Will Humble Assurance & Licensure, Wills Blog

ADHS’ Regulation of Nursing Homes Shows Some Improvement After Years of Scandal

Arizona Department of Health Services Long Term Care Facility Regulation Follow-up Report

A September 2019 Arizona Auditor General Report found ADHS hadn’t been investigating (or not timely investigating) long-term care facility complaints. The Auditor General made 5 recommendations to the Department. ADHS (Colby Bower) replied to the Auditor’s report by disputing most of the findings rather than admitting to the shortcomings and committing to make changes.

Because the Christ-era Department disputed the 2019 findings and made no effort to correct the deficiencies- it comes as no surprise that the Auditor General’s May 2022 30-month follow-up found ADHS had not implemented any of the recommendations.

The Auditors found additional significant complaint-prioritization and investigation failures, including inappropriately closing most high-priority complaints without a required on-site investigation.

The Auditors read ADHS the Riot Act in the May 2022 report and made 4 additional recommendations in our 30-month follow-up report. Perhaps the most shocking findings were:

Between 7/1/19 and 4/21/21 ADHS (under the leadership of former Director Christ and Assistant Director Colby Bower) lowered the priority level of 98% of their open high priority complaints, giving them months more time to investigate and giving the appearance they were making improvements. ADHS leadership then CLOSED 79% of those former high priority complaints without ever doing an investigation.

See Auditor General’s Office Produces Scathing Review of ADHS’ Nursing Home Complaint Investigations During the Director Christ Era

AZ Failed to Properly Investigate Nursing Home Complaints, Report Says

Last week the Auditor General released a newer update… a 36-month review of the 2019 initial report. Last week’s review is the first follow-up report examining ADHS’ actions after Cara Christ &  Colby Bower left the agency for Blue Cross Blue Shield of AZ.

Good news this time. The auditors found ADHS had begun making progress correcting the earlier egregious findings. It’s clear that under the new leadership (after Christ/Bower left) ADHS had internally conceded there were large shortcomings in their performance and they began to make positive changes.

Arizona Department of Health Services Long Term Care 36-month Review (azauditor.gov)

The attitude that things need to change began in late 2022 as shown by the fact that the Auditors found ADHS had begun implementing 6 of the Auditor’s 9 recommendations. Importantly, the agency did not dispute the findings as they had done during Director Christ’s tenure.

Tom Salow, new chief of the Licensing Division, posted a blog last week that reflects the new attitude at the Agency committing to fix their problems rather than sweeping them under the rug as had occurred during the previous administration.

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

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

I was able to attend a stakeholder meeting last week at ADHS and was impressed with the candor the team spoke with as they admitted that the findings of the 30-months follow up were a ‘wake up call’.

The problems and staffing shortages that are a legacy of decisions made during the Ducey Administration didn’t develop overnight – and fixing the damage won’t be immediate, but I’m finally confident they are honestly working to correct the disturbing findings in the 2019 and 2022 Audit reports.

See: Report: Arizona Health Department may still put seniors at risk (azcentral.com)

Will Humble State Legislature, Wills Blog

Chad Campbell Tapped as Hobbs’ New Chief of Staff

Former Democratic lawmaker Chad Campbell will begin his job as Governor Hobbs’ chief of staff tomorrow. The move came as no surprise. Pretty much everybody expected Campbell to be asked to serve in the post – in large part because he brings precisely the right skill set to the job – and has the right personality for the post.

Campbell served four terms in the House from 2007 to 2014, including two terms as minority leader. After that he was at Strategies 360 and then Lumen Strategies (both consulting companies).

He has a reputation of working well with both Republicans and Democrats and has a no-nonsense style that many politicians – and agency directors – will appreciate. He was a key reason why Governor Brewer was able to get the deal to restore and expand AHCCCS back in the day.

Good call

Will Humble Air Quality, Climate Change, Wills Blog

AzPHA Urges Corporation Commission to Deny APS’ 13.6% Rate Increase: Proposal Doubles Down on Coal

Arizona Public Service has filed for a rate increase with the Arizona Corporation Commission that would result in an annual net rate increase of $460 million, which would result in a net 13.6% bill increase for ratepayers. APS is asking captive ratepayers to pay for the continued operation of their Four Corners and Cholla coal-fired plants through 2031. The also have removed their original plan to have the Four Corners plan go seasonal starting this year.

