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ARIZONA HOUSE OF REPRESENTATIVES
Fifty-first Legislature – Second Regular Session
Minutes of Meeting
House Hearing Room 4 -- 9:30 a.m.
Chairman Carter called the meeting to order at 9:44 a.m. and attendance was noted by the secretary.
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Mrs. Brophy McGee |
Mr. Meyer |
Mr. Boyer, Vice-Chairman |
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Mrs. Gonzales |
Ms. Steele |
Mrs. Carter, Chairman |
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Mr. Lovas |
Ms. Townsend |
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None |
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HB2078 - DPA/SE (8-0-0-0) HB2086 - DPA/SE (8-0-0-0) HB2333 - DPA/SE (7-1-0-0) HB2436 - DPA (8-0-0-0) HB2490 - DP (8-0-0-0) HB2531 - DPA (8-0-0-0) HB2549 - DP (8-0-0-0) |
HB2573 - DP (8-0-0-0) HB2641 - HB2648 - DPA (8-0-0-0) HB2667 - DP (8-0-0-0) HM2002 - DP (7-1-0-0) HR2008 - DP (8-0-0-0) |
Chairman Carter welcomed individuals from the Arthritis Foundation Arizona Advocacy Council and the Arizona Association of Providers for People with Disabilities.
PRESENTATION
The presentation on Childhood Obesity was not given.
CONSIDERATION OF BILLS
HB2436 - food handler training; courses; certification - DO PASS AMENDED
Vice-Chairman Boyer moved that HB2436 do pass.
Ryan Sullivan, Majority Research Assistant Analyst, explained that HB2436 directs counties that require food handler training and certification for employees in the food service industry to offer an accredited certification and outlines specific requirements for the course (Attachment 1). The Carter 17-line amendment to HB2436 dated 02/14/14 (Attachment 2) contains the following provisions:
Vice-Chairman Boyer moved that the Carter 17-line amendment to HB2436 dated 02/14/14 (Attachment 2) be adopted.
Representative T.J. Shope, sponsor, stated he has been working on this legislation with the Arizona Restaurant and Hospitality Association and counties across the state. One of the main pieces is providing reciprocity for food handler licenses.
Sherry Gillespie, Arizona Restaurant and Hospitality Association, spoke in favor of HB2436. She stated that food safety is and will continue to be a primary tenet of the industry. This bill requires future food handler training programs to meet higher standards while allowing accessibility for employees to take the courses.
Names of those who signed up in support of HB2436 but did not speak:
John MacDonald, Arizona Restaurant Association
Garrick Taylor, Arizona Chamber of Commerce and Industry
Names of those who signed up as neutral on HB2436 but did not speak:
Todd Madeksza, County Supervisors Association
Colby Bower, Arizona Department of Health Services
Question was called on the motion that the Carter 17-line amendment to HB2436 dated 02/14/14 (Attachment 2) be adopted. The motion carried.
Vice-Chairman Boyer moved that HB2436 as amended do pass. The motion carried by a roll call vote of 8-0-0-0 (Attachment 3).
HB2667 - persons with disabilities - DO PASS
Vice-Chairman Boyer moved that HB2667 do pass.
Yvonne Tindell, Majority Research Intern, explained that HB2667 replaces terminology throughout the Arizona Revised Statutes relating to persons with disabilities (Attachment 4).
Representative Stefanie Mach, sponsor, related that Stephanie Parker from the Aurora Foundation brought to her attention the current terminology in statute for people with disabilities, which is appalling. Everyone, including those with disabilities, should be seen as whole people who are fully capable of many things in society and can contribute a lot.
Merrill Eisenberg, representing self, in support of HB2667, said although it may seem trivial or unnecessary to change statutory language used when referring to people with disabilities, the terms currently in statute have been used since the beginning of the last century. Language changes over time because the way things are thought about changes. People with disabilities object to the term handicapped.
Names of those who signed up in support of HB2667 but did not speak:
Leonard Clark, representing self
Donna Kruck, Arizona Bridge to Independent Living
Tara Plese, Arizona Alliance for Community Health Centers
David Carey, Arizona Disability Advocacy Coalition
Suzanne Schunk, representing self
Anneliese Hollobaugh, representing self
Lisa Berger, representing self
Vanity Denise Caraveo Sandoval, representing self
Haydee Moran, representing self
Randi Wyatt, representing self
Jessica Burns, representing self
Neda Spiric, representing self
Lacey Markle, representing self
Patricia Carroll, representing self
Adrienne Verdel, representing self
Peyton Taylor, representing self
Kendal Konski, representing self
Cristina Felix, representing self
Edward Myers, representing self
Carol McDermott, representing self
Jon Meyers, representing self
John Duffy, representing self
Susan Cannata, The Arc of Arizona, Inc.
Brandy Petrone, Arizona Association of Providers for People with Disabilities
Names of those who signed up as neutral on HB2667 but did not speak:
Colby Bower, Arizona Department of Health Services
Question was called on the motion that HB2667 do pass. The motion carried by a roll call vote of 8-0-0-0 (Attachment 5).
HB2573 - schools; immunizations; registered nurses; posting - DO PASS
Vice-Chairman Boyer moved that HB2573 do pass.
Ryan Sullivan, Majority Research Assistant Analyst, explained that HB2573 places requirements on charter schools, school districts and private schools to post online information regarding health services and pupil immunizations and adds charter schools to the entities required to complete and file a report with the local health department and the Arizona Department of Health Services (ADHS) regarding pupil immunizations (Attachment 6).
Mr. Meyer, sponsor, related that as budget cuts were made, nurses were eliminated in some school districts. It is challenging for parents of children with medical issues who are considering where to send their child to school, to know if a nurse is available on campus; it would be good to have the information available. Also, there is the potential to lose herd immunity in some schools, which places students, teachers and parents at risk; it would be good for parents to know the percentage of children on campus that have been immunized.
Dr. Bob England, Director, Maricopa County Department of Public Health, spoke in support of HB2573. He indicated that this legislation is meant to help parents participating in school choice make more informed decisions by incorporating health information such as the immunization rate and qualifications of personnel on campus who are providing health services. He discussed the importance of herd immunity to keep vaccine preventable diseases from spreading and noted that schools already tabulate this data; no extra work will be required except to post the data online if the school has a website. He added that having a nurse or other qualified health care professional on campus keeps children in school and is especially important for children with chronic illnesses such as asthma, diabetes, etc.
Rory Hays, Arizona Nurses Association, spoke in support of HB2573. She said this was attempted a few years ago so she is delighted to see this legislation introduced again.
Vice-Chairman Boyer announced the names of those who signed up in opposition of HB2573 but did not speak:
Janice Palmer, Arizona School Boards Association
Ms. Palmer was not present to speak so Mr. Meyer surmised that she perceives HB2573 as an unfunded mandate on school districts. He added that it will not take a lot of resources for implementation, and if an outbreak did occur on a school campus, it would cost the school and school district much more than the cost of posting. If Ms. Palmer has another issue with the bill, he is willing to work on a Floor amendment.
Names of those who signed up in support of HB2573 but did not speak:
Pat VanMaanen, representing self
Tara Plese, Arizona Alliance for Community Health Centers
Don Isaacson, Pfizer Inc.
Kelly Ridgway, Arizona Pharmacy Alliance
Norman Moore, Pfizer Inc.
Rebecca Nevedale, Arizona Chapter of the American Academy of Pediatrics
Laura Dearing, Arizona Society of the American College of Osteopathic Family Physicians; Arizona Academy of Family Physicians
Question was called on the motion that HB2573 do pass. The motion carried by a roll call vote of 8-0-0-0 (Attachment 7).
HB2333 - medical marijuana fund; education; intervention - DO PASS AMENDED S/E
S/E: medical marijuana fund; purposes
Vice-Chairman Boyer moved that HB2333 do pass.
Vice-Chairman Boyer moved that the Carter three-page strike-everything amendment to HB2333 dated 02/17/14 (Attachment 8) be adopted.
Vice-Chairman Boyer
moved that the Brophy McGee seven-line amendment to the strike-everything
amendment to HB2333 dated 02/18/14
(Attachment 9) be adopted.
Sophia Horn, Majority Research Intern, explained that the Carter three-page strike-everything amendment to HB2333 (Attachment 8) allows monies in the Medical Marijuana Fund (MMF), subject to availability, to be spent for specific purposes (Attachment 10). The Brophy McGee seven-line amendment to the strike-everything amendment to HB2333 dated 02/18/14 (Attachment 9) allows monies to be allocated to the Biomedical Research Commission for marijuana research that is approved by an institutional review board in Arizona and conducted in a university setting with the intent to conduct thorough, objective clinical research on the safety, efficacy and adverse events associated with marijuana.
Representative Ethan Orr, sponsor, stated that he and others have been working with the dispensary industry to determine how to implement the Arizona Medical Marijuana Program in a more orderly way that serves all constituents. The strike-everything amendment provides a reasonable way to spend funds available from cardholder fees to protect children through education, school resource officers and, with the amendment, medical research to find out the impact of people using medical marijuana. In response to a question, he said it is estimated that $2 million annually will be obtained in this fund. Because of Proposition 105, the funding can only be spent in furtherance of the Medical Marijuana Act (Act); many of the dispensaries believe this is in furtherance of the Act and support the legislation.
Representative Orr responded to further questions about differences from the Senate bill, the potential for the funding to be used for administrative costs and furthering the Act.
Kimberly MacEachern, representing self, spoke in favor of the strike-everything amendment to HB2333. She advised that MATFORCE is an organization in Yavapai County with the goal of substance abuse prevention. The organization is very successful, mainly due to its focus on education, which is a major part of this legislation. She provided a handout showing the type of information that would be provided (Attachment 11), adding that MATFORCE does not support using the funds to research something that will only benefit one industry.
Theresa Ulmer, representing self, in opposition to the strike-everything amendment to HB2333, made the following points:
In response to a question about
studies relating to the detrimental impact of marijuana on adolescents, Ms.
MacEachern returned to the podium and referred to the handout
(Attachment 11).
Representative Orr remarked that marijuana is currently provided as a medicinal product through dispensaries, which has caused some unintended consequences. This legislation is an attempt to begin a discussion on how everyone can work together to make the system work effectively.
Mrs. Brophy McGee said the purpose in offering the amendment to the strike-everything amendment is that assumptions are made about marijuana use so clinical objective research is needed to see how it is impacting Arizonans, particularly Arizona children.
Mrs. Gonzales commented that she does not believe the strike-everything amendment furthers the Act. She expressed concern that the state will end up losing in litigation and the money will end up being used to pay court costs rather than for educational purposes.
Representative Orr responded that is why he has been meeting with representatives of the industry and the Arizona Department of Health Services (ADHS) and the reason for using the language may to expand the authority of the Director of ADHS. He opined that ADHS would not take any action without first consulting the Attorney General's Office and vetting through the dispensary association and patient advocates.
Names of those who signed up in support of the strike-everything amendment to HB2333 but did not speak:
David Landrith, Arizona Medical Association
Amanda Weaver, Arizona Osteopathic Medical Association
Names of those who signed up as neutral on the strike-everything amendment to HB2333 but did not speak:
Leonard Clark, representing self
Colby Bower, Arizona Department of Health Services
Question was called on the motion that the Brophy McGee seven-line amendment to the strike-everything amendment to HB2333 dated 02/18/14 (Attachment 9) be adopted. The motion carried.
Vice-Chairman Boyer moved that the Carter three-page strike-everything amendment to HB2333 dated 02/17/14 (Attachment 8) as amended be adopted. The motion carried.
Vice-Chairman Boyer moved that HB2333 as amended do pass. The motion carried by a roll call vote of 7-1-0-0 (Attachment 12).
HB2078 - technical correction; public health - DO PASS AMENDED S/E
S/E: cancer treatment medications; cost-sharing
Vice-Chairman Boyer moved that HB2078 do pass.
Vice-Chairman Boyer moved that the Carter four-page strike-everything amendment to HB2078 dated 02/14/14 (Attachment 13) be adopted.
Ingrid Garvey, Majority Research Analyst, explained that the Carter four-page strike-everything amendment to HB2078 dated 02/14/14 (Attachment 13) states that specified insurers who provide coverage for cancer treatment medications may not require a higher copayment, deductible or coinsurance amount for patient-administered cancer medications than those medications that are administered by a health care provider (Attachment 14).
Chairman Carter, sponsor, stated that there is a national movement relating to oral chemotherapy parity funding.
Marc Osborn, America's Health
Insurance Plans, spoke in opposition to the strike-everything amendment to
HB2078. He stated that adding additional regulations during implementation of
the Affordable Care Act (ACA) will result in higher premiums and additional
costs for consumers. He requested a 2016 effective date in order to meet new
filing deadline requirements from the ACA. Also, oral chemotherapy drugs are
handled on the pharmacy side of insurance while intravenous drugs are handled
on the medical side, so integrating those two systems will take time. He added
that this legislation limits choices and options. It only impacts about
12 percent of people covered by health insurance and the subset that is the
most price-sensitive. If this bill passes, an increased cost in premiums is
anticipated and businesses and individuals struggling to keep any type of
insurance may be kept out of the marketplace. Referring to subsection B, which
states that an insurer cannot adjust intravenous copayments in order to be in
compliance with the ACA, he submitted that the cost of drugs will change and
pricing flexibility is needed to adapt to the marketplace.
Mr. Osborn responded to questions concerning copayments, the request for a delayed effective date and pricing flexibility.
Brian Hummell, Arizona Director, Government Relations, American Cancer Society Cancer Action Network, spoke in favor of the strike-everything amendment to HB2078. He said this legislation is offered under the premise that cancer patients who are insured should have access to the latest anti-cancer medications.
James Brewer, Executive
Director, Arizona Chapter, Leukemia and Lymphoma Society; Fair Access to Cancer
Treatment Coalition, spoke in favor of the strike-everything amendment to HB2078.
He indicated that the Fair Access to Cancer Treatment (FACT) Act states that if
an insurance plan provides coverage for intravenous (IV) and oral cancer
medications, the out-of-pocket cost to the patient should be equal. Currently,
IV treatments are covered under the medical plan and oral therapies are covered
under pharmacy benefits, which often creates a wide disparity in out-of-pocket
expenses by patients. Cancer patients need this action to ensure they have
access to whichever treatment is best for them. Most of the new treatments are
orally based and often no IV counterpart exists. This legislation was passed
in 27 states and in
Washington, D.C. where there have not been negligible increases in premiums.
Referring to subsection B, he indicated that a recommendation was included in a
Texas Department of Insurance study that the language is necessary and
important. He is willing to discuss timing of implementation because of the
concerns raised, but many patients cannot afford to wait.
Linda Frisk, State Pharmacist, Arizona Oncology; Member, Pharmacy Advisory Board, U.S. Oncology, spoke in favor of the strike-everything amendment to HB2078. She related that oral chemotherapy agents are specifically technologically designed to target mutations inside cancer cells. These agents are less toxic to normal cells, there is an increased response rate, an increase in overall survival and the cancer becomes a chronic disease the patient can live with as long as the medication is taken. She said 100 to 400 oral agents are in the pipeline designed to target different types of cancer. Patients are struggling to obtain the right therapy which, many times, is oral.
Ali McBride, Clinical Coordinator, University of Arizona Cancer Center, spoke in favor of the strike-everything amendment to HB2078. He testified that through the development of drug therapies in the oral oncolytic field there have been numerous advances at different disease stages. The major issue is that when companies are developing these biotech drug therapies, they often delineate resources for availability as an oral drug or an IV drug and there is usually no crossover or means between the two therapies. With the actual change to oral drug therapies, there has been a change in terms of patient care and cost of care. A recent patient with chronic lymphocytic leukemia (CLL) had a gene mutation that did not allow for better progression with IV therapies so a new breakthrough drug therapy was used that may help in delaying or preventing the progression of CLL; however, the upfront copayment for the first dose was $3,500. Numerous studies have shown that patients are able to return to work while continuing treatment with these oral medications.
Linda May, representing self, spoke in favor of the strike-everything amendment to HB2078. She testified that she is a cancer patient who is battling leukemia and one of the lucky few who has had access to a life-saving oral chemotherapy called Gleevec. She lost her ability to earn so she has been forced to rely on family to help pay for medications, health insurance premiums and doctor/hospital visits. She pays a $35 copayment for the oral medication, which costs $7,409.49 without insurance. Oral chemotherapy medications have made enormous progress in the war against cancer but most cancer patients do not have access to them. She asked the Committee to help people who cannot help themselves.
Gregg Baumgarten, representing self, spoke in favor of the strike-everything amendment to HB2078. He said he is the survivor of a rare blood cancer called chronic myelogenous leukemia and a living example of how advances have been made in combatting cancer. He currently takes 100 milligrams of Sprycel every day, but it costs approximately $10,000 per month so his deductible in the first two weeks of the year is almost $7,000 out of pocket. The oral chemotherapy enables him not only to survive but to function on a day-to-day basis as a contributing taxpaying member of society. There are people in his circumstance who must make life and death decisions with regard to treatment because they cannot afford the out-of-pocket expenses and copayments.
Cathy Dalzell, Chair, Advisory Council for International Cancer Advocacy Network, spoke in favor of the strike-everything amendment to HB2078. She said she is an 18-year breast cancer survivor and the daughter of a lymphoma survivor. Access to oral drugs is critically important for patients who may experience a reoccurrence of cancer and who cannot go back to the standard drugs they took years ago. She urged the Members to support this legislation.
Dr. La Verne Harris, representing self, spoke in favor of the strike-everything amendment to HB2078. She stated that she has cancer and when she was diagnosed, she was told she had two or three years to live and nothing could be done to help her because she was chemo resistant and did not qualify for a bone transplant. She left her job and has been participating in a clinical trial with the National Institutes of Health with an oral cancer treatment, which keeps the cancer at bay. The Food and Drug Administration approved the drug, but not for her particular cancer, which she is told will occur in 2014. The cost of paying for an oral cancer treatment compared to IV treatment is prohibitive, so when this drug becomes available outside the clinical trial, she may not be able to afford it and her cancer will progress.
Names of those who signed up in support of the strike-everything amendment to HB2078 but did not speak:
Elaine Arena, representing self
Laura Knaperek, representing self
Donna Kruck, Arizona Bridge to Independent Living
Joan Koerber-Walker, representing self
Bridget Eagy, representing self
Jason Bezozo, Banner Health
Deborah Land, representing self
Victoria Smith, representing self
Pamela Giannonatti, representing self
Sharon Kolb, representing self
Jovanna Perez, representing self
Fransoany Reyes, representing self
Sharon Carlson, representing self
Frank Nagy, representing self
Zachary Singh, representing self
Tina Brown, representing self
Robin Hansen, representing self
Shayna Diamond, representing self
Christian Stumpf, American Lung Association of Arizona
Nicole Olmstead, American Heart Association
Names of those who signed up in opposition to the strike-everything amendment to HB2078 but did not speak:
Kathyrn Busby, Health Net, Inc.
Wendy Briggs, Cigna HealthCare of Arizona, Inc.
Jay Kaprosy, CVS Caremark
Chuck Bassett, Blue Cross Blue Shield of Arizona
Question was called on the motion that the Carter four-page strike-everything amendment to HB2078 dated 02/14/14 (Attachment 13) be adopted. The motion carried.
Vice-Chairman Boyer moved that HB2078 as amended do pass. The motion carried by a roll call vote of 8-0-0-0 (Attachment 15).
HR2008 - ovarian cancer awareness day - DO PASS
Mrs. Brophy McGee moved that HR2008 do pass.
Ingrid Garvey, Majority Research Analyst, explained that HR2008 is a resolution that the Arizona House of Representatives proclaim the first Friday of September each year as Ovarian Cancer Awareness Day in the State of Arizona (Attachment 16).
Laura Knaperek, representing self, spoke in favor of HR2008. She stated that she is an ovarian cancer survivor. Ovarian cancer is the silent killer because there is no screening and, because of that, it has not received much attention over the years. She is now a member of Pound Out Cancer (Attachment 17). One of the most important things that can happen is research, but an evaluation center is also needed for women with symptoms; a notch group of women cannot qualify for government programs and cannot afford health insurance.
Tamera Call, representing self, spoke in favor of HR2008. She related that she is an ovarian cancer survivor. She thought she had the flu, but she was fortunate because the physician at the urgent care center she went to recognized the symptoms as serious and sent her to the hospital where she was diagnosed after having an ultrasound. She urged the Members to support awareness to make a difference.
