Standing Committees Policies for the Jurisdiction of the Health Committee

NCSL supports federal efforts to address health workforce shortages. In particular:

National Health Services Corps

NCSL urges Congress through the National Health Service Corps (NHSC) programs to:

1. develop additional mechanisms to recruit and retain minority participants;
2. augment informal efforts to match communities with specific cultural traditions with health care providers with shared cultural experiences, or who are specifically trained in culturally diverse community-based systems of care;
3. increase and formalize efforts to recruit and place health professionals who represent racial and ethnic minorities in communities who request them;
4. improve training to encompass cultural competency that considers geographical/regional differences that may affect the health delivery system;
5. more directly involve communities in the recruitment, selection and retention of health care professionals through community sponsorships;
6. increase the emphasis on public/private partnerships, including faith-based institutions, to enhance community involvement and contractual arrangements with independent health care providers;
7. develop programs to assist remote communities, those too small for community health centers, but large enough to need assistance in obtaining primary health care for its citizens; and
8. provide technical assistance to states and local communities in implementing NHSC programs and maximizing resources.

The Conrad 30 State J-1 Visa Program

NCSL urges Congress to:

• Permanently authorize the Conrad 30 State J-1 Visa program;
• Make additional waivers in states for academic medical centers;
• Increase the current cap on the number of visa waivers per state;
• Allow physicians who work in underserved areas for five years (three of which could be through the Conrad 30 program) would be eligible for a green card through the physician National Interest Waiver (NIW) program and exempt from the worldwide cap on employment-based green cards;
• Allow physicians who serve in Conrad 30 "flex" spots to be eligible for the National Interest Waiver (NIW) green card program.
• Allow physicians who enter the country on a J visa to receive graduate medical education or training with the intent to immigrate permanently; and
• Allow spouses and children or physicians on J visas to be exempt from the two- year home country return requirement.

HRSA Health Professions Grants and Cooperative Agreements

The Health Resources and Services Administration (HRSA), through a number of grants and cooperative agreements, supports innovations and targeted expansions in health professions education and training. Most of these programs focus on: (1) increasing the diversity of the health care workforce; (2) preparing health care providers to serve diverse population; and (3) preparing health care providers to practice in the nation's medically underserved communities. NCSL urges Congress to continue to support these important programs.

Community Health Centers, Rural Health Centers and Federally-Qualified Health Centers

NCSL urges Congress to continue its support of community health centers, rural health centers and Federally Qualified Health Centers and similar and related facilities play critical role in the health care safety net.

NCSL urges Congress to adopt legislation that amends the Public Health Service Act to deem a health professional volunteer providing primary health care to an individual at a community health center or rural health center to be an employee of the Public Health Service for purposes of any civil action that may arise from providing services to patients.

This protection would apply when:

1. the service is provided to the individual at a community health center or rural health center through offsite programs or events carried out by the center; and
2. the health care practitioner does not receive any compensation for providing the service, except repayment for reasonable expenses.

Rural Health Programs and State Rural Health Offices

NCSL urges Congress to:

• Support discretionary rural health programs that provide important health service support and resources to rural and remote areas of the country. Programs include, but are not limited to:
  • Rural health outreach grants
  • Rural health research program
  • Rural health flexibility grants
  • Telehealth programs

NCSL urges Congress to continue its support of the State Office of Rural Health Grant Program. Today's state offices provide an institutional framework that links small rural communities with state and federal resources and develops long-term solutions to rural health problems. States have become a major agent for change in rural health policy and service delivery, due in part to the work performed by the state rural health offices.

Workforce Training

NCSL urges Congress to consider legislation that will promote cultural competency training for health care providers, thus helping to decrease the racial, ethnic, gender language, disability and socio-economic disparities apparent today within health care.

The National Conference of State Legislatures (NCSL) strongly supports the Older Americans Act programs and the services funded through this act. NCSL urges Congress to:

• appropriate sufficient funding to meet the growing demands for the OAA programs., especially the National Family Caregiver Support Program;
• provide states flexibility to establish standards and decide how program funds will be distributed;
• ensure that OAA programs reach low-income, minority and rural elderly households;
• increase effort to inform those eligible about services available to them under the OAA and other state and federal programs;
• strengthen the authority of state government through designated State Units on Aging to ensure that service funds under the Act are used to support independence in older populations and the most vulnerable members of the population, the very old, the frail, the isolated, and limited English-speaking individuals, with particular attention to low-income minority persons; and
• provide states the authority to distribute funds based on their own criteria.

NCSL urges Congress to provide states flexibility in the administration of the OAA and the authority to:

• transfer funds between the nutrition program and the social services program according to a state's needs;
• to transfer funds between congregate and home delivered meals; and
• determine the type and circumstances under which Area Agencies on Aging (AAA)'s can directly provide services.

