Will Humble Uncategorized, Wills Blog

AzPHA Public Health Policy Update: February 14, 2018

The Legislative Committees are in full swing and agendas are full.  Several of the priority public health bills have been successful so far, but there’s a long way to go still. 

Last week the following bills passed their house of origin and will be going over to the other chamber:

HB 2038 Drug overdose review teams; records                

HB 2071 Rear-facing car seats         

HB 2127 Children’s health insurance program

HB 2208 Prohibition, photo enforcement (we’re against this one)

HB 2228 Annual waiver, applicability (tribes)

SB 1022 ADHS; homemade food products            

SB 1083 Schools; recess periods

 

Priorities for this Week

Our top Action priority this week is in the Senate Health and Human Services Committee Wednesday at 2 pm when SB 1445 AHCCCS Dental care, pregnant women will be heard along with SB 1245 Snap Benefit Match.  On Thursday in House Health HB 2389  Syringe access programs; authorization will be heard.

Remember to stay engaged and voice your opinion via the www.azleg.gov commenting system.  Click the following links for: Request to Speak account registration form; a Step-by-step use of the Request to Speak platform; and to Locate your Elected Officials

 

Wednesday

Senate Health and Human Services: 2pm

SB 1445 AHCCCS Dental care, pregnant women

This is a priority Bill for AzPHA.  It would provide oral health coverage for pregnant women who receive their health insurance coverage through AHCCCS.  The benefit would be limited to $1000 and could be used for other than emergency dental procedures (beginning October 1, 2017 all adult Medicaid members became eligible for up to $1000 in emergency dental services per year).  Lots of good public health reasons to support this one. 

Members of the committee are Nancy Barto, David Bradley, Kate Brophy McGee, Judy Burges, Rick Gray, Katie Hobbs, and Kimberly Yee.  You can contact these members directly by email (here is the list) and you can also sign in using the RTS system.

 

SB 1245 Snap Benefit Match

This Bill would appropriate $400K to ADES to develop the infrastructure for a produce incentive program within the Supplemental Nutrition Assistance Program (SNAP) 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.  We’ve signed up in support of this Bill.  It hasn’t been scheduled for a committee hearing yet.

 

SB 1394 Abortion reporting

This Bill 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.). 

Thursday

House Health Committee: 9 pm

HB 2389  Syringe access programs; authorization

Under this Bill, organizations in Arizona may establish and operate a needle exchange program.  Persons, employees and volunteers operating within the scope of the law may not be charged or prosecuted for their activities. It’s currently a felony to distribute needles to illegal drug users. While many people thought that this should be included in the Opioid Special Session, it was not.

We’ve signed up in support of this bill because this type of program is evidence-based and reduces the spread of bloodborne diseases as well as engaging in intravenous drug users into treatment.  Hearing is in the House Health Committee Thursday morning (2/15). 

 

Below are a list of the bills that we’re tracking and advocating for or against.  They’re in order of Bill number.  I included a colored comment to show where the bill is in the process.

 

House Bills

HB 2038 Drug overdose review teams; records                

Passed the House 57-0-2

Under this proposed Bill, law enforcement agencies would 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.  We’re signed up in support of this one.

 

HB 2064 Medical marijuana; packaging; labeling              

Hearing in House Commerce Committee Tuesday

This Bill proposes that medical marijuana dispensaries be prohibited from selling a marijuana product that’s packaged or labeled in a manner that’s “attractive to minors”. Due to voter protection, this legislation requires the affirmative vote of at least 3/4 of the members of each house of the Legislature for passage.  We’re supporting this bill. It’s being Held right now by the Commerce Committee.

 

HB 2071 Rear-facing car seats         

Passed House 33-25-1

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.  This Bill cleared the House Transportation & Infrastructure Committee last Wednesday.

 

HB 2084 Indoor tanning; minors; restricted use

Passed House Health, Waiting for Rules Committee

Under this proposal, tanning facility operators would be prohibited from allowing a person under 18 years of age to use a “tanning device”. Tanning facilities are prohibited from advertising or distributing promotional materials that claim that using a tanning device is free from risk or will result in medical or health benefits. We’ve signed on in support of this. It received a Do Pass recommendation from the House Health Committee last week.

 

HB 2109 Tobacco possession; sale; age; signage                

Waiting on a Hearing in Commerce Committee

This Bill would prohibit furnishing a tobacco product to a person who is under 21 years of age. The definition of “tobacco product” is expanded to include “electronic smoking devices”. We’ve signed up in support. It received a Do Pass recommendation from the House Health Committee two weeks ago but so far the Commerce chair hasn’t put it on the agenda.

 

HB 2127 Children’s health insurance program

Passed House 46-12-1

This Bill removes 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

Waiting for a Hearing in Rules Committee

This Bill 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.

 

HB 2208 Prohibition, photo enforcement

Passed the House 31-27-1

This Bill 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 last week and is moving on to the Senate.

 

HB 2222 Feminine hygiene products, requirements

Waiting for a Hearing in Rules Committee

This Bill would require the Arizona Department of Corrections to offer female inmates an unlimited supply of feminine hygiene products free of charge. We signed up in support, that the Bill received a Do Pass recommendation in committee (5-4).

 

HB 2228 Annual waiver, applicability

Passed the House 58-0-1

This Bill 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 2324 Community health workers; voluntary certification

Waiting for a Hearing in the Rules Committee

This Bill is a top priority for us. It would charge the ADHS with developing a voluntary certification program for community health workers.  The Department rulemaking would include certification standards including qualifications, core competencies, and continuing education requirements. We’ve signed up in support of this bill.  It received a Do Pass recommendation from the House Health Committee last week.

This would be a very good week to reach out to your State Representatives and Senator and let them know you support this measure as it will go to a Floor vote soon.  You can find their contact information at www.azleg.gov.

 

HB 2348 Vehicle emission standards

Held in Energy and Natural Resources Committee

Existing AZ law requires Arizona vehicle emission standards to be consistent with federal law.  This Bill would require ADEQ to adopt the California clean air emission standards beginning on January 1, 2018.  It would just apply to the sales of new cars.

 

HB 2443  Medical services purchase, premiums

Waiting for a Hearing in the Health Committee- but not on agenda this week so it’s probably dead

The Bill would essentially allow Arizonans that don’t normally qualify for Medicaid to buy Medicaid health insurance.  It would ask AHCCCS to write the rules and regulations for the program including setting a premium that ensures people buying in would pay full freight.  If approved, it would allow people to buy in beginning on October 1, 2019. 

The bill is also contingent on CMS approval.  Here’s a link to a really good document that discusses the merits of a Medicaid buy-in system.  

 

Senate Bills

SB 1007  Motorcycle operation; riding between lanes          

Waiting for a Hearing in Transportation Committee

Under this proposal, motorcycle operators would no longer be prohibited from passing in the same lane occupied by the vehicle being overtaken and from operating a motorcycle between the lanes of traffic if they’re wearing a helmet.  We decided to take a position against this one in our Public Health Policy Committee last week. No action this week.

 

SB 1022    DHS; homemade food products            

Passed Senate 30-0

Under this Bill, ADHS would 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

Passed Senate 26-3-1

Under this Bill, district and charter schools would be required to provide at least 2 recess periods during the school day for pupils in grades K-5.  We’ve signed in support of this bill. 

 

SB 1245 Snap Benefit Match

To be heard in Senate HHS Wednesday

This Bill would appropriate $400K to ADES to develop the infrastructure for a produce incentive program within the Supplemental Nutrition Assistance Program (SNAP) 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.  We’ve signed up in support of this Bill. 

 

SB 1250 Food Producers, Ordinances

Failed 2-5 in Governance Committee

This Bill would make it clear that cities, towns and counties can’t restrict food producers including community gardens from producing food products with some exceptions and inspection authority.

 

SB 1261 Texting while driving

Passed Transportation Committee- awaiting Rules

This bill was introduced last week and 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

Passed HHS, Awaiting Education Committee

This Bill was introduced last week and would 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

To be heard in Senate HHS Wednesday

This Bill 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

Passed Governance Committee 4-3, Waiting for Rules Committee

This Bill 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 received a Do Pass recommendation from the Senate Government Committee last week.

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Will Humble Uncategorized, Wills Blog

AzPHA Public Health Policy Update: February 6, 2018

 

New Bills this Week

Before we get to the committee agendas for this week- here are a few new bills that were proposed.

SB 1261 Texting while driving

This bill was introduced last week and 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.  It’s being heard at 2 pm today (Tuesday) in the Senate Transportation and Technology Committee.

