Bill Tracking
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The following is a list of all health-related bills currently sitting in various legislative committees. This list represents a combination of old bills from 2007 that were left in committees when the first session ended and new bills that were introduced prior to the start of the second session on January 15, and as such, have not been referred to a committee yet.
Bills listed here were selected based on a series of subjective criteria to determine whether they were "health policy-related" or not. All bills currently sitting in the Senate and House Health, Education, and Social Services committees were examined, and any that obviously dealt with non-health-related education or social services issues were eliminated. Every other House and Senate committee was then examined for health-related bills, which were included in the final list.
After determining the full set of health-related bills still in committee or pre-filed for the new session, they were divided into several general categories. This was done to facilitate finding bills that dealt with certain key health policy issues and to make overall navigation of the list easier. The remaining bills were categorized as "general" health policy-related because of the wide range of subjects they covered.
The information listed for each bill includes the bill number, the short title, the primary sponsor or sponsors, the committee in which the last action on the bill took place, and the date on which the last action on the bill took place. A short summary of each bill is also included.
Abbreviations have been used for committee names. The committee names and their abbreviations are: · (H) HES: House Health, Education, and Social Services Committee · (S) HES: Senate Health, Education, and Social Services Committee · (H) L&C: House Labor & Commerce Committee · (S) L&C: Senate Labor & Commerce Committee · (S) SED: Senate Special Committee on Education · (H) FIN: House Finance Committee · (S) FIN: Senate Finance Committee · (H) RLS: House Rules Committee · (S) JUD: Senate Judiciary Committee
The list of bills is current as of January 11, 2008.
Certificate of Need
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Bill number
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Short title
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Primary sponsor
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Committee/date of last action
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HB
4
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MEDICAL FACILITY CERTIFICATE OF NEED
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Sponsor: LYNN
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(H) HES/
01/16/07
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"HB 4 removes the current Certificate of Need requirement for health care facilities in Alaska boroughs having a population of over 25,000 people." -Rep. Lynn
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SB
65
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MEDICAL FACILITY CERTIFICATE OF NEED
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Sponsor: HUGGINS
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(S) HES/
01/26/07
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"SB 65 removes the current requirement for a Certificate of Need (CON) for health care facilities, except for nursing homes and residential psychiatric treatment centers, 'in a borough with a population of more than 25,000 ... ' Smaller communities would still require, as a practical matter, the Certificate of Need." -Sen. Huggins Drugs
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Bill number
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Short title
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Primary sponsor
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Committee/date of last action
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HB
81
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ALASKA PRESCRIPTION DRUG TASK FORCE
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Sponsors: GUTTENBERG, CISSNA
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(H) HES/
01/16/07
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"HB 81 will create a Prescription Drug Task Force within the Alaska Department of Health and Social Services. This Task Force will find ways to reduce the cost of prescription drugs and increase affordable access to prescription drugs for Alaskans.
"Ten members representing various entities and business sectors will sit on the task force and will gather information from industry, government, citizens, and other sources. Subsequent present reports to the Governor and to the Legislature will suggest actions to increase access to and reduce the cost of prescription drugs." -Rep. Guttenberg
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HB
82
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PRESCRIPTION DRUG DISCOUNTS
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Sponsors: GUTTENBERG, CISSNA
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(H) HES/
01/16/07
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This bill would affect prescription drug discount pricing, and would place requirements on pharmacies that obtained prescription drugs through discount pricing. It would also require DHSS to conduct a study pertaining to prescription drug discounts and report the findings to the legislature.
Pharmacies would segregate prescription drugs purchased through discount pricing from other drug stock by physical or electronic means, and maintain records of the acquisition and disposition of the discounted drugs in a way that is separate from other pharmacy records. The purchase of discounted prescription drugs is regulated according to guidelines in the federal Social Security Act. The mandated DHSS report would be a study of the feasibility of providing discounted prescription drug pricing to every person in the state who is not otherwise covered by a prescription drug plan. A report summarizing the findings would be presented to the legislature on or before January 1, 2008.
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HB
208
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DRUG PRODUCT SUBSTITUTION
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Sponsor: HES
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(H) HES/
03/19/07
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This bill affects the substitution by a pharmacist of an equivalent drug product. With a few specific exceptions, unless a prescription indicates that it is to be dispensed as written, a pharmacist may, with the consent of the patient or the minor patient's parent or guardian, substitute an equivalent drug product.
The two exceptions mentioned explicitly in the bill relate to drugs for epilepsy or seizures, and to the substitution of a drug for a registered brand or trade name product. The substitution of drugs for epilepsy or seizure disorders must follow strict guidelines, including a timeframe for how long a pharmacist may dispense an equivalent drug product when supply of the prescribed drug is at issue. The substitution of a drug for a registered brand or trade name product can only be done with permission from the author of the prescription, with a procedure laid out should the pharmacist be unable to get in contact with the author of the prescription.