NCSL supports additional resources for the ombudsman program.

NCSL believes that participants with incomes below 125 percent federally established level of poverty, should not be subject to cost sharing. Fees collected through this mechanism should provide for expanded services and increased availability of services to those elderly with the greatest economic and social need. This will also enhance the coordination and equity between OAA, the Social Services Block Grant, and state-financed programs that are often funded on a sliding fee scale.

Senior Community Service Employment Program

NCSL supports the Senior Community Service Employment Program. NCSL calls for increased cooperation between the states and the national contractors. NCSL supports congressional proposals to provide states and national contractors more flexibility on administrative costs while keeping these costs to a minimum.

Federal Policies on Aging

NCSL urges Congress to:

1. preserve the financial integrity of the Social Security system;
2. eliminate all forms of age discrimination against older workers;
3. provide funds for direct services for the elderly;
4. fund the development of integrated, coordinated, community-based continued care systems to help prevent the unnecessary institutionalization of the elderly; and
5. provide additional support for gerontological research, education and training.

Behavioral health describes both mental health and substance use disorders (SUD). NCSL supports efforts that examine the issues of behavioral health through the comprehensive and holistic approach of the four pillars-prevention, intervention, treatment and recovery.

NCSL supports federal legislation, funding and programing that would:

• Provide block grants to states with flexibility to address the most pressing behavioral health issues in their states;
• Support state efforts to reduce stigma, treat behavioral health conditions in a holistic way and further integrate behavioral health with primary care and public health services;
• Enhance integrated care while protecting confidentiality for patients with substance use disorder;
• Support state efforts to develop, improve and expand core behavioral health mobile crisis response systems which includes crisis hotlines (including 988), crisis response teams and mobile units and crisis stabilization programs; and
• Reduce barriers and expand access to behavioral health services by providing telehealth and tele-prescribing flexibilities and resources including in the areas of coverage, reimbursement and licensure portability.
• Support state efforts to build a diverse workforce to meet the growing demand for behavioral health services.

NCSL may comment on proposed federal rulemaking regarding the above outlined objectives.

Regulation of Interstate and Internet Sales of Tobacco Products

Illegal interstate, tribal and internet sale of tobacco products affects the health and safety of the nation’s citizens and has a particularly negative effect on state revenues. Tobacco sellers that evade state tobacco taxes: (1) use the profits of these sales to finance other illicit activities; (2) undermine state efforts to reduce youth access to tobacco products by making lower cost products available to them through the mail; and (3) reduce state revenue. In addition, many of these sellers fail to comply with the provisions of the Master Tobacco Settlement Agreement, endangering state compliance with the Agreement and reducing state payments under the agreement by illegally gaining market share in cigarette sales by offering lower prices made possible by their failure to pay the appropriate state taxes.

The Prevent All Cigarette Trafficking (PACT) Act became effective in June 2010. NCSL supports the PACT Act and the continuing partnership between the states and the Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) to implement this important law. The law: (1) Imposes improved recordkeeping requirements to implement these recommendations; (2) Prohibits the commercial importation of tobacco products, including smokeless tobacco products, into any state in violation of state or federal law; (3) Increases the penalties for noncompliance with the federal laws regulating interstate and internet sale of tobacco products; (4) Authorizes states to enforce tobacco tax collections through the Jenkins Act; (5) Permits states to collect triple damages in any suit against entities selling tobacco in states in violation of the laws of the state and make debts incurred in the purchase of these products uncollectible through actions in courts; (6) Prohibits interstate tobacco sellers from doing business in a state that is party to the Master Settlement Agreement if the seller is not in full compliance with the Model Statute or the Qualifying Statute enacted by the state; and (7) Preserves existing agreements between states and tribal governments regarding cigarette taxes.

FDA Regulation of Tobacco and Tobacco Products

The Family Smoking Prevention and Tobacco Control Act of 2009 establishes the Food and Drug Administration (FDA) as the agency responsible for the regulation of the manufacturing, marketing and sale of tobacco products. In summary, the law: (1) Restricts the sale and marketing of tobacco products to young people;(2) Authorizes the FDA to restrict tobacco marketing;(3) Requires tobacco manufacturers to disclose information about the ingredients of their products and any changes they make to the ingredients; (4) Authorizes FDA to require changes to tobacco products to protect the public health; (5) Authorizes the FDA to regulate “reduced harm” claims;(6) Requires more prominent health warnings; and (7) Funds FDA regulation of tobacco products through a user fee imposed on tobacco manufacturers. The law does not permit states to regulate the content of tobacco products, tobacco labeling or advertisements. The law does preserve some important state and local government regulatory authority. Specifically, states may adopt laws or regulations related to the sale, distribution, possession or exposure to tobacco products and may restrict the time, place and manner of tobacco product advertising. The law also does not preempt most state-based civil claims. The preservation of state authority permits states to actively support and enhance FDA initiatives.