SB 1377 Dental therapy, licensure, regulation

This Bill was introduced last week and would 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.  We haven’t taken a position at this time.  It’s on the agenda in the Senate Health and Human Services Committee this Wednesday. 

SB 1394 Abortion reporting

This Bill 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.). This one is being heard in the Senate Health & Human Services Committee Wednesday at 2 pm.

HB 2348 Vehicle emission standards

Existing AZ law requires Arizona vehicle emission standards to be consistent with federal law. This Bill would require ADEQ to adopt the California clean air emission standards beginning on January 1, 2018.  It would just apply to the sales of new cars.

HB 2512 Water program amendments

This Bill would provide a pathway for counties to exempt themselves from existing water use and extraction requirements.  It could post water supply issues in some parts of the state in coming years.

 

Committee Hearings this Week

This is a busy time of year in the Legislature.  Committees are in full swing and agendas are full. Below is a summary of the committee hearings… I’ve pasted a quick summary of the Bills that are being heard this week.  After that is a listing of the other bills that haven’t been heard in their committees yet.

Remember to stay engaged and voice your opinion via the www.azleg.gov commenting system.

 

Monday

House Military, Veterans, and Regulatory Affairs Committee

HB 2222 Feminine hygiene products, requirements

This Bill would require the Arizona Department of Corrections to offer female inmates an unlimited supply of feminine hygiene products free of charge. We signed up in support.  This Bill received a Do Pass recommendation in the Military, Veterans, and Regulatory Affairs Committee yesterday (5-4).

 

Tuesday 

Senate Transportation Committee @ 2 pm, HHR 1

SB 1261 Texting while driving

This bill was introduced last week and 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.  We signed up in support.

 

House Energy, Environment and Natural Resources @ 2pm

HB 2512 Water program amendments

This Bill would provide a pathway for counties to exempt themselves from existing water use and extraction requirements.  

HB 2348 Vehicle emission standards

Existing AZ law requires Arizona vehicle emission standards to be consistent with federal law.  This Bill would require ADEQ to adopt the California clean air emission standards beginning on January 1, 2018.  It would just apply to the sale of new cars.

 

Wednesday 

Senate Government, Wednesday @ 2 pm, SHR 109

SB 1250 Food Producers, Ordinances

This Bill would make it clear that cities, towns and counties can’t restrict food producers including community gardens from producing food products with some exceptions and inspection authority. We’ve signed up in support.

 

Senate Health and Human Services, @ 2pm

SB 1377 Dental therapy, licensure, regulation

This Bill was introduced last week and would 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.  We haven’t taken a position at this time.  

SB 1394 Abortion reporting

This Bill 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.).

 

House Judiciary & Public Safety @ 2 pm HHR 4

HB 2038 Drug overdose review teams; records                

Under this proposed Bill, law enforcement agencies would 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.  We’re signed up in support of this one.

 

Public Health Bills that Progressed Last Week

HB 2324 Community health workers; voluntary certification

This Bill is a top priority for us. It would charge the ADHS with developing a voluntary certification program for community health workers.  The Department rulemaking would include certification standards including qualifications, core competencies, and continuing education requirements. We’ve signed up in support of this bill.  It received a Do Pass recommendation from the House Health Committee last week.

This would be a very good week to reach out to your State Representatives and Senator and let them know you support this measure as it will go to a Floor vote soon.  You can find their contact information at www.azleg.gov.

HB 2109 Tobacco possession; sale; age; signage                

This Bill would prohibit furnishing a tobacco product to a person who is under 21 years of age. The definition of “tobacco product” is expanded to include “electronic smoking devices”. We’ve signed up in support. It received a Do Pass recommendation from the House Health Committee last week.

HB 2084 Indoor tanning; minors; restricted use

Under this proposal, tanning facility operators would be prohibited from allowing a person under 18 years of age to use a “tanning device”. Tanning facilities are prohibited from advertising or distributing promotional materials that claim that using a tanning device is free from risk or will result in medical or health benefits. We’ve signed on in support of this. It received a Do Pass recommendation from the House Health Committee last week.

HB 2208 Prohibition, photo enforcement

This Bill 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.  It received a Do Pass recommendation from the House Judiciary and Public Safety Committee last week.

SB 1420 medical marijuana; inspection; testing; appropriation

This Bill 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 received a Do Pass recommendation from the Senate Government Committee last week.

 

Bills Waiting in the Wings

House Bills

HB 2064 Medical marijuana; packaging; labeling              

This Bill proposes that medical marijuana dispensaries be prohibited from selling a marijuana product that’s packaged or labeled in a manner that’s “attractive to minors”. Due to voter protection, this legislation requires the affirmative vote of at least 3/4 of the members of each house of the Legislature for passage.  We’re supporting this bill. It’s being Held right now by the Commerce Committee.

HB 2071 Rear-facing car seats         

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.  It cleared the House Transportation & Infrastructure Committee last Wednesday.

HB 2127 Children’s health insurance program

This Bill removes 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.  This one cleared the House Health Committee a couple of weeks ago.

HB 2197 Health professions, workforce data

This Bill 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. No news on this one.

HB 2228 Annual waiver, applicability

This Bill 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 2389  Syringe access programs; authorization

Under this Bill, organizations in Arizona can establish and operate a needle exchange program.  Persons, employees and volunteers operating within the scope of the law may not be charged or prosecuted for their activities. It’s currently a felony to distribute needles to illegal drug users.

We’ve signed up in support of this bill because this type of program is evidence-based and reduces the spread of bloodborne diseases as well as engaging in intravenous drug users into treatment. No hearings scheduled yet.

HB 2443  Medical services purchase, premiums

The Bill would essentially allow Arizonans that don’t normally qualify for Medicaid to buy Medicaid health insurance.  It would ask AHCCCS to write the rules and regulations for the program including setting a premium that ensures people buying in would pay full freight.  If approved, it would allow people to buy in beginning on October 1, 2019.  

The bill is also contingent on CMS approval.  Here’s a link to a really good document that discusses the merits of a Medicaid buy-in system.  It has not yet been assigned to a committee.

 

Senate Bills

SB 1007  Motorcycle operation; riding between lanes          

Under this proposal, motorcycle operators would no longer be prohibited from passing in the same lane occupied by the vehicle being overtaken and from operating a motorcycle between the lanes of traffic if they’re wearing a helmet.  We decided to take a position against this one in our Public Health Policy Committee last week. No action this week.

SB 1022    DHS; homemade food products            

Under this Bill, ADHS would 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.  This bill as passed through both of it’s assigned committees over the last couple of weeks.

SB 1083 Schools; recess periods

Under this Bill, district and charter schools would be required to provide at least 2 recess periods during the school day for kids in grades K-5.  We’ve signed in support of this bill.  It got a Do Pass recommendation from the Education Committee a couple of weeks ago and both Caucuses support it- a good sign.

SB 1245 Snap Benefit Match

This Bill would appropriate $400K to ADES to develop the infrastructure for a produce incentive program within the Supplemental Nutrition Assistance Program (SNAP) 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.  We’ve signed up in support of this Bill.  It hasn’t been scheduled for a committee hearing yet.

SB 1445 AHCCCS Dental care, pregnant women

This is a priority Bill for AzPHA.  It would provide oral health coverage for pregnant women who receive their health insurance coverage through AHCCCS.  The benefit would be limited to $1000 and could be used for other than emergency dental procedures (beginning October 1, 2017 all adult Medicaid members became eligible for up to $1000 in emergency dental services per year).  Lots of good public health reasons to support this one.

 

Federal Budget Drama Update

The House Appropriations Committee released the next Continuing Appropriations Act (H.J. Res 128) designed to update current continuing resolution that expires Thursday.  The proposed CR extends funding for the federal government through Mar. 23. Here’s what’s in it:

  • Community Health Centers: Provides $3.6 billion in FY18 and FY19.
  • National Health Service Corps: Provides $310 million in FY18 and FY19.
  • Family to Family Information Centers: Provides $6 million for FY18 and FY19.
  • Census: Provides $51 million to prepare for the 2020 census.
  • Medicaid Disproportionate Share: Eliminates the Medicaid DSH reductions scheduled for FY18 and FY19. The DSH reduction of $4 billion for FY20 remains and adds a total of $6 billion in additional DSH reductions to offset the cost of eliminating the FY18 and FY19 reductions.
  • Sexual Risk Avoidance Program (formerly Abstinence Education program): Provides $75 million in FY18 and FY19.
  • Personal Responsibility Education Program: Provides $75 million in FY18 and FY19.

The House is expected to vote tonight.  After that, the Senate will probably modify the bill and send it back to the House. All this needs to be done before midnight on Friday to avert another federal government shutdown.

