Will Humble Professional Development, Wills Blog

8th Annual Rural Women’s Health Symposium! August 17 & 18: Prescott Resort and Conference Center

This year’s theme for the 8th Annual Rural Women’s Health Symposium is Supporting Rural Communities: Resilient & Refocused.

Rural communities have faced many challenges in the past few years. The Symposium hopes to strengthen your efforts by bringing people back together in person and focusing on supporting rural communities to overcome these hardships. The goal is to explore ways we can support providers, healthcare workers, and community members in serving rural women. The Symposium is a chance to learn from each other and share best practices as leaders, advocates, and experienced community members.

More information and registration here: 2023 Rural Women’s Health Symposium – AACHC
Will Humble Behavioral Health, Wills Blog

New Opportunities for Schools to Provide Behavioral Health & Other Services

Schools have been able to bill AHCCCS for medically necessary services they provide in schools if the child is a Medicaid member, and the services are included in the kid’s individualized education plan or IEP. IEPs are a set of goals and expectations that are individually developed for kids in schools.

A couple of years ago AHCCCS developed a State Plan Amendment that would allow schools more flexibility and dropped the requirement that kids have an IEP or 504 plan.

An 504 plan allows the school to give accommodation to students who may have a disability affecting their learning. It’s unlike an IEP because you can have any disability. In order to have an IEP, students need to qualify for the services under specific categories.

 

Under the new rules, services can be documented in “… any other documented individualized health or behavioral health plan or as otherwise determined medically necessary.”

See the State Plan Amendment

The new State Plan Amendment is a potential game-changer for schools that want to augment the behavioral health (or other services) they want to provide for their students. The services can be provided to any student that’s an AHCCCS member – even if they don’t have an IEP… opening up possibilities to meet behavioral health needs of students even if they don’t have a disability.

The list of potentially covered services are:

  1. Speech-Language Pathology Services
  2. Occupational Therapy Services
  3. Physical Therapy Services
  4. Nursing Services
  5. Specialized Transportation Services
  6. Behavioral Health Services
  7. Personal Care Services
  8. Audiology Services
  9. Physician Services
  10. Nurse Practitioner Services

To get reimbursed the school provides need to meet AHCCCS’ service definitions and at document the ‘other documented individualized health or behavioral health plan’.

Schools are reimbursed the lesser of AHCCCS’ fee-for-service schedule or the amount billed by the school minus an AHCCCS administrative fee. 

I’m not sure how many schools are taking advantage of the new flexibilities built into the new State Plan Amendment provisions. I’ve pitched the idea of doing a story to a couple journalists- so we’ll see if anybody follows up and sheds some light on this.

I don’t expect Superintendent of Public Instruction Tom Horne to pay any attention to this or to encourage public schools to participate. Let’s just say he has other priorities like eliminating nonexistant critical race theory, encouraging even more participation in the private and homeschool voucher program and ‘classroom discipline’.

Arizona Medicaid School Based Claims FAQs
Will Humble Maternal Health, Reproductive Health, Wills Blog

FDA Approves First Nonprescription Daily Oral Contraceptive

Last week the AZ Board of Pharmacy’s rules allowing Pharmacists to Dispense Contraceptives w/o a Physician Prescription became effective. This week brought a potentially bigger change- FDA’s approval of Opill (norgestrel) – a tablet for nonprescription use to prevent pregnancy. This is the first time FDA has approved a daily oral contraceptive approved for use without a prescription.

Approval of this progestin-only oral contraceptive pill supplies a choice for consumers to buy oral contraceptive medicine without a prescription at drug stores, convenience stores and grocery stores, as well as online.  

From the FDA’s Decision Memo: The potential benefits of an increase in the ability for consumers to prevent unintended pregnancy (with its attendant medical, economic, and societal harms) outweigh the potential risks of the product in the nonprescription setting.

The manufacturer hasn’t identified a launch price – and how big of a deal this is will in large part be tied to the price consumers would pay over the counter for the product.

Decision Memo

Opill Consumer Information

Will Humble Climate Change, Wills Blog

Arizona Joins US Climate Alliance

Governor Hobbs has used her authority as Governor to join the U.S. Climate Alliance. The Alliance is a bipartisan coalition of governors committed to reducing greenhouse gas emissions consistent with the goals of the Paris Agreement. Smart, coordinated state action can ensure that the United States continues to contribute to the global effort to address climate change. 

US Climate Alliance Fact Sheet

Each member state, including Arizona has to commit to:

  • Reduce collective net greenhouse gas emissions 26% by 2025 and 50% by 2030 and achieve overall net-zero GHG emissions by 2050.
  • Accelerating new and existing policies to reduce greenhouse gas pollution, building resilience to the impacts of climate change, and promoting clean energy deployment at the state and federal level.
  • Centering equity, environmental justice, and a just economic transition in their efforts to achieve their climate goals and create high-quality jobs.
  • Tracking and reporting progress to the global community in proper settings, including when the world meets to take stock of the Paris Agreement.
Will Humble Disease Control, Wills Blog

Did the SARS CoV2 Virus Have a Natural or Laboratory Origin? Here’s What the ‘Intelligence Community’ Says:

The COVID-19 Origin Act of 2023 told the U.S. Intelligence Community to declassify information relating to potential links between the Wuhan Institute of Virology and the origin of the COVID-19 pandemic. A summary of that information was recently released by the US government. It came from the Intelligence Community rather than scientists…  so take that into consideration as you read the report.