The National Conference of State Legislatures (NCSL) supports efforts to improve the safety, quality, access to and affordability of our nation’s drug supply including actions such as:

• Enhances the safety of the drug supply chain,
• Promoting innovation by drug manufacturers to develop new effective pharmacotherapies; and
• Taking initial steps to address drug shortages.

Federal standards should not create an administrative burden on state regulatory agencies. The FDA should prioritize initiatives that ensure the effectiveness and quality of any drugs sold in the United States.

Regulation of Internet Pharmacy

NCSL supports Congressional actions to:

• Establish disclosure standards for internet pharmacies,
• Prohibit dispensing of prescription drugs over the internet to persons who have not been prescribed a drug by a licensed health care prescriber, and
• Authorize state attorneys general to shut down non-complying pharmacy sites by using the federal court system.

NCSL urges the federal government to increase efforts to prosecute organizations in violation of the law

Importing Prescription Drugs

NCSL supports federal efforts to contain costs and expand access to safe and effective pharmaceuticals by exploring the feasibility of importing prescription drugs from other countries.

Personal Use Policy

Although FDA guidance has been issued, the current federal policy on drug importation is still unclear. NCSL urges the FDA to clarify its “personal use” policy and how the policy is to be enforced.

Regulation of Compounding Pharmacy

NCSL urges the FDA to work closely with state legislators, state public health officials, state boards of pharmacy and other important state and local officials, and providers and industry representatives to develop procedures and systems that retain state regulatory authority where appropriate and that will improve the overall safety of the nation’s pharmaceutical supply chain, and the regulation of compounding pharmacies.

State Prescription Drug Monitoring Programs

NCSL supports the five-year reauthorization of the National All Schedules Prescription Electronic Reporting Act (NASPER) adopted in the Comprehensive Addiction and Recovery Act (CARA). NCSL is particularly interested in continued discussions to increase the effectiveness and interoperability of State Prescription Drug Monitoring Programs (PDMPs) and looks forward to working with federal partners to expand and improve the programs.

NCSL Applauds Global Health Equity Week, Nov. 11-15, 2024

Global Health Equity Week 2024 (GHEW) is an annual event that will next take place on Nov. 11-15, 2024.GHEW provides key public and private health and information technology stakeholders an opportunity to convene around the country in support of the use of health information and technology to transform the public’s overall health and well-being and eliminate health disparities. Initiated in 2006 by HIMSS as National Health IT Week, Global Health Equity Week has emerged as a premier event highlighting the importance of health equity to our national health improvement agenda. The week serves as a landmark annual occasion for bringing together diverse global policymakers to affect change. Focus areas this year are:

1. Digital Health Literacy, Inclusion, and Access
2. Social Determinants of Health
3. Maternal Health

The National Conference of State Legislatures (NCSL) has worked closely with HIMSS and other stakeholder organizations to promote understanding among state policymakers of the contributions of health IT in meeting the goals of improving health outcomes and the quality and safety of healthcare delivery, containing healthcare costs, and improving the work-life of health professionals. Moreover, NCSL applauds HIMSS for elevating the value of health IT in addressing social determinants of health through Global Health Equity Week events. NCSL and other stakeholders recognize the importance of health information technology and data to ensure states become more resilient to public health threats like COVID-19, the opioid crisis, natural disasters, and chronic diseases that greatly affect our most vulnerable communities. NCSL and HIMSS support state actions to leverage health IT and data systems to achieve these goals. For instance, broadband access and connected health often lead to better health outcomes through the adoption of telehealth and digital decision-making tools essential to empowering people to engage in their own care – care that is value-based, secure, reliable, and that takes into account the social determinants that drive improved outcomes and reduced health disparities.

NCSL encourages its members to observe Global Health Equity Week in appropriate ways in their respective state capitals as well as in the Nation's Capital. NCSL also encourages its members to advocate for their respective delegations to the United States Congress to join in recognizing the benefits of health information and technology as they act to improve healthcare for all citizens during Global Health Equity Week and beyond.

NCSL strongly supports a secure interoperable system of electronic health information for the United States that:

• supports interoperability, not uniformity;
• makes security of the data a priority;
• provides strong consumer protections;
• establishes severe penalties for individuals or entities that compromise information in the system; and
• makes every effort to make the system available and affordable to the widest possible range of providers and consumers.

NCSL supports strong protections in circumstances where non-health care professionals need access to personal health care data. This includes requiring law enforcement representatives to have a court order to obtain information from an individual's medical record, recognizing legal exceptions that exist. This also includes retaining and strengthening existing research protocols and confidentiality standards for health care researchers.