 

Will Humble Medicaid, Wills Blog

AzPHA Comment Letter to CMS Regarding AHCCCS Work Requirement Directed Waiver

February 5, 2018

 

Seema Verma

Administrator,

The Centers for Medicare and Medicaid Services

7500 Security Boulevard

Baltimore, MD 21244

 

RE: Arizona (AHCCCS) 1115 Waiver Application

Dear Administrator Verma:

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.

The Arizona Health Care Cost Containment System (AHCCCS) has requested permission through an 1115 Waiver Application to implement changes to its 1115 demonstration in response to its state legislation, (Senate Bill 1092). Through their amendment, AHCCCS requests to implement employment and community engagement requirements as a condition of Medicaid eligibility and bi-annual verification of compliance with employment and community engagement requirements as well as other changes in family income or other eligibility factors.  They have also asked for the authority to limit lifetime coverage for “able-bodied adults” to five years unless an individual is considered exempt by the state.

Section 1115 of the Social Security Act gives the Secretary of Health and Human Services authority to approve experimental, pilot, or demonstration projects that are found by the Secretary to be likely to assist in promoting the objectives of the Medicaid program. The purpose of these demonstrations, which give states additional flexibility to design and improve their programs, is to demonstrate and evaluate state-specific policy approaches to better serving Medicaid populations.

A core tenant of these waivers is to conduct a robust evaluation of demonstration projects to properly gauge their effectiveness.  We urge the Centers for Medicare and Medicaid Services to stay true to this commitment and withhold approval of the waiver.

until after AHCCCS submits an evaluation design that will satisfactorily measure the effectiveness of this waiver application in meeting the health and wellness needs of our nation’s vulnerable and low-income individuals and families. 

Because a comprehensive evaluation plan has not been submitted with this waiver application, it is unclear how the Administration will evaluate the plan’s effectiveness and meet the intent of the 1115 waiver requirements. 

For example, the application provides no insight into how AHCCCS will evaluate program impact on health outcomes and track and report on the number of individuals whose eligibility is discontinued due to failure to demonstrate compliance with the Waiver’s work/job training requirements.

It is unclear whether AHCCCS will track and report on the number of individuals who seek and obtain exemptions from the work requirement and how population impacts will be disaggregated by sociodemographic characteristics including age, sex, race, ethnicity and geography. The application does not discuss whether they will use external metrics such as hospital uncompensated care reports to provide early indicators of any potential provider impacts on changes in coverage that may result from the waiver.

AHCCCS identifies basic proposed evaluation methods such as the rate of employment, job seeking, education and employment support and development activities for able-bodied adults and state that they will track and report on the average household income.  However, their discussion does not constitute an evaluation plan. CMS guidance states that evaluations must assess program impact on health outcomes – a topic which is not addressed in the AHCCCS Waiver application.

We are aware the Secretary of Health and Human Services and the CMS Administrator are receptive to the kind of waiver request that AHCCCS is requesting, and that Section 1115 demonstrations are generally approved for an initial five-year period and can be extended for up to an additional three to five years, depending on the populations served. 

However, because of the large and challenging system changes that will be required by AHCCCS and members under this request, we strongly urge CMS to withhold any approval until the Administration submits a credible and robust evaluation strategy and plan.

We also urge CMS to limit any approval to 3 years, pending the results of an objective evaluation of the impact that these changes will have on vulnerable and low-income individuals and families.

Additionally, we urge CMS to ask AHCCCS for a complete and evidence-based rationale for how a 5- year limit on lifetime benefits could possibly further the mission of meeting the health and wellness needs of our nation’s vulnerable and low-income individuals and families. Many chronic medical conditions such as diabetes and asthma require continual chronic disease management.  Without connection to care these conditions become more challenging and more expensive. With a 5-year limit on benefits, former members will be disconnected from care, resulting in poor outcomes and increased compensated and uncompensated care.

Additionally, there are many unknowns about how the Administration will implement the 5-year limit. For example, how will the Administration keep track of exempt member months over time and how will they be able to apply and allocate those months toward the 5-year limitation? What mechanisms will be used to allow members to supply the needed data, and how will the communication loop be implemented and maintained.

Sincerely,

 

Will Humble, MPH

Executive Director,

Arizona Public Health Association

Will Humble Opioids, Wills Blog

AzPHA Public Health Policy Update: January 30, 2018

Special Session Produces Opioid Intervention Product

Last week’s Special Session of the Legislature produced a robust new law that includes a host of new interventions to address Arizona’s opioid epidemic.  Here’s a link to the official document that describes the final new law.

Various pieces go into effect at different times, so all the provisions won’t be implemented all at once.  Some things have an expiration date.  For example, the Good Samaritan component of the law expires on July 1, 2023.

The new law has over 90 provisions that impact prescribing and dispensing practices, criminal prosecution, drug drop off locations, educational programs and a new fund to assist with treatment.  If you’re interested, the best thing is to examine it in detail.

This was a textbook example of solid public health policy development that included enhanced surveillance and analysis, a literature review, research of best practices, stakeholder input, and bipartisan consultation that resulted in a consensus bill.  It’s not perfect (for example it doesn’t decriminalize needle exchange) but it’s a testament to good public policy-making.

 

New Bills this Week

Before we get to the committee agendas for this week- here are a couple of new bills that were proposed.  AzPHA supports both of them.

SB 1445 AHCCCS Dental care, pregnant women

This is a priority Bill for AzPHA.  It would provide oral health coverage for pregnant women who receive their health insurance coverage through AHCCCS.  The benefit would be limited to $1000 and could be used for other than emergency dental procedures (beginning October 1, 2017 all adult Medicaid members became eligible for up to $1000 in emergency dental services per year).  Lots of good public health reasons to support this one.

HB 2443  Medical services purchase, premiums

The Bill would essentially allow Arizonans that don’t normally qualify for Medicaid to buy Medicaid health insurance.  It would ask AHCCCS to write the rules and regulations for the program including setting a premium that ensures people buying in would pay full freight.  If approved, it would allow people to buy in beginning on October 1, 2019.  The bill is also contingent on CMS approval.

 

Committee Hearings this Week

Now that the Special Session is finished, the various House and Senate committees are back in full swing.  Several of the priority public health bills that we’re following are progressing through the system. 

Below is a summary of the committee hearings… I’ve pasted a quick summary of the Bills that are being heard this week.  After that is a listing of the other bills that haven’t been heard in their committees yet.

Remember to stay engaged and voice your opinion via the www.azleg.gov commenting system. I gave a summary of how to sign up for the system in my policy update 2 weeks ago.

Tuesday

House Commerce, Tuesday, 1/30 @ 2 pm, HHR 1

HB 2064 Medical marijuana; packaging; labeling              

This Bill proposes that medical marijuana dispensaries be prohibited from selling a marijuana product that’s packaged or labeled in a manner that’s “attractive to minors”. Due to voter protection, this legislation requires the affirmative vote of at least 3/4 of the members of each house of the Legislature for passage.  We’re supporting this bill.

 

Wednesday

Senate Government, Wednesday, 1/31 @ 2 pm, SHR 109

SB 1420 medical marijuana; inspection; testing; appropriation

This Bill 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.

 

House Judiciary & Public Safety, Wednesday, 1/31 @ 2 pm HHR 4

HB 2038 Drug overdose review teams; records                

Under this proposed Bill, law enforcement agencies would 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.  We’re signed up in support of this one.

Thursday

House Health, Thursday, 2/1 @ 9 am, HHR 4

HB 2084 Indoor tanning; minors; restricted use

Under this proposal, tanning facility operators would be prohibited from allowing a person under 18 years of age to use a “tanning device”. Tanning facilities are prohibited from advertising or distributing promotional materials that claim that using a tanning device is free from risk or will result in medical or health benefits. We’ve signed on in support of this.

HB 2109 Tobacco possession; sale; age; signage                

This Bill would prohibit furnishing a tobacco product to a person who is under 21 years of age. The definition of “tobacco product” is expanded to include “electronic smoking devices”. We’ve signed up in support of this bill.

HB 2197 Health professions, workforce data

This Bill 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.

HB 2228 Annual waiver, applicability

This Bill 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 2324 Community health workers; voluntary certification

This Bill is a top priority for us. It would charge the ADHS with developing a voluntary certification program for community health workers.  The Department rulemaking would include certification standards including qualifications, core competencies, and continuing education requirements. We’ve signed up in support of this bill. 

