State Legislature Off to a Slow Start

By late January the state legislature is usually in full swing with jam packed committee agendas and a bewildering number of bills to go through. That’s not the case this year. House and Senate Health Committee meetings have been routinely canceled or not scheduled at all – and committee agendas are pretty light with just a few bills.

Maybe that’s because about half of the state legislature is new this year and members are still getting their sea legs. I’m not sure. 

Anyway – that’s good for at least right now, because we’re busy getting ready for our annual conference on February 23. We’re just about to get our agenda set and expect to announce that early next week. 

The Senate Health committee is scheduled to meet on Tuesdays from 2-4pm…  but Senate Health isn’t meeting this week. House Health is scheduled for Mondays from 2-4pm. They are meeting this week, but it’s a pretty light agenda.

I expect most of the action in House Health to be about HB2284; homelessness; housing; facilities. That bill would dictate how the Arizona Department of Housing should allocate funds for individuals experiencing homelessness. The drama is all about the details. 

It would require ADOH to use the money for parking areas that have access to potable water, electric outlets and bathrooms sufficient to serve that parking area and camping facilities. 

Importantly, it requires ADOH to spend money on those things before spending monies on permanent housing for individuals experiencing homelessness. It also prohibits people experiencing homelessness from camping and storing personal property anywhere except those designated areas. Here’s a more detailed review of the bill from Leg Council: HB2284 Discussion

It took us awhile to take a position on the bill because there are lots of pieces to it and it’s a bit out of my wheelhouse. A few of our Public Health Policy Committee members did some research and determined that the bill, as is, would do more harm than good – and we’ve signed up in opposition to the bill (although I don’t plan on speaking in Committee about it tomorrow).

The other bill we’re tracking with action so far is HB2001, which would exempt ADHS from the Administrative Procedures Act (that law provides the requirements for agency rulemakings). ADHS would be exempt only if the proposed rules reduce a regulatory burden without jeopardizing health and safety and don’t increase costs to the persons regulated. The public would have a minimum of 15 days to comment on the rules.

That bill passed through the House Health Committee 9-0. We signed up neutral on that bill. While I trust that Director Cullen will use the additional authority wisely and for good public health purposes, I’d like to see the exemption time limited to ensure that a future administration doesn’t use that authority to dismantle health and safety regulations at the Department. Hopefully that bill will be amended to limit it to just 3 years or something like that.

Here’s our bill tracking spreadsheet thus far. This list will grow substantially as the legislative session progresses.

Register Today: The Hertel Report 2023 Winter State of the State

Register Today: https://www.thehertelreport.com/product/2023-winter-state-of-the-state/

AZPHA Members Use Coupon Code AZPHA2023 for $15 Off at Checkout

2023 WINTER STATE OF THE STATE

Arizona healthcare leaders provide fresh insight and trends impacting our local managed care industry. Stakeholders and guest speakers from across the healthcare continuum will add to the conversation.

Register Here https://www.thehertelreport.com/product/2023-winter-state-of-the-state/

GUEST SPEAKERS

  • Dr. Charlton Wilson
  • Mark Stephan, MD & Seth Dubry, MD
  • Equality Health
  • Paul Rose
  • Chief Executive Officer of Western Asset Protection

Substantial Advancements in Addressing the Social Determinants of Health are Hallmarks of Governor Hobbs’ Budget

Governor Hobbs Releases 2023-24 Budget Proposal 

Governor Hobbs released her proposed budget last Friday. It reflects a governor who is committed to improve the social determinants of health and assist families. The budget makes critical investments to protect the health and wellness of all Arizonans. 

  • $463M and $115M in federal fund expenditure authority to utilize year three of federal funding given directly to AHCCCS and DES respectively for home and community-based services programs
  • $257M for AHCCCS program caseload growth and unwinding of federal Covid-19 policies
  • $150M deposit into the Housing Trust Fund to assist families and individuals who are currently or at risk of becoming unhoused
  • $50M General Fund set-aside for a refundable child tax credit for low-income families beginning tax year 2023
  • $24M to make feminine hygiene products tax exempt
  • $20M to expand the income eligibility cutoff for the KidsCare program from 200 percent of the federal poverty level to 300 percent of the federal poverty level
  • $16M to make permanent a sales tax exemption for infant diapers
  • $9.7M to address an Arizona State Hospital staffing shortfall
  • $11M to fully fund the adoption subsidy for adoptive parents, backfill federal funding, and implement the Positive Parenting Program
  • $6.1M in ongoing funding to augment existing Title X family planning dollars to provide expanded family planning services to low-income women, doubling the current amount provided to women in Arizona
  • $14M to reduce caseloads for Adult Protective Services
  • $4.4M to make permanent federal funds to increase Arizona Early Intervention Program (AzEIP) Provider Rates
  • $2.5M to expand the Healthy Families AZ program for voluntary home-visits to families that are at high risk of abuse or neglect, adding capacity for additional 300 families
  • $2.7M for Medicaid enterprise system modernization
  • $200,000 in ongoing funding for pregnancy services that are inclusive of all options and support personal choice

Of course, a budget proposal is just that, a proposal. The ultimate result will come later this spring after negotiations with the state legislature… but it certainly is nice to have an executive proposal that prioritizes evidence-based strategies to improving the health status of ordinary Arizonans.

AHCCCS Eligibility Redeterminations Start April 1; 25% (600K) of Currently Enrolled AHCCCS Members May Lose Eligibility 

The big federal omnibus bill signed by President Biden last week directs states to begin their Medicaid redetermination efforts starting on April 1, 2023. AHCCCS thinks about 600,000 of the 2.5 million currently enrolled AHCCCS members may lose eligibility over the coming year once redetermination happens.

The federal government gave states an extra 6.2% in federal contribution toward a state’s Medicaid costs in exchange for not disenroll people from Medicaid during the public health emergency. The omnibus bill phases out the 6.2% enhanced federal match. Beginning on April 1, the enhanced match will drop 5% and continue to drop each quarter until the enhanced match is eliminated on Jan. 1, 2024.

The bill didn’t end the public health emergency (in fact HHS just extended it until August 2023) but redetermination will now begin on April 1 rather than when the emergency expires.

Healthcare providers can help get the word out that AHCCCS members should ensure that their mailing address, phone number & email address are up to date on www.healthearizonaplus.gov and urge AHCCCS members respond to requests from AHCCCS for more information.

The State Medicaid Advisory Committee met last week and AHCCCS staff provided an overview and update on various projects including how they’ll be redetermining eligibility later this year.

AHCCCS has a “Return to Normal” webpage with more info including community and contractor resources.

Governor Hobbs Taps AzPHA Member Zaida Dedolph Piecoro to be her Health Policy Advisor

Good news! Governor Hobbs has tapped AzPHA Director of Public Health Policy Zaida Dedolph Piecoro to serve as her health policy advisor. Zaida is a long-time member of AzPHA and has been serving as the Director of Public Health Policy on our Board of Directors for the last few years. She begins her new post on Tuesday,

Zaida stepped down from her role at the Children’s Action Alliance and also stepped off our Board of Directors last Friday to avoid any kind of perceived conflict of interest.

It’ll certainly be delightful & refreshing to have a friend of evidence-based public health policy on the 8th Floor advising the governor and her team on administrative and policy matters!

According to our By-laws, it’s Kelli Donley Williams’ responsibility to name a new Director of Public Health Policy to the Board. In the meantime, I’ll run the weekly public health policy committee meetings.

Call to Action: Comment on ADHS’ Planned Revisions to the AZ Student Loan Program for Health Professionals: Comments Due by January 22

A law was passed last legislative session adding a Behavioral Health Loan Repayment Program to the existing ADHS State Student Loan Program for health professionals. The new law adds several disciplines to the list of folks who can qualify to participate in the program including behavioral health providers, behavioral health technicians, behavioral health nurse practitioners, psychiatric nurse practitioners, registered nurses, practical nurses, physicians, psychiatrists, or psychologists. Folks that qualify can have a generous portion of their student loans paid off if they serve in a behavioral health facility or the Arizona State Hospital.

Another change to the state student loan program makes folks eligible to participate if they work at an Indian Health Service facility, tribal or urban Indian health facilities that isn’t required to provide a sliding fee scale to be eligible.

ADHS has developed Administrative Code (Rule) changes to implement the new laws.  Whatever changes they adopt will be hard-wired into state code for many years so it’s essential that we examine the rules and make suggested changes while we can. This is an ‘emergency rulemaking’, meaning we have this one opportunity to examine the draft rules and make comments.

Comments are due in only 11 days: by January 22, 2023.

I especially urge those of you who have experienced the ‘back end’ of the student loan repayment program as a qualifying site or as a student to go through the rules and provide comments!

Here are the Proposed Draft Rules & a link to their Online Survey (Closes January 22, 2023).

I made the following suggested changes to the rules this morning adding an additional incentive for qualifying sites to donate to the State Loan Repayment Program (item number 6):

R9-15-104. Donations to a Loan Repayment Program

A person donating monies to a loan repayment program shall designate whether the donation may be used by the Department for either loan repayment allocations or for administrative costs associated with a loan repayment program or is to be used for loan repayment allocations for one or more of the following:

  1. The Primary Care Provider Loan Repayment Program, established according to A.R.S. § 36-2172;
  2. The Rural Private Primary Care Provider Loan Repayment Program, established according to A.R.S. § 36-2174;
  3. The Behavioral Health Care Provider Loan Repayment Program, established according to A.R.S. § 36-2175;
  4. A specific type or types of primary care provider, behavioral health care provider, or other eligible individuals; or
  5. A specific county in Arizona; or
  6. A specific qualifying service site or sites.

Express Your Support or Opposition to Bills this Session on AZLEG.gov

The Arizona State Legislature uses the ‘Request to Speak’ (RTS) system facilitate tracking of bills proposed and allowing the public to register an opinion on bills and to request to speak on a bill in a committee. It replaces the old slips of paper used back in the day and lets committee chairperson know you want to speak to the committee. Under the old paper system, you could only sign in to speak or register an opinion if you were physically at the capitol.

After the initial setup at a kiosk located in the House or Senate, the RTS program allows you to participate from your home or office. When the committee is in session, the committee members and the public will see a list of names of people who have registered an opinion.

It also shows whether you want to speak or not, who you represent. You can also leave more detailed comments or links to resources in comment boxes. This information is also available if a person searches past committee agendas. Legislators, journalists and the public will see your bill position throughout the process.

A catch is that you’re required to come to the capitol the first time you use the RTS system. When you come to the Capitol, you create an account and sign in on one of the Kiosks in either the House or Senate.

If you create an account at home, you’ll only be able to use the Bill Status Inquiry application to track activity on a bill, not register an opinion or create a request to speak until you come to the capitol and sign in on one of the Kiosks here.

Here’s a quick tutorial summarizing how to get set up and use Arizona’s RTS system: Using the Request to Speak Program

Using RTS has a bit of a learning curve, but if I can become proficient at using it- anybody can!

Compelling & Disturbing Testimony at the Joint Legislative Psychiatric Hospital Review Council Cries Out for Arizona State Hospital Governance Reform

A couple of years ago the state legislature passed a bill authorizing an Interim legislative committee called the Joint Legislative Psychiatric Review Council. Its mission runs through 2026 and includes making recommendations regarding psychiatric hospital capacity in AZ including the bed capacity at the Arizona State Hospital and other public facilities and the feasibility of transferring oversight of the Arizona State Hospital.

The Council published a report of their findings in December 2021 with a host of recommendations to improve psychiatric care in AZ. The findings of the report helped establish the need for two important bills from last legislative session including SB1444 – prohibiting ADHS leadership from retaliating against patients due to family participation in Arizona State Hospital Independent Oversight Committee meetings & forcing the ASH Superintendent and Chief Medical Officer attend and participate in meetings (they’d been blowing them off during the Ducey administration).

Joint Legislative Psychiatric Hospital Review Council

The legislature also passed, and the former governor signed SB1651 requiring AHCCCS to annually report to the Joint Legislative Budget Committee a host of additional fiscal records on expenses in the behavioral health system. It also earmarked $25M in the state budget to develop secure BH residential facilities for persons with a serious mental illness diagnoses who are chronically resistant to treatment.

The final action of the outgoing legislature occurred last week at the Joint Legislative Psychiatric Hospital Review Council. Testimony at the Council meeting last week was compelling, with Sommer Mutter describing in excruciating detail the trials and tribulations she experienced while her brother was civilly committed to the Arizona State Hospital (which is both run and regulated by ADHS).

I encourage you to listen to her testimony which you can do at this link on the AZLEG website: Video Player (azleg.gov). Shocking testimony.

New Psychiatric Hospital Review Council Recommendations

2023 Joint Legislative Psychiatric Hospital Review Council PowerPoint

Later discussions at the Council focused on the importance of fixing the conflict of interest posed by the fact that ADHS both runs and regulates the Arizona State Hospital.

More on the details about why having an entity regulate itself are here: Assaults at the Arizona State Hospital Highlight the Need for Governance Reform: A Primer

We sincerely hope the incoming legislature takes advantage of the work of the Council and holds ADHS accountable for fixing the problems left by the Ducey administration and investigates new legislation to improve institutional accountability at the Arizona State Hospital.

Editorial Note: I have confidence that the Arizona State Hospital will be honestly regulated under the Hobbs administration. However, a major institutional conflict of interest remains – with ADHS both operating & regulating ASH. While I expect conditions to improve at ASH under this administration, the institutional governance conflict needs to be fixed.

Unless institutional checks and balances are implemented it’s inevitable that a future administration will again have intentionally slipshod oversight of ASH operations as had occurred under former Governor Ducey & Director Christ.

Our Legislative Session Advocacy Approach

This week marks the beginning of the 2023 legislative session. The kickoff will be the Governor Hobbs’ State of the State address to the legislature at 2pm today when she’ll outline what he sees as priorities. It’ll be held in the House of Representatives and is generally open to the public (in the top gallery) buy you’d need to get there early. Visit the governor’s official website for details: Office of the Arizona Governor Katie Hobbs

Our Advocacy Approach

AzPHA will follow the session closely and express our support or opposition to bills based on a simple core principle…  we support bills that will have a positive impact on public health especially when they are evidence-based or evidence-informed.  We will oppose bills that are likely to have a negative impact on public health.  Our support or opposition to bills is located on the https://www.azleg.gov/ site under RTS Current Bill Positions.

We have a host of Resolutions that also guide our advocacy which are posted on the members only website and on our main website as well. The fact that we have Resolutions on so many core public health priorities make it easy for us to be swift with our support or opposition. Our Resolutions go all the way back to the 1930s. They are initiated by either the Board or our members and all resolutions have been voted on and approved by our members.

Our Public Health Policy Committee has a discussion board on Basecamp and that’s also where we post information, research and documents related to public health policy.  Let me know if you’d like to sign up for that Basecamp site at [email protected].

Our policy committee also has conference calls every Friday afternoon from 2 to 2:30 on Zoom (for members). Links to the meetings are in our Public Health Policy Committee Basecamp. Members can email [email protected] to get access to our Basecamp.

It’s Opening Day for the State Legislature Manana

Tomorrow is opening day for the 56th Arizona Legislature. As often is the case after redistricting, there’s a ton of turnover among legislators. In fact, more than half of the legislators are new this session! There are 30 new members in the House and 16 new members in the Senate.

Governor Katie Hobbs will also deliver her first State of the State address to a joint session of the Arizona House and Senate tomorrow morning.

The Senate Health committee is meeting on Tuesday at 2pm. They’ll be hearing a bill that would require AHCCCS to pay for medically necessary cochlear implants for their members (SB 1716). We have signed up in support of that bill (we’re the 1st organization to sign up in support!). In the committee comments we suggested they amend the bill to include a restoration of the bone anchored hearing aid benefit (which was eliminated by AHCCCS in 2010).

The House Health Committee isn’t meeting next week. They’ll be meeting on Monday mornings once they start work.

____________

COMMITTEE ON HEALTH AND HUMAN SERVICES

DATE: Tuesday, January 10, 2023, TIME: 2:00 P.M. ROOM: SHR 1

SENATORS: Borrelli, Hatathlie, Shamp (Vice-Chairman), Burch, Wadsack, Shope (Chair), Gonzales

HOUSE COMMITTEE ON HEALTH & HUMAN SERVICES

Monday, January 9, 2023, ROOM HHR 4 NOT MEETING THIS WEEK (future times TBD)

Members: Bliss, Hernandez, Shah, Contreras, Mathis, Parker B (Vice-Chair), Gress Pingerelli, Montenegro (Chair)