NCSL also supports the establishment of grant, loan and demonstration programs to provide financial and technical support to health care providers, state and local governments, and other entities that will play a key role in the development and successful operation of an interoperable health information system. States must be permitted to supplement federal financial support to physicians and hospitals with state grant or loan programs for up to 100 percent of costs. It is critical that publicly financed programs such as Medicaid and Medicare become active participants in the system and that creating this capacity be a priority within the federal budget.

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Under the provisions of HIPAA, federal law supersedes state law, except when the Secretary of the Department of Health and Human Services determines that the state law is necessary:

• to prevent fraud and abuse;
• to ensure the appropriate state regulation of insurance or health plans; and
• for addressing controlled substances, or for other purposes.

NCSL supports a broad interpretation of this provision that would result in limited preemption of state laws. Federal legislation should provide a floor, not a ceiling and only preempt state laws that are less protective.

NCSL also supports:

• administrative simplification provisions of HIPAA. All affected entities, must be afforded adequate time to implement changes to these provisions; and
• federal and state governments sharing information; however, confidentiality of medical records and information must be protected.

Principles for Federal Health Insurance Reform

States must retain authority to regulate health insurance and continue to set and provide oversight on insurance matters. NCSL opposes any proposals that would expand the preemption of state laws and regulations beyond those already established in the Employee Retirement Income Security Act of 1974 (ERISA), the Patient Protection and Affordable Care Act (ACA), and that would exempt any insurer or entity from state health insurance standards and laws. Federal health insurance legislation that establishes mandated benefits or uniform standards must have inclusive state feedback prior to implementation and work to establish standards that work for all states.

Implementations of Health Reforms at the Federal Level

NCSL urges any implementation of health reforms at the federal level to require state action to comply and to allow a reasonable amount of time for state legislatures to debate and enact any necessary legislation for their constituents. NCSL supports developing a process for declaring "substantial compliance" for states that already have similar legislation in place. NCSL urges federal partners to recognize that health insurance programs in the states and territories are where innovations in health insurance and healthcare delivery happen and to utilize states’ models of health insurance and care moving forward.

Federal Demonstration Authority for States to Experiment with Innovative Health Care Reform Initiatives

NCSL supports federal initiatives to provide financial assistance and to authorize states to experiment with innovative approaches to:

• increase access to and affordability of health care services, including mental health, to the uninsured or underinsured,
• improve the quality and cost-effectiveness of our health care system and the flexibility to test new models that do so,
• increase access to the broad range of long-term care services including home and community-based services (HCBS) that will enable constituents to live in their own homes or communities that provide personalized and a high-quality care,
• support for health insurance plans that work to integrate physical, behavioral and social determinants of health with the aim of reducing costs and improving overall health outcomes for individuals, and
• explore a broad range of approaches and financing mechanisms to improve our health care system including reinsurance programs.
• allow states to continue their work on addressing issues which include but are not limited to surprise medical billing, out-of-network and in-network billing practices and transparency for health care prices and health insurance plans and/or Certificate of Need regulated by states. This includes programs providing patients with the information they need to be active consumers in healthcare pricing across providers and services. When pursuing any changes to medical billing practices, NCSL urges federal partners to not supersede states’ ongoing work or authority in state regulated health plans, to involve states in a timely way when drafting any potential changes to medical billing practices, to be transparent, and to provide adequate time for states to implement any changes.

NCSL supports federal initiatives that provide needed assistance to state and local governments for the prevention and treatment of HIV/AIDS and related conditions.

Prevention and Education

NCSL Supports:

• Prevention and education programs that are culturally sensitive, age appropriate, evidence based, holistic, and tailored to be effective with a specific audience.
• The continuation of state flexibility with respect to needle exchange programs and efforts to work with the federal government to develop best practices regarding the prevention of new cases of blood borne conditions.

Confidentiality and Civil Rights

NCSL supports:

Federal efforts to sustain the privacy of personal medical records and is particularly supportive of efforts to protect individuals with HIV/AIDS from experiencing discrimination in employment, housing, insurance coverage and public accommodations.

NCSL opposes:

• Federal legislation that would impose either a mandate for or a prohibition of state partner notification requirements or contact disclosure or tracing programs.

• Federal legislation that would require states to establish civil and criminal penalties for the knowing transmission of HIV. Provisions of this sort are particularly onerous if the receipt of federal financial assistance is contingent upon their passage.
• Federal initiatives regarding confidentiality and civil rights must enhance, strengthen, and underscore the states' responsibility for action in these areas and allow state flexibility in such initiatives.