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HB
300
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DOCUMENT PRENATAL ALCOHOL EXPOSURE
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Sponsor: DOLL
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PREFILE RELEASED/
01/11/08
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HB 300 would require health care professionals to document an infant's prenatal exposure to alcohol. The bill intends for such information to be used for the purposes of screening for fetal alcohol syndrome. A person licensed under the statute attending or making a postnatal examination of a mother and infant would, if the mother consents to such information being put in the medical file, document the infant's prenatal exposure to alcohol. Such information would only be used for the purposes of providing medical diagnosis, treatment, or care.
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HB
304
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CANCER DRUG REPOSITORY
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Sponsor: NELSON
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PREFILE RELEASED/
01/11/08
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HB 304 amends the statute covering the Board of Pharmacy to include regulations for the implementation of the cancer drug repository and redistribution program established for recipients of medical assistance. Medical Assistance for Needy Persons statute (AS 47.07) would be amended to define and describe the cancer drug repository and redistribution program, and establishes guidelines that must be followed by dispensing pharmacies.
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SB
114
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DRUG PRODUCT SUBSTITUTION
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Sponsor: HESS
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(S) L&C/
03/12/07
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This bill affects the substitution by a pharmacist of an equivalent drug product. With a few specific exceptions, unless a prescription indicates that it is to be dispensed as written, a pharmacist may, with the consent of the patient or the minor patient's parent or guardian, substitute an equivalent drug product.
The two exceptions mentioned explicitly in the bill relate to drugs for epilepsy or seizures, and to the substitution of a drug for a registered brand or trade name product. The substitution of drugs for epilepsy or seizure disorders must follow strict guidelines, including a timeframe for how long a pharmacist may dispense an equivalent drug product when supply of the prescribed drug is at issue. The substitution of a drug for a registered brand or trade name product can only be done with permission from the author of the prescription, with a procedure laid out should the pharmacist be unable to get in contact with the author of the prescription.
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SB
196
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PRESCRIPTION DATABASE
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Sponsor: GREEN
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Pre-file released/
01/04/08
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This bill would amend statutes related to the control and regulation of pharmacy. It would add a provision of the Board of Pharmacy that allows for the establishment and maintenance of a controlled substance prescription database.
The proposed database would contain data regarding every prescription for a IA, IIA, IIIA, IVA, or VA controlled substance under state law, or a schedule I, I< III,IV, or V controlled substance under federal law dispensed in the state to any person other than an inpatient at a licensed health care facility. The bill also establishes guidelines for the pharmacist-in-charge of each covered pharmacy to submit certain information regarding such prescriptions to the board for inclusion in the database. Such information would include the names of prescribing prescriptions and individuals who receive prescriptions for controlled substances from licensed practitioners and who subsequently obtain dispensed controlled substances from a drug outlet in quantities or with a frequency inconsistent with generally recognized standards of dosage for that controlled substance.
Education
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Bill number
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Short title
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Primary sponsor
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Committee/date of last action
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HB
55
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WWAMI MEDICAL SCHOOL
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Sponsor: KELLY
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(H) HES/
01/16/07
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"The purpose of HB 55 is to address the severe doctor shortage in Alaska. According to the Alaska Physician Supply Task Force, Alaska would need an increase of 28% (375 doctors) to catch up with the lower 48. Increasing the in-state production of physicians by increasing the number of medical school and residency positions in Alaska is the No. 1 goal according the Task Force." -Rep. Kelly
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HB
66
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REQUIRE CPR FOR HIGH SCHOOL GRADUATION
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Sponsor: GRUENBERG
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(H) HES/
01/16/07
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HB 66 would require certification in cardiopulmonary resuscitation and first aid for the issuance of a secondary school diploma. The requirement may be waived when the governing body of the school district provides proof that a student is incapable of performing the necessary functions for certification. Each district in the state public school system would be responsible for initiating and conducting a program leading to CPR/first aid certification for its students.
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SB
32
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WWAMI/NURSE EDUC LOAN REPAYMENT
PROGRAM
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Sponsor: WILKEN
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(S) HES/
01/16/07
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This bill recognizes that there is a shortage of qualified medical doctors and registered nurses in the state, and seeks to establish the Alaska medical doctors and registered nurse recruitment loan repayment programs. The purpose of the programs would be to provide financial incentives through the repayment, in whole or in part, by the state of education loans for medical doctors and registered nurses completing a term of employment as a medical doctor or a registered nurse in the state. In consultation with the Alaska Commission on Postsecondary Education, standards and criteria would be established for the Alaska medical doctor and registered nurses recruitment loan repayment programs. Rules governing the commission's actions related to these programs are specified.
