Arizona Legislative Policy Updates
Last updated: May 22, 2018
Ebola Outbreak in Democratic Republic of the Congo
WHO Policy Body Concludes it’s Not a Public Health Emergency of International Concern (yet)
The Democratic Republic of the Congo’s (DRC) Ministry of Health has confirmed 45 cases of Ebola Virus Disease in the last few weeks. Most of them have been in the remote Bikoro health zone, but 1 case is in Mbandaka, a city of 1.2 million, which is bad because of the city's size and because it's next to the Congo river- a major transportation corridor for people and trade. Large cities that are also transportation hubs can serve as a distribution channel for the virus.
The WHO’s Emergency Committee met last week and heard about the DRC’s surveillance & interventions. The Committee concluded that “… the interventions underway provide strong reason to believe that the outbreak can be brought under control, including: enhanced surveillance, establishment of case management facilities, deployment of mobile laboratories, expanded engagement of community leaders, establishment of an airbridge, and other planned interventions. In addition, the advanced preparations for use of the investigational vaccine provide further cause for optimism.”
The Committee concluded that “… the conditions for a Public Health Emergency of International Concern (PHEIC) have not currently been met.” They advised against travel or trade restrictions as interventions. Despite not being classified as a PHEIC, resources are still available to the DRC from the WHO consistent with the WHO’s Emergency Response Framework.
Activities include distribution of vaccine to Congo (4,000 doses so far and 3,000 more coming), cold chain resources, prepositioning of additional vaccine in Mali and support and treatment and surveillance staff from WHO & Medecins Sans Frontieres. They are using a ring vaccination strategy around cases and contacts. Surprisingly I don't see anything on the CDC's website about the outbreak right now, but hopefully they're engaged.
Let’s hope that the WHO Emergency Committee is right and the Ministry has the resources, expertise and logistical support they need to quickly identify cases and conduct the needed interventions to stop the spread before this becomes a regional or international epidemic like it did in 2014.
HHS to Restrict Title X Family Planning Program
Last week the President announced that the US Department of Health and Human Services will be changing federal family planning programs (Title X) to “ensure that taxpayers do not indirectly fund abortions”. The statement suggested that HHS would be shortly proposing regulations that would ban Title X family planning providers from referring patients to abortion clinics.
Title X was enacted almost 50 years ago to provide quality family planning care to those who may not be able to afford it on their own. Federal funds through Title X already can’t be used for abortion services. The funds are dedicated to access to medically accurate comprehensive healthcare for low-income individuals and families. The reproductive healthcare and family planning services include contraception, cancer and STD testing as well as counseling and education and more. Title X funding has contributed to the recent and significant decline in unintended and teen pregnancies as well as unplanned births and has reduced abortions.
Proposed changes by HHS haven’t been released yet. We don’t know if they’ll propose an emergency rule (hitting Title X networks immediately) or go through a normal rulemaking process. The normal process (including posting the proposed rule in the Administrative Register and a comment period) would be slower because the public would have the chance to comment, and comments would need to be reviewed before the rule could be finalized.
This has already been a chaotic year for Title X applicants for family planning service providers. It’s normally a 3-year funding cycle for Title X providers, but the Administration has changed that to a 1-year cycle- and applications for the coming year are due this Thursday (5/24).
If the proposed rule is the same one that was proposed by the Reagan Administration (and later rescinded by Clinton), it would prevent any provider from referring or providing information on abortion services. We don’t know the fine points of the rule yet, and cannot speculate about its structure, but we will keep you updated as we learn more.
AzPHA Comments on AHCCCS’ Network & Appointment Standards
AHCCCS is rolling out new integrated care contracts on October 1, and most members will be receiving services for both acute and behavioral care from these managed care organizations. One of the keys to making sure that members have access to a health care provider when they need it is for AHCCCS to make sure each managed care organization has an adequate network of contracted providers.
AHCCCS sets their network adequacy standards in what’s called their “AHCCCS Contractors Operations Manuals”, or ACOMs for short. From now through May 28, 2018 AHCCCS is accepting public comment on their proposed manuals for network expectations for the integrated care contracts that start on October 1.
Kaiser Family Foundation “Public Charge” Issue Brief
The US Department of Homeland Security is mulling to allow the federal government to take into account the use of federal health, nutrition, and other non-cash public programs like Medicaid, the Children’s Health Insurance Program, and WIC when making a determination about whether someone is likely to be a “public charge.” Under these changes, use of these programs by an individual or a family member, including a citizen child, could result in a person being denied lawful permanent resident status or entry into the U.S.
Such changes would apply to coverage provided to legal immigrants and their citizen children, leading to decreased participation in Medicaid, CHIP, Affordable Care Act marketplace coverage and other programs, even though they would remain eligible for them.
The Kaiser Family Foundation published a new issue brief this week that provides an overview of the 10.4 million kids in the U.S. that have a non-citizen parent (the parent is the person that would be affected by the changes). Then issue brief presents different scenarios of disenrollment from Medicaid and CHIP to illustrate the potential effects on their health coverage and discusses the implications for their health.
US Farm Bill: An Opportunity to Leverage Policy to Reduce Obesity
You’ve probably heard about the “Farm Bill” at one point or another. While it’s called the Farm Bill- it’s not just about farms. It’s the bill that sets the food and agricultural budget and policy for the US. The bill impacts farming livelihood, and also determines how food is grown and which foods are grown. It was last reauthorized by Congress in 2014 and Congress is now working on a new reauthorization.
The 2014 Farm Bill (the Agricultural Act of 2014) included some changes and reforms to the Supplemental Nutrition Assistance Program (SNAP or food stamps) and the Commodity Supplemental Food Program. In Arizona, SNAP benefits help put food on the table for more than one million people each month, with more than half of the benefits going to kids and teens.
The 2014 Farm Bill did a few things that promoted healthier options by requiring SNAP retailers to provide healthy choices. The ’14 law also provided grant programs to encourage people that receive SNAP benefits to buy more fruits and vegetables, provide funding for loan programs for healthy food retailers, and create opportunities for schools to add different kinds of vegetables as part of school menus.
Rather than strengthen the food quality requirements, the bill currently being debated by the House Agriculture Committee would expand the existing SNAP work requirements. Right now, SNAP requires childless adults between 18 and 49 who don’t have disabilities to work or be in work training to qualify. The draft legislation would expand the work requirement to include adults up to 59 and people who care for children older than 6. The draft bill also would set tighter time frames for recipients to find work and stiffen the penalties if they don’t.
SNAP recipients covered under the work requirement would have to document that they are working or getting job training for 20 hours a week. The first time an individual doesn’t comply with that requirement would trigger a loss of benefits for a year. Failing to comply again would result in being locked out of SNAP for three years.
The proposed changes would increase state costs by requiring states to collect monthly information from most SNAP users about their hours worked, their hours of participation in work programs, and the reasons they may not be working in a work program.
The APHA has set up a way that you can Contact your representative today and urge them to include nutrition standards for foods to qualify for purchase under SNAP and also to comment about the new proposed work/work training requirements.
Sonoran Prevention Works Scores Syringe Access Grant
Sonoran Prevention Works received a $125,000 grant from the Vitalyst Health Foundation to support advocacy and education for syringe access programs – a proven harm reduction strategy in response to the opioid crisis and rising hepatitis-C and HIV infection rates. They’ll be partnering with the University of Arizona College of Medicine Tucson and Creosote Partners to destigmatize syringe access programs and understand the comprehensive needs of people who inject drugs.
The Maricopa County Sheriff's Office will also work with Sonoran Prevention Works to implement a needle stick prevention program and to educate law enforcement on injection drug use. These partnerships will work to support policy change that treats substance use as a public health issue.
Snapshot of Public Health-related Bills in the Books
Well, the 2018 Legislative Session is in the books. All in all, it was a good year for public health at the state level. Several more good public health-related bills were signed today including:
HB 2324 Voluntary Certification for Community Health Workers
HB 2088 Public Health Guidelines in Schools
HB 2235 Dental Therapy Licensure
SB 1245 SNAP- Fruits and Vegetables
HB2371 Statewide Food Truck Licensing
Public Health-related Bills Signed Into Law (2018)
HB 2038 Drug overdose review teams; records was passed and signed. Once it takes effect later this year, law enforcement agencies will now be required to provide unredacted reports to the chairperson of a local Drug Overdose Fatality Review Team on request.
HB 2228 Annual waiver, applicability was signed by the Governor. It’s good. It will direct AHCCCS to exempt tribes from their directed waiver request that asks for CMS permission to implement work requirements for some Medicaid members. The recently submitted Waiver request includes an exemption for American Indians, however, this would place the exemption into statute.
HB 2323 Schools; inhalers; contracted nurses was signed by the Governor. This bill adds contracted nurses to the list of people who are authorized to provide emergency inhaler medication in case of respiratory emergencies. Some charter and independent schools don’t employ nurses directly but engage them through contracts.
HB 2484 local food tax; equality, which will ban Arizona cities and counties from taxing sugary drinks as a public health intervention.
SB 1022 DHS; homemade food products ADHS will be required to establish an online registry of food preparers that are authorized to prepare "cottage food products" for commercial purposes. Registered food preparers would be required to renew the registration every three years.
SB 1083 Schools; recess periods was passed and signed! Beginning next school year K-3 will need to have at least 2 recess periods. Grades 4 and 5 will need to have 2 recess periods the year after that.
SB 1389 HIV; needs assessment; prevention was signed by the Governor last week. It requires the ADHS to establish and implement an HIV Action Program.
SB 1394 Abortion reporting was passed by the House and signed by the Governor. It will require the ADHS to collect and report additional data regarding abortions that are performed in AZ.
HB 2038 Drug overdose review teams; records
HB 2228 Annual waiver, applicability
HB 2484 local food tax; equality
SB 1022 ADHS; homemade food products
SB 1083 Schools; recess periods
SB 1389 HIV; needs assessment; prevention
SB 1394 Abortion reporting