Counseling and Testing

NCSL supports:

• The promotion of rapid testing programs and the use of rapid testing in non-medical settings when appropriate and when counseling is available and provided on-site.

Health Professionals Providing HIV Treatment and Care

NCSL supports:

• The decision by the Centers for Disease Control and Prevention (CDC) to continue to permit state and local health officials establish guidelines regarding procedures that health care workers infected with HIV or Hepatitis B should be permitted to perform.

• The Blood-Borne Pathogen Standard rule promulgated by the Occupational Safety and Health Administration (OSHA) and the Needlestick Safety and Prevention Act.

Ryan White CARE Act

Federal grants supporting state efforts to provide prevention, care and treatment to people with at risk of or living with HIV/AIDS should provide maximum flexibility to states to enable them to develop programs that best meet the needs of their residents.

NCSL supports:

• Continued and adequate funding for states through the Ryan White C.A.R.E. Act and through cooperative agreements with the CDC and federal partners,
• Permitting states to demonstrate, in their state plan, that they have addressed the needs of all populations within their boundaries, in lieu of federal statutory mandates, and
• Ongoing federal resources to provide for the development and distribution of prevention and treatment medications. It is important the funding keep pace with the approval and availability of new prevention drugs and treatment therapies.

NCSL opposes:

• The imposition of state matching or maintenance of effort requirements in these programs.

Medicaid Guiding Principles

NCSL supports a partnership in the Medicaid program that achieves mutually agreed upon goals, improved outcomes for recipients, flexibility, transparency, and accountability in administration of programs and opportunities for savings for states, territories and local governments. NCSL urges the federal government to consider state legislative calendars when making changes to Medicaid programs since not all legislatures meet on a year-round basis.

NCSL also urges Congress and the Administration to seek the counsel and expertise of state and territory legislators as new Medicaid initiatives are being developed. NCSL urges federal partners to provide states adequate time to review and ultimately implement any new changes.

NCSL urges the federal government to improve relations between states and the Centers for Medicare and Medicaid Services (CMS) through improved technical assistance and CMS stakeholder engagement with states. NCSL also urges the federal government to consider the diversity of state needs, and the diversity, complexity, and size of each state’s Medicaid program when scaling new programs and allowing states to voluntarily participate in new state options through state plan amendments.

Block Grants

NCSL urges Congress and the Administration to provide states flexibility when exploring block grant programs. Any proposals must refrain from establishing unfunded mandates and any cost shifting requirements for implementing a block grant program in states and territories.

Waivers

NCSL supports Congress and the Administration in their ongoing efforts to grant waivers, where appropriate, and in permitting states and territories to develop innovative programs and service-delivery systems in health and human services. NCSL urges the federal government to bring successful waiver programs to scale and integrate them into the underlying program when appropriate and encourages federal efforts to streamline waiver applications, reviews and approvals.

NCSL urges the federal government to make information about state waivers and state plans publicly available and easily searchable to better inform state decision making.

Emergency Assistance and Countercyclical Assistance

NCSL urges Congress to study options to include a provision establishing emergency and countercyclical assistance to states within the Medicaid statute. The provision would become effective upon some triggering event, such as an economic downturn, natural disaster, act of terrorism, pandemic or other public health emergency. In these instances, it would be recommended to add any additional financial assistance to states and territories through an enhanced federal match or some other mechanism that would revert to the regular federal-state cost sharing formula when an emergency has been resolved. This is a complex but critical component to fiscal security for the Medicaid program.

Medicaid Managed Care

NCSL encourages federal partners to recognize and support the work of states and territories with their Medicaid managed care stakeholders in the following areas:

• expanding care to those with complex medical needs,
• improving reach and support for rural health care populations,
• improving the implementation of patient-centered care and facilities,
• increasing integration of physical and behavioral health care services,
• continuing development of value-based purchasing and payments focusing on health outcomes over number of services delivered, and
• the role of community health centers, safety-net hospitals and academic medical services in providing primary and emergency care for Medicaid enrollees.

Children’s Health Insurance Program (CHIP)

NCSL supports an on-time, multi-year authorization of CHIP and encourages the federal government to continue providing flexibility to carry out the program’s operation.

NCSL recommends the following for the program:

• support for states to develop and test systems of coverage for low-income children and explore ways for states to share examples of best practices with each other,
• eliminate any burdensome waiting periods for CHIP enrollment to ensure a reduction in gaps of coverage for children, and
• continue efforts to streamline and facilitate the CHIP and Medicaid application process.

The U.S. Department of Health and Human Services (HHS), the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH), plays an important role in supporting state and local public health infrastructure. HHS provides national surveillance of infectious disease, applied research to develop new or improved diagnoses, disease prevention and control strategies, and helps strengthen states’ capacity to respond to outbreaks of new or reemerging disease. Federal support through grants and cooperative agreements, research and technical assistance is key to the stabilization and effective operation of the nation’s public health system and provides critical support for the state and local public health infrastructure.

