Administrative Law Judge Recommends Reversing PTSD Decision

June 6th, 2014 by Will Humble 22 comments »

Last December I denied a petition to add Post Traumatic Stress Disorder to the list of debilitating medical conditions that qualify people for an Arizona Medical Marijuana Registration Card.  I denied the petition because there was a lack of scientific evidence to document whether Cannabis is helpful or not to treat or provide palliative care for Post-Traumatic Stress Disorder.  Here’s the report conducted by the UA Mel and Enid Zuckerman College of Public Health that summarizes the available scientific evidence.

Earlier this year a group of folks appealed my decision to the Arizona Office of Administrative Hearings.  A hearing was held a few weeks ago.  This week an Administrative Law Judge ruled that: “…  the Appellant’s appeal is granted and that PTSD is added to the list of debilitating conditions for which marijuana may be dispensed”.

According to the Office of Administrative Hearings, I have until July 9 to either accept, reject or modify the recommended decision.  I’ll be studying the report and will make a decision after analyzing the Decision and Order.

Working Hard for Public Health

June 5th, 2014 by Will Humble 1 comment »

Dr  WalterEvery year, the Arizona Medical Association works with us to find one person who really stands out in the public health field to win the Public Health Service Award.  This year Dr. Frank Walter, the medical director for our Bureau of Public Health Emergency Preparedness, was given the award at last week’s annual dinner.

Dr. Walter’s enthusiasm for public health is extraordinary. He’s an informed and energetic public health advocate – both when there when there’s a real emergency and when working with us in our exercises.  Dr. Walter’s guidance and expertise helps us help our partners be ready for any type of emergency.  He also sits on the states Medical Direction Commission for EMS where his toxicology background helps make good decisions about what ambulances need to carry in our state.

Congratulations to Dr. Frank Walter for being chosen to receive the 2014 Public Health Services Award.

American Indian Healthcare Matrix (Part V): Wrap-up

June 4th, 2014 by Will Humble 1 comment »

In this 5-part series on American Indian Healthcare we’ve covered the basics the Indian Health Service and ”638’s” administered by tribes and tribal organizations.   Here we learned about unique opportunities Native Americans have when seeking health care services.  Members of 566 federally recognized American Indian Tribes and their descendants are eligible for services provided by the Indian Health Service without regard to income.

We covered the fact that American Indians are eligible to apply for and receive Medicare, Medicaid and the Children’s Health Insurance Plan and that American Indians are exempt from cost sharing requirements in the AHCCCS (Medicaid) and KidsCare programs.  American Indians are exempt from the managed care requirement used by AHCCCS, so they can either elect to receive their AHCCCS benefits through a health plan or through the American Indian Health Program, which is a fee-for-service program rather than a capitated managed care program. American Indians applying for Medicaid services in Arizona need to meet the same income requirements as all other applicants.  Even when American Indian members sign up with an AHCCCS health plan, they can always go to Indian Health Service or ”638” facilities for their care.

Last week’s post covered the Affordable Care Act as it relates to American Indians including the fact that they can enroll in Marketplace plans at any time without regard to Open Enrollment periods. American Indians wishing to buy health insurance in the Health Insurance Marketplace don’t need to pay out-of-pocket costs (like deductibles, copayments and coinsurance) if their income is up to $70,650 for a family of 4.  And remember, they also qualify for services from the Indian Health Service  and ”638’s” without regard to income.

Last week we discussed the Indian Healthcare Improvement Act, which improves and enhances the covered services for American Indians through the IHS, adds additional flexibility for tribal members, and updates current law regarding collection of reimbursements from Medicare, Medicaid, and Children’s Health Insurance Program by Indian health facilities.

Medicare eligibility is the same for American Indians as it is for other populations. In addition, if an Indian health care provider delivers services- Indians are not responsible to pay for out-of-pocket costs. And, if Medicare services are received at an Indian hospital or clinic, Medicare pays for covered services, which in turn helps Indian health care providers and their surrounding communities.  The fed’s partner with tribes to help with Medicare plan enrollment, plan service delivery and billing via the CMS American Indian/Alaska Native Center.

So, just to wrap it up…  the health care matrix for Native Americans includes: 1) The Indian Health Service and ”638’s” administered by tribes and tribal organizations; 2) Medicaid, Medicare and the Children’s Health Insurance Program; 3) Insurance options under the Affordable Care Act (they don’t need to pay out-of-pocket costs like deductibles, copayments and coinsurance if their income is up to $70,650 for a family of 4 and can enroll at any time); 4) Enhanced services under the Indian Healthcare Improvement Act; and 5) Medicare eligibility- which is the same for American Indians as it is for other populations.  If an Indian health care provider delivers services- Indians are not responsible to pay for out-of-pocket costs.

Will Humble, MPH
Director
Arizona Department of Health Services
“Health and Wellness for all Arizonans”

 

Get In the Health Care Driver’s Seat

June 3rd, 2014 by Will Humble No comments »

doctors rushing patientLet’s face it.  When it comes to being in control as a consumer- information is power.  And being in control of your own health and health care is probably one of the most important things you can do as you go through life.  Up until the last couple of years, the healthcare world has been opaque when it comes to getting the information that you need to make good decisions- whether it’s quality indicators or costs.  But that’s changing rapidly- especially in Arizona.

Today we posted the second complete year of AZ Hospital Compare– which provides Arizona consumers with data on quality, care, costs, and charges at Arizona hospitals.  The info on AZ Hospital Compare can help you make better decisions when choosing a hospital for childbirth or an elective procedure.  It can also help you negotiate price if you’re paying cash.  Hospital administrators can use the data to make sure they’re on track for their own goals and compare themselves to the competition.

For example, if you need an operation, you may want to look at how safe hospitals are for patients having surgery.  You also might want to look at some of the quality data that comes from patients themselves.  If you’re planning to have a baby, you can look up the percentage of births by hospital that end up in Caesarian-sections.

The costs and charges sections give the most recent data available for how much hospitals are charging on average and how much those services cost the hospital to provide.  Sticking with the childbirth theme, a C-section without complications on average was charged at $18,920 in 2012, but you can also see that one hospital charged on average $44,166 for it.  A normal (vaginal) childbirth was a lot cheaper – the average charge in 2012 was $10,565, while the most expensive rate charged by a hospital was $24,057.

Like I said- information is power when it comes to making smart decisions as a consumer- and our new AZ Hospital Compare site provides you with more information to put you in the driver seat.

Summer Means It’s Time for Sun Safety

June 2nd, 2014 by Will Humble No comments »

sunscreenSkin cancer is now the most common cancer in the U.S. but is preventable by using good judgment.  Thirteen new studies confirm what most of us have suspected, that protecting your skin from damaging UV rays with clothing, sunscreen, hats, sunglasses and shade, decreases sunburns, tanning and the formation of moles—all factors in developing a potentially fatal skin cancer like melanoma.

About 20% of Arizonans are likely to develop skin cancer during their lifetime. In addition to the health burden of treating skin cancer, the annual economic burden is $5.3B.  Our ADHS SunWise Program focuses on preventing skin cancer with free sun safety curriculum that is now mandated for all 1,100 K-8 public schools. SunWise has been educating students and teachers statewide with free school assemblies  and district workshops for over 12 years.

Your kids may have participated in the annual poster or video contests and demonstrated their favorite ways to stay safe in the sun. To learn more about strategies to prevent skin cancer, check out the Community Preventative Services Task Force findings and be sure to visit the SunWise home page for free resources, video and poster contest winners and more. SunWise is also playing a part in our acclaimed Empower program by encouraging child care facilities to be SunWise.

Live Broadcast: Launching of the Arizona State Health Improvement Plan

May 31st, 2014 by Will Humble No comments »

ArizonaWe’ll be having a live web broadcast about our State Health Improvement Plan on Monday, June 2, 2014 at 2:00 p.m. The web broadcast will provide an overview of the State Health Assessment and State Health Improvement Plan… including the next steps.  Tune in if you can.

Summer Means it’s Time for Sun Safety

May 30th, 2014 by Will Humble No comments »

uvi_mapSkin cancer is now the most common cancer in the U.S. but is preventable by using good judgment.  Thirteen new studies confirm what most of us have suspected, that protecting your skin from damaging UV rays with clothing, sunscreen, hats, sunglasses and shade, decreases sunburns, tanning and the formation of moles—all factors in developing a potentially fatal skin cancer like melanoma.

About 20% of Arizonans are likely to develop skin cancer during their lifetime. In addition to the health burden of treating skin cancer, the annual economic burden is $5.3B.  Our ADHS SunWise Program focuses on preventing skin cancer with free sun safety curriculum that is now mandated for all 1,100 K-8 public schools. SunWise has been educating students and teachers statewide with free school assemblies  and district workshops for over 12 years.

Your kids may have participated in the annual poster or video contests and demonstrated their favorite ways to stay safe in the sun. To learn more about strategies to prevent skin cancer, check out the Community Preventative Services Task Force findings and be sure to visit the SunWise home page for free resources, video and poster contest winners and more. SunWise is also playing a part in our acclaimed Empower program by encouraging child care facilities to be SunWise.

AZ Teen Birth Rate Drops 30% in 5 Years

May 29th, 2014 by Will Humble No comments »

PromI’ve often blogged about why teen pregnancy is an important Arizona winnable battle and why it’s a key public health indicator.  Having a baby as a teenager impacts the mom, the dad, the baby and the whole community.  Teen parents often don’t finish high school which, in turn, reduces their ability to financially take care of their newborn and results in an estimated $11B per year in increased health care, foster care, incarceration, and lost tax revenue nationwide.

Today, the CDC released Preliminary Birth Data for 2013 which includes the teen birth rate.  Arizona’s teen birth rate decreased 10% in the last year.  In fact, since 2009 our teen birth rate has dropped more than 30%…  from 10,725 in 2009 to 7,222 in 2013.

There are lots of theories as to why the teen birth rate is dropping.  We’ve been providing teen pregnancy prevention education since the mid 1990’s.  This sustained effort with evidence-based interventions is one factor that has contributed to the decline in teen pregnancies.  There are literally thousands of kids around the state learning about healthy relationships and the impact of having a baby before they are ready.  Also, one study showed that the recent  drop in teen births may be partially linked with a popular TV shows called 16 and Pregnant and Teen Mom.

Another example of evidence-based program is the home visiting program run by the Nurse Family Partnership.  First-time moms who enroll work with registered nurses in a home setting find the support they need to have a healthy pregnancy, improve their child’s health and development, and become more economically self-sufficient. A number of the first-time moms that enroll in this program are teen mothers that receive information and support on a number of topics including how to prevent a subsequent pregnancy.

1920 ADHS Annual Report

May 29th, 2014 by Will Humble No comments »

With our Annual Report coming up soon, I was surfing the web to get some ideas last night and ran across our 1920 ADHS Annual Report.  Call me a public health geek, but I couldn’t put my iPad down.

The Annual Report covers our agency activities that year- things like our new (1919) Midwifery regulations, an STD report (from the Bureau for the Control of Venereal Diseases chapter), efforts to improve physical activity in high schools, TB (the leading cause of death that year) and smallpox and other infectious diseases control efforts, and child welfare.  Interestingly, the report (on page 14) discusses the State Legislature’s creation of the State Child Welfare Board in 1919.  Since our Agency had a similarly named program, we renamed our Child Welfare Bureau the Child Hygiene Division of the State Board of Health in 1920 to avoid confusing the 2 missions.

There’s also a host of information about restaurant, grocery store, dairy and water supply sanitary inspection results for the year (by city).  The Report includes a section on the Arizona State Laboratory, and Vital Statistics like Births and Deaths (by cause).  Our Agency budget appears to have been a grand total of $20,000 (including $585 in federal funds).

American Indian Healthcare Matrix (Part IV)

May 28th, 2014 by Will Humble No comments »

So far in this series, we’ve covered the Indian Health Service, the ”638’s” administered by tribes and tribal organizations, and Medicare, Medicaid, and Children’s Health Insurance Plan.  This week focuses on the Affordable Care Act & the Indian Healthcare Improvement Act.

American Indians wishing to buy health insurance in the Health Insurance Marketplace won’t need to pay out-of-pocket costs (like deductibles, copayments and coinsurance) if their income is up to $70,650 for a family of 4.  Those earning too much to qualify for Medicaid but less than 400% of the Federal Poverty Limit may also be eligible for advance premium tax credits that lower monthly premiums right away.

American Indians can enroll in Marketplace plans at any time without regard to Open Enrollment periods.  All American Indians who are eligible to receive services from an Indian health care provider may receive an exemption from the shared responsibility payment (a.k.a. the Individual Mandate) even if they don’t maintain minimum essential coverage under the Affordable Care Act.

The Indian Healthcare Improvement Act was permanently authorized by the passage of the Affordable Care Act.   The Act improves significantly on the Indian Healthcare Improvement Act legislation passed in 1976.  Modifications and improvements to the Act include:

  • Provides authorization for hospice, assisted living, long-term, and home- and community-based care;
  • Extends the ability to recover costs from third parties to tribally operated facilities;
  • Updates current law regarding collection of reimbursements from Medicare, Medicaid, and CHIP (Children’s Health Insurance Program) by Indian health facilities;
  • Allows tribes and tribal organizations to purchase health benefits coverage for IHS beneficiaries;
  • Authorizes IHS to enter into arrangements with the Departments of Veterans Affairs and Defense to share medical facilities and services;
  • Authorizes the establishment of a Community Health Representative program for urban Indian organizations to train and employ Indians to provide health care services; and
  • Directs the IHS to establish comprehensive behavioral health, prevention, and  treatment programs for Indians.

Remember, Native Americans also qualify for services from the Indian Health Service and ”638’s” without regard to income.