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SB
73
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WWAMI MEDICAL SCHOOL
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Sponsor: ELLIS
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(S) SED/
02/02/07
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"Under the WWAMI agreement, students pay in-state tuition at the University of Washington and the State of Alaska pays the difference. Students who enter the program must return to Alaska to practice or pay back the State's subsidy. Current statute places a cap on the number of students allowed into the WWAMI program at 10. Senate Bill 73 removes that cap, and establishes a new minimum of 20 students per year be placed into the WWAMI program." -Sen. Ellis General Health Policy
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Bill number
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Short title
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Primary sponsor
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Committee/date of last action
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HB
36
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NURSE SUPERVISION OF EMT TRAINING
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Sponsor: KAWASAKI
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(H) L&C/
03/28/07
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"House Bill 36 would allow nurses within an EMT training program to teach skills to paramedics in the clinical setting. Qualified nurses would provide training to paramedics in a scope of activities under direct supervision. By allowing nurses to assist in paramedic's training the state of Alaska will be able to provide skilled workers with complete understanding of the necessary lifesaving skills." -Rep. Kawasaki
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HB
100
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AIR AMBULANCE SERVICES
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Sponsor: COGHILL
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(H) HES/
02/15/07
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"This legislation exempts for-profit air ambulance services from insurance regulations under AS 21.03 in order that they may solicit membership subscriptions, accept membership applications, and charge membership fees.
"In order to protect consumers this bill establishes that air ambulance services must: · have certification under AS 18.08.082 · be in operation in Alaska for at least two years · not deny emergency medical service to any person." -Rep. Coghill
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HB
124
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INTENSIVE SERVICES FUNDING
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Sponsor: NELSON
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(H) HES/
02/07/07
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This bill seeks to amend AS 14.17.420 to affect intensive services funding. It proposes that when a student who is counted for intensive services funding transfers to another school district within the state, the transferring district would have to pay the district receiving the transfer the unused portion of funds allocated for the transferring student within 30 days of the transfer. The transferring district's payment would be based on a pro rata share of the amount received for the period in which the student attended school in the district.
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HB
136
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DENTAL HYGIENISTS
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Sponsor: STOLTZE
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(S) FIN/
05/04/07
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"The provisions of House Bill 136 follow the expanded functions of dental hygienists in other states to improve access to preventative oral health care. Specifically, HB 136: · Allows a licensed dental hygienist to place "fillings" into a cavity prepared by a licensed dentist. · Authorizes a licensed dental hygienist to administer local anesthetic agents under the general supervision of a licensed dentist. · Permits a licensed dental hygienist to enter into a collaborative agreement with a licensed dentist in which the dentist authorizes the dental hygienist to perform certain duties stipulated under HB 136 without the supervision of the dentist." -Rep. Stoltze
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HJR
26
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CONST AM: CONTROL OF MINOR'S
MEDICAL CARE
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Sponsors: COGHILL
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Pre-file released/
01/04/08
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HJR 26 proposes an amendment to the Alaska Constitution. It would grant a parent or guardian the right to direct and control the medical care and treatment of the parent or guardian's minor child. This right would be subject only to emergency exceptions and judicial bypass. The judicial bypass procedure would be narrowly tailored to protect the rights and health of the minor child and be consistent with standards established by the United States Supreme Court. The proposed amendment would be placed before the voters in the next general election as determined by the state's constitution and election laws.
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SB
28
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LIMIT OVERTIME FOR REGISTERED
NURSES
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Sponsor: DAVIS
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(S) FIN/
04/18/07
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"SB 28, hereafter also to be known as "The Alaska Safe Nursing and Patient Care Act," prevents Alaska registered and licensed practical nurses from being forced to work mandatory overtime, i.e., compulsory as opposed to voluntary work in excess of an agreed to, predetermined, regularly scheduled shift, and it protects patients from the dangers caused by overworked nurses ... This legislation also protects nurses from discrimination and retaliation by employers who continue to force them into working hours beyond what they believe safe for quality care. SB 28 requires that health care facilities monitor, document, and report overtime semiannually and face penalties for knowing violations." -Sen. Davis
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SB
29
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MEDICAL PATIENT BILLING DISCLOSURES
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Sponsor: DYSON
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(S) HES/
01/16/07
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SB 29 would affect certain aspects of patient billing disclosures. The bill adds a new section to the existing statute (AS 18.20) that specifies what licensing a hospital must have to be regulated under the proposed law. The bill also adds a new section to the existing statute that specifies what information hospitals that received government money for the purchase, construction, repair, equipping, or operation of the hospital would have to disclose on each patient billing. Several terms that would be related to this information are also defined, including "government money," "hospital," and "patient billing.
