By Pele Fischer, JD
In the last edition of Arizona Physician, I provided an overview of the sunrise applications requesting regulation and expansion of scope of practice, which for health professions is determined at the state level through an established mechanism called the sunrise process. These sunrise applications were reviewed at a December 16, 2016, hearing, and the outcomes set the stage for some of the health policy issues we will see this legislative session in Arizona.
The Arizona Medical Association (ArMA) represented physician concerns at the legislative committee hearing where legislators reviewed the applications. ArMA worked in collaboration with our physician community partners including Arizona Osteopathic Medical Association (AOMA), Academy of Pediatrics (AzAAP), and Academy of Family Physicians (AzAFP). The hearing lasted more than eight hours and all of the decisions met or exceeded expectations of organized medicine. Physicians who participated dedicated their entire day to be at the hearing to ensure that sound medical science and patient safety concerns were well represented and effectively conveyed.
There were nine sunrise applications submitted by the September 1 deadline. Two of the sunrise applications, regulation of phlebotomists and scope expansion for naturopaths to administer IV antibiotics, were withdrawn prior to the hearing. Of the remaining seven, only two were not approved.
Requests for expansion of scope of practice: CRNAs; Naturopaths; Pharmacists; Podiatrists
Arizona Association of Nurse Anesthetists – APPROVED; negotiations between CRNAs and ArMA are ongoing regarding updates to current statutory language which require the administration of anesthetics by a CRNA be done under the direction of and in the presence of a physician or surgeon, adequately reflecting current health care delivery in Arizona
Patient safety and physician-led care are of paramount importance to physicians in this negotiation.
Arizona Naturopathic Medical Association – NOT APPROVED; This application requested authority for naturopaths to sign medical exemptions for required immunizations. The physician groups strongly opposed this application, citing concerns that Arizona has some of the most lenient exemption policies and as a result, herd immunity has been compromised. Allowing another pathway for exemptions will only worsen a serious public health concern.
Arizona Pharmacy Association – APPROVED; After a lengthy series of stakeholder meetings and back forth negotiations, the Arizona Pharmacy Association finally scaled back its sunrise application enough to receive approval by the committee. The approved proposal would allow pharmacists the ability to prescribe over the counter and prescription nicotine replacement products (inhalers and sprays); this does not include Chantix or Zyban. It would also allow pharmacists the ability to extend a routine, non-controlled, chronic medication for an amount equal to or less than 14 days (to be further negotiated) under certain circumstances.
The CORE Institute (regarding Podiatrists) – APPROVED – The physician groups all supported this sunrise application that would allow podiatrists the ability to perform toe and partial foot amputations.
Sunrise requests for regulation: CHW; Art Therapists; Dental Therapists
Arizona Community Health Workers Association (Requesting voluntary certification for Community Health Workers) – APPROVED;
Arizona Art Therapy Association (Requesting regulation of Art Therapists) – APPROVED;
Dental Care for AZ (Requesting licensure of Dental Therapists) – NOT APPROVED;
53rd Arizona Legislature & State of the State
Arizona’s 53rd legislature was called to order on Monday, January 9, and Governor Doug Ducey gave his State of the State address. This is the Governor’s annual opportunity to publicly set forth his expectations and priorities for the coming months and years to the assembled Legislature and other state elected and appointed officials. Governor Ducey’s speech focused on the theme of “boundless opportunity” that Arizona has to offer, and devoted the bulk of his remarks to public education, proposing a number of significant reforms.
The Governor called for continued and expanded effort for efficient licensure of various professions and decreased regulations. He spoke of a new state website, www.redtape.az.gov, where citizens can report tedious regulations within state government, with the goal of repealing 500 onerous regulations by the year’s end. The Governor proposed providing up to an additional 12 months of TANF (welfare) assistance to Arizonans’ actively job-searching; additional efforts to reduce recidivism such as Employment Centers to assist inmates in finding jobs; improved public safety by continuing the efforts of the Border Strike Force; enacting drug addiction prevention efforts; and funding cyber security.
While Governor Ducey’s remarks were limited in the area of health care, he did state that he wants to add SCID, Severe Combined Immunodeficiency, to the newborn screening requirements in Arizona. Regarding the opioid epidemic, the Governor stated that he wants to see a physician continuing medical education (CME) requirement, one hour of the forty biennially required CME hours, on the subject of drug addiction. He also stated that he has issued a new executive order allowing inmates facing addiction when leaving prison, the opportunity to enter into a pilot program to be treated with Vivitrol to help with their transition.
Governor Ducy’s executive budget was released on January 13. We will review it carefully for implications for healthcare and will provide updates and insights in the next issue.
Governor Ducey’s state of the state address and executive budget sets the stage for the legislative session. Now the legislature begins its hard work.
Beyond the policy areas already mentioned, there are numerous other health-related issues that ArMA is currently engaged in and will likely be addressed in some capacity during the 2017 legislative session. These include: balance/surprise billings, health-related board reforms, addressing the opioid epidemic, and the future of healthcare reform, specifically, “repeal and replace” of the Affordable Care Act (ACA), and the future of Medicaid/AHCCCS expansion.
As the legislative session progresses, we will know the additional areas of healthcare legislation that legislators and interest groups are pursuing. ArMA fights and advocates for YOU, Arizona physicians, and your patients. Our lobbying team tracks hundreds of bills throughout the legislative session and is a strong and powerful advocate for solutions based on the best interests of physicians and patients. Please make sure to check back for future updates regarding the 2017 legislative session.