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To start off the meeting of Public Health and Health Equity, Sam Bahrami introduced Lorey Bratten, the newly-hired program director for the NMAB. DOR representatives did not attend due to Marijuana Enforcement Division rulemaking. No new non-voting participants were present.
The majority of the meeting consisted of the subcommittee reviewing Billy Wynne’s draft recommendations. These were generally the initiatives the subcommittee has been working on, reformatted into a concise recommendation in a format that the full NMAB could vote on and present to DOR. Recommendations under consideration by the Public Health & Health Equity subcommittee which are highly dependent on the work of other subcommittees were not included. Of nine total recommendations, two were approved for referral to the full NMAB, two were approved for referral to the Products, Research, and Data subcommittee, one was dropped entirely, and four were tabled and will be revisited in the future.
Recommendations approved by motion for referral to the full NMAB:
1. For purposes of the Natural Medicine Access Program, the terms Health Equity and Equity are defined as: Health equity is both an outcome and a process. Health equity happens when everyone has equal and equitable opportunity to be as healthy as they can be. Recognition of one’s race, ethnicity, disability, age, sexual orientation, gender identity, socioeconomic status, geography, or preferred language is vital to promoting equitable health and well-being. Health equity work includes building bridges to positive health outcomes, such as ensuring access to local providers who reflect the diversity of the community that they serve.
2. The State should establish a clear pathway for Facilitators with Medical or Psychotherapy Facilitator licenses to bill the State Medicaid program for otherwise covered mental health care, substance use disorder intervention services, or behavioral health services that are delivered in conjunction with natural medicine services, in compliance with section 12-179-113(1)(c) of the Natural Medicine Health Act.
Despite existing concerns around facilities that receive federal Medicaid funding potentially losing that funding if they allow Natural Medicine on their premises, this recommendation was approved to encourage the state to begin work on allowing reimbursement for already-covered services.
Recommendations approved for referral to the Products, Research, and Data subcommittee:
1. For purposes of promoting research in and innovation in Natural Medicine as well as reducing the cost of relevant liability insurance, the State should make public all deidentified data collected under the Natural Medicine Access Program. All data must be aggregated to preclude the identification of personal health information.
This recommendation expanded the original suggestion of providing data to insurance underwriters to allow broader public access to anonymized data collected through the regulated natural medicine program.
2. The legislature should clarify the Natural Medicine Health Act to allow Facilitators to purchase Natural Medicine and Natural Medicine Products from Cultivators or Distributors without affiliation with a Healing Center.
Residual questions exist around DEA concerns around storage requirements if facilitators are permitted to remain in possession of Natural Medicine. Rochelle Galey of the BHA suggested looking into the framework of Methadone distribution and storage.
Recommendations tabled pending revision or want of additional information:
1. The State should prioritize accreditation of Facilitator training programs that offer incentives to graduates to commit to offering discounted services to historically underserved or marginalized communities, including those with lower household income, those in rural or frontier areas, those with disabilities. indigenous peoples, racial and ethnic minorities, and those who identified as LGBTQIA+. Such incentives could include discounted tuition or loan forgiveness programs.
Lundy expressed that the better course of action would be to prioritize access to training programs, rather than focusing on who a potential facilitator would be serving. Further discussion elucidated uncertainty around what training programs will actually look like and if the state can partner with existing higher education institutions to expand access. DORA will look into the role of higher education institutions in expanding training program access.
2. The State should include a Health Equity Assessment in the annual report it is required to publish under section 12-179-105(1)(i) of the Natural Medicine Health Act that assesses access to Natural Medicine Services by underserved and marginalized communities, including those with below average household income, those in frontier or rural areas, those with disabilities, indigenous peoples, racial and ethnic minorities, and those who identify as LGBTQIA+.
Although the subcommittee is generally in support of this idea, concerns around increasing costs ultimately resulted in this recommendation being tabled. Changes will likely include language that encourages the state to partner with existing entities that collect this data and placing a theoretical limit of “to the extent possible”.
3. The State should allow licensees to pay licensing fees over a period of months or years, rather than requiring payment in full before the license is awarded.
Issues with this suggestion centered around the fact that the state needs the full license fee up front to fund the operation of the program. DORA staff indicated they will look into options of partnering with a 3rd-party vendor such as Affirm which would allow the state to receive the full fee while allowing a licensee to pay over time. Additional concerns include contracting and procurement processes that could both take a long time to implement and drive up costs.
4. If the legislature authorizes the State to adopt taxation of aspects of the Natural Medicine Program, the State should allocate a portion of those tax revenues to the creation of a Social Equity Licensure Program that offers grants, loans, technical assistance, and other support to individuals and organizations that receive a Facilitator, Healing Centers, Cultivator, Tester, or Distributor license. The State should use clear, enforceable criteria for identifying qualified social equity licensees, such as prior criminal convictions relating to natural medicine or household wealth.
Tristan Watkins of the CBO cautioned the subcommittee not to draw on the cannabis industry heavily given the differences in the sales model and less clear disparate impact of the war on drugs on marginalized communities than existed in cannabis. Combined with the fact that a tax would need to be a ballot measure, the subcommittee concluded this is not feasible by day 1 of the program and will revisit it at a later date.
Recommendations dropped completely:
A requirement that any natural medicine licensee submit a Social Equity Statement indicating their plan to address equity concerns was dropped after discussion elucidated that such requirements are largely ineffective, perceived as virtue-signaling, and seen as unfairly shifting the burden of ensuring equity from the state onto individual businesses.
The next meeting was scheduled for Tuesday, November 14th at 1pm.