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SB
98
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DENTAL HYGIENISTS
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Sponsor: DAVIS
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(S) HES/
02/28/07
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"SB 98 allows Alaskans better access to professional training, skills, and technology available to meet their oral health care needs with expanded services provided by dental hygienists licensed under AS 08.32. Many Alaskans either cannot afford regular oral health care, do not understand the need for it, or live in areas or facilities not served by oral health care professionals. SB 98 also will help stem what the Surgeon General reported as a 'silent epidemic of oral diseases affecting our most vulnerable citizens ... No one should suffer from oral diseases or conditions that can be effectively prevented and treated.'" -Sen. Davis
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SB
107
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NATUROPATHS
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Sponsor: DAVIS by request
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(S) L&C/
03/07/07
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"For purposes of expanding allowed procedures and regulating the growing practice of naturopathic medicine in Alaska, SB 107 establishes required licensing fees, a Naturopathic Advisory Committee, and an Alaska Naturopathic Formulary Council ... New naturopathic procedures under SB 107 allow minor surgery, including operative, electrical, and other methods of repair to superficial lacerations and abrasion or lesions, and removal of foreign bodies in superficial tissues. The bill also allows naturopaths to use antiseptics and local anesthetics in connection with allowed procedures. The law prohibits naturopaths from performing major surgery, and spinal and general anesthetics." -Sen. Davis
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SB
181
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ANATOMICAL GIFTS
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Sponsor: MCGUIRE
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(S) HES/
05/15/07
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This bill would affect anatomical gifts; donations to the anatomical gift awareness fund; a registry of anatomical gifts; and the organizations that handle the procurement, distribution, or storage of all or a part of an individual's body. The majority of changes proposed in SB 181 are to change the particular Alaska statutes that govern anatomical gifts issues to the most current statutory number. The bill would also add a number of sections to the existing statute in order to address several issues, including who may make an anatomical gift before the donor's death; the manner of making an anatomical gift before the donor's death; and the rights and duties of procurement organizations and others. The bill would also address the need for uniformity of the law with regard to the subject matter, and also defines the terms used in the text.
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SB
252
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LEAVE FOR ORGAN/BONE MARROW
DONATIONS
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Sponsor: LEDOUX
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(S) HES/
05/15/07
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"The Richard Foster and Alec Cesar Donor Act would require the State of Alaska to grant a paid leave of absence to an employee for the purpose of making a personal organ or bone marrow donation. The employer is not required to provide more than 80 hours of leave, however the leave may not be less than 40 hours unless the employee requests fewer hours. Verification may be required and the State may not retaliate or sanction an employee for requesting this leave." -Rep. LeDoux Medical Assistance and Health Insurance
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Bill number
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Short title
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Primary sponsor
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Committee/date of last action
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HB
140
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MEDICAL ASSISTANCE ELIGIBILITY
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Sponsor: GARA
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(H) HES/
02/28/07
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"HB 140 raises the eligibility level for Denali Kid Care to 200 percent of the federal poverty guideline. It extends optional coverage to children of families that earn between 200 and 350 percent of the federal poverty guideline by offering coverage at a sliding scale fee of between $200 and $1200. Families that earn above 200 percent of the federal poverty guideline would have to certify that health insurance is not offered through their work." -Rep. Gara
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HB
198
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SENIOR BENEFITS/MED. ASSISTANCE
ELIG.
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Sponsor: HAWKER
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(H) RLS/
04/10/07
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"HB 198 establishes the Alaska Senior Assistance Program to provide cash assistance payments to low-income Alaska seniors.
"The existing Senior Care Program, which is scheduled to sunset June 30, 2007, is amended to remove the little used prescription drug benefits and increase monthly cash payments to Alaskans, age 65 and older, based on their incomes related to federal poverty level guidelines adjusted for Alaska (FPL-A). Monthly payments are: · $250 per month to individuals with income less than 75% of FPL-A · $175 per month to individuals with income from 75% to less than 100% of FPL-A · $125 per month to individuals with income from 100% to less than $135% of FPL-A
"The Alaska Senior Assistance Program combines desirable features of both the Longevity Bonus and Senior Care programs into a single needs based structure that delivers real help to low-income seniors across Alaska. Program enrollment is open to all qualifying seniors.