For these reasons and others, AzPHA submitted the letter below to the Commission urging them to oppose the rate request and urge the utility to return to the Commission with a request that includes more investment in renewable sources and energy efficiency and relies less on coal.

See AzPHA’s APS Rate Increase Opposition Letter

The Commission is having a Public Comment session on June 7 from 6 – 8:30pm.  To attend in person, go to 1200 West Washington Street, Phoenix, Arizona 85007 and enter from the back or north side of the building. You will need to go through security to enter. To speak in person, either complete a “Request to Speak” form on one of the kiosks in the lobby at the ACC or fill out a paper slip or use your computer or mobile device ahead of time and request to speak via the ACC Portal here https://efiling.azcc.gov/cases. To provide telephonic comments, phone 1-877-309-3457, then enter the passcode 801972877#.

SUBMIT WRITTEN COMMENTS TO THE DOCKET

To submit a public comment, go to https://efiling.azcc.gov/cases, Click on “Make A Public Comment in a Docket.” Complete your information and click “Submit.”  Be sure to include the docket number at the top of your comments – Docket NumberE-01345A-22-0144

Action kit for APS Rate Case 2023

____________

May 31, 2023

RE: APS 13.6% Rate Increase Request: Docket E-01345A-22-0144

Dear Commissioners,

The Arizona Public Health Association respectfully urges the Arizona Corporation Commission to deny Arizona Public Services’ $460M rate increase – which would result in a net 13.6% bill increase for ratepayers. As an alternative, we request you urge the utility to return to the Commission with a request that includes more investment in renewable sources and energy efficiency and relies less on coal.

AZPHA understands that public utilities like APS have capital needs and variable costs that periodically require rate increases to ensure a reliable supply of energy and meet anticipated peak demands. However, we believe this request (Docket E-01345A-22-0144) is unreasonable and excessive as it focuses investments on expensive energy sources (coal) rather than cheaper and cleaner renewable sources and underleverages energy efficiency.

If implemented as requested, this rate increase would pose an avoidable burden on vulnerable and low-income Arizonans. Why do I use the word avoidable? Because with better planning, the utility could acquire cleaner energy sources with lower operating costs that would moderate this excessive rate increase request.

For example, APS’ request rests on an existing strategy to continue operation of their outdated coal-fired power plants, even though those plants are no longer economical to operate and are more costly than clean energy alternatives.

Since the last rate case, APS has spent hundreds of millions of dollars in capital expenses and operations and maintenance costs at the coal fired Four Corners Generating Station and Cholla Power Plant. The rate increase before you rest on APS’ plan to spend hundreds of millions more to keep Four Corners operating until 2031. We think this is short-sighted and harmful to Ratepayers.

If APS were asking Ratepayers for an increase to cover capital costs to increase renewable capacity (solar) while quickly phasing out coal, we could understand the Commission’s decision to approve the rate increase. However, that is not the request before you.

This request doubles down on inefficient and expensive energy production by continuing to run the costly (and dirty) Four Corners and Cholla Power Plants through 2031 while under-investing in renewable sources and energy efficiency.

APS could save ratepayers money, reduce pollution, and moderate their rate increase request by retiring the Four Corners Power Plant before 2031 and replacing it with lower-cost renewable energy. At a minimum, their plan should have switched Four Corners to seasonal operations this year as originally planned.

In addition to over-committing to coal sources (rather than less expensive renewable sources of energy), APS’ request fails to increase resources to incentivize energy efficiency – the lowest cost energy option for meeting peak demands.

APS’ rate increase should have included increased investments in energy efficiency, which can reduce customer bills. Investing in energy efficiency helps keep electric bills lower and as noted above can lower energy burden on those with low incomes. Investments

in efficiency result in all electricity customers paying less than it would cost to generate that same power from more expensive alternatives.

In short, we understand that utilities like APS require periodic rate increases to plan for growth, meet customer needs, and accommodate peak loads. However, we believe the request (as submitted) focuses too much of APS’ resources on expensive energy sources (coal) rather than pressing forward with cheaper renewable sources and leveraging energy efficiency – strategies that are better mid-term approaches to serving and protecting Ratepayers.