Report on Potential Links Between the Wuhan Institute of Virology-& COVID-19

There are several sources of Intelligence in the report including the FBI, CIA and many others. Each agency takes a different take on the origins of the COVID-19 pandemic. Those differences “… stem from differences in how agencies weigh intelligence reporting, scientific publications, intelligence and data gaps.”  

The FBI & the Department of Energy think the virus originated via a laboratory-associated incident. The National Intelligence Council and four other intelligence agencies think SARS-CoV-2 was most likely caused by natural exposure to an infected animal.

The CIA was “… unable to determine the precise origin of the COVID-19 pandemic, as both hypotheses rely on significant assumptions or face challenges with conflicting reporting”.

Almost all the intelligence agencies assessed that SARS-CoV-2 was not genetically engineered and that “… both a natural and laboratory-associated origin remain plausible hypotheses to explain the first human infection”.

We’ll probably never really find out the real answer as to the origin of the virus in part because the Chinese Government has been unwilling to fully cooperate with a full investigation of the origin of the virus.

Will Humble Public Health, Wills Blog

AZ Public Health Journalism this Week:

Raising Phoenix: Mind Games – PHOENIX magazine

Antibiotic shortages expected to worsen syphilis epidemic – NYT –

Arizona joins US Climate Alliance after lull in climate efforts (azcentral.com)

Peer-to-peer program supports Arizona teens after suicide attempts (azcentral.com)

Launch of community health worker training program – Arizona PBS (azpbs.org)

Media’s right to private records – Arizona PBS (azpbs.org)

Will Humble Professional Development, Public Health, Wills Blog

Consider Your Public Health Wins

Kelli Donley Williams – AZPHA President

I had the opportunity to sit down with AzPHA member Gordon Jensen and board member Dr. Kara Geren for coffee recently. We came together to discuss AzPHA’s priority in improving firearm safety statewide. While we visited and shared our interest in the work, we also shared the reality that working in public health can often feel thankless. We batted around small wins over the years and how to be personally satisfied with this field, you have to have the ability to celebrate the small joys and recognize when they become big wins.  

Gordon shared with us a quote from Dan Gross, President of the Brady Campaign to Prevent Gun Violence, which ran in “The Nation’s Health in May 2015: “Our goal is not to ban guns any more than the goal of automobile safety is to ban cars. It’s simply to make the products as safe as possible and keep them out of the hands of the wrong people.”  

This comparison brought the three of us to discussing ashtrays as a standard feature in American-made vehicles. We laughed realizing ashtrays in cars are longer the norm. There wasn’t a parade for this design update, or likely even a press release. But it came after decades of public health officials crying for national changes to discourage tobacco use. Think of the countless community coalitions, neighborhood groups, voters, and more who came together to say smoking is a smelly, puking habit.*   

This isn’t a small joy, but a huge win. If you want to smoke in your car today, it is nowhere near as convenient as it once was.  

Whether you’re early in your career in public health, looking at retirement, or like me and somewhere in between, I hope you’ll take a moment to consider your public health wins. You are part of a bigger whole working every day to make our communities stronger, healthier, and better places to live. We’re going to keep banging on the drum and working to build new partnerships to come up with solutions. It may feel thankless somedays, but I’m grateful you’re here.  

*High fives to all Arizona kids who saw these commercials in junior high like I did and immediately swore off ever trying cigarettes. And higher fives to those at ADHS who made that statewide campaign a reality, hopefully forever reducing tobacco rates in Arizona.

Will Humble Community Health Workers, Wills Blog

Community Health Workers now Being Reimbursed via AHCCCS

Certified Community Health Workers & employed by AHCCCS registered providers can now bill for reimbursable services! Claims for covered services provided by the certified CHW or CHR need to be given by the registered AHCCCS provider. A CHW or CHR can be employed by multiple AHCCCS registered providers. AHCCCS registered providers may employ multiple CHWs or CHRs.

In order to obtain Medicaid reimbursement, the CHW needs to be certified by ADHS and may only deliver covered services within their scope of practice under specified AHCCCS registered provider types.

These provider types are listed in question 8 of the CHW/CHR Frequently Asked Questions.

The employer may only submit claims using the allowed codes for the covered services provided by its CHWs or CHRs. Additional billing guidance will be added to the AHCCCS Fee-for-Service Provider Billing Manual.