"The new Alaska Senior Assistance Program sunsets June 30, 2011 if not reauthorized." -Rep. Hawker
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HB
231
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MEDICAL ASSISTANCE:KIDS/DISABLED/ PREGNANT
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Sponsor: DOLL
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(H) HES/
04/02/07
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This bill would amend the eligibility guidelines for medical assistance for needy persons (AS 47.07.020 [b]). Specifically, the bill seeks to change language that affects eligible disabled persons by specifying the official poverty line in question would be Alaska-specific, and clarifies that such information would come from the United States Department of Health and Human Service. The bill would also specify that persons under 19 years of age and pregnant women who are not otherwise covered under other sections of the law would only be eligible for assistance must come from households with incomes that do not exceed 200 percent of the federal poverty line for Alaska, as set by the US DHHS.
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HB
242
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MANDATORY UNIVERSAL HEALTH CARE
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Sponsor: LEDOUX
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(H) HES/
04/26/07
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"This bill establishes a framework mandating and ensuring affordable health coverage for all Alaskans. A board of 11 stakeholders will oversee the plan, making certain that residents are able to choose and purchase coverage that provides adequate care. The bill also provides: · A framework for personal choice: This bill facilitates a relationship between health insurance providers and individuals, and doesn't assume that a one size fits all solution will meet the health care needs of all Alaskans. · A unique voucher system: By pooling money from all stakeholders, a sliding scale voucher system will ensure that every Alaskan can take personal responsibility for acquiring health insurance coverage. The system will also make it easy for multiple entities to contribute towards a health plan for an individual. · A health care clearinghouse: The clearinghouse will disseminate information about quality health care products, assisting Alaskans who are utilizing vouchers under the Alaska health care plan. · The Alaska health care fund: This fund will receive contributions from individuals, businesses and government to ensure that all interested parties contribute to the health of Alaskans." -Rep. LeDoux
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HCR
2
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HEALTH INFORMATION & REFERRAL
SYSTEM
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Sponsor: CISSNA
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(H) HES/
01/22/07
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This resolution seeks to recognize the need for an integrated state-wide health-related information and referral system. It addresses the need for basic and accurate information in an effective market-based health care system, and it recognizes need for consumers and residents of the state to have accurate, informed information about health care costs in order to make accurate decisions on health-related expenditures.
The resolution also recognizes certain growing health care trends: that a growing number of Alaskans cannot afford or access health insurance; that a growing number of people over the age of 65 who are covered by Medicare are having trouble finding doctors who will keep or accept them as patients; and that the state already has a shortage of physicians and that the percentage of medical doctors over the age of 50 is increasing, a trend that will worsen as the state's population continues to age.
In an effort to address these issues, this resolution of seeks government and private sector partners to investigate and build an integrated statewide information and referral system using like systems created in other states that use state-of-the-art software and well-maintained databases so state residents can maximize their health purchases within the state. This integrated statewide information and referral system be used to create an information system for health volunteerism options and a network of community health contacts that in times of natural disasters or statewide emergencies could be used to coordinate services and to disseminate information.
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HJR
10
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MEDICAL ASSISTANCE FOR CHILDREN
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Sponsor: HES
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(H) FIN/
03/05/07
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This joint resolution would formally ask the Alaska Legislature to urge the Alaska Congressional delegation to "work diligently to achieve a timely reauthorization of the State Children's Health Insurance Program (42 U.S.C. 1397aa - 1397jj, Title XXI of the Social Security Act) to continue federal medical assistance percentages for the Denali KidCare program," and to also urge "Governor Palin to work with the Alaska Congressional delegation to ensure reauthorization of the State Children's Health Insurance Program in a timely manner." The resolution would also proclaim that "all components of state government should work together with educators, health care providers, social workers, and parents to ensure that all available public and private assistance for providing health benefits to uninsured children in the state be used to the maximum extent possible," and that the Alaska Legislature would urge Governor Palin to "work to provide meaningful assistance to help identify and enroll children who qualify for medical assistance or Denali KidCare." -House HESS
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SB
87
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MEDICAL ASSISTANCE ELIGIBILITY
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Sponsor: Wielechowski
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(S) FIN/
03/14/07
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"SB 87 raises the eligibility limit for participation in the Denali KidCare program to 200% of the federal poverty level (FPL), currently $27,000/year for a single parent and child ... SB 87 would also allow families with incomes up to 350% of the FPL to buy into Denali KidCare using a sliding fee scale for premiums and a 20% co-pay. Those with the greatest means would reimburse the state roughly 90% of its costs. Participants would have to certify that they don't have access to health insurance at work." -Sen. Wielechowski
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SB
106
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APPROP: COMMUNITY HEALTH CENTERS
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Sponsor: Davis
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(S) FIN/
03/07/07
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This bill would give a special appropriation to DHSS for payment of a grant to the Alaska Primary Care Association to create a community health centers program. APCA is a non-profit organization.