 

Public Health Related Bills Waiting in the Wings

House Bills

HB 2071 Rear-facing car seats         

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.  This Bill cleared the House Transportation & Infrastructure Committee last Wednesday.

HB 2208 Prohibition, photo enforcement

This Bill 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 cleared the House Judiciary and Public Safety Committee last week.

HB 2127 Children’s health insurance program

This Bill removes 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.  This one cleared the House Health Committee a couple of weeks ago.

HB 2389  Syringe access programs; authorization

Under this Bill, organizations in Arizona may establish and operate a needle exchange program.  Persons, employees and volunteers operating within the scope of the law may not be charged or prosecuted for their activities. It’s currently a felony to distribute needles to illegal drug users.

We’ve signed up in support of this bill because this type of program is evidence-based and reduces the spread of bloodborne diseases as well as engaging in intravenous drug users into treatment. No hearings scheduled yet.

 

HB 2222 Feminine hygiene products, requirements

This Bill would require the Arizona Department of Corrections to offer female inmates an unlimited supply of feminine hygiene products free of charge. We signed up in support.

 

Senate Bills

SB 1007  Motorcycle operation; riding between lanes          

Under this proposal, motorcycle operators would no longer be prohibited from passing in the same lane occupied by the vehicle being overtaken and from operating a motorcycle between the lanes of traffic if they’re wearing a helmet.  We decided to take a position against this one in our Public Health Policy Committee last week.

SB 1022    DHS; homemade food products            

Under this Bill, ADHS would 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

Under this Bill, district and charter schools would be required to provide at least 2 recess periods during the school day for pupils in grades K-5.  We’ve signed in support of this bill.

SB 1245 Snap Benefit Match

This Bill would appropriate $400K to ADES to develop the infrastructure for a produce incentive program within the Supplemental Nutrition Assistance Program (SNAP) 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.  We’ve signed up in support of this Bill.  It hasn’t been scheduled for a committee hearing yet.

SB 1250 Food Producers, Ordinances

This Bill would make it clear that cities, towns and counties can’t restrict food producers including community gardens from producing food products with some exceptions and inspection authority.

Thanks… and check out our upcoming Spring Conference “Together for Tomorrow: Protecting Arizona’s Children at www.azpha.org.

 

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Will Humble

Executive Director, AZPHA

 

Will Humble Opioids, Wills Blog

AzPHA Public Health Policy Update: January 24, 2018

Opioid Special Session this Week

The Governor called a Special Session of the Legislature this week to facilitate the passage of a series of statutory changes to address Arizona’s Opioid epidemic. The Bill (called HB 2001 in the House) tackles a wide range of issues as identified in ADHS’ September 5 report.  Some of the interventions include:

  • Limiting the first-fill of opioid prescriptions to 5 days for opioid naïve patients and limiting dosage levels to align with federal prescribing guidelines (exemptions are included for cancer, trauma or burn patients, hospice or end-of-life patients, and those receiving medication assisted treatment for substance use disorder);
  • Expanding access to Naloxone for law enforcement or corrections officers;
  • Increasing oversight mechanisms, and enacting criminal penalties for manufacturers who defraud the public about their products;
  • Enhancing continuing medical education for all professions that prescribe or dispense opioids;
  • Enacting a Good Samaritan law to allow people to call 911 for a potential opioid overdose;
  • Requiring e-prescribing;
  • Requiring all pharmacists to check the Controlled Substances Prescription Monitoring Program prior to dispensing an opioid or benzodiazepine; and
  • Identifying gaps in and improving access to treatment, including for uninsured or underinsured Arizonans, with a new $10 million investment.

The Bill is moving rapidly and received a pass recommendation from the House Health Committee on Tuesday. The expedited process and the Stakeholder meetings that were included during its development will likely result in quick passage and approval. AzPHA has signed up in support of the measure.

 

AHCCCS Proposes Ending “Prior Quarter Coverage”

Under Medicaid law, states are required to provide coverage beginning 3 months prior to the person’s application if the person would have been eligible during those months. Medicaid covers unpaid medical bills incurred during that time. 

The retroactive coverage ensures that enrollees aren’t hit with medical bills for the 3 months before they applied for Medicaid if their income was so low that they would have been Medicaid eligible. It also provides an incentive for doctors and hospitals to treat uninsured Medicaid eligible people because they’ll be paid for the services once the person is enrolled. 

AHCCCS is proposing a Prior Quarter Coverage Waiver Amendment asking CMS’ permission to stop covering “prior quarter” coverage. The public has until February 25 to comment on the proposal.  Written comments can be sent to [email protected].

You may want to think about framing your comments by urging CMS to require a 6 month or 1-year limit on the waiver and make final approval conditional upon an evaluation of the impact on hospitals’ and community providers’ uncompensated care burden as well as the effect on consumer medical debt and gaps in coverage prior to enrollment.

 

Federal Budget Deal Includes CHIP

The (temporary) federal budget bill that was passed and signed this week included a 6-year extension of the federal Children’s Health Insurance Program (called KidsCare in AZ).

Importantly, the federal contribution rate of 100% will stay in place until October 1, 2019.  When AZ approved the KidsCare program a couple of years ago- it was contingent on the fed’s continuing to pay 100% of the costs for the program. Under the current statute, if the federal contribution drops the program would be automatically frozen.

HB 2127 would remove the trigger that automatically freezes the KidsCare program if FMAP (the federal contribution) drops below 100% and allow the state to freeze it if costs are more than the state or federal allotment. We’ve signed up in support of this bill because it provides a pathway to keep Kids Care if the federal government drops its contribution level.  This will be heard in House Health on Thursday.

 

AZ Legislative Update

Last week I covered the Bills relating to public health that had been proposed as of last week.  Here are the new bills from this week:

 

SB 1245 Snap Benefit Match

This bill would appropriate $400K to ADES to develop the infrastructure for a produce incentive program within the Supplemental Nutrition Assistance Program (SNAP) 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.  We’ve signed up in support of this Bill.  It hasn’t been scheduled for a committee hearing yet.

 

SB 1250 Food Producers, Ordinances

This bill would make it clear that cities, towns and counties can’t restrict food producers (including community gardens) from producing food products with some exceptions and including inspection authority. 

 

HB 2208 Photo Enforcement

This bill would prohibit cities and other jurisdictions from having photo enforcement for red light running and speeding.  While nobody likes getting a ticket in the mail, the data suggest that photo enforcement saves lives and prevents injuries (especially photo red lights).  We’ve signed up in opposition to the bill.  SB 2208 will be heard in the House Judiciary and Public Safety Committee on Wednesday afternoon.

 

Bills Being Heard in Committee this Week

 

HB 2324 Community Health Workers; Voluntary Certification

This Bill (which is a priority for AzPHA) is being heard in the House Health Committee on Thursday, January 25.  It would charge the ADHS with developing a voluntary certification program for community health workers.  The Department rulemaking would include certification standards including qualifications, core competencies, and continuing education requirements. We’ve signed up in support of this bill.

 

HB 2084 Indoor tanning; minors; restricted use

This Bill will be heard in the House Health Committee on Thursday.   Tanning facility operators would be prohibited from allowing a person under 18 years of age to use a “tanning device”. Tanning facilities are prohibited from advertising or distributing promotional materials that claim that using a tanning device is free from risk or will result in medical or health benefits. We’ve signed on in support of this.

__________________

 

Yuma County Gets Grant to Combat Childhood Poverty

The National Association of Counties has selected Yuma County to be part of the Rural Impact County Challenge: National Effort to Combat Childhood Poverty.  The program is a partnership between the National Association of Counties and the Robert Woods Johnson Foundation’s County Health Ranking and Roadmaps Program.  

Yuma County is part of a cohort of 11 communities selected nationwide to participate.  A link to the program can be found here: http://www.naco.org/resources/programs-and-services/rural-impact-county-challenge-national-effort-combat-rural-child.

Will Humble State Legislature, Wills Blog

AzPHA Public Health Policy Update: January 17, 2018

Voice Your Opinion this Legislative Session

As the leading public health professionals in the state, it’s important that you engage in public health policy development. After all, we’re the people that have first hand knowledge about the public health implications of the decisions that our elected officials make.

The good news is that it’s easier than ever to voice your opinion. Our state legislature has a transparent way to track bills through their www.azleg.gov website. The site allows you to track when bills are being heard in committee and provides an opportunity for you to express your support, opposition, or neutrality from your home or office.  

The main URL to bookmark in your computer is http://www.azleg.gov – which is the State Legislature’s official website.  It got an overhaul last year making it easier to work with.

If you have the number for a bill you’re interested in following, simply go to the upper right corner of the http://www.azleg.gov website and punch in the numbers. Up pops the bill including its recent status, committee assignments and the like. 