NCSL urges the administration and Congress to continue to support: (1) grants and cooperative agreements to state and local governments for a broad range of public health activities; and (2) research and technical assistance, which assists states in the development and implementation of effective programs. In addition, NCSL supports efforts to foster the development of public and private sector partnerships to increase community accessibility to public health information and public health programs.

Health Disparities

HHS and its offices, institutes, and centers, should work with NCSL and state policymakers to reduce and eliminate health disparities by: (1) identifying social determinants which lead to health disparities; and (2) helping to create and enhance standards for the collection and reporting of data on:

1. race, ethnicity, sex, primary language, disability status;
2. those living in rural, underserved metropolitan and frontier areas; and
3. other characteristics identified by the Secretary of HHS by federally-funded health and health care programs in order to analyze and monitor health disparity trends and develop promising practices and programs to eliminate disparities, based on the data collected.

Reporting Requirements

NCSL believes reporting requirements are important, but should be limited to requirements where there is a reasonable expectation that the data will be used to: (1) analyze trends; (2) improve patient outcomes; (3) improve programs; and (4) eliminate health disparities. In addition, efforts must be made to impose data collection and reporting requirements in the least burdensome way possible.

Funding

NCSL urges the President and Congress to maintain funding to HHS, including the CDC, OMH, and NIH, to:

1. support the continued efforts of the HHS Office of Minority Health’s National Partnership for Action to End Health Disparities (NPA)’s efforts to mobilize a nationwide, comprehensive, community-driven, and sustained approach to combating health disparities, and;
2. continue support for the Regional Blueprints for Action, which aligns with the National Stakeholder Strategy to help guide action at the local, state, and regional levels;
3. augment outreach and other efforts targeting populations, including racial and ethnic minorities, at higher risk of chronic diseases and illnesses;
4. provide quality and efficient care;
5. improve health outcomes;
6. increase cost-effectiveness;
7. meet legislative, organizational, and accreditation standards; and
8. develop additional evidence-based prevention and interventions targeting ethnic and racial minorities.

Clinical Trials and Research

NCSL urges the federal government to make every effort to include more women and minorities in clinical trials and other research initiatives to improve health care strategies and programs and to eliminate disparities.

Health Promotion and Disease Prevention

NCSL urges the administration and Congress to continue to support public health education initiatives that are culturally sensitive, language accessible, and age appropriate,. It is imperative that these public health education initiatives integrate (1) healthy lifestyle choices and (2) disease prevention messages and (3) strategies targeted for all communities and ages as well as other specifically identified populations within the community who have special healthcare concerns, needs and risks.

Healthy and Responsible Lifestyle Choices

NCSL supports programs that promote voluntary healthy lifestyle choices and reduce high-risk behaviors through education, counseling and, treatment, and encourages federal government to provide adequate funding for these programs.

Preventive Health and Health Services Block Grant

NCSL urges Congress to continue to support this program. Under this program, states are given maximum flexibility to design and implement programs that meet the needs of their citizens.

Preventive Health Screenings and Check-Ups

NCSL urges Congress to increase support for initiatives to promote regular preventive health screenings and check-ups. NCSL is particularly supportive of efforts that provide information about and promote screening for cardiovascular disease, dental disease, obesity, asthma, diabetes, and cancer. NCSL also supports efforts to ensure that children receive age-appropriate check-ups and screenings that include recommended childhood immunizations, comprehensive dental, vision and hearing screenings, and recommended follow-up treatment.

Chronic Disease Management

NCSL urges Congress to continue to support initiatives that promote affordable access to care and the management of chronic conditions such as obesity, cardiovascular disease, dental disease, diabetes, asthma, kidney disease, mental health disorders, and a wide range of autoimmune diseases. NCSL is supportive of initiatives that provide case management services to children with one or more chronic conditions.

Oral Health

NCSL supports federal initiatives that promote oral health by encouraging individuals to have regular check-ups and to practice good oral hygiene. These initiatives should include educational activities that emphasize the importance of good dental care to overall good health. NCSL supports efforts to increase access to quality, affordable dental care, including initiatives to improve public and private sector coverage of dental services, and improve oral health literacy within the public. NCSL also urges HHS to provide states flexibility to develop innovative Medicaid dental programs to increase access to and the utilization of oral health care services.

Health Education for Health Care Professionals

NCSL supports efforts to encourage institutions that train health professionals to include in their curriculum a greater emphasis on culturally competent health promotion and disease prevention information.

Access to Health Screenings and Disease Treatment

NCSL supports efforts to encourage insurers and other third-party payers, including Medicare and Medicaid, to cover cancer screening tests. NCSL supports federal initiatives to improve coverage of cancer screenings, tests, and treatments that have been shown based on evidence-based evaluation to be beneficial for the population served.

Technical Assistance to States to Improve the Quality, Capacity, and Access of Mental Health Services

NCSL urges HHS to provide technical assistance to states to monitor and improve the provision of mental health services to adults and children and to work with the medical community to develop guidance regarding behavior therapies that may replace or be used in concert with medications to reduce the dependence of on psychotropic medications as the primary or sole treatment.

Mental Health Treatment of Children

NCSL encourages the federal government to support efforts to:

1. develop treatment protocols to be used before advancing to pharmacotherapies;
2. offer guidance to the primary care community on the alternatives to pharmacotherapies for mental illness in children; and
3. increase the pediatric mental health workforce.

Vaccines and Immunizations

Childhood Immunizations

NCSL supports efforts designed to increase the overall number of children immunized and the use of alternative sites such as schools, community health centers, or other community settings to deliver vaccines to children when appropriate, cost effective, and convenient. NCSL urges the federal government to increase public education initiatives designed to provide parents with the most up-to-date information regarding recommended immunizations for children and supports continued research to improve the safety and efficacy of childhood immunizations. NCSL urges Congress and the Administration to work with states to ensure every child receives the recommended childhood immunizations and to improve immunization delivery, education, funding and other policies to help meet that goal over the long term. Finally, NCSL asks Congress to continue to allow states to set child vaccine coverage policy.

Adult Immunizations

NCSL urges Congress to continue efforts to increase the number of adults who receive recommended immunizations and encourages continued special efforts to ensure high-risk adults, young adults, and older adults receive all recommended immunizations.

Vaccine Supply

NCSL urges the administration and Congress to provide or appropriate sufficient funds to maintain a reasonable stockpile of pediatric immunizations and vaccine, seasonal influenza vaccine and vaccines that may be used during a pandemic so that everyone who needs an immunization can be served.

Workplace Safety and Health Care Workers

Occupational Hazards/Workplace Safety

NCSL urges the federal government to increase awareness of occupational hazards and ways to avoid accidents in the workplace. Information must be provided to employers and employees and should be included in the national effort to emphasize health promotion and disease prevention.

Pandemic and All-Hazards Preparedness

State and local governments are the first line of defense against acts of bioterrorism and other public health emergencies. State legislators are committed to enhancing the ability of their states to prepare for and respond to these events. A strong partnership between states, the federal government, and other public and private non-profit entities is the best way to accomplish this goal. NCSL urges to the administration and Congress to:

1. provide states, territories, and the District of Columbia with direct, sufficient and stable funding to enable them to continue to build and maintain an infrastructure to support ongoing efforts to respond to bioterrorism and other public health emergencies;
2. pass federal funds through the states for distribution to local governments, hospitals and other entities, permitting state officials to take the lead in planning on a regional and statewide basis and utilize federal funds in the most efficient and effective way;
3. require grantees to collaborate with their respective states and coordinate all of their activities with the state plan;
4. provide states the flexibility necessary to meet their diverse needs and priorities;
5. build upon existing national and state efforts;
6. ensure that regulations and requirements imposed on states are accompanied by sufficient funding and deadlines to support implementation, both immediately and in the long term; and
7. authorize the appropriate federal official to temporarily waive or modify the application of federal laws that may impede implementation of state plans during a bioterrorist attack or other public health emergency.

Public Health and the Environment

Lead Poisoning

NCSL supports federal efforts to prevent and detect lead poisoning in children. and the environment NCSL urges the federal government to continue to assist state and local health officials in addressing this serious health care problem.

Vector-Borne Illness

NCSL supports the efforts of the CDC to abate vector-borne illness, including-Chikungunya, Eastern equine encephalitis virus (EEEV), Lyme-Disease, Malaria, Rocky Mountain spotted fever, and West Nile Virus, and Zika virus–by:

1. providing training and assistance to front-line disease surveillance and response staff;
2. offering clinical education programs;
3. collaborating with state and local health departments; and
4. providing funding to states to support epidemiology and response activities addressing vector-borne disease.

Maternal and Child Health

Maternal and Child Health (MCH) Block Grant

The MCH block grant allows states to meet a broad range of health services for mothers and children. NCSL supports the MCH block grant and urges Congress to continue to provide adequate funding. NCSL opposes efforts to transfer program responsibilities to the MCH block grant without the funding to accompany it, thereby reducing the funding available to functions currently funded through the block grant.