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SB
160
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MANDATORY UNIVERSAL HEALTH CARE
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Sponsor: FRENCH
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(S) HES/
04/23/07
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"This bill establishes a framework mandating and ensuring affordable health coverage for all Alaskans. A board of 11 stakeholders will oversee the plan, making certain that residents are able to choose and purchase coverage that provides adequate care. The bill also provides: · A framework for personal choice: This bill facilitates a relationship between health insurance providers and individuals, and doesn't assume that a one size fits all solution will meet the health care needs of all Alaskans. · A unique voucher system: By pooling money from all stakeholders, a sliding scale voucher system will ensure that every Alaskan can take personal responsibility for acquiring health insurance coverage. The system will also make it easy for multiple entities to contribute towards a health plan for an individual. · A health care clearinghouse: The clearinghouse will disseminate information about quality health care products, assisting Alaskans who are utilizing vouchers under the Alaska health care plan. The Alaska health care fund: This fund will receive contributions from individuals, businesses and government to ensure that all interested parties contribute to the health of Alaskans." -Sen. French
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SB
170
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INSURANCE COVERAGE FOR WELL-BABY
EXAMS
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Sponsor: MCGUIRE
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(S) HES/
05/10/07
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SB 170 would require any health care insurer that offers health insurance that covers a dependent of a covered individual to, initially and at each renewal, provide coverage for the cost of well-baby exams. Such coverage would still be subject to the standard policy provisions applicable to other benefits. The bill also defines certain terms: health care insurer, health care professional, and well-baby exam.
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SB
179
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DEPENDENT HEALTH INSURANCE; AGE
LIMIT
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Sponsor: DAVIS
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(S) L&C/
05/14/07
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SB 179 would prevent health care insurers who provide coverage of a child through family care insurance from denying enrollment for a dependent child of the insured who is less than 26 years of age. Such insurers would also be prohibited from denying enrollment and disenrolling or eliminating coverage for such dependent children.
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SB
212
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MEDICAL ASSISTANCE ELIGIBILITY
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Sponsor: DAVIS
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Pre-file released/
01/04/08
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This bill would raise the eligibility level for Denali KidCare from 175 percent of the federal poverty level (FPL) to 200 percent FPL. It would affect eligible persons under 19 years of age and eligible pregnant women. SB 212 would also affect cost-sharing mechanisms for certain eligible recipients by raising the upper eligibility limit from 175 percent FPL to 200 percent FPL.
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SJR
11
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SUPPORTING U.S. VETERANS' HEALTH CARE
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Sponsor: WIELECHOWSKI
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(S) HES/
05/09/07
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This resolution calls for the Alaska State Legislature to ask the federal government for "adequate" funding for veterans' health care.
"The press has documented the neglect of Walter Reed Army Medical Center, and former Secretary of Veterans Affairs Anthony Principi has publicly stated that the Department of Veterans Affairs has been struggling to provide health care to the rapidly rising number of veterans who require it.
"As the state with the largest per capita number of veterans, it is essential that we send a clear signal of our commitment to care for our military personnel both on active duty and as veterans. While our legislature tries to do all we can for our vets and returning soldiers, our federal government has the primary responsibility of meeting the needs of our veterans. We need to call on Congress, as a state, to adequately fund critical veteran services." -Sen. Wielechowski Mental Health
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Bill number
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Short title
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Primary sponsor
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Committee/date of last action
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HB
173
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INVOLUNTARY PSYCHOTROPIC DRUG
TREATMENT
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Sponsor: DHSS
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(H) HES/
03/05/07
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This bill would allow courts to approve the involuntary use of psychotropic drugs on patients after strict guidelines for such administration had been met. The bill would also make it so that the court's approval applies to the patient's initial period of commitment if the decision was reached during the initial period. If the decision is made during a period for which the initial commitment has been extended, then the court's approval would apply to the period for which the commitment was extended.