As a final note, we commend APS for including $10M/year in coal community transition funding (over 9 years) for communities that would be impacted by their belated plan to close coal-fired plants in 2031. A final proposal should accelerate the use of those funds over a shorter time period to accommodate a more rapid decommission of those plants.

Sincerely,

Will Humble, MPH

Executive Director, Arizona Public Health Association

Will Humble Behavioral Health, Wills Blog

How Does ADHS Regulate Sober Living and Residential Behavioral Health Facilities

How ADHS regulates sober living homes and behavioral health residential facilities

In Part 1 of ADHS’ Licensing blog series, they covered what a sober living home (SLH) actually is and  explained other types of homes that are often confused for sober living homes, including behavioral health residential facilities (BHRF), which are also licensed by the Arizona Department of Health Services (ADHS).

This week ADHS posted more information about ADHS’ role in regulating homes that require licensure as a sober living home or behavioral health residential facility.

They also posted a  fact sheet to help clarify some of these differences. See How ADHS regulates sober living homes and behavioral health residential facilities.

Will Humble Climate Change, Wills Blog

Arizona & the Bipartisan Infrastructure Investment and Jobs Act

Back in November 2021 congress passed and the president signed a $1.2 trillion spending bill called the Infrastructure Investment and Jobs Act. You might know it better as the bipartisan infrastructure bill.

Over the next several years Arizona is set to receive billions of dollars for infrastructure development including projects that address energy efficiency, electric grid improvements, broadband expansion, workforce development and more.

The funding presents an opportunity for Arizona to work with communities in all corners of the state to continue ensuring resiliency in the state’s economy, improve energy efficiency and convert to carbon free energy sources.

Arizona began implementing the Act during the previous administration with the establishment of the Infrastructure Investment and Jobs Act (IIJA) Task Force.

The Task Force is made up of state agency directors or their staff, tribe leadership and subject-matter experts. Their direction is to maximize the opportunity for Arizona communities to receive discretionary grant funding for Arizona infrastructure projects.

Areas of focus include:

  • Broadband
  • Infrastructure Workforce Development
  • Cybersecurity
  • Healthy Forests
  • Energy 
  • Water

The infrastructure law funding is distributed very differently than the American Rescue Plan Act. Under ARPA, governors were given wide latitude to decide where ARPA funds should be allocated. By contrast, the infrastructure act is far more board based, competitive and governors aren’t the decision-maker in terms of cutting checks.

Rather than making funding decisions, the IIJA Task Force is charged with writing letters of support, helping search for grant opportunities, technical assistance with grant criteria and helping with grant writing and data collection.

The Task Force also tracks progress and performance of grant applications of Arizona IIJA funding opportunities (which run through 2026).

The IIJA Task Force has a program manager (Cindi Ptak). The Task Force has representatives from several entities (many of which have had senior leadership changes in the last few months):

  • Governor’s Office
  • ADOT
  • ADEQ
  • ADWR
  • Water Infrastructure Finance Authority
  • ADES
  • Department of Forestry and Fire Management
  • ADOA
  • Arizona Commerce Authority
  • Governor’s Office of Homeland Security
  • ADoH
  • Governor’s Tribal Liaison

I can’t find any minutes of meetings that the Task Force may have had nor do I see a schedule of future meetings. Perhaps once the legislative session ends the Task Force will meet and the executive director will provide more information about the IIJA Task Force. Here is the website for the IIJA Task Force (which is pretty primitive still): IIJA Task Force — Information and Resources

You can track federal spending in Arizona through USAspending.gov

Here’s a good map out of the Bipartisan Infrastructure Law (BIL) Maps Dashboard and state-by-state fact sheets: FACT SHEET: White House Highlights Infrastructure Progress in Every Corner of the Country, Updates State-by-State Fact Sheets

Here are the climate, clean energy, and electric vehicle projects with direct Arizona links that have been funded so far via the Bipartisan Infrastructure Bill: Bipartisan Infrastructure Bill Impacts in AZ through May 5 2023

Will Humble Early Childhood, Wills Blog

Social Media & Public Health

Message from the Surgeon General: Social Media and Youth Mental Health

The US Surgeon General came out with a report this week outlining several categories including:

  • Negative impacts on kids
  • Social media can expose children to content that presents risks of harm
  • Social media use can be excessive and problematic for some children

The report offers some interventions described as “A Way Forward” outlining some actions that can be taken to make social media safer and healthier for youth (and includes a bibliography of references).

