American Indian Healthcare Matrix (Part II)

May 9th, 2014 by Will Humble No comments »

Over the next couple of weeks, I’ll continue my series on the healthcare matrix for American Indians.  Last week I covered the basics of the Indian Health Service.  This week’s write-up is about something called “638’s”.

Tribes and Tribal Organizations can elect to administer healthcare services that normally would be administered by the IHS. This option is available under Public Law 93-638…  a.k.a. the Indian Self Determination and Education Assistance Act of 1975.  Under the Act, Tribes and Tribal Organizations can either: 1) Administer programs and services the IHS would otherwise provide (referred to as Title 1 Self-Determination Contracting); or 2) Assume control over health care programs and services that the IHS would otherwise provide (referred to as Title V Self-Determination Governance Compacting).  Since the Public Law ends in the numbers 638 many people refer to facilities that operate under these provisions as “638’s”.

Tribes can choose to combine the options above based on their individual needs and circumstances.  The IHS and Tribes and Tribal Organizations have negotiated numerous “638” self-governance compacts- in fact this program constitutes about 38% of the IHS budget ($1.5B).  In Arizona, there are about 30 “638” facilities administered by various tribes or tribal entities.  Here’s a listing of the “638’s” in AZ.

Next week I’ll cover Medicaid and Medicare options for American Indians.

American Indian Healthcare Matrix (Part I)

May 8th, 2014 by Will Humble 3 comments »

baby - native americanOver the next couple of weeks, I’ll be writing a series on the healthcare matrix for American Indians. I’ll be covering the basics of the Indian Health Service, how Medicaid and Medicare interface with Native Americans, as well as some of the basics of the Affordable Care Act as it relates to American Indians. Let’s start with the Indian Health Service.

The Indian Health Service (within HHS) is responsible for providing federal health services to American Indians. Provision of health services to members of federally-recognized tribes grew out of the special government-to-government relationship between the federal government and Indian tribes. This relationship was established in 1787 under Article I, Section 8 of the Constitution and has been fortified by numerous treaties, laws, Supreme Court decisions, and Executive Orders. The IHS is a principal federal health care provider and health advocate for Indian people and its goal is to raise their health status to the highest possible level.

The IHS provides a health service delivery system for about 65% of the 3.4 million American Indians and Alaska Natives in the US. The Indian Health Service is divided into 12- three of which are in Arizona: Navajo, Phoenix, and Tucson. Folks can search for the nearest IHS Health Facility using the Find Health Care website or simply download a complete listing of IHS Facilities.

Members of 566 federally recognized American Indian and Alaska Native Tribes and their descendants are eligible for services provided by the Indian Health Service (without regard to income). Eligibility is based on whether or not an individual is enrolled in a Federally recognized tribe. This FAQ page provides clarification for gray-area issues.

Next week I’ll cover the Indian Self-Determination and Education Assistance Act (Public Law 93-638) which has linkages to the IHS. In following weeks, I’ll cover Medicaid, Medicare, and the Indian Healthcare Improvement Act.

Newborn Screening & Immunizations Law

May 7th, 2014 by Will Humble No comments »

baby hearing testHouse Bill 2491 has been in the media and became a law with the Governor’s signature.  The new law requires us to add critical congenital heart defect (CCHD) to our newborn screening program protocol.  This new screening and reporting requirement will kick in once our rulemaking is complete- probably this Fall.

The screening test we’ll be adding is a pulse-ox test that happens in the hospital.  A device that measures oxygen levels in the blood is placed on the right hand and foot of a newborn to measure oxygen levels.  A Iow oxygen reading can be a sign that the baby might have a heart problem.  Most hospitals are already doing the screening, but our new rules will make the screening requirement explicit…  helping us close the information loop with doctors to ensure they have the information they need to do appropriate and timely medical management.

The new law also requires us to take a look at adding severe combined immunodeficiency disorder (SCID) and Krabbe disease to our screening panel.  These screens would require some new equipment and perhaps some increased costs, so we’ll be doing a full cost-benefit analysis with stakeholder input moving forward before making any decisions.

The new law also creates an advisory committee (that we’ll chair) to look at immunizations.  The advisory committee will look at the current system and make recommendations on improving Arizona’s system for making sure all kids have access to life-saving immunizations while keeping costs reasonable for everyone.

“People First” Law

May 6th, 2014 by Will Humble 2 comments »

A few years ago, the legislature made some important changes to the language in our state laws by removing hurtful words related to people with developmental disabilities.  Last year, the legislature removed some really old definitions and terms related to mental illness.  This year a new law was passed and signed (HB 2667) that went through all sections of Arizona statutes (the bill was over 400 pages long) and replaced several terms with people first language.  For example, the new laws would refer to “persons with a disability”, rather than a “disabled person”.   The effort was driven by the community, working for positive changes in Arizona’s laws.


Major Regulatory Reform Milestone

May 5th, 2014 by Will Humble No comments »

clipboard-iconLast week we passed a major milestone in our Strategic Plan when we filed our final new set of rules for the Arizona’s 5,500 licensed healthcare facilities.  With this week’s filing – we’ve now completed our overhaul of the State’s regulations for hospitals, behavioral health inpatient facilities, nursing care institutions, recovery care centers, hospices, behavioral health residential facilities, assisted living facilities, outpatient surgical centers, outpatient treatment centers, adult day health care facilities, home health agencies, behavioral health specialized transitional facilities, substance abuse transitional facilities, behavioral health respite homes, adult behavioral health therapeutic homes, child care facilities and the regulatory standards for licensed professional midwives.

During our 4 year regulatory reform effort, we worked hard with our partners to develop a better set of rules.  The new model sets some prescriptive minimum standards – and then requires facility operators to develop an additional set of policies and procedures to ensure patient and resident health & safety.  Facilities are also required to measure patient and resident outcomes.  If they have bad (preventable) outcomes – our survey teams will determine whether the facility wasn’t following its policies and procedures, had inadequate policies and procedures, or both.

While the rules are done, we still need to educate and train our survey teams and healthcare facilities on the new regulations.  Because the final rules depend largely on outcomes and solid policies and procedures rather than just static standards – this effort won’t happen overnight.  It’ll probably take about 18 months to get everybody up to speed on the new expectations.

First Case of MERS in U.S.

May 2nd, 2014 by Will Humble No comments »

MERS-CoV picA healthcare worker who recently returned from Saudi Arabia is the first confirmed case of Middle East Respiratory Syndrome coronavirus (MERS-CoV) in the U.S.  The person’s in stable condition in isolation in an Indiana hospital.

All public health agencies around the world have been carefully watching for new cases of MERS since the disease was discovered in Saudi Arabia in 2012. There’ve been 401 cases, 93 have died.

CDC’s not releasing a lot of information about the first case, except to say the patient was providing healthcare in Saudi Arabia and started experiencing severe respiratory symptoms after returning to the states.  Based on the patient’s symptoms and travel history, the hospital sent a sample to the Indiana state lab, where it tested positive for MERS-CoV.  Today, the CDC confirmed the positive result. We can do this testing at our state lab too.

The virus causes severe respiratory symptoms like fever, cough, and shortness of breath. The virus has spread person-to-person among family members and close contacts… but there hasn’t been any sustained transmission.  The CDC and others are working together to track down all people who have been in contact with this patient.  At this point, no other cases have been detected.

Dodging the Measles Bullet?

May 1st, 2014 by Will Humble No comments »

10707_loresYou might remember from a few weeks ago that a single patient exposed over 1,000 Arizonans to measles.  Because measles is highly infectious and 90% of unvaccinated contacts become infected, Public Health worked overtime to identify and interview suspected cases.   Health care facilities were placed on heightened alert.  The State Laboratory rushed testing of suspicious measles cases.  Media interviews alerted the public of concerning symptoms.

This time, at least, it looks like we’ve dodged a bullet from this case.  We haven’t found any secondary cases yet, which means Arizona may have come out of this without an outbreak.  While we can breathe a lucky sigh of relief, efforts now redouble to ensure that 95% of the population is vaccinated against measles (making it harder for future measles cases to spread), that we maintain vaccination records for Arizonans, and that we’re prepared to control the next infectious disease that flies into AZ.

5 Years of Behavioral Health Innovation Paying Dividends (Part III)

April 30th, 2014 by Will Humble No comments »

Over the past couple of weeks, I’ve reflected about some of the innovative strategies that we’ve implemented with our behavioral health community partners over the last several years to improve the health status of folks with a serious mental illness.  So far, I’ve covered integrated health homes and improvements to the crisis system.

On the kids front, more than 1,500 Maricopa County youth who experience behavioral health challenges have benefitted from participating in “MY LIFE” (Magellan Youth Leaders Inspiring Future Empowerment).  Through this group- members get support from their peers and develop critical skills in leadership and mental health resiliency.  Their activities have been invaluable in the fight against stigma associated with behavioral health issues.

Minors in the juvenile justice system in Maricopa County have had access to culturally relevant substance use and disorder treatment programs.  Sixty-four percent of the participants in the 21-month program decreased or eliminated their substance use- and more than 70% report completing treatment without returning to the juvenile justice setting.  Magellan earned the SAMSHA Science and Service Award for implementing this program.

FDA Study Committee Recommends Disapproval of New Opiate Painkiller

April 29th, 2014 by Will Humble No comments »

prescriptionLast week an FDA panel unanimously recommended rejecting a new drug that’s a combination of morphine and oxycodone – two very strong painkillers.  The panel, Anesthetic and Analgesic Drug Products Advisory Committee, said the company didn’t provide data to prove that Moxduo is more effective or safer than using one of the already available drugs.


“Health Windows” Provide Important Health Information to Hard-to-Reach Populations

April 28th, 2014 by Will Humble No comments »

flagsVentanilla de Salud (Health Windows) is a program that improves access to preventive health care, health education, and public health screening at Mexican consular offices throughout the US. There are 5 Ventanillas in AZ (Douglas, Nogales, Phoenix, Tucson, and Yuma).  The Ventanillas are operated jointly by the Department of Health of Mexico (Secretaria de Salud de México) and the Department of Foreign Affairs of Mexico (Secretaria de Relaciones Exteriores de México).

Their health education mission includes providing information about diabetes, obesity, hypertension, mental health, substance abuse, women’s health, domestic violence, birth control and health insurance.  Nationwide 1,182,760 people accessed services in 2013 and another  2,718,617 received educational information and referral to community health centers or received early detection results.

The Program has had an important influence on the relationship between Arizona and Sonora by strengthening ties between the two states through the delivery of health information.  You can find out more about the Ventanillas, including Locations and Health Information on the Ventanilla de Salud website— and make sure you add this to your list of community public health prevention partners.