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HB
239
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SUBSTANCE ABUSE/MENTAL HEALTH
PROGRAMS
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Sponsor: DAHLSTROM
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(H) HES/
04/17/07
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"House Bill 239 proposes several changes to Alaska's statutes concerning drug and alcohol abuse improving the quality of and access to treatment and prevention programs. The legislation: · mandates priority treatment for pregnant women seeking help in overcoming addiction. This will hopefully have a positive impact by reducing the incidents of Fetal Alcohol Spectrum disorders and in turn save money; · gives priority to state grantees who utilize evidence-based programs, as well as programs that address substance abuse prevention and addiction within prisons; · supports the Department of Health and Social Services in their efforts to identify people with co-occurring mental and substance abuse disorders so this population can be better served; and · ensures faith-based strategies for treating substance abuse are not discriminated against in statute." -Rep. Dahlstrom
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SB
8
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MENTAL HEALTH PATIENTS RIGHTS:
STAFF GENDER
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Sponsor: Davis
|
(S) FIN/
05/02/07
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"SB 8 provides that a mental health patient 18 years of age or older who is receiving mental health treatment and being provided intimate care at a hospital shall have the right to have care provided by a staff member who is the gender that the patient requests ... The supervisor or manager employed by a hospital shall post notice of this right in a conspicuous place, so patients know they may exercise this right when they are concerned about the gender of staff responsible for their personal intimate care ... the bill requires that the facility document the non-compliance in the patient record that the intimate care was provided by a licensed or unlicensed staff member of a gender opposite that requested by the patient ... Lastly, this bill will preserve information for inquiry into grievance procedures at mental health facilities under Title 47." -Sen. Davis
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SB
51
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APPROP: MENTAL HEALTH BUDGET
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Sponsor: RULES BY REQUEST OF THE
GOVERNOR
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(S) FIN/
01/19/07
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This bill, written at the request of Governor Palin, makes appropriations for the operating and capital expenses of the state's integrated comprehensive mental health program.
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SB
186
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MENTAL HEALTH PATIENT GRIEVANCES
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Sponsor: DAVIS
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Pre-file released/
01/04/08
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SB 186 would repeal and reenact the patient grievance procedure. It would clarify and expand the current statute, including the definition of who is a mental health patient under the statute, and would clarify the grievance procedure at facilities subject to the statute. The bill lays out what information a grievance form must include.
The bill also sets up three levels of review for grievances: an initial review by a supervisory staff member to attempt to reach a mutually agreed-upon resolution of the grievance; if a resolution is not reached, then the grievant must initiate a review by either the chief executive officer if it is a private facility or the commissioner's designee if it is a public facility within 20 days; the grievant my finally appeal the written decision from level two to the Office of Administrative Hearings within 20 days of the level two decision.
The bill also defines several terms used in the legislative language.
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SB
195
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MENTAL HEALTH CARE INSURANCE
BENEFIT
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Sponsor: DAVIS
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Pre-file released/
01/04/08
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This bill would affect how health care insurance policies treat certain mental health issues, including alcoholism and substance abuse. It would change certain requirements placed on insurers, including prohibiting the insurer from placing a greater financial burden on an insured for diagnosis or treatment of alcoholism or drug abuse than for other medical care. It also defines certain terms related to the changed statute. SB 195 changes language in certain places that clarifies covered medical care, and clarifies definitions of certain terms used in the bill. State Boards and Issues
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Bill number
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Short title
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Primary sponsor
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Committee/date of last action
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HB
50
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CHILD PLACEMENT COMPACT
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Sponsors: COGHILL, NEUMAN
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(H) HES/
01/16/07
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This bill affects the Interstate Child Placement Compact by seeking to establish an interstate commission for the placement of children. It also seeks to amend Rules 4 and 24 of the Alaska Rules of Civil Procedure.
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HB
114
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EXTEND STATE MEDICAL BOARD
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Sponsor: LABOR & COMMERCE
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(H) HES/
01/30/07
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This bill would extend the termination date of the State Medical Board through June 30, 2013.
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HB
263
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CITIZEN HEALTH ADVISORY BOARD
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Sponsor: CISSNA
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(H) HES/
05/15/07
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This bill proposes the formation of the Citizen's Health Advisory Board. It would be created within the Department of Health and Social Services and consist of the following commissioners or commissioners' designees: administration; health and social services; commerce, community, and economic development; corrections; environmental conservation; education and early development; public safety; labor and workforce development; and the attorney general or the attorney general's designee. The board would also consist of 32 persons nominated by all health units or districts who would represent the interested parties in the Alaska health care discussion, including but not limited to insurance companies, Native health care, legislators, and consumers. The stated purpose of the board is to develop strategies and recommendations to improve public health and health care, and to reduce health care costs for state businesses and residents.
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HB
276
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EXTEND ALASKA COMMISSION ON AGING
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Sponsor: DOLL
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Pre-file released/
01/04/08
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HB 276 would extend the termination date of the Alaska Commission on Aging to June 30, 2016.
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HB
279
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COMMISSION ON AGING
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Sponsor: DOLL, KERTTULA
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Pre-file released/
01/04/08
|
This bill would make changes to the duties and powers of the Alaska Commission on Aging and DHSS. Added to the duties of DHSS would be the ability to establish state policy relating to and administering federal programs subject to state control as provided under the Older Americans Act of 1965, and to administer the older Alaskans service grants under certain state statutes and the Adult Day Care and Family Respite Care grants. HB 279 would also affect the role of the Executive Director of the Commission, and would also affect various grants and programs administered by DHSS.