The Maternal, Infant and Early Childhood Home Visiting Program (MIECHV)

The MIECHV program facilitates collaboration and partnership at the federal, state, and community levels to improve the health of at-risk children through evidenced-based home visiting programs. NCSL supports community-based, state-federal partnerships and initiatives that working with parents and caregivers provides a supportive environment to:

1. improve maternal and child health;
2. promote healthy child development and school readiness;
3. improve parenting skills; and
4. prevent child abuse and neglect.

NCSL urges Congress to continue financial support for the MIECHV program and to provide state flexibility in the administration of the program based on needs assessments that identify community and family vulnerabilities.

Universal Newborn Screening

The Universal Screening program provides competitive grants to states for the implementation of a national program of universal newborn screening ,that includes using a few drops of blood from a newborn’s heel within 24-48 hours after birth to screen for certain genetic, endocrine and metabolic disorders, as well as newborn hearing screening. Newborn hearing screening consists of: (1) physiologic testing prior to hospital discharge; (2) audiologic evaluation by three months of age; and (3) entry into a program of early intervention by six months of age. NCSL supports the State Universal Newborn Screening program and urges Congress to continue to provide adequate funding. NCSL supports the autonomy of each state to execute its state screening program and supports federal efforts that incentivize states to screen for every disorder included on the federal Recommended Uniform Screening Panel (RUSP) and to include new conditions added to the RUSP in the future to the state screening panel in a timely manner.

Teen Pregnancy Prevention

The federal government offers a range of programs and supports to state governments to help reduce teen pregnancies recognizing that state, tribal, and local governments are best situated to determine the best programs for their constituents. NCSL supports the full range of programs available to state, tribal, and local governments and researchers to help prevent unplanned teen pregnancies. NCSL supports continued funding for these critically important programs.

The development of a comprehensive approach to deliver support services for elderly persons and persons with disabilities is critical. Without such system, long-term care expenditures will continue to overwhelm state and federal health care budgets, limiting necessary expenditures for primary and preventive health care.

NCSL supports:

• States being provided new options for setting financial and functional criteria to qualify for these services.
• The development of expanded options for private long-term care insurance, flexible life insurance products, and home equity sharing programs, such as reverse annuity mortgages.
• Initiatives to provide incentives for employers to offer and for individuals to establish health savings accounts and other innovative financing options to pay for a broad range of supportive services.
• Efforts to assist family members who are caregivers, including tax incentives and programs that provide support services, such as respite care.

Increasing Options for Home and Community-Based Care

NCSL continues to support the development of more home and community-based options under Medicaid to provide and integrate long term care services. NCSL supports the federal government encouraging states to develop innovative programs to improve the long-term care system. NCSL urges the Administration and Congress to work with states to develop assessment tools that will help states better identify what level of services individual clients need and the most appropriate settings for the client to receive care and these assessments should be made available to all elderly persons and persons with disabilities to help them plan for their long-term care needs.

Long-Term Care Insurance

NCSL supports strong federal action to protect consumers of long-term care insurance from predatory pricing or inadequate benefit plans. NCSL urges the Administration and Congress to speed the development of long-term care insurance as a viable alternative or complement to Medicaid support for long-term care services. At the same time, tax credits, partnership programs, and other incentives should not be seen as a tool for reduced funding for Medicaid. While the states will continue to take primary responsibility for the regulation of long-term care insurance, NCSL supports the development and evaluation of programs and initiatives that would: (1) provide preferential tax treatment for individuals who purchase qualified long-term care insurance; (2) provide tax incentives for private employers and a Medicaid bonus program for state and local government employers to encourage the them to offer long-term care insurance as a benefit; and (3) encourage and provide incentives to employers to offer long-term care insurance, as a condition of receiving federal benefits, such as business tax credits;

Alzheimer's Disease and Other Dementia Related Disorders

NCSL supports continued federal efforts that: (1) lead to the development of new drug treatments; (2) assist in disease management; and (3) improve the early diagnosis of these conditions.

NCSL supports federal initiatives to improve the accessibility and quality of health care services to U.S. veterans and their families. NCSL is particularly supportive of efforts to:

• increase access to health care services to veterans and their families;
• improve and expand mental health services both in person and remotely;
• provide assistance to veterans and their families regarding the range of health care services available to them and the appropriate means of accessing the services;
• expand and improve services to veterans who are amputees, who have traumatic brain injuries or other conditions or injuries sustained during active duty. NCSL urges the Department of Defense and the Department of Veterans Affairs to work closely with state and local governments to when they can assist in the implementation of these initiatives, including sharing information with state Veteran’s Departments regarding the status of veterans residing in the state;
• improve the operation of the Veterans Health Administration.

Extension of TRICARE Prime to Veterans in the U.S. Commonwealths and Territories

NCSL supports the extension of TRICARE prime to American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, the Commonwealth of Puerto Rico and the Virgin Islands.