For example:

  • Policymakers can take steps to strengthen safety standards and limit access in ways that make social media safer for children of all ages, better protect children’s privacy, support digital and media literacy, and fund additional research.
  • Technology companies can better and more transparently assess the impact of their products on children, share data with independent researchers to increase our collective understanding of the impacts, make design and development decisions that prioritize safety and health.
  • Parents and caregivers can make plans in their households such as establishing tech-free Zones that help protect sleep and better foster in-person relationships, teach children and adolescents about responsible online behavior, and model that behavior, and report problematic content and activity.
  • Children and adolescents can adopt healthy practices like limiting time on platforms, blocking unwanted content, being careful about sharing personal information, and reaching out if they or a friend need help or see harassment or abuse on the platforms.
  • Researchers can further prioritize social media and youth mental health research that can support the establishment of standards and evaluation of best practices to support children’s health.

It would certainly be nice if the harmful effects of exposure to social media lends itself to simple and effective interventions. Sadly, that is not the case – and as the full report points out – there’s no simple intervention that’s easy to implement fore this public health problem.

Will Humble State Legislature, Wills Blog

Legislative Week in Review

Allie Bones – Governor Hobbs’ Chief of Staff since she took office resigned last week. The governor is expected to name her next chief of staff after the long holiday weekend. Look for Chad Campbell to be the new chief – that’s just a hunch – I don’t have any inside info.

Republican leaders of the House and Senate Health Committees (Shope, Montenegro) convened a two-day forum of a “Novel Coronavirus Southwestern Intergovernmental Committee. I went to the first couple of hours on the first day and quickly discovered that it’s a poor use of my time, so I left. I’ll spare you the details, but if you want to know more read this: Senate COVID hearing light on facts, heavy on misinformation.

The Governor signed nine bills last week including a continuation of AHCCCS and a new database of health professionals who’ve had their licenses revoked. She vetoed 22 bills – including limits on the use of student pronouns, a higher bar to get  unemployment benefits, bad changes to elections procedures, and SB1234, which would have forbid the use of any photo enforcement of traffic laws throughout the state -including photo red lights.

Governor Hobbs has signed 160 new laws and vetoed 94.

The House and Senate are still adjourned for two more weeks. The only thing scheduled next week is a Director Nominations Committee meeting for Martin Quezada for the Registrar of Contractors  Wednesday.

Will Humble Professional Development, Wills Blog

Maricopa County Public Health COVID-19 Video

On January 26, 2020, Maricopa County confirmed its first case of COVID-19. Within weeks, it was a public health emergency. This video tells the story of the county’s response over the first 2 years.  Four million people in an area nearly the size of Vermont. 

The Maricopa County Communications Office brings you news, insight, and curiosities from the heart of Phoenix and the 9,200+ square miles encompassing it. This is what is happening in your County, right here on YouTube: https://www.youtube.com/watch?v=TrWnrae_yUA&feature=youtu.be

Will Humble Firearm Safety, Public Health, Wills Blog

AzPHA’s Firearm Violence Report Featured in “The Nation’s Health”

AzPHA’s landmark report of firearm violence epidemiology and intervention evidence review is featured in the June edition of the American Public Health Association’s monthly newspaper The Nations Health

The article discusses how the AzPHA Board of Directors identified firearm violence as a top priority and how our affiliate followed through by publishing our comprehensive report.

The piece does a nice job answering ‘why’ we felt compelled to write the report and our hope that the work will translate into policy action by implementing some evidence-based foundational laws that have been proven to reduce firearm injury and mortality.

Any good policy intervention starts with surveillance and an evidence review, and we decided to do that…   to fill that gap. Any good Affiliate should think of themselves as a conduit for policy change and face the kinds of issues where there is resistance at the state level in terms of the governor.

Also from the article: ‘Making the report a reality was no easy task. The public health impact of firearm violence was not a priority for state agencies during the administration of former Arizona Governor Doug Ducey. A lack of buy in at the state level kept the health department from leading on gun violence prevention, but as a nonprofit organization, AZPHA is able to advocate for causes that might challenge the direction taken by state agencies.’

See the full article in The Nation’s Health: June 2023

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