The dark blue tabs provide more detailed info about the bill.  For example, the “Documents” tab displays the actual language of the bill including the most recent versions.

You’ll see that bills have committee assignments on the Bill Status pages. You can easily check the committee agendas each week on the website too.  Go to the “Committee Agenda” and pull up the agenda for the committee you’re interested in.  

Most of the bills we’ve been following and advocating for or against have been assigned to either the House Health Committee or the Senate Health and Human Services Committee.  This year the House Health Committee meets on Thursdays at 9 am. The Senate Health & Human Services Committee meets Wednesdays at 2 pm.

I’m encouraging all of you to weigh in for and against bills when you believe that it’s in the best interests of public health to do so. It’s straightforward.

First you need to create an account with an e-mail address and a password. You’ll need to go down to one of the kiosks in the House or Senate to set up your account and password- but after that you’ll be able to sign in for or against bills from your home or office. If you don’t want to use your work email address you can use a personal e-mail.

The Arizona Community Action Association (ACAA) has created an alternative way for you to create an account.  You fill out this form granting the ACAA permission to create an RTS account on your behalf.  ACAA will create a default password for your account, which will need to be changed when you gain access to your account. 

Once your account is set up, you can sign in support or against any bill at the Azleg’s My Bill Positons site at https://apps.azleg.gov/RequestToSpeak/MyBillPositions 

Even if you don’t have an account, you can click on each bill and find out who has signed in for or against or neutral on the bill.  Just go to the tab over each bill that says “RTS Current Bill Positions” and you’ll see who has signed in support or against each bill. Sometimes you’ll see our name up there (AzPHA).

 

Public Health Bills So Far

The legislative session just started last week. We’re in the initial phases of digging into the bills that have been proposed so far.  There are still a few weeks left for lawmakers to propose new bills- but here’s a summary of the ones we’re tracking so far:

 

HB 2324 Community health workers; voluntary certification

SPONSOR: CARTER

This Bill would charge the ADHS with developing a voluntary certification program for community health workers.  The Department rulemaking would include certification standards including qualifications, core competencies, and continuing education requirements. We’ve signed up in support of this bill. 

 

SB 1010 Tobacco possession; sale; age; signage

SPONSORS: FARNSWORTH D, BOYER                 

This Bill would prohibit furnishing a tobacco product to a person who is under 21 years of age. The definition of “tobacco product” is expanded to include “electronic smoking devices”. We’ve signed up in support of this bill.

 

HB 2071 Rear-facing car seats

SPONSOR: BOLDING                 

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.  It’s being heard in the House Transportation & Infrastructure Committee on Wednesday.

 

HB 2127 Children’s health insurance program

SPONSOR: COBB

This Bill removes 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 Kids Care if the federal government drops its contribution level.  This will be heard in House Health on Thursday.

 

HB 2389  Syringe access programs; authorization

SPONSOR: RIVERO

Under this Bill, organizations in Arizona may establish and operate a needle exchange program.  Persons, employees and volunteers operating within the scope of the law may not be charged or prosecuted for their activities. It’s currently a felony to distribute needles to illegal drug users.

We’ve signed up in support of this bill because this type of program is evidence-based and reduces the spread of bloodborne diseases as well as engaging in intravenous drug users into treatment.

 

SB 1083 Schools; recess periods

SPONSOR: ALLEN S

Under this Bill, district and charter schools would be required to provide at least 2 recess periods during the school day for pupils in grades K-5.  We’ve signed in support of this bill.

 

SB 1022    DHS; homemade food products

SPONSORS: FARNSWORTH D, KAVANAGH                 

Under this Bill, ADHS would 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.

 

HB 2040 Pharmacy board; definitions; reporting

SPONSOR: CARTER                 

This Bill proposes various changes to the Board of Pharmacy functioning including requiring a medical practitioner, pharmacy or health care facility that dispenses a controlled substance to submit the required informational report to the Board once each day. We’ve signed up in support.

 

HB 2038 Drug overdose review teams; records

SPONSOR: CARTER                 

Under this proposed Bill, law enforcement agencies would 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.  We’re signed up in support of this one.

 

HB 2084 Indoor tanning; minors; restricted use

SPONSOR: CARTER                

Under this proposal, tanning facility operators would be prohibited from allowing a person under 18 years of age to use a “tanning device”. Tanning facilities are prohibited from advertising or distributing promotional materials that claim that using a tanning device is free from risk or will result in medical or health benefits. We’ve signed on in support of this.

 

SB 1007  Motorcycle operation; riding between lanes

SPONSOR: FARNSWORTH D                 

Under this proposal,motorcycle operators would no longer be prohibited from passing in the same lane occupied by the vehicle being overtaken and from operating a motorcycle between the lanes of traffic as long as they’re wearing a helmet.  

We haven’t taken a position on this yet.  Interesting that lane splitting would only be lawful if wearing a helmet.  Right now, only people under 18 are required to wear a helmet.  We’ll talk about this one in our public policy committee next week.

 

HB 2064 Medical marijuana; packaging; labeling

SPONSORS: LEACH                 

This Bill proposes that medical marijuana dispensaries be prohibited from selling a marijuana product that’s packaged or labeled in a manner that’s “attractive to minors”. Due to voter protection, this legislation requires the affirmative vote of at least 3/4 of the members of each house of the Legislature for passage.  We’ll talk about this one in our public policy committee next week.

 

HB 2014  Marijuana; civil penalty

SPONSOR: CARDENAS                 

Under this proposal, possession, use, production, or transporting for sale an amount of marijuana weighing less than one ounce is subject to a civil penalty of up to $100, instead of being classified as a class 6 felony.  We’ll talk about this one in our public policy committee next week.

 

HB 2030  Pain treatment; dosage limit; prohibition

SPONSOR: LAWRENCE                 

Under this proposal, state or any other political subdivision would be prohibited from limiting the morphine milligram equivalents per day of a schedule II controlled substance that may be prescribed for pain management by a licensed health professional.  We’re likely to oppose this on (but we haven’t done so yet).  

We’ll take a position once we know the content of the upcoming opioid special session.

 

HB 2033  Drug overdose; good samaritan; evidence

SPONSOR: LAWRENCE                 

Under this proposal, a person who seeks medical assistance for someone (or themselves) experiencing a drug-related overdose and who needs medical assistance can’t be charged with possession or use of a controlled substance as a result of seeking medical assistance.  

We will likely support this bill- but like 2033, we’ll wait for the special session.

 

SB 1016  Duty to report; life-threatening emergency

SPONSOR: KAVANAGH                 

Under this proposed Bill, a person who knows that another person is exposed to or has suffered a life-threatening emergency is required to report the emergency and its location to a peace officer, fire department or other governmental entity responsible for public safety. Violations are a class 1 (highest) misdemeanor.  

This bill isn’t what appears to be on it’s surface because it’s effect would be to penalize those that do not call for medical assistance rather that providing an incentive to ask for assistance like HB 2033 would do.  We will likely oppose this bill.

 

Opioid Special Session?

There are rumors circulating about the Capitol that the Governor will call a Special Session next week to tackle bills related to the opioid epidemic.  The Special Session would be triggered by an Executive Order that would call for the session.  We’ll continue to track this and weigh in on the policy proposals that come out of the session.

 

Federal Budget Update

Last night, Rep. Frelinghuysen, chairman of the House Appropriations Committee, released the text of a Continuing Appropriations Act (H.J. Res 125). Fortunately, in this proposal, the Prevention and Public Health Fund isn’t used as an offset in this legislation. The bill includes the following provisions relevant to public health:

  • Federal Funding: The current continuing resolution expires this Friday, Jan. 19. This bill extends funding for the federal government through Feb. 16. 
  • Children’s Health Insurance Program (CHIP): Extends funding for the CHIP program through FY23, provides a 11.5% Federal Matching Assistance Percentage (E-FMAP) in FY20, and returns to the traditional pre-Affordable Care Act matching rate in FY21, FY22, and FY23. 

There are many people that follow the federal budget process closely that believe it’s likely that there will be a temporary federal government shutdown because of complex issues like immigration reform and a border wall.

Will Humble Uncategorized, Wills Blog

Public Health Policy Update: January 10

Governor to Call Special Session on Opioid Epidemic

During his State of the State address yesterday the Governor suggested that he’ll call for a Special Session of the Legislature to address legislation to mitigate the opioid epidemic in AZ. He said a package of opioid legislation will be released the week of January 15 along with an Executive Order calling for a special session. 

The legislative proposals will likely be aligned with the ADHS’ September 5 opioid report which is robust and has many practical and specific recommendations.  

There are literally dozens of specific recommendations, but I picked out a few of the more interesting ones below:

  • Impose a 5-day limit on all first fills for opioid naïve patients for all payers;
  • Require pharmacists to check the CSPMP prior to dispensing an opioid;
  • Require 3 hours of opioid-related CME for all professions that prescribe or dispense opioids;
  • Establish an all payers claims database to establish better surveillance data;
  • Eliminate dispensing of controlled substances by prescribers;
  • Regulate pain management clinics to prohibit “pill mill” activities;
  • Establish enforcement mechanisms for pill mills and illegal opioid dispensing;
  • Enact a good Samaritan law to allow bystanders to call 911 for a potential opioid overdose; and
  • Urging AHCCCS to ask permission to pay for substance abuse treatment in correctional facilities.

For the full picture you can visit the Report which is quite impressive and a testament to the team that developed the report.

We’ll be closely following the Special Session and we’ll be advocating for proposals that are evidence-based and likely to make a difference.

 

AHCCCS Caps First Fill Opioid Prescriptions at 5 Days

AHCCCS issued a new policy that imposes “first fill limits” of 5 days for opioid prescriptions (the former limit was 7 days).  You can review the changes to the AHCCCS Medical Policy Manual 310-V, Prescription Medications-Pharmacy Services.

 

Federal Prosecutor Changes Medical Marijuana Guidance

The U.S. Department of Justice issued a memo last week that outlines the Administration’s federal marijuana enforcement policy. The memo basically directs U.S. Attorneys to enforce the Controlled Substances Act and to “follow well-established principles when pursuing prosecutions related to marijuana activities”.  It also reinforces “local control to federal prosecutors” regarding how to deploy Justice Department prosecutorial resources.

The memo ends the 2009 “Ogden Memo” policy that discouraged federal law enforcement and prosecutors from pursuing persons and organizations (e.g. dispensaries and cultivation facilities) in states where the drug is legal for medical and recreational use when people and organizations are acting in accord with their state’s laws.

The new policy could have implications for Arizona’s Medical Marijuana program.  With the issuance of this memo it’ll be up to Acting US Attorney for Arizona Elizabeth Strange to make decisions about what to do regarding persons that are in accord with the AZ Medical Marijuana Program but are in violation of the federal Controlled Substances Act.

 

Federal Comment Period on AHCCCS Work Requirement Request

A 2015 AZ law requires AHCCCS to annually ask CMS for permission to require work (or work training) and income reporting for “able bodied adults” as well as a 5-year lifetime limit on AHCCCS eligibility.

A few weeks ago AHCCCS turned in their official waiver request asking permission to implement the following requirements for certain adults receiving Medicaid services: 

  • A requirement to become employed, actively seek employment, attend school, or partake in Employment Support and Development activities (with exceptions);
  • A requirement to bi-annually verify compliance with the requirements and report changes in family income; and
  • Limit lifetime coverage for able bodied adults to 5 years (with exceptions).

The federal public comment period is open through February 5. You can review the AHCCCS waiver application and submit comments on the CMS website.  AzPHA will be submitting comments consistent with the letter that we submitted to AHCCCS back in February.

 

AzPHA Public Health Policy Committee

Our AzPHA Public Health Policy Committee will get into full seasonal swing shortly. Our first 2018 call will be on Monday January 22 at 11am.  

We discuss the various state bills that are under consideration (including budget bills) and talk about advocacy strategies.  We also talk about federal advocacy strategies.

Our Public Health Policy Committee has a Basecamp site where we post policy documents, bills, and research.  We also schedule our meetings through the Basecamp. 

Contact [email protected] if you’re a member and you’d like to join our Public Health Policy Committee and/or get access to the Policy Committee Basecamp.

Will Humble Medicaid, Wills Blog

Final 2017 AzPHA Public Health Policy Update

 

AHCCCS Submits Work Requirement Waiver

An AZ law (from 2015) requires AHCCCS to annually ask the Centers for Medicare and Medicaid Services (CMS) for permission to require work (or work training) and income reporting for “able bodied adults” as well as a 5-year lifetime limit on AHCCCS eligibility. 

The work requirement and 5-year limit requests that were turned in during the Obama Administration were denied, but the new administrator CMS has publicly said (and written) that they’re receptive to proposals from states to require work or community engagement for people who want to receive Medicaid.

This week AHCCCS submitted their official waiver request asking permission to implement the following requirements for certain adults receiving Medicaid services: 

  • A requirement to become employed, actively seek employment, attend school, or partake in Employment Support and Development (ESD) activities (with exceptions below);
  • A requirement to bi-annually verify compliance with the requirements and any changes in family income or other eligibility factors; and
  • Limit lifetime coverage for able bodied adults to five years (with exceptions below).

    Here are the proposed exempted groups:

    • People who are at least 55 years old;

    • American Indians;

    • Women up to the end of the month in which the 90th day of post-pregnancy occurs;

    • Former Arizona foster youths up to age 26;

    • People determined to have a serious mental illness;

    • People receiving temporary or permanent long-term disability benefits from a private insurer or from the government;

    • People determined to be medically frail;

    • Full-time high school students who are older than 18 years old;

    • Full-time college or graduate students;

    • Victims of domestic violence;

    • People that are homeless;

    • People who have recently been directly impacted by a catastrophic event such as a natural disaster or the death of a family member living in the same household;

    • Parents, caretaker relatives, and foster parents; or

    • Caregivers of a family member who is enrolled in the Arizona Long Term Care System.

    Able-bodied adult members will be required to meet the following activities or combination of activities, for at least 20 hours per week to qualify for AHCCCS:

    • Be employed;

    • Attending school; or

    • Attending an ESD program (e.g. English as a Second Language courses, parenting classes, disease management education, courses on health insurance competency, and healthy living classes. 

    People looking for a job and meeting the requirements to receive unemployment benefits would be deemed as meeting the work requirements.

    Community service hours may count toward the required 20 hours per week for people transitioning from the justice system, living in an area of high unemployment, or who otherwise face a significant barrier to employment.

    The entire waiver request is 678 pages long- but don’t let that scare you off.  The meat of it is only 13 pages long.

    P.S. I didn’t see a request to change the reimbursement scheme for community health centers or the limitations on non-emergency medical transportation in the waiver request.

     

    New Tax Law Repeals Penalties for Not Having Health Insurance

    The new federal tax law that will be signed shortly eliminates the penalties that people currently need to pay for choosing not to have health insurance. The penalty elimination begins on January 1, 2019…  so, there will still be a financial penalty for not having health insurance during 2018. 

    The tax penalty for not having health coverage in 2017 is $695 per adult and $347 per child, or 2.5% of one’s household income, whichever is greater. About 4 million US taxpayers paid the penalty in 2016 (an 80,000 Arizonans paid the tax penalty that year).

    The CBO estimates that eliminating of the mandate will result in 80,000 more Arizonans becoming uninsured during the first year of implementation (2019).  By 2027 they estimate that the number of uninsured will rise by 13 million people nationally (260,000 in Arizona).

    The change is also expected to increase premiums on the Marketplace by an unknown amount in 2019 because younger and healthier people are expected to disproportionately elect not to buy health insurance.  Part of that increase may be mitigated if congress chooses to restore the Cost Sharing Reductions and if they authorize a reinsurance program

     

    CDC Submits Much Smaller Budget Request

    This week the CDC turned in their FY 18 budget request.  The overall request is 17% smaller than last year’s agency budget.  If enacted as requested, the funding cut would have big implications for state and county health departments.  The request is for $6B in budget authority which is $1.2B less than the FY 2017 Continuing Resolution (CR) level (a 17% reduction).  Here’s a link to the actual budget request. 

    Here are the bullet’s identified as an introduction to the request from the CDC Director:

    •  Creation of the new America’s Health Block Grant, reforming the model of existing state-based chronic disease programs to increase flexibility

    • Reform of public health preparedness and response activities, including a greater emphasis on risk in the state grant program.

    • Enhanced support for vector-borne disease outbreaks

    • Critical investments to improve our laboratories and facilities

    • Continued efforts to reduce deaths due to opioid abuse, misuse, and overdose

    The budget request is too long and complicated to characterize fully here- but I’ve picked out a few highlights.

    America’s Health Block Grant Program ($500 million)

    The FY 2018 budget request includes a new $500 million “America’s Health Block Grant” to increase flexibility on the leading chronic disease challenges specific to each State, which could include preventing and better managing heart disease and diabetes—two of the most common and costly chronic diseases—as well as arthritis, the leading cause of disability in the United States. 