Answers to Key Questions about Integrating CHWs into the Network of Care

  • How does a CHW/CHR obtain voluntary certification?
  • What provider types can bill for CHW/CHR services?
  • How does a CHW/CHR organization become an AHCCCS-registered provider?
  • How does an employer bill for CHW/CHR services? If I have additional questions about Medicaid reimbursement for CHW/CHRs, who should I contact?
Will Humble Social Determinants, Wills Blog

Community Cares Can Help You Address the Social Determinants of Health

Contexture (Arizona’s health information exchange) is collaborating with AHCCCS and Solari Crisis & Human Services to implement a single, statewide referral system called CommunityCares with the goal of helping to address social determinants of health needs in Arizona.

CommunityCares – Contexture

The flagship product of the CommunityCares initiative is a new technology platform that connects healthcare and community service providers, streamlines the referral process, and provides easier access to vital services. The tool even confirms when social services are actually delivered.

Partners in the network are securely connected through their “Unite Us” shared software.

Joining the network is free for community-based organizations and many organizations who are considered part of the safety net, like community health centers, tribal clinics, and mental health centers.

Using CommunityCares e-tool, community partners can build a coordinated care network, track outcomes, & find service gaps while empowering members to take ownership of their own health.

Once a network partner identifies a person’s social needs, they can send a secure electronic referral to a network partner for the needed service. Partners involved in that person’s care will have visibility into whether or not the referral is accepted and once accepted, whether or not that person received the services and what happened as a result.’

Unite Us (the technical partner) onboards and trains all partners who use the platform to ensure consistency, compliance, and accountability to the network.

Schedule a Demo with Contexture

Network partners may include community-based organizations, safety net health care providers, health systems, insurers, and other groups looking to better support people to achieve healthy outcomes. Network partners can choose to take part in whatever way works best for them and can change how they take part in the network over time.

  • Unite Us builds HIPAA, SAMHSA, 42 CFR Part 2, and FERPA-compliant networks in which proper viewing permissions are assigned for sensitive classes of information.
  • All network information is dually protected by secure technology and user procedures. The network is routinely audited for digital security.
  • Consent is needed from every person who has a client record in the network before information is shared.
There are financial incentives to participate
Milestone 1 – $2,000
Sign Access Agreement, go live on the system and opt-in to receive referrals for at least one service. User login and training required.
Milestone 2: – $3,000
Respond to 75% of referrals within two business days for six total months.
Milestone 3 – $5,000
Respond to 75% of referrals within two business days for 12 total months.

If this sounds like it’s something you or the partners you work with could benefit from visit the website at Community Cares. 

Will Humble Climate Change, Injury Prevention, Public Health, Wills Blog

Maricopa County Heat Surveillance Report: Persons Experiencing Homelessness, Men without a College Education at Highest Risk for Heat Exposure Death

This week is shaping up to set a record for the most number of consecutive days with temperatures over 110F. The lower Sonoran desert temps are forecast to be in the 112-117 range each day this week, and the National Weather Service believes there’s a 10% chance we could have multiple days over 120F mid-week.

See the Area Forecast Discussion from the National Weather Service 

Environmental heat is by far the deadliest weather phenomena with far more mortality than floods, cold, and lightning combined. It’s not even close.  As one of the hottest places on Earth, our Arizona deserts are among the more lethal places weatherwise.

As part of their efforts to mitigate bad outcomes from heat exposure, the Maricopa County Department of Public Health has been conducting public health surveillance to inform policy interventions at the county and city level.

MCDPH published their newest report last month which had some important findings:

View Maricopa County Public Health’s Environmental Heat Mortality Surveillance Report 
  • 425 heat-associated deaths occurred during 2022 in Maricopa County, a 25% increase from 2021.
  • Individuals experiencing homelessness make up the largest proportion of heat-associated deaths in 2022. Among deaths where the living situation is known, people experiencing homelessness are accounting for an increasingly large share of all heat-associated deaths in recent years.
  • Maricopa County found 283 deaths involving substance use, representing over 2/3 of all heat-associated deaths recorded in 2022. Note: Methamphetamine was involved in 90% of heat-associated deaths involving drug use. Methamphetamine was a contributing factor or main cause of death in 53% of all heat-associated deaths.
  • Fifty-eight percent (58%) of all heat-associated deaths occur in July. 
  • Males accounted for more than 80% of heat-associated deaths in 2022. Two-thirds (66%) of all heat-associated deaths occurred among individuals aged 50 years or older.
  • 60% of heat-associated deaths occurred among non-Hispanic White individuals, however African Americans (7.4%) and American Indians (3.6%) are overrepresented among heat deaths.
  • More than 66% of adult decedents did not attend any post-secondary schooling, among all heat-associated deaths with known educational background. Note: Perhaps this is a marker for people with outdoor occupations and those experiencing homelessness.
  • The majority of outdoor heat-associated deaths occurred in an Urban Area in 2022. 70% of outdoor heat deaths and over half of all overall heat-associated deaths occurred in an Urban Area within Maricopa County throughout the year.
  • All indoor heat-associated deaths in 2022 occurred in uncooled environments.  Among indoor deaths where an AC unit was present, the unit was non-functioning in 78% of cases. In 2022, 42% of indoor deaths were among females, despite females making up less than 20% of the overall heat deaths for the year.

View Maricopa County Public Health’s Environmental Heat Mortality Surveillance Report 

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