assistance are less likely to be approved.  Proposed new changes expected to be out for public comment shortly that will broaden the benefits considered to include non-cash assistance like WIC, SNAP, Medicaid, CHIP, school lunch programs, and perhaps even participation in the Vaccines for Children program.

In 1999, the INS issued Rules to “address the public’s concerns about immigrant fears of accepting public benefits for which they remained eligible, specifically medical care, children’s immunizations, basic nutrition and treatment of medical conditions that may jeopardize public health.” Here’s that final Rule from 1999. 

The (1999) Rule states that “Other non-cash public benefits that will not be considered include Medicaid; CHIP; emergency medical assistance; other health insurance and health services for the testing and treatment of symptoms of communicable diseases; emergency disaster relief; nutrition programs, such as Food Stamps and WIC; housing benefits; energy benefits; job training programs; child care; and non-cash benefits funded under the TANF program.” 

The new proposed Rule is expected to be released shortly and says that: “DHS does not believe it is appropriate to set aside such benefits in its public charge analyses. DHS, therefore, proposes to consider cash and non-cash public benefits that are means-tested or otherwise used to meet basic living requirements” as they consider applications (e.g. WIC, SNAP, Medicaid, CHIP, school lunch programs, and perhaps even VFC).  These kinds of changes will have a chilling effect on whether people who can now legally participate in these programs would continue to do so. It would also make it less likely that folks will participate in other kinds of public health programs like disease control and childhood vaccinations.

We’ll keep an eye on the Federal Register (DHS Docket No. USCIS 2010-0012) and comment on the package at www.regulations.gov from a public health perspective.

 

School Safety Bill Expected this Week

We expect somebody from the legislature to propose a school/firearm safety bill this week. A couple of weeks ago the Governor floated the idea of a new law that would do several things related to school safety like: 1) Increase behavioral health resources in schools; 2) Increase school resource officer funding and training and increases the presence of law enforcement on school grounds; 3) Severe Threat Order of Protection orders that would restrict firearm access for people who are a danger to themselves or others; and 4) Establish a “Center for School Safety” with a centralized reporting tip line to report and investigate concerns of school safety.  There was no discussion of a universal background check provision.

We’ll withhold our judgment about whether to support the bill until after it’s released and we have a chance to talk to some subject matter experts about the nuances of the proposal.

 

Legislative Session Update

SB 1083 Schools; recess periods was passed and signed!  Beginning next school year K-3 will need to have at least 2 recess periods. Grades 4 and 5 will be added the following year. This makes AZ a national leader in state school recess policy. A big shout out to AzPHA member Scott Turner and Christine Davis from Arizonan’s for Recess for their heavy lifting to make this happen!

SB 1445 AHCCCS Dental care, pregnant women unanimously cleared the House Appropriations committee last week.  We were hoping to get a Rules committee hearing next week (Monday April 9) but it’s not on the agenda for today. The big hurdle will be getting an appropriation to cover the state match into the budget.

HB 2324 Community health workers; voluntary certification succeeded in the Senate’s Committee of the Whole (a voice vote) but wasn’t brought up for a final vote in the Senate as we had hoped (called 3rd Read).  To get through COW, we supported an amendment to “grandfather” current CHWs who’ve worked for 6 months over 3 years as a CHW & to prohibit the state and subdivisions from offering preferential public contracts for voluntarily certified CHWs. We hope to get on the Senate 3rd Read (final floor vote) calendar this week.

HB 2389 Syringe access programs; authorization passed the full Senate 2 weeks ago but in a substantially weakened form. The original bill would’ve decriminalized needle exchange programs. The amendment only decriminalizes syringe exchange programs when and where the ADHS declares a public health emergency because of the rapid spread of infectious diseases. When the amended bill went back to the House for concurrence- it was refused (a good thing) and it’ll now go to a conference consisting of Rivero, Navarrete, Udall, Borelli, Brophy McGee, and Mendez. We sent information to the urging the conference committee members to drop the amendment requiring a ARS 36-761 emergency to provide prosecutorial protection for syringe exchange programs.

SCR 1005 is troubling new Resolution that’s a Strike Everything amendment in the House. It states that voter initiatives that have any kind of money attached need to go back to the ballot every 10 years. It’s unclear whether it’s intended to be prospective or whether it applies to previously approved measures (it’s quite cryptic).  Here’s what it says: “AN INITIATIVE (which has money attached) IS REPEALED TEN YEARS AFTER THE EFFECTIVE DATE OF THE INITIATIVE UNLESS AN EARLIER REPEAL DATE APPLIES TO THE INITIATIVE”. 

If it makes it through the Legislature it would still need to be approved by voters- but it’s a troubling proposal indeed as things like First Things First, the Smoke Free Arizona Act, and Proposition 204 which provides a lot of Medicaid funding could get caught up in the requirement. Fortunately, there are a few steps left in the process so perhaps we can stop this in its tracks.

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Here’s a snapshot of where the various bills we’re working on are in the system. 

HB 2038 Drug overdose review teams; records (Signed into Law)

HB 2071 Rear-facing car seats (Stalled in Senate)

HB 2084 Indoor tanning; minors; restricted use (Now called SB 1290 as Striker) 

HB 2127 Children’s health insurance program (Now called SB 1087 as Striker)

HB 2197 Health professions, workforce data (Ready for Senate Floor Vote)

HB 2208 Prohibition, photo enforcement (Effectively dead)

HB 2228 Annual waiver, applicability (Passed Senate COW, Needs 3rd Read)

HB 2323 Schools; inhalers; contracted nurses (Ready for Senate Floor Vote)

HB 2324 Community health workers; voluntary certification (Senate floor vote this week)

HB 2389 Syringe access programs; authorization (Passed Senate- going bk to House)

HB 2484 local food tax; equality (Signed by Governor)

SB 1022 ADHS; homemade food products (Signed by Governor) 

SB 1083 Schools; recess periods (Passed and Signed)

SB 1245 Snap Benefit Match (Needs Rules Committee & Budget Line)

SB 1261 Texting while driving (Now HB 2159 traffic violations; traffic survival school)

SB 1420 Medical marijuana; inspection; testing; appropriation (Needs House Rules)

SB 1445 AHCCCS Dental care, pregnant women (Needs House Rules Committee)

SB 1377 Dental therapy, licensure, regulation (Failed in House now HB2235 in Senate)

SB 1394 Abortion reporting (Ready for House Floor Vote)

SCR 1005 Voter Initiative Sunset (striker in the House)

 

Public Health-related bills that have been passed and signed so far:

HB 2038 Drug overdose review teams; records was passed and signed last week.  Once it takes effect later this year, law enforcement agencies will now be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request. 

HB 2484 local food tax; equality, which will ban Arizona cities and counties from taxing sugary drinks as a public health intervention.

SB 1022  DHS; homemade food products ADHS will be required to establish an online registry of food preparers that are authorized to prepare “cottage food products” for commercial purposes. Registered food preparers would be required to renew the registration every three years.

SB 1083 Schools; recess periods was passed and signed!  Beginning next school year K-3 will need to have at least 2 recess periods.

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House Bills

HB 2038 Drug overdose review teams; records                

Passed and Signed

Law enforcement agencies will now be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request.  All information and records acquired by a Team are confidential and not subject to subpoena, discovery or introduction into evidence in a civil or criminal proceeding or disciplinary action.

HB 2071 Rear-facing car seats         

Stalled in Senate

This Bill would require kids under 2 years old to be in a rear-facing restraint system unless the child weights at least 40 pounds or is at least 40 inches tall.  We’ve signed up in support of this bill.  No action has yet been taken in the Senate so this bill is effectively dead.

HB 2084 Indoor tanning; minors; restricted use

Stalled in Senate- now SB1290 in House

This bill had been languishing in the Senate after passing the House by a 45-15 vote. Because of its lack of movement in the Senate it had appeared to be dead again this year.  However, this week it reappeared as a Strike All amendment in the House again as SB 1290.  It got a unanimous pass recommendation from the House Health Committee last Thursday- so was back in business but is now being held in House Rules. 

HB 2127 Children’s health insurance program

Stalled in Senate- now SB 1087 in House

After passing the House, this bill had been languishing in the Senate and appeared dead.  However, it was resurrected this week in the form of SB 1087 and was passed again by the House Health Committee last Thursday.  It still needs another House floor vote before it goes back to the Senate again.  It would remove the trigger that automatically freezes the KidsCare program if FMAP (the federal contribution) drops below 100%.  It allows the state to freeze it if costs are more than the state or federal allotment. The bill does not require the state to appropriate any money for a state share.  We’ve signed up in support of this bill because it provides a pathway to keep KidsCare if the federal government drops its contribution level. 

HB 2197 Health professions, workforce data

Ready for Senate Floor Vote

This bill is looking good and ready for a final Senate floor vote.  It would require AZ health licensing boards to collect certain data from applicants (beginning January 2020) to get better data about health professions workforce distribution and needs.  The data would be confidential.  Over the long-term this bill would be helpful in providing better data with which to improve the distribution and capacIty of the public health workforce in Arizona.

HB 2208 Prohibition, photo enforcement

Died in Senate

This one would prohibit cities and other jurisdictions from having photo enforcement of red light and speeding violations.  While nobody likes getting a ticket in the mail, the data suggest that photo enforcement saves lives and prevents injuries (especially red-light photo enforcement).  We’ve signed up in opposition to the bill.  This bill passed the House 31-27 but stalled in the Senate.  Honestly, it looks dead.

HB 2228 Annual waiver, applicability

Needs Senate 3rd Read

This would direct AHCCCS to exempt tribes from their directed waiver requests to CMS asking permission to implement work requirements for some Medicaid members.  The recently submitted Waiver request includes an exemption for American Indians, however, this would place the exemption into statute.

HB 2323   Schools; inhalers; contracted nurses

Ready for Senate Floor Vote

This bill adds contracted nurses to the list of people who are authorized to provide emergency inhaler medication in case of respiratory emergencies. Some charter and independent schools don’t employ nurses directly but engage them through contracts. Ready for a final Senate floor vote.

HB 2324 Community health workers; voluntary certification

Still needs Senate 3rd Read (Passed COW)

This succeeded in the Senate’s Committee of the Whole (a voice vote) but wasn’t brought up for a final vote in the Senate as we had hoped (called 3rd Read).  To get through COW, we supported an amendment to “grandfather” current CHWs who’ve worked for 6 months over 3 years as a CHW & to prohibit the state and subdivisions from offering preferential public contracts for voluntarily certified CHWs. We hope to get on the Senate 3rd Read calendar this week.

HB 2389  Syringe access programs; authorization

Passed Senate in Weak Form- going back to House

This passed the full Senate 2 weeks ago but in a substantially weakened form. The original bill would’ve decriminalized needle exchange programs. The amendment only decriminalize programs when and where the ADHS declares a public health emergency because of the rapid spread of infectious diseases. When the amended bill went back to the House for concurrence- it was refused (a good thing) and it’ll now go to a conference committee consisting of Rivero, Navarrete, Udall, Borelli, Brophy McGee, and Mendez. We will encourage them to drop the amendment requiring a ARS 36-761 emergency to provide prosecutorial protection for syringe exchange programs.

HB 2484 local food tax; equality

Signed by Governor

The Governor signed this bill, which bans Arizona cities and counties from taxing sugary drinks as a public health intervention. The bill doesn’t specifically mention taxes on sugary drinks, but states that any tax on food needs to be uniform.  products must be uniform. Right now, there aren’t any Arizona cities or counties that are taxing soda and other sugary drinks, and this new law will ensure that it stays that was. 

 

Senate Bills

SB 1022    DHS; homemade food products            

Signed by Governor

ADHS will be required to establish an online registry of food preparers that are authorized to prepare “cottage food products” for commercial purposes. Registered food preparers would be required to renew the registration every three years. This is a sensible addition to the current cottage industry food law and we’ve signed up in support.

SB 1083    Schools; recess periods

Signed by Governor

This was passed and signed!  Beginning next school year K-3 will need to have at least 2 recess periods.  Grades 4 and 5 will be added the following year. This makes AZ a national leader in state school recess policy. A big shout out to AzPHA member Scott Turner and Christine Davis from Arizonan’s for Recess for their heavy lifting to make this happen!

SB 1245 Snap Benefit Match

Needs House Rules Committee and Budget Line Item

This Bill needs House Rules review before a House floor vote (and of course needs to make it through the budget process). This good Bill would appropriate $400K to ADES to develop a produce incentive program within the Supplemental Nutrition Assistance Program for members to buy Arizona-grown fruits and vegetables.  It would also provide matching funds to SNAP-authorized vendors as an incentive to participate in the fruits and vegetable program. 

SB 1261 Texting while driving

Now HB 2159 and Moving Again in House

This has been languishing for the last few weeks because it hasn’t been called up for a floor vote in the Senate.  Last week, the language from SB 1261 was added as an amendment onto HB 2159 traffic violations; traffic survival school.  This bill, with the addition of the texting language, is now in the House awaiting a final vote. 

This would prohibit drivers from “using a portable wireless communication device to read, write, or send an electronic message while driving” (unless the car is stopped).  The first violation would be a petty offense with a fine between $25 and $99.

SB 1377 Dental therapy, licensure, regulation

Stalled in House now HB 2235

This bill failed to get a Pass recommendation from the House Health Committee last week (5-4) and is now HB 2235 as a striker.  It would have set up a new licensed class of dental professionals called a Dental Therapist. Their scope of practice would be somewhat less than a DDS, but they could do some procedures like filling cavities. This has been a somewhat controversial bill as there are stakeholders of both sides that are quite passionate about their position on this Bill.  

SB 1394 Abortion reporting

Ready for House Floor Vote

This one would require the ADHS to collect and report additional data regarding abortions that are performed in AZ. The data would be collected and reported by providers and would include the reason for the abortion (economic, emotional health, physical health, whether the pregnancy was the result of rape or incest, or relationship issues etc.).  The bill was given a Do Pass recommendation last week by the House Judiciary & Public Safety Committee- although it was amended slightly by removing the requirement that physicians ask and report specifically why the woman is asking for the procedure.

SB 1420 Medical marijuana; inspection; testing; appropriation

Needs House Rules Approval

This would require the ADHS to set up testing standards for medical marijuana and begin enforcing the standards beginning in 2019.  We’re supporting this legislation.  It passed the full Senate last week and was given a Pass recommendation by the House Military, Veterans & Regulatory Affairs Committee this week.

SB 1445 AHCCCS Dental care, pregnant women

Needs House Rules and Floor Vote & a Budget Line Item

This unanimously cleared the House Appropriations committee last week.  We were hoping to get a Rules committee hearing next week, (Monday April 9) but it’s not on the agenda, sadly.  The big hurdle will be getting an appropriation to cover the state match into the budget.

SB 1470  Sunrise process; health professions

After a dramatic start, this bill looks like it will have a consensus ending.  The sunrise process bill stakeholders negotiated changes to the current scope of practice sunrise process that everybody seems to be able to live with.  It passed in House this week by a 59-0 vote. It’s now ready for the Senate to concur in the House’s amendment.