Mary Steigerwald, Women's Care Center, Dignity Health, spoke in favor of HR2008. She said not only is it important to educate people, but also to set up screening guidelines for ovarian cancer, which is very lethal. Many women do not know the symptoms, and even if they do, many providers do not. She noted that an ovarian cancer evaluation center was established to provide genetic screenings, pelvic ultrasounds and counseling; hopefully, federal dollars provided to the Arizona Health Care Cost Containment System can be obtained for ovarian cancer treatment for women who are diagnosed.
Joseph Casey, representing his mother; President, Ovarian Cancer Alliance of Arizona, in favor of HR2008, stated that his mother passed away at the age of 47 from ovarian cancer. The symptoms are discoverable and treatable, but if discovered too late, the chances of survival are greatly reduced. He asked the Members to help spread awareness of the symptoms at the family level, as well as in hospitals, across the state. He added that men are also affected; he is the son of a deceased carrier of BRCA and ovarian carrier and he carries the BRCA mutation.
Chairman Carter, sponsor, stated that this resolution is about creating an Ovarian Cancer Awareness Day and she appreciates the testimony. This is a first step in addressing policy around this issue.
Names of those who signed up in support of HR2008 but did not speak:
Brian Hummell, American Cancer Society Cancer Action Network
Stefanie Casey, representing self
Tara Plese, Arizona Alliance for Community Health Centers
Question was called on the motion that HR2008 do pass. The motion carried by a roll call vote of 8-0-0-0 (Attachment 18).
HB2490 - appropriation; mental health first aid - DO PASS
Vice-Chairman Boyer moved that HB2490 do pass.
Ingrid Garvey, Majority Research Analyst, explained that HB2490 appropriates $250,000 from the General Fund in fiscal year 2015 to the Arizona Department of Health Services (ADHS) for the purpose of providing mental health first aid training for adults who regularly interact with adolescents (Attachment 19).
Ms. Steele, sponsor, remarked that this is a newer version of last year's mental health first aid bill. It is intended to meet the needs of youth who are 12 to 18 years of age and make training available to anyone who is around teenagers so that when mental illness begins to show up, which often occurs in adolescence, they are able to help and prevent tragedy. It is also meant to address depression, anxiety, eating disorders, substance abuse disorders, etc.
Jason Winsky, Combined Law Enforcement Association of Arizona, in favor of HB2490, endorsed the mental health first aid training, which he attended as a police officer.
Ms. Steele stated that she saw a news story about eight-year-old Sabrina Santos Vasquez who died in July of apparent severe abuse. As the Child Protective Services situation is being reviewed, an incredible lesson can be learned from Sabrina's teenage mom; preventive services need to be provided.
Names of those who signed up in support of HB2490 but did not speak:
Donna Kruck, Arizona Bridge to Independent Living
Emily Jenkins, Arizona Council of Human Services Providers
Craig Sparrazza, representing self
James Dunn, representing self
Steve Muratore, representing self
Pat VanMaanen, representing self
Rory Hays, Arizona Nurses Association
Eddie Sissons, Mental Health America of Arizona
David Landrith, Arizona Medical Association
Laura Dearing, Arizona Society of the American College of Osteopathic Family Physicians; Arizona Academy of Family Physicians
Tara Plese, Arizona Alliance for Community Health Centers
Bahney Dedolph, representing self
David Carey, Arizona Disability Advocacy Coalition
Suzanne Schunk, representing self
Stephanie Seigla, representing self
Anneliese Hollobaugh, representing self
Lisa Berger, representing self
Lacey Markle, representing self
Vanity Denise Caraveo Sandoval, representing self
Haydee Moran, representing self
Randi Wyatt, representing self
Jessica Burns, representing self
Neda Spiric, representing self
Patricia Carroll, representing self
Adrienne Verdel, representing self
Peyton Taylor, representing self
Kendal Konski, representing self
Cristina Felix, representing self
Carol McDermott, representing self
Edward Myers, representing self
John Duffy, representing self
Jon Meyers, representing self
Names of those who signed up as neutral on HB2490 but did not speak:
Leonard Clark, representing self
Colby Bower, Arizona Department of Health Services
Question was called on the motion that HB2490 do pass. The motion carried by a roll call vote of 8-0-0-0 (Attachment 20).
HB2531 - court-ordered evaluation services; payment - DO PASS AMENDED
Vice-Chairman Boyer moved HB2531 do pass.
Vice-Chairman Boyer moved that the Brophy McGee five-line amendment to HB2531 dated 02/17/14 (Attachment 21) be adopted.
Sophia Horn, Majority Research Intern, explained that HB2531 eliminates a charge against the counties associated with court-ordered evaluations if a person is eligible for federal benefits or has private health insurance coverage (Attachment 22). The Brophy McGee five-line amendment to HB2531 dated 02/17/14 (Attachment 21) limits the options in which counties can recover costs from court-ordered evaluations to Arizona Health Care Cost Containment System recipients.
Vice-Chairman Boyer asked what diagnostic tool is used for court-ordered psychological evaluations.
