WEEK FIVE 02/09 – 02/15: THE PROCESS OF HEALTH POLICY MAKING (STATUTORY AND REGULATORY MECHANISMS)

According to Arizona Legislative Council (2003), health policy formation goes through three phases in the legislative process: formulation, implementation, and evaluation. The policy formulation phase includes drafting a bill in proper form and getting a legislator to sponsor your bill from either the House or the Senate. The bill is assigned a number and goes through the First Reading. The Speaker/President assigns the bill to the appropriate Standing Committee. The Standing Committee reviews the bill (e.g. holds hearings, expert testimonies, and statements) and makes amendments. The Rules Committee, composed of attorneys, makes sure that the bill is constitutional before it goes to the Whole House for the Second Reading. The Whole House is a floor debate and it is opened to the public. If the bill clears by the majority of a voice vote, then it is given to the Legislative Counsel for engrossing before the Third Reading. There are no more debates or amendments in the Third Reading and a formal vote is counted. If it passes, then the Speaker/President signs it and it goes to the other House/Senate to go through the whole process all over again. If the bill passes without amendments, then it goes to the Governor. If it has amendments, then it goes to the Conference Committee (with members from both the House and the Senate) so that both the House and the Senate can work together to agree on the amendments before passing it on to the Governor to sign. If the Governor does not sign the bill in 5 days, then it automatically becomes a law/statue or if the Governor vetos the bill, then the House and Senate may override the veto by two thirds vote (Arizona Legislative Council, 2003). Citizens may also petition for an “initiated state statute” so that the public can vote on the proposition or measure (BallotPedia, n.d.).

Once a statue has been passed, there is a 90 day period before the “general effective date” (Arizona Legislative Council, 2003). The 90 day period is to allow an opportunity for a veto referendum (BallotPedia, 2003). Next is the implementation phase where the statute or law is put into action through regulatory mechanisms by the state (Abood, 2007). In this case, the Arizona Department of Health Services (AZDHS) was put in charge to develop the policies, rules, and regulations for the Arizona Medical Marijuana Program.

The evaluation and modification phase is when policies are re-evaluated and may be amended, usually in an incremental fashion (Abood, 2007). The AZDHS usually holds an annual rulemaking review. Medical Marijuana was on the 2015 Regulatory Agenda to review Articles 1-3. However, the AZDHS is currently not conducting any rulemaking activities this year due to a rulemaking moratorium established by the Governor, Doug Ducey (Arizona Department of Health Services, 2015).

A personal interview with Dr. Gina Mecagni (February 8, 2015), an ER physician and Medical Director of several medical marijuana dispensaries in Arizona, states that if she could change anything about the Medical Marijuana Program, it would be allow dispensaries to be present in more populated areas. Pharmacies are not allowed to sell medical marijuana because they are regulated by the DEA (Morran, 2014). Therefore, patients have to travel to a remote, unpopulated, industrial area to pick up their medicine. Dr. Mecagni (February 8, 2015) points out the perpetuating stigma surrounding medical marijuana as patients with legitimate medical conditions have to pick up their medications in an undesirable area surrounded by barb wire, junk yards, and security dogs.

Lastly, if we wanted to change the legislative language in the Arizona Medical Marijuana Act (ARS 36-2801) to include nurse practitioners, we would have to go through the legislative process again and there would only be two ways. One would be if the state legislature votes for the amendment to be placed on the ballot, called a “legislatively-referred constitutional amendment” or if there is a petition to include this initiative on the ballot called an “initiated constitutional amendment” (BallotPedia, n.d.).

References

Abood, S. (2007). Influencing health care in the legislative arena. Retrieved from http://www.medscape.com/viewarticle/553404_3 

Arizona Department of Health Services. (2015). Office of administrative counsel and rules. Retrieved from http://www.azdhs.gov/ops/oacr/rules/index.htm

Arizona Legislative Council. (2003). Arizona legislative manual: Legislative procedure. Retrieved from http://www.azleg.state.az.us/alisPDFs/council/legman2003.pdf 

BallotPedia. (n.d.). Laws governing the initiative process. Retrieved from http://ballotpedia.org/Laws_governing_the_initiative_process_in_Arizona 

Morran, C. (2014). Why can’t you get medical marijuana at CVS or Walgreens? Reviewed from http://consumerist.com/2014/05/13/why-cant-you-get-medical-marijuana-at-cvs-or-walgreens/

Advertisements

6 thoughts on “WEEK FIVE 02/09 – 02/15: THE PROCESS OF HEALTH POLICY MAKING (STATUTORY AND REGULATORY MECHANISMS)

  1. I agree that there does appear to be a stigma associated with medical marijuana. One problem that I have is by Nurse practitioners not being able to prescribe it ties their hands with cancer patients or patients with glaucoma. Why is a Naturopath allowed to recommend marijuana when they are unable to prescribe any other drugs? This seems weird to me to only be able to prescribe marijuana? I also ‘ feel that customers should have to go to undesirable neighborhoods just to visit a dispensary. This is troubling, we in healthcare still have problems with medical marijuana, and I am not sure why. Other states have adopted new healthcare policies making it a choice for patients, hopefully here in Arizona we can remain open to new things while not endangering patients, like epileptic children and mothers, by making them travel in undesirable areas for their medication.

    Like

  2. Lynn
    Thank you for the detailed description of the entire process. It takes a long time for these bills to get into a new policy. I hope that this program would allow dispensaries in the more populated areas to benefit the patients with legitimate medical conditions.

    Like

  3. That was very detailed and helped me understand this process a lot better. I am concerned though about having to go to undesirable neighborhoods to fill a prescription for marijuana. People could get seriously hurt just because they were in that neighborhood for their medication. Any information on how some dispensaries are authorized and others are not?

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s