    The request proposes to eliminate the following programs completely:

    • Preventive Health and Health Services Block Grants (-$160.0 million)

    • Racial and Ethnic Approaches to Community Health (-$51.0 million)

    • Prevention Research Centers (-$25.4 million)

    • Cancer Prevention and Control (-$18.1 million)

    • Hospitals Promoting Breastfeeding (-$8.0 million

    • National Early Child Care Collaboratives (-$4.0 million)

    • Health Promotion (-$10.5 million)

    • Occupational Safety and Health (-$138.5 million) – eliminating funding for state and academic partners for conducting, translating, or evaluating research

    • Education and Research Centers (-$28 million)

    The following programs would be significantly scaled back (but not eliminated in their entirety):

    • Chronic Disease Prevention and Health Promotion (-$222 million) – the agency says that the America’s Health Block Grant could make up a portion of this cut if states prioritize these activities in their block grant

    • Public Health Preparedness and Response (-$136.3 million)- with large reductions in the state cooperative agreements

    • Immunization Program (-$89.5 million) – CDC would continue to provide funding to the 64 immunization awardees for state infrastructure awards, vaccine direct assistance, and laboratory capacity- but at a substantially reduced level.

    • Emerging and Zoonotic Infections (-$64.9 million)

    Remember that this is the agency’s budget request- not a final funding decision by congress.  In all likelihood, the agency was directed by the Executive to submit a budget that’s 17% smaller- reflecting the goals of the President’s budget.  As such- the CDC Director (Brenda Fitzgerald, MD) may not really want to make these cuts- but when you work for an Executive you gotta to follow their instructions (or quit- in which case someone else will).

    You can weigh in regarding the proposed CDC budget with your Representative and Senators by sending a message via this: APHA FCDC Funding Action Alert Tool.

    ___________

    Innovative Community Health Worker Strategies: Medicaid Payment Models for Community Health Worker Home Visits

    By Tina Kartika December 19th, 2017

    Due to mounting evidence that community health workers (CHWs) can improve health outcomes, increase access to health care, and control medical costs,[1] states are increasingly engaging their CHW workforce to replicate those successes at the state level. However, the policies and programs that regulate and pay for CHWs differ dramatically across states,[2] and states facing difficulties advancing CHW initiatives can gain insights from the experiences of other programs across the country.

    The National Academy for State Health Policy (NASHP) recently updated its State Community Health Worker Models Map, and is currently identifying innovative state strategies that have helped CHW initiatives meet their goals. This case study, which explores payment models for CHWs conducting home visits in Minnesota, New York, Utah, and Washington State, is the second in a series of products that highlight those CHW program strategies.

    Community Health Workers and Home Visits

    Health outcomes are influenced by many factors, one of which is physical environment. Living in an unhealthy home environment can cause or exacerbate health issues. For example, exposure to lead in the home from lead paint or contaminated drinking water, “affects the brain’s ability to control impulses and process information,” which can lead to children’s underperformance in school and later in the workplace.[3] Exposure to dust mites, mold, and cockroaches can trigger asthma attacks.[4]

    In addition to improving health outcomes and quality of life, addressing health hazards in the home environment can yield positive economic results. Remediating lead paint hazard in homes built before 1960 is estimated to generate $3.5 billion of earnings, health and education savings, and quality-adjusted life year benefits for 311,000 low-income children.[5] Home visiting services targeting asthma are estimated to generate $1.39 to $5 of savings for every dollar invested.[6] Assessing the home environment is a critical first step to reduce these hazards, and CHWs can be trained to conduct healthy home assessments,[7] educate, and connect patients to resources during home visits.[8]

    Payment Models

    Low-income households are more likely to live in unhealthy homes with significant lead-based paint hazards and indoor allergens.[9] Although Medicaid covers many low-income children and adults,[10] few state Medicaid programs directly reimburse CHWs to provide in-home services that address healthy home environments. The following are examples of payment models used by several states to finance home-based preventive services provided by CHWs:

    §  Medical expenditure: In Minnesota, home-based preventive services provided by CHWs can be reimbursed under Medicaid as long as the services qualify as diagnostic-related patient education and the CHWs work under the supervision of a licensed medical professional. Beneficiaries can receive up to 12 hours of these services each month.

    §  Administrative expenditure: Some accountable care organizations (ACOs) in Utah are covering the costs of home-based preventive services through administrative payments.[11] According to a National Center for Healthy Housing case study, Medicaid managed care organizations (MCOs) in New York can also choose to provide home-based asthma services and bill the services as administrative expenses.

    §  Incentive payment: Under the authority of 1115 waivers, 12 states have implemented Delivery System Reform Incentive Payment (DSRIP) programs that “restructures Medicaid funding into a pay-for-performance arrangement in which providers earn incentive payments outside of capitation rates for meeting certain metrics or milestones based on state-specific needs and goals.”[12] New York’s and Washington’s DSRIP programs in particular include projects that incentivize participating provider entities to provide CHW home visits to their members.

    §  In New York, 8 out of 25 participating Performing Provider Systems (PPSs) have implemented a project that expands asthma home-based self-management programs and includes home environment assessment, remediation, and education. During a meeting in February 2017, five of those eight PPSs reported engaging CHWs to meet the goals of the project.[13]

    §  Similarly, Washington’s Accountable Communities of Health (ACHs) can choose to implement a DSRIP project on chronic disease prevention and control and pay CHWs to conduct home visits for asthma services using DSRIP funding.

    Takeaways

    Minnesota, New York, Utah, and Washington provide examples of using Medicaid dollars to finance CHW home-based services. States can enable providers to bill certain CHW home visits as medical expenses, encourage MCOs to cover these services as administrative expenses, and use incentive payments to fund these services. States seeking sustainable CHW programs can explore these models to determine what fits their needs and goals.

    Acknowledgements: The author thanks Anna Guymon, the New York State DSRIP Team, Jill Rosenthal, and Amy Clary for their helpful comments and contribution to this case study. This case study was made possible by support from the National Center for Healthy Housing.

    Will Humble Physical Activity, Wills Blog

    AzPHA Public Health Policy Update- December 13, 2017

    More Evidence that Physical Activity Improves Grades

    It’s no secret that physically active kids are healthier, but a state study released Wednesday found that they also do better on reading and writing, and even school attendance.

    Fourteen schools in central and northern Minnesota each received $10,000 to implement three-year physical activity programs under a study conducted by the state’s departments of Health and Education.

    Most schools went beyond merely beefing up the traditional physical education class. Instead, they incorporated physical activity throughout the day — before and after school as well as movement within the classroom.

    Researchers found that students who were physically fit were much more likely to score better on state standardized tests. They were 27% more likely to be proficient in math and 24% more likely to be proficient in reading.

    Each school chose its own set of activities. For example, one school took  two 10-minute breaks each day to move around, sometimes using internet programs such as GoNoodle. They also had before- and after-school activities such as running, yoga, cross-country skiing and snowshoeing.

     

    Minnesota Adopting Physical Activity Standards for Schools

    Legislation passed in 2016 requires the Minnesota Department of Education to adopt the national physical education standards and “modify them according to state interest.” 

    Using the SHAPE America National Standards as a base, they are in the process of making changes to the national standards address state statutory requirements and best practices in physical education. 

    The new standards will replace the state’s current standards, the National Standards for Physical Education, which were developed by the National Association for Sport and Physical Education, adopted by Minnesota in 2010, and implemented in all schools in the 2012-2013 school year. 

    Here are their current Physical Education Standards Draft Rules 

     

    E-cigs quadruple probability of smoking tobacco
    A newly published study found that young adults using electronic cigarettes quadruple their chance of smoking tobacco within 18 months. 

    The study, published in the American Journal of Medicine monitored young adults aged between 18 to 30 years – who had never smoked conventional cigarettes for a year.  Of the participants who said they vaped e-cigarettes in the first questionnaire, 47% had started smoking cigarettes 18 months later compared to 11% percent of those who didn’t use e-cigarettes.

     

    Arizona WIC Implements Electronic Benefit Transfer

    Arizona’s Women, Infant, and Children implemented an electronic benefits system last week, providing enhanced (and more secure) service and benefits to participants, clinic staff, and WIC vendors (grocery stores authorized to accept Arizona WIC benefits).  

    The program began moving away from paper benefits back in checks to an electronic system thanks to a $5M grant they received from the USDA in 2014.  It’s basically an electronic system that replaces paper vouchers with a card for food benefit issuance and redemption at authorized WIC grocery stores. Stores in Arizona that participate in WIC services sell about $150M in healthy foods to participants each year.  

    WIC is a national nutrition and breastfeeding program that serves low income women, infants, and children and provides nutrition education, breastfeeding information and support, referrals to community services, and healthy foods. The Arizona WIC Program serves more than 160,000 women, infants, and children each month with services provided by 21 local agencies.

    Congratulations to Celia Nabor and her entire team, including the folks in I.T. that made EBT transfer a reality.  From now on all current and future WIC members (and vendors of course) will benefit from the team’s work. Accomplishments like this are the things that make public service jobs so rewarding.

     

    ADHS’ Opioid Surveillance Rulemaking

    The ADHS initiated a rulemaking last week for opioid surveillance and reporting requirements. The draft rules are based on the emergency rules currently in effect.  They plan to host some meetings to solicit input on the draft rules prior to proposing formal rules. They’re also accepting comments through their online portal.

    Will Humble Medicaid, Prevention, Wills Blog

    AzPHA Public Health Policy Update- December 6

    Newborn Screening Policy Success Story

    In 2014 a bipartisan group of AZ lawmakers passed a bill charging the ADHS with expanding their newborn screening program to include newborn pulse oximetry screening in hospitals. The test gives the baby’s doctors quick information about whether the newborn might have a congenital heart abnormality. Quick info like that gives them a chance to do early interventions that can save lives and improve outcomes. The agency and hospitals collaborated to implement the new testing and reporting procedures in 2015.

    A new study this week in the Journal of the American Medical Association found that states that had our kind of congenital heart disease screening program (based on pulse oximetry) had 33% fewer infant deaths from critical congenital heart disease compared to states without screening policies.

    Kudos to our public health partners at the American Heart Association in AZ for raising awareness with our legislators and for that body to recognize and pass this important evidence-based intervention.  This new study demonstrates that it’s saving lives.

     

    Medicaid Work Requirements & 5 Year Limit on Horizon

    An AZ law (from 2015) requires AHCCCS to annually ask the Centers for Medicare and Medicaid Services (CMS) for permission to require work (or work training) and monthly income reporting for “able bodied adults” as well as a 5-year lifetime limit on AHCCCS eligibility. 

    The work requirement and 5 year limit requests that were turned in during the Obama Administration were denied, but the new administrator CMS has publicly said (and written) that she’s receptive to proposals from states to require work or community engagement for people who want to receive Medicaid.

    We’re getting closer to having these requirements become part of AZ’s Medicaid program with a transmission of a concept letter from AHCCCS to CMS about the upcoming 2017 request.

    A few months ago, AHCCCS floated a draft waiver for public comment that outlined the following requirements for “able-bodied adults” receiving Medicaid services:

    • A requirement for all able-bodied adults to become employed or actively seeking employment or attend school or a job training program;
    • A requirement for able-bodied adults to monthly verify compliance with the work requirements and any changes in family income;
    • The authority to ban people from enrollment for 1 year if they fail to report a change in family income or lie about compliance with the work requirements; and
    • Limit lifetime coverage for all “able-bodied” adults to 5 years (except for certain circumstances). 

    Hundreds of comments were turned in urging AHCCCS to change the initial waiver request.  AzPHA submitted a response letter back in February.  Several hundred people and organizations turned also in comments.  

    While AHCCCS hasn’t released the content of their final waiver request, they did issue a letter last week outlining what they intend to include in the Waiver (after considering the public comments).  

    It’s a lengthy letter and I can’t summarize it all here – but interestingly – it includes a wider list of persons that would be exempt from the eligibility restrictions and the 5 year benefit limit (which already included folks with disabilities) including:

    • People over age 55
    • Women for three months after a pregnancy
    • Former foster youth up to age 26
    • People diagnosed with a serious mental illness
    • People receiving temporary or permanent long-term disability benefits
    • Full-time high school students over age 18
    • Full-time college or graduate students
    • Victims of domestic violence
    • Homeless individuals
    • People impacted by a death of family members in their immediate household
    • A parent or caregiver of a child under age 13
    • A caregiver of a family member in the Arizona Long Term Care System
    • People considered medically frail under state law
    • American Indians

    There are other areas covered in the letter that go beyond the requirements of the 2015 law including:

    • Freezing the current base payment rates for community health centers and choosing an alternative inflation factor for future payments; and

    • Limits on paying for emergency medical transportation.

    If some (or all) of the items in the waiver are approved (which appears likely) how AHCCCS implements the reporting requirements, coordinates with other agencies like ADES, and determines compliance with the eligibility requirements will have a profound impact on access to care for this population.

    We’ll continue to track this when the actual waiver request is turned in.

     

    Community Health Worker Training Program Accredited

    The Arizona Community Health Worker Association (AzCHOW) approved Central Arizona College’s CHW curriculum and training program last week, a key milestone toward building a robust CHW workforce in Arizona.

    Their CHW program is approved for 5 years, at which time the program will be reviewed for renewal. The CHW curriculum provides the core competencies and skills students need for employment opportunities. Students are introduced to community and public health topics like chronic disease management, health communication, health literacy, counseling and motivational interviewing, wellness and health advocacy. 

    The program can be completed in 1 year through distance learning and includes a 90- hour internship which can be completed.

    The CHW training program was implemented in August of 2016 and the first cohort of students graduated in August of this year.  The second cohort of students is working towards the CHW certificate, and will graduate in August of 2018. 

    For more information on the Community Health Worker Certificate Program and application form, please visit www.centralaz.edu/CPH or call Kim Bentley at 480-677-7780.  

     

    Tax Bill Could Have Public Health Implications

    The Senate approved their version of tax reform by a 51-49 vote last week. Last month, the House approved their version by a 227-205 vote. In the next couple of months, they’ll resolve differences between the two bills and produce a conference bill.

    The Senate version repeals the individual mandate for people to have health insurance or pay a fine.  The Congressional Budget Office estimates that repealing of the individual mandate could increase the number of uninsured by 4 million by 2019 and 13 million in 2027. They also estimate that the repeal will increase health insurance premiums by 10% per year but also save the federal government $338 billion (e.g. fewer advance premium tax credits).

    The Pay-As-You-Go Act of 2010 (PAYGO) requirement could threaten the Prevention and Public Health Fund and other public health programs. Congress will need to waive the PAYGO requirements separately to prevent these cuts from moving forward. Senator McConnell reportedly assured Senator Collins that the PAYGO waiver will happen, but waiving it will take 60 votes in the Senate.

     

    Affordable Care Act – too big to fail and too big to ignore

    By: Jana Granillo in the November 30, 2017 AZ Capitol Times 

    How does the Affordable Care Act affect me and my community? Well, that is a big question with a big answer. ACA is big, it is more than the marketplace and mandates – which, by the way, is still the law. It is a whole system of care and infrastructure and problem solving intended to make us healthier as a nation.

    When I think of the ACA, what churns to the top of my thoughts are vulnerable populations, my neighbors, my own insurance, and where I live.

    When I hear students playing in the schoolyard, I know many are economically disadvantaged. We have a shockingly large percentage of students on Free and Reduced Lunch. How many of those children are on AHCCCS/Medicaid or participate in the ACA Marketplace?

    When I commute, I drive by community health centers, also known as Federally Qualified Health Centers. ACA funding impacts these clinics.

    When I grocery shop, I see seniors counting their pennies with clipped coupons. Which seniors will endure a fall or become victim to MRSA, a staph infection?  How many of them are Medicare and Medicaid dual eligible?

    When I hear a first-responder siren, I think about behavioral health.  According a recent report on the opioid crisis, my community is on a data map and it is colored red. Does the siren tell of another victim? Does that victim have behavioral health options or even a treatment bed for evaluation?

    When I choose doctors, I wonder if they were part of the National Service Corp.

    What about treatment options? Is there a new medication on the horizon for a chronic condition or disease by the National Institute of Health? Will my elderly relative have to travel to Phoenix to get treatment that is not available in the rural areas?

    Will the county hospital financially be in the “green” this year or do we take a hit on our property taxes to support the district? Will they receive Disproportionate Share Payments  for serving the underserved? What funding will be available?

    What about all those medically served by the fire department, especially those who don’t have a point of care – who pays for that?

    Finally, I ponder, will our family (employer) insurance be there tomorrow? I can’t afford a premium without help.

    So, does ACA affect me, my family and my community? Answer: BIG yes!

    How do we go forward? The answer is to include experts from multiple health disciplines to define reform around a common goal: affordable quality health care systems that are responsible, provide short-term stabilization and long-term solutions that protect all us.

    — Jana Lynn Granillo is a AZPHA member and community health

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