Mrs. Brophy McGee, sponsor, remarked that she believes there is a specific process outlined for court-ordered psychological evaluations, which involves two evaluations. The counties are currently conducting the evaluations and being asked to intervene in cases of seriously mentally ill individuals. This bill is a follow-up on Speaker Andy Tobin's suggestion during the budget crisis that counties and municipalities identify and implement cost saving measures that could avoid placing an additional financial burden on the state. It allows counties to seek federal insurance payments to cover costs associated with court-ordered evaluations.
Kristin Cipolla, County Supervisors Association of Arizona, in support of HB2531, stated that the bill, with the amendment, will allow counties to seek federal insurance payments to cover costs associated with court-ordered evaluations, which are conducted when a person is perceived as a danger to himself or herself or to others, and the judge orders not one but two psychiatric evaluations. Counties are currently the payer of only resort even if that person has Medicaid health insurance; for populations with Medicaid that are not fully funded by the federal government, counties pay any state portion in order to prevent the state from being financially impacted. In response to a question, she related that some counties spend about $13,000 and some of the larger counties, such as Pima County, spend over $4 million annually.
Names of those who signed up in support of HB2531 but did not speak:
Suzanne Schunk, representing self
Anneliese Hollobaugh, representing self
Lacey Markle, representing self
John Duffy, representing self
Todd Madeksza, County Supervisors Association
Names of those who signed up as neutral on HB2531 but did not speak:
Jennifer Carusetta, Arizona Health Care Cost Containment System
Chuck Bassett, Blue Cross Blue Shield of Arizona
Question was called on the motion that the Brophy McGee five-line amendment to HB2531 dated 02/17/14 (Attachment 21) be adopted. The motion carried.
Vice-Chairman Boyer moved that HB2531 as amended do pass. The motion carried by a roll call vote of 8-0-0-0 (Attachment 23).
HB2549 - nursing care institutions; therapeutic drugs - DO PASS
Vice-Chairman Boyer moved that HB2549 do pass.
Ingrid Garvey, Majority Research Analyst, explained that HB2549 adds a new section of statute regarding nursing care institutions and therapeutic substitutions (Attachment 24).
Chairman Carter, sponsor, said this bill allows skilled nursing facilities to create drug substitution formularies on a facility-wide basis like hospitals have done for years, but the prescriber still retains the decision-making power on whether the substitution is appropriate for the patient.
Richard Lasota, registered nurse; Division Director, Life Care Centers of America, in favor of HB2549, stated that Life Care operates 17 skilled nursing facilities in Arizona and more than 200 facilities nationally. The company is deeply committed to quality care and lives of the residents. This bill will allow therapeutic substitutions in nursing home settings. Life Care utilizes therapeutic substitutions in many other states and it is safe and economical.
Names of those who signed up in support of HB2549 but did not speak:
Sylvia Balistreri, representing self
Richard Park, representing self
Scott Wynn, representing self
Ella Barney, representing self
John Albrechtsen, representing self
Michael Haener, Arizona Health Care Association
Genny Rose, representing self
Kathleen Pagels, Arizona Health Care Association
Don Isaacson, Leading Age Arizona
Rory Hays, Arizona Nurses Association
Dean Kidder, representing self
Linda Doescher, representing self
Kyrstyn Richardson, representing self
Kathleen Langford, representing self
Frank Langford, representing self
Larry Litman, representing self
Ken Green, representing self
Tyler Litman, representing self
Phyllis Gaylord, representing self
Blake Gillman, representing self
Eddie Wagoner, representing self
David Landrith, Lobbyist, Arizona Medical Association
Jeron Walker, representing self
Cynthia Leach, representing self
Jeff Gray, Lobbyist, Arizona Pharmacy Alliance
Matt Ham, representing self
Names of those who signed up as neutral on HB2549 but did not speak:
Colby Bower, Arizona Department of Health Services
Question was called on the motion that HB2549 do pass. The motion carried by a roll call vote of 8-0-0-0 (Attachment 25).
HB2086 - technical correction; technical registration board - DO PASS AMENDED S/E
S/E: sale of dextromethorphan; age requirement
Vice-Chairman Boyer moved that HB2086 do pass.
Vice-Chairman Boyer moved that the Carter two-page strike-everything amendment to HB2086 dated 02/17/14 (Attachment 26) be adopted.
Ingrid Garvey, Majority Research Analyst, explained that the Carter two-page strike-everything amendment to HB2086 dated 02/17/14 (Attachment 26) makes it unlawful for any commercial entity to sell or trade a finished drug product containing any quantity of dextromethorphan (DXM) to a person under 18 years of age, for a person under 18 to purchase a product containing any quantity of DXM and for any person to possess, receive or distribute DXM unless the person is registered pursuant to the Food and Drug Administration (FDA) or licensed with the Arizona State Board of Pharmacy (Attachment 27).
Ryan O'Daniel, Consumer Healthcare Products Association, spoke in favor of the strike-everything amendment to HB2086. He related that over the past few years, there has been an increased prevalence and abuse of products containing DXM, which is most commonly known as cough syrup. It is important to send the message to teens, parents and the federal government that the problem is known and attempts are being made to resolve it. The penalty language included for the retailer is a warning for a first offense and a $50 fine for a second offense unless the retailer can demonstrate that a training program is in place that would have educated the employee to verify the age of the purchaser.
Names of those who signed up in support of the strike-everything amendment to HB2086 but did not speak:
Janna Day, Consumer Healthcare Products Association
Names of those who signed up as neutral on the strike-everything amendment to HB2086 but did not speak:
John Mangum, Arizona Food Marketing Alliance
Janet Underwood, Arizona Retailers Association
Jeff Gray, Arizona Pharmacy Alliance
Question was called on the motion that the Carter two-page strike-everything amendment to HB2086 dated 02/17/14 (Attachment 26) be adopted. The motion carried.
Vice-Chairman Boyer moved that HB2086 as amended do pass. The motion carried by a roll call vote of 8-0-0-0 (Attachment 28).
HM2002 - burn pits; health risks; veterans - DO PASS
Vice-Chairman Boyer moved that HM2002 do pass.
Ingrid Garvey, Majority
Research Analyst, explained that HM2002 is a memorial that asks the United
States Congress to recognize that open-air burn pits impose significant health
risks and enact a presumption of a service connection between open-air burn pit
exposure and subsequent illnesses that is similar to the presumption in place
for exposure to Agent Orange
(Attachment 29).
Representative Mark Cardenas, sponsor, remarked that he was exposed to a garbage dump covered with dirt that was burned every day when he was in Iraq, and thousands of returning veterans are now claiming they have respiratory problems as the result of exposure to burn pits. Every person deployed to Iraq and Afghanistan has a letter in their medical record stating that burn pits were operated widely at military sites in Iraq and Afghanistan but, at this time, research does not show evidence of long-term health problems. Vietnam veterans were told not to worry about the chemical Agent Orange, but upon returning home, began to suspect their ill health, instances of wives having miscarriages and children born with birth defects may be related to Agent Orange. The Veterans' Administration (VA) website now contains a list of diseases that veterans exposed to Agent Orange are considered at high risk of acquiring, which is considered as part of their disability rating, making the VA responsible for all health care costs in relation to treating their illness. This memorial asks Congress to take the same type of precaution with veterans who were exposed to burn pits.
Leonard Clark, representing self, related that he served in the Persian Gulf in 1990-1991 in the Arizona Army National Guard where he and others were exposed to burn pits, nerve gas, experimental Anthrax, open sewage, etc. He has many friends who are having breathing problems. He had a University of Arizona track scholarship, but when he returned from the Persian Gulf, he could barely run, and when he was tested at the VA, he was diagnosed with moderate asthma. He asked the Members to support HM2002.
Names of those who signed up in support of HM2002 but did not speak:
Brian Tobin, representing self
Question was called on the motion that HM2002 do pass. The motion carried by a roll call vote of 7-1-0-0 (Attachment 30).
HB2648 - reimbursement; orthotic and prosthetic devices - DO PASS AMENDED
Vice-Chairman Boyer moved HB2648 do pass.
Vice-Chairman Boyer moved that the Brophy McGee two-page amendment to HB2648 dated 02/18/14 (Attachment 31) be adopted.
Ingrid Garvey, Majority
Research Analyst, explained that HB2648 prohibits specified insurers from
reimbursing a health care provider for an orthotic or prosthetic device
furnished to a subscriber unless they meet specific qualifications (Attachment
32). The Brophy McGee two-page amendment to HB2648 dated 02/18/14 (Attachment
31) removes the language from
Title 20, Arizona Revised Statutes (A.R.S.), which is the insurance statute,
and adds a new article in Title 36, Chapter 25, A.R.S., which is health care quality
assurance. It states that beginning January 1, 2015, custom orthotic or
prosthetic devices furnished to an individual by a health care provider must
meet the following requirements:
· Be provided from a facility that is accredited by an accreditation organization approved by the Centers for Medicare and Medicaid Services (CMS)
· Be provided by a health care provider that is a qualified practitioner defined by federal law or licensed pursuant to statute
· Have a valid prescription for the device
· States that this section does not require a health care provider to accept Medicare patients
· Mirrors language in the Arizona Health Care Cost Containment System statutes to allow reimbursement for prosthetic devices
Mrs. Brophy McGee, sponsor, stated that stakeholder meetings were held and the purpose of this bill, with the amendment, is to establish minimal standards for providers of orthotics and prosthetics. If someone is given the wrong kind of brace, it could exacerbate the condition. She said a similar program exists with Medicare.
Vice-Chairman Boyer asked if there is an issue with non-CMS-accredited facilities offering deficient prosthetic devices. Mrs. Brophy McGee answered that there are providers who do not provide the appropriate type of orthotics, treatment and fit, so the bill is intended to establish minimum standards to that effect.
James Stabler, Chief Counsel, CopperPoint Mutual Insurance Company formerly State Compensation Fund of Arizona, neutral on HB2648, stated that CopperPoint is the largest provider of workers' compensation insurance. He noted that he just found out about this bill the previous day and would like to be involved in any further discussions since the company has not had time to analyze how this may impact their business operations with the many medical providers the company does business with in the state. He endorsed removal of the Title 20 section with the amendment.
Brandy Petrone, representing Hanger, spoke in support of HB2648. She indicated that this legislation is intended to provide minimum standards for qualified providers in order to ensure patient safety and quality of care, and the amendment provides a better approach to the intent. She made a commitment to continue working with stakeholders. In response to questions, she related that the federal government has been dealing with fraudulent billing and patient care issues relating to prosthetic and orthotic devices that have been fitted by an individual who is not properly licensed or educated. Locally, Hanger has had individuals who need to be refitted or have adjustments made, for example, by an individual who is an employee of the manufacturer so there is no phone number or office to visit for follow-up care. She advised that 10 nationally-recognized organizations are approved by CMS to provide accreditation.
Names of those who signed up as neutral on HB2648 but did not speak:
Jennifer Carusetta, Arizona Health Care Cost Containment System
Andrew Carlson, Arizona Department of Insurance
Chuck Bassett, Blue Cross Blue Shield of Arizona
Kathyrn Busby, Health Net, Inc.
Question was called on the motion that the Brophy McGee two-page amendment to HB2648 dated 02/18/14 (Attachment 31) be adopted. The motion carried.
Vice-Chairman Boyer moved that HB2648 as amended do pass. The motion carried by a roll call vote of 8-0-0-0 (Attachment 33).
HB2641 - tobacco products;
schools; business premises - DO PASS AMENDED FAILED
Vice-Chairman Boyer moved HB2641 do pass.
Vice-Chairman Boyer moved that the Townsend four-page amendment to HB2641 dated 02/18/14 (Attachment 34) be adopted.
Vice-Chairman Boyer assumed the Chair.
Sophia Horn, Majority Research Intern, explained that HB2641 makes it a class 2 misdemeanor to sell a tobacco product to a minor, redefines tobacco product and adds language surrounding electronic smoking devices (Attachment 35). The Townsend four-page amendment to HB2641 dated 02/18/14 (Attachment 34) contains the following provisions:
· Reinstates a vapor product to the definition of tobacco product with additions
· Removes the definition of electronic smoking device
· Prohibits the use of vapor products on school grounds
· Allows businesses to prohibit the use of vapor products on their premises
· Requires businesses and persons at businesses that sell tobacco products to register with the Arizona Department of Health Services (ADHS)
· Adds penalties for violations
· Allows the ADHS to adopt rules
Ms. Townsend, sponsor, stated that the intent of the bill is to assist businesses and to keep these products out of the hands of minors. The Attorney General's Office has a website where owners of stores that sell the products are required to register and penalties are increased for people who sell the products to minors.
Chairman Carter resumed the Chair.
Discussion followed about the definition of electronic smoking devices.
John Mangum, representing Arizona Food Marketing Alliance, spoke in opposition to HB2641. He expressed concern about reclassification of the penalty for selling tobacco products to a minor to a class 2 misdemeanor, which is a potential four months in jail and a fine between $750 and $1,000. This legislation is one more step in the state becoming involved in private business and private property activities that does not make sense. All a business has to do is post a notice in the doorway prohibiting the use of these products. Additionally, every business that retails tobacco products will be required to register, which is probably 30,000 to 50,000 stores across the state, and there are heavy penalties if it is not done. He added that he was not involved in the stakeholder process nor was anyone in the retail business invited.
Discussion continued between Mr. Mangum and Ms. Townsend regarding regulation of private businesses. Ms. Townsend indicated that she is willing to work on changing the penalty.
William Cohen, representing self, spoke in opposition to HB2641. He stated that he is the owner/founder of a registered nonprofit organization that supports veterans by providing nicotine alternatives. He appreciates reinstatement of the old language, noting that vapor products are not tobacco products. Vapor products are safe and used to help people stop using tobacco products. There is already a law making it illegal to sell these products to minors and a regulation is already in place allowing businesses to ban certain activities.
Brian Hummell, American Cancer Society Cancer Action Network, neutral on HB2641, indicated that the underlying bill and definition is what he suggested last year. He endorsed the registry requirement.
Colby Bower, Chief Legislative Liaison, Arizona Department of Health Services, neutral on HB2641, stated that the amendment contemplates the registry at ADHS; however, there is no funding provided.
Chris Mason, representing self, spoke in opposition to HB2641. He testified that he is a business owner. He is uncertain about the registry and opined that it should be the responsibility of the individual store owner to know better than to sell to a minor.
In response to a question, Ms. Townsend indicated that a fiscal note has not been requested. She pointed out that the Attorney General's Office indicated to her that the website is already available so no additional appropriation will be necessary.
Names of those who signed up in support of HB2641 but did not speak:
Art Harding, Arizona Attorney General's Office
Names of those who signed up as neutral on HB2641 but did not speak:
Nicole Olmstead, American Heart Association
Christian Stumpf, American Lung Association of Arizona
Pat VanMaanen, representing self
Names of those who signed up in opposition to HB2641 but did not speak:
Michelle Ahlmer, Arizona Retailers Association
Question was called on the motion that the Townsend four-page amendment to HB2641 dated 02/18/14 (Attachment 34) be adopted. The motion carried.
Vice-Chairman Boyer moved that HB2641 do pass. The motion failed by a roll call vote of 3-5-0-0 (Attachment 36).
Without objection, the meeting adjourned at 1:46 p.m.
_________________________________________
Linda Taylor, Committee Secretary
April 23, 2014
(Original minutes, attachments and audio on file in the Office of the Chief Clerk; video archives available at http://www.azleg.gov)
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COMMITTEE ON HEALTH
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February 19, 2014
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