December 2016—Public Health Law News

CDC Grand Rounds About Public Health Law. CDC presented “Public Health Law: A Tool to Address Emerging Health Concerns” on Tuesday, December 13, 2016. An archived webcast is available in the CDC Grand Rounds Previous Sessions area of the webpage. This session of Grand Rounds celebrated the 15th anniversary of CDC’s Public Health Law Program (PHLP). Speakers provided an overview of public health law, described how it is an essential component of contemporary public health practice, and discussed modern concepts of public health law, including legal epidemiology.

---

Job Announcement. The Office of General Counsel for the South Carolina Department of Health and Environmental Control is seeking an experienced attorney to join the agency as the sole advisor of the State of South Carolina for all questions involving the protection of public health. Applicants must possess a juris doctor degree from an American Bar Association-accredited law school and be admitted and authorized to practice law in the highest court of at least one state or the District of Columbia. Applications must be submitted by December 18, 2016.

---

Public Health and HIPAA Blog. Health IT Buzz has published a blog article, “How HIPAA Supports Public Health through the Sharing of Electronic Health Information,” by Lucia Savage, Health IT Buzz’s chief privacy officer, and Matthew Penn, director of PHLP.

Healthy People 2020  Law and Health Policy Project Resources. PHLP, in partnership with the Healthy People 2020  initiative  (HP2020),  has published two new legal and policy resource anthologies related to HP2020  topic areas, including access to health services and disability and health.

---

Menu of Selected Tribal Mosquito and Vector Control Laws. This menu, published by PHLP, offers examples of selected tribal laws related to mosquito and vector control that can be used by jurisdictions interested in developing or updating their own vector control laws to respond to threats of vector-borne diseases.

National: US will ban smoking in public housing nationwide

New York Times   (11/30/2016)   Mireya Navarro

The Department of Housing and Urban Development announced a new rule banning smoking inside public housing residences. The rule will come into effect early next year and will affect more than 1.2 million households across the country. It states that no one may smoke inside or within 25 feet of any public housing residences or office buildings. The ban is not without controversy, however.

Public health officials argue that this rule will bring huge health gains by preventing second-hand smoke from harming public housing residents, including 760,000 children nation-wide. Housing officials add that preventing smoking-related fires and property damage will save money.

Critics cite concerns about possible evictions or increased police involvement in public housing communities. Others protest on the grounds of governmental intrusion: they don’t like the idea of the government telling them what they can do within the privacy of their own homes. In addition, the federal government will not provide any additional funds to local housing authorities to enforce this mandate.

[Editor’s note: Learn more by reading HUD Secretary Castro Announces New Rule Making Public Housing Smoke-Free and Questions and Answers on HUD’s Smoke Free Public Housing Proposed Rule.]

California: ‘Victimizing me all over again’: San Bernardino victims fight for treatment
New York Times   (11/30/2016)   Richard Pérez-Peña

---

California: 10 more victims identified in Oakland warehouse fire that killed at least 36
ABC 7   (12/05/2016)  
[Editor’s note: Read the City of Oakland, California’s press release [PDF - 33KB] about the fire, 12/04/2016.]

---

Florida: Dr. Hansel Tookes fought for four years to create Florida’s first needle exchange
Miami New Times   (11/15/2016)   Jess Swanson
[Editor’s note: Learn more about Miami Dade County, Florida’s needle exchange program, which will be begin with a pilot program at the University of Miami.]

---

Florida: Sarasota smoking ban in HUD units three years later
10 News   (12/05/2016)   Isabel Mascareñas

---

North Dakota: Protesters gain victory in fight over Dakota access oil pipeline
New York Times   (12/04/2016)   Jack Healy and Nicholas Fandos
[Editor’s note: Read the US Department of the Army’s release, Army will not grant easement for Dakota Access Pipeline crossing, 12/04/2016.]

---

National: FDA agrees to new trials for Ecstasy as relief for PTSD patients
New York Times   (11/29/2016)   Dave Philipps
[Editor’s note: Learn more about Post Traumatic Stress Disorder (PTSD).]

---

National: Needle exchanges significantly reduce HIV infections, but problems remain
Business Insider   (11/29/2016)   Andrew Joseph
[Editor’s note: Learn more about how sharing needles is related to HIV infections and needle exchanges.]

---

National: Obesity goals missed
US News   (12/05/2016)   Mike Stobbe
[Editor’s note: Learn more about CDC’s Winnable Battles Final Report and about Ten Great Public Health Achievements from 2001–2010, all of which are related to law.]

Australia: A group of high school students has made Martin Shkreli’s $750-drug Daraprim for $2
Business Insider   (12/01/2016)   Fioan MacDonald

---

Uganda: HIV/Aids activists have asked Parliament to amend the HIV Prevention and Control Act
New Vision 30   (11/30/2016)   Noah Jagwe

---

World:  Princess Cruises hit with largest-ever criminal penalty for ‘deliberate pollution’
NPR   (12/01/2016)   Merrit Kennedy
[Editor’s note: Learn more by reading the US Department of Justice’s release, Princess Cruise Lines to Pay Largest-Ever Criminal Penalty for Deliberate Vessel Pollution.]

Title: Senior Director of Public Policy and Advocacy at Georgia Watch

Education: JD, University of the District of Columbia David A. Clarke School of Law, BA in English and Political Science, Emory University

---

Public Health Law News (PHLN): Please describe your education and career path.

Stephens: I grew up in Tennessee but have lived in Georgia on and off for the past 15 years. I went to Emory University for my undergraduate degree, then spent some time in New Mexico and DC, and landed back in Atlanta in 2009. My parents are social workers and nurses. My mother and step-father have held management and leadership positions in nonprofits for as long as I can remember. I have certainly been influenced by my parents whose careers emphasized community improvement and working to help others.

PHLN: What drew you to law and, more specifically, health law?

Stephens:The law is an important tool for shaping our society and protecting our rights. I wanted my education to provide me with the ability to have influence and help my community in positive ways through my work, and I saw the study of law as a necessary step in being able to accomplish those career goals in whatever field I chose. I didn’t go to law school with a desire to practice health law or engage in consumer advocacy; it was just a natural evolution for me. I chose my law school because of its explicit focus on training public interest lawyers. I had an internship in law school in the public benefits unit at the Legal Aid Society of the District of Columbia where I learned about the critical benefits provided by our Medicaid and Social Security programs. I also worked in law school in legal clinics where I represented low-income tenants and homeowners in DC. These experiences led me to work in the Health Law Unit at the Atlanta Legal Aid Society after law school where I worked on a variety of civil legal issues for many clients with terminal or life-threatening illnesses. I began to understand even more clearly the necessity of our public benefit programs and of the desperate need for affordable healthcare access for many Georgians. After the passage of the Affordable Care Act, I saw an opportunity to do policy work to encourage Medicaid expansion in Georgia. I wanted—and continue to want—to be part of the solution that will improve healthcare access for vulnerable members of my community.

PHLN: Please describe Georgia Watch and your position there.

Stephens: Georgia Watch is a nonprofit, nonpartisan 501(c)3 organization with a mission to empower and protect Georgia consumers related to matters that affect their wallets and quality of life through education, advocacy, and policy development. We work to safeguard consumer protections in personal finance; ensure access to safe, quality, affordable health care; protect the right to trial by jury; promote access to the courts; and encourage fair utility rates and renewable energy options.  Since its founding in 2002, Georgia Watch has informed and assisted consumers through statewide outreach, including workshops, online presence, and informational brochures, as well as a toll-free consumer hotline that enables us to provide one-on-one assistance. While we look out for all Georgia residents, we pay particular attention to those who most need a champion—senior citizens, low-wealth individuals, the uninsured, the underinsured, and those who are most at risk for predatory business practices and the high cost of utilities and health care. Ultimately, Georgia Watch is a voice for the voiceless, supporting Georgians whose interests should be represented at the Legislature, in state agency decisions, or before the Public Service Commission.

As the senior director of Public Policy and Advocacy at Georgia Watch, I work to advance the mission of the organization across all program areas: health care, energy, civil justice, and financial protection. I supervise the work of the Health Access Program, and I author policy reports and educational resources for consumers. I also conduct advocacy work at the state and national levels and collaborate with government agencies, community-based organizations, professional associations, policymakers, legislators, academic partners, advocacy groups, and other stakeholders. 

PHLN: What are your day-to-day job responsibilities?

Stephens: In my advocacy work, I help conceptualize and draft legislation, collect consumer stories that articulate why our initiatives are so important, and regularly meet with other stakeholders, legislators, and policymakers to gather support and build consensus on different issues.

Part of my work is managing grant-funded projects. That work can include planning meetings and leading activities for our health-focused projects that involve relationship building and collaborative work. Some of our grant-funded project work involves writing policy papers that encourage discussion and advance best practices. In 2015, we released two healthcare policy reports: one examining barriers for advanced practice registered nurses [PDF - 1.13MB] in Georgia and suggesting policy changes that would improve rural healthcare access, and another providing an in-depth look at the first round of community health needs assessments [PDF - 1.61MB] conducted by Georgia’s nonprofit hospitals.

PHLN: What projects are you currently working on?

Stephens: We have two projects that focus on rural health that I’m particularly excited about. We have a Patient-Centered Outcomes Research Institute Pipeline to Proposal award through which we have built a partnership of individuals and groups that share a desire to advance patient-centered outcomes research focused on the provision of primary care in rural Georgia communities by non-physician providers. We also have a collaborative project through which we are building and strengthening relationships among consumer advocacy organizations, employers, and public health agencies in our state. We’re identifying areas of common interest and alignment among these groups and highlighting innovative approaches to multi-sector community health improvement in rural Georgia communities.

We have two projects through which we are working to address the issue of medical bills and medical debt. We’re building on some existing resources [PDF - 589KB] that we have developed to put together a comprehensive medical debt guide for consumers. We also have a legislative initiative to pass a law in Georgia that will protect consumers from surprise out-of-network medical bills.

PHLN: What is surprise medical billing?

Stephens:  A surprise medical bill can occur in any situation where a consumer’s health plan covers less than expected. A surprise out-of-network medical bill occurs when an insured consumer inadvertently encounters out-of-network providers at an in-network facility during the course of the consumer’s care. The consumer is then responsible for the excess medical costs of the out-of-network provider. This is sometimes called “balance billing.”  These bills often occur in a hospital or ambulatory care facility where anesthesiologists, surgical assistants, emergency room, or other specialty care providers are generally contracted, and not hospital employees. These providers do not necessarily participate in all of the same insurance plan networks as the facility in which they work. In Georgia, consumers are not required to receive advance notice that they could encounter an out-of-network provider or any estimate of what the cost of that care might be. Consumers could receive surprise out-of-network medical bills in the following scenarios:

• When they seek care at an emergency room at an in-network hospital and are unaware that some of the contracted providers are outside of their insurance plan network
• When they have a planned procedure at an in-network hospital and certain hospital-based providers involved in the procedure, such as anesthesiologists or surgical assistants, are outside of their insurance plan network
• When lab work or ultrasound tests are sent to out-of-network lab companies or radiologists

PHLN: How is surprise medical billing related to public health? 

Stephens: This is an issue that affects the public’s ability to access affordable health care. If insured consumers cannot accurately predict their healthcare costs, or if an emergency hospital visit can result in a devastating amount of medical debt for a family with health insurance, that signals a problem in our healthcare system that needs to be fixed.

PHLN: How are states addressing surprise medical billing?

Stephens: States that have recently passed legislation to stop surprise medical bills with rules that apply to both insurers and providers are: New York, Connecticut, Florida, and most recently, California. Many other states, like Georgia, are working on comprehensive protections. The New York law, which went into effect in 2015, protects consumers from owing more than their in-network cost-sharing (copayment, coinsurance, or deductible) for care received in emergency situations. It sets up an independent dispute resolution process that does not put the consumer in the middle of a dispute over charges between an insurer and a provider.

There is also proposed federal legislation (HR 3770) that would prohibit balance billing by hospitals and providers in emergency situations. It requires that consumers with planned procedures be given advance notice about the network status of the hospital and the providers that might be part of their care. These protections would apply to hospitals that accept Medicare payments, which is most.

PHLN: What kinds of surprise billing interventions are being considered in Georgia?

Stephens: Comprehensive legislation is currently being considered in Georgia that would require:

• Disclosure to consumers about out-of-network care in advance from healthcare providers and facilities;
• Hospital price transparency for standard charges and notice to consumers about contracted out-of-network providers at the hospital;
• Insurer disclosure provisions for consumers;
• A process for determining payment of surprise out-of-network bills, including establishment of an out-of-network reimbursement rate workgroup;
• Creation of an independent dispute resolution process by the Insurance Commissioner;
• Protections for consumers from unanticipated out-of-pocket costs in emergency situations, and
• A ban on balance billing after assignment of benefits.

PHLN: What other projects are you excited about working on currently? 

Stephens: We are working to raise awareness among consumers about how they can do their homework before choosing a physician or hospital for their care. Medical errors are one of the leading causes of death in the United States. People might know this, but they remain confused about how to make informed choices before purchasing health care. We have a web page for consumers that walks them through how to find quality and safety ratings for hospitals and physicians. And we have partnered with The Leapfrog Group to raise awareness about their Hospital Safety Grades and hospital compare tool.

PHLN: How might partnerships like the one between Georgia Watch and the Leapfrog Group improve public health outcomes? 

Stephens: Improving quality and safety in health care are public health priorities. Encouraging provider transparency and the development of reliable measures are critical to these efforts. By guiding consumers to tools they can access to evaluate provider quality and by encouraging and thanking hospitals that share information about their safety protocols, practices, and outcomes by voluntarily participating in The Leapfrog Group’s Annual Hospital Survey, we believe that we are helping to improve public health in our state.

PHLN: What other resources does your program offer?

Stephens: We have a resources page on our Georgia Watch website to help consumers find a free or low-cost clinic, access affordable health care at Georgia hospitals and handle medical bills. We also have resources for consumers in our financial protection and consumer energy program areas to help people find reliable credit counseling and save money on their power bills.

PHLN: What is your favorite part of your job?

Stephens: I love connecting with people and solving social problems. I get to do that every day in my work. I don’t always experience victories, but I feel like I’m constantly working toward worthwhile goals that will make my community and the lives of those living in it better. I truly appreciate that about my work.

PHLN: What are the greatest challenges you face in your position??

Stephens: Health care is complex—all of the social issues that we work on are. The answers become less simple when many different stakeholders get involved. Finding solutions that work for everyone and creating consensus can be very challenging, but it’s always an important goal.

PHLN: What would you be doing if you weren’t in health law and policy?

Stephens: I grew up riding horses and love the outdoors. I used to want to be a large animal vet. I read every book in James Herriot’s “All Creatures Great and Small” series. Despite my small stature, I think I would have made a great farm vet.

PHLN: Have you read any good books lately?

Stephens: Lately, I’ve been doing quite a bit of reading to stay up-to-date on issues that affect my work and my community. I love historical fiction and tend to gravitate toward books for pleasure that can transport me to another time and place.

PHLN: If you could travel anywhere in the world, where would you go and what would you do?

Stephens: Wow—there is so much world to see! I have travelled quite a bit and love the new perspectives that travel abroad and exposure to different cultures brings. This summer, I saw orca whales up-close in the wild in Canada, which has always been a dream of mine. I would love to see the aurora borealis (northern lights) someday. Can you tell I’m a cold weather person?

PHLN: Do you have any hobbies?

Stephens: I have a very active two-and-a-half-year-old. So, for the past six weeks, my husband and I have been taking him to different state parks for hikes every weekend. It’s been a great way to get outside and see more of the state. We also love camping and try to do that a couple of times each year.

The first reader to correctly answer the quiz question will be featured in a mini public health law profile in the January 2017 edition of the News. Email your entry to PHLawProgram@cdc.gov with “PHL Quiz” as the subject heading; entries without the heading will not be considered. Good luck!

---

Public Health Law News Quiz Question: December 2016

What career would Beth Stephens have, if she wasn’t working in public health law and policy? 

Carlos Santos-Burgoa

Question: Patrick Peck’s work supports which Native American tribe?

Answer: Seminole Tribe of Florida

Employment organization and job title:

Professor of Global Health and of Environmental and Occupational Health
Director, Program of Global Health Policy 
The George Washington University
Milken Institute School of Public Health, Department of Global Health

A brief explanation of your job:  
I’m a faculty member doing research and teaching on global health policies, mainly on regulatory capacity on chronic diseases risk factors (environmental, tobacco, alcohol diet, physical activity).

Education: 
MD, MPH, PhD in epidemiology

Favorite section of the News:
Global Public Health Law

Why are you interested in public health law? 
Law frames what we want to be delivered in our public health functions. It structures our interventions in such a way that it is clearly understood by everyone and eventually enforceable.

What is your favorite hobby?
Photography

Federal: Government hasn’t demonstrated pressing need to stay in insurance marketplace risk corridor case.
Moda Health Plan, Inc. v. The United States [PDF - 69KB]
The United States Court of Federal Claims
Case No. 16.648C
Filed 11/28/2016
Opinion by Judge Thomas C. Wheeler

---

New York: Deceased wishes must prevail over survivor’s own preferences in burial location, decedent to be disinterred then reburied in Israel.
Matter of Lipiner v. Plaza Jewish Community Chapel
Docket No. 156059/16, Motion Seq. No. 002
Filed 11/22/2016
Opinion by Justice Arlene P. Bluth

---

New York: Landlord not obligated to use non-chemical pest control methods for bedbugs.
People v. LMA Assoc. LLC v. Topey
City Court of Mount Vernon, New York
Case No. 16-3198
Decided 11/30/2016
Opinion by Judge Adam Seiden

"This is the stuff public health dreams are made of; very quickly, this will expand to HIV and hep-C prevention and overdose prevention across Miami and to the entire state of Florida,” says Dr. Hansel Tookes of Florida’s first needle exchange program, launched December 1, 2016.

[Editor’s note: This quote is from “Dr. Hansel Tookes fought for four years to create Florida’s first needle exchange,” in the Miami New Times, 11/15/2016, by Jess Swanson.]