Legislative Update: Representative David Stringer’s Replacement is Announced by AzHHA

Greg Ensell, Vice President of Government Relations

In light of Representative David Stringer’s resignation, Arizona’s House of Representatives was left split 30-29, leaving republicans one vote shy of the 31 votes needed to pass a bill out of chamber. Because of this, the House suspended floor votes until a replacement was found. Yesterday, Yavapai County Board of Supervisors picked Steve Pierce in a 4-1 vote, over former Secretary of State Ken Bennett and GOP organizer Steven Sensmeier, in a special meeting to fill Stringer’s vacant seat. Steven Pierce, former State Senator and Majority Whip was one of numerous supporters of the Medicaid Expansion under Governor Brewer’s leadership.

Below you will find a sample of legislation that AzHHA is currently tracking:

SB 1089, Telemedicine, Sponsor: Senator Heather Carter

SB 1089 is intended to expand telemedicine coverage. The bill requires commercial health insurers to cover medical services provided by telemedicine if they cover the same service when provided in person. AzHHA strongly supports the bill. (SB 1089 passed Senate Health and Human Services 8-0; passed Senate 29-0; passed House Health and Human Services 9-0).

SB 1352, Transfer of the Health Care Directives Registry, Sponsor: Senator Heather Carter

SB 1352 is intended to improve healthcare provider access to healthcare directives like living wills. The bill moves the Arizona Health Care Directive Registry from its current location at the Secretary of State to the state’s Health Information Exchange organization Health Current. AzHHA strongly supports the bill because increasing provider access to health directives is consistent with the policy priority of improving end-of-life care. (SB 1352 passed Senate Health and Human Services 7-0; passed Senate 30-0; passed House Health and Human Services Committee 9-0).

SB 1354, Allocation of Graduate Medical Education Funds, Sponsor: Senator Heather Carter

SB 1354 is intended to make a significant dent in the physician shortage affecting Arizona - especially in rural and medically underserved areas. As amended, the bill appropriates: 1) $20 million to AHCCCS for Graduate Medical Education (GME); 2) $11 million to U of A Medical School; 3) $10 million for costs related to nurse training and to encourage retired doctors to return to practice; 4) $4 million to Arizona Department of Health Services (ADHS) for the primary care provider loan repayment program; and, 5) $5 million to the Board of Medical Student Loans program. (SB 1354 passed Senate Appropriations 9-0; passed Senate 28-2; passed House Appropriations 10-1).

Arizona has not appropriated state general funds for GME in approximately a decade. In 2018, AHCCCS provided more than $239 million in GME payments to Arizona hospitals. Of that amount, $205 million in federal matching funds were triggered by $88 million from local, county, tribal jurisdictions, hospitals and universities. If passed, more than $66 million ($20 million state funds + $46 million federal funds) will be available for medical residencies and rotations in rural and medically underserved areas.

HB 2041, Petition for Assaulted Hospital Employees, Sponsor: Mark Finchem

HB 2041 is intended as a state-level response to the nationally recognized issue of healthcare workplace safety. This bill allows hospital employees, volunteers, and others who have been assaulted to petition a court to require the assailant get a blood test. An amendment removed the requirement for a hospital to report an assault to the ADHS within 72 hours of an assault and replaced it with nonbinding language expressing the Legislature’s intent to encourage hospitals to keep and report statistics on workplace safety to public policy researchers. Following the amendment, AzHHA’s position is neutral on the bill. (HB 2014 passed House Judiciary 9-1; passed House Health and Human Services 9-0; passed House Rules 8-0; passed House 57-2; passed Senate Health and Human Services 7-0; Senate COW approved).

H2122, Prohibition of Do-Not-Resuscitate Orders on Minors, Sponsor: Nancy Barto

HB 2122 is intended to prohibit healthcare providers from placing do-not-resuscitate (D-N-R) orders on minors against the will of the parents or guardians. The bill originally introduced: 1) Prohibits providers from implementing a D-N-R order without the written or oral consent of both parents or guardian of a minor; 2) If the parent or guardian orally consents to implement a do-not-resuscitate order, two witnesses other than the parent, guardian or physician must be present and willing to attest to the consent; and, 3) Prohibits a healthcare provider from withholding care even if, using reasonable medical judgement, they believe that care will harm the patient and/or cause unnecessary pain or suffering.

The Senate Health and Human Services amended the bill to permit only one witness to be present and allow a provider to put a DNR order on a minor after 48 hours of unsuccessfully attempting to contact the parents or legal guardian of the minor. (H 2122 passed House Health and Human Services 8-0; passed House Rules 5-1; passed House 58-0; passed Senate Health and Human Services 8-0).

Recent Legal Challenges in Healthcare by AzHHA

A series of legal challenges to the Affordable Care Act (ACA), Medicaid work requirements and association health plans sets the stage for the coming high-profile court battles last week. AzHHA will continue to monitor these issues and inform members as new information is made available. Below are some descriptions of last week’s legal challenges.  

  • The U.S. Department of Justice announced it agreed with an earlier court decision (Texas v. United States) that the ACA is unconstitutional because Congress eliminated the ACA’s individual insurance mandate penalty in its Tax Cuts and Jobs Act of 2017.

  • A federal judge in DC ruled against work requirements for some Medicaid recipients in Kentucky and Arkansas. This ruling created uncertainty in similar plans in 7 other states.

  • A federal judge in DC blocked rules that would have allowed small businesses and individuals to band together to create group health plans (association health plans/AHPs). The ruling said the administration’s effort to allow AHPs was a clear effort to avoid following the rules of the ACA. Since the administration passed its Final Rule in 2018, 28 AHPs had gone into effect in 13 states. Their fate is now uncertain.

HRET HIIN Update by AzHHA

Vicki Buchda, Director of Care Improvement

Great news! The Centers for Medicare and Medicaid Services (CMS) remains committed to the Hospital Innovation Improvement Network (HIIN) work and is offering another extension. In addition to lives saved and harms avoided, for every dollar invested by CMS, approximately 9 dollars are saved. The nineteen hospitals in our state who are participating in HRET’s HIIN are continuing to work toward the goal of 20% reduction in harms, including hospital acquired infections, falls, pressure ulcers and a 12% reduction in readmissions. They are also working diligently on increasing patient and family engagement and health equity.

On March 21, AzHHA partnered with HSAG to offer a day-long conference on opioids. Over 300 people attended. Participants represented the continuum of care, including acute care, long term care, home care, behavioral health, community health, and first responders, both police and fire.

A planning committee is in the early stages of planning the 6th Annual HAI/HAC Prevention Summit. Save the Dates: July 17th Acute Care Day and July 18th Long Term Care Day.

50 Women Can Change the World - Healthcare Leadership Program by AzHHA

Shayna Diamond, Director of Community Affairs

The 50 Women Can Change the World - Healthcare Leadership Program brings together 50 inspiring and influential women from diverse backgrounds to build a vibrant sisterhood that will advance your career while changing the world. This four-month program will run April - July. AzHHA members will receive an exclusive discount of $1,000 when applying. Please contact Communications@azhha.org for promo code. For more information about the program, please contact Teri Radosevich.

Point of Pride: Terros Health by AzHHA

Last month was the National Council for Behavioral Health’s Conference in Nashville, TN. During this conference, 50 years of achievements in the behavioral health industry were celebrated as well as the work of those individuals in the communities making a difference. The National Council Awards of Excellence recognized individuals and organizations working to strengthen behavioral healthcare, enhance access to care and support our communities with visionary leadership. This year, Terros Health’s Trish Bleth was the recipient of the Peer Support Worker of the Year. Congratulations to Trish on this special recognition.