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HCR
1
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PUBLIC HEALTH AND HEALTH COMPACT
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Sponsor: CISSNA
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(H) HES/
01/22/07
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"Alaska faces a health crisis. The availability of accessible and affordable health care in our great state is challenged by a forecast of shrinking provider ranks and increased need for care, rising costs and limited funds to meet them."
"The Health Compact encourages all Alaskans to make healthy choices to promote their own health and well being, and to share their experiences and ideas with one another. It dedicates the remainder of the year 2007 as a time to join the Compact, and dedicates 2008 as a year for sharing ideas and taking action." -Rep. Cissna
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SB
188
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EXTEND ALASKA COMMISSION ON AGING
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Sponsor: THERRIAULT
|
Pre-file released/
01/04/08
|
SB 188 would extend the termination date of the Alaska Commission on Aging to June 30, 2016.
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SB
209
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EXTEND ALASKA COMMISSION ON AGING
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Sponsor: DAVIS
|
Pre-file released/
01/04/08
|
SB 209 would extend the termination date of the Alaska Commission on Aging to June 30, 2016. Women's Health Issues
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Bill number
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Short title
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Primary sponsor
|
Committee/date of last action
|
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HB
190
|
NURSING MOTHERS IN WORKPLACE
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Sponsor: CISSNA
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(H) HES/
04/25/07
|
This bill would add a new section to AS 23.10 Employment Practices and Working Conditions to specifically address break time in the workplace for nursing mothers. HB 190 calls for reasonable unpaid break time each day for employees who are the nursing mothers of children to either breastfeed or express milk. The timing of such activities must occur at times during the workday that would reasonably ensure the health and comfort of the mother and child, and would allow the employee to maintain breast milk supply. The bill also calls for the employer to provide a private, secure, and sanitary room, or other location in close proximity to the work area, other than a toilet stall, where the employee can express milk or breastfeed the child, only so long as this provision would create a substantial and undue hardship on the employer. The Department of Labor would enforce this section, and would be responsible for regulating the process by which an employee may register a complaint, and would also be able to issue civil fines to employers.
|
HB
301
|
PARTIAL-BIRTH ABORTION
|
Sponsor: KELLER, COGHILL
|
Pre-file released/
01/11/08
|
This bill would define the term "partial-birth abortion," as well as define several acts which are related to the larger definition.
|
SB
58
|
JURY DEFERRAL FOR BREAST-FEEDING
WOMEN
|
Sponsor: ELTON
|
(S) JUD/
01/19/07
|
SB 58 would excuse breastfeeding women from jury duty. A woman may claim such legal exemption provided the child is less than three years of age. The bill would amend Rule 15 (1) of the Alaska Rules of Administration.
|
HB
270
|
MEDICAL FACILITY
LISENCING/ABORTION
|
Sponsor: COGHILL
|
Pre-file released/
01/04/08
|
This bill would add a type of facility to the list of permissible locations in which to perform abortions. It would add facilities licensed as ambulatory surgical centers that are approved for the purpose by DHSS. HB 270 would also clarify issues regarding the payment for abortion services used by DHSS for such a purpose, and would also clarify what is meant by "ambulatory surgical center" for the purposes of performing abortions.
|
SB
113
|
NURSING MOTHERS IN WORKPLACE
|
Sponsor: ELLIS
|
(S) L&C/
03/12/07
|
SB 113 would require employers to "provide reasonable, unpaid break time to nursing mothers for the purposes of breastfeeding or expressing breast milk. The bill also requires employers to provide a sanitary and safe place for the employee to do so, unless doing it would create an undue hardship for the employer." -Sen. Ellis Workers Compensation
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Bill number
|
Short title
|
Primary sponsor
|
Committee/date of last action
|
|
HB
200
|
WORKER'S COMP: DISEASE PRESUMPTION
|
Sponsor: DAHLSTROM
|
(H) FIN/
05/05/07
|
HB 200 would grant "benefits to firefighters stricken with certain types of cancer and heart disease due to their exposure to toxic chemicals, and high levels of carbon monoxide. The requirements of this bill are that the claims must be made within five years after the last day of employment. HB 200 also includes a presumption that compensation for certain disabilities resulting from blood born pathogens be covered." -Rep. Dahlstrom
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SB
117
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WORKER'S COMP: DISEASE PRESUMPTION
|
Sponsor: FRENCH
|
(S) L&C/
03/14/07
|
"Senate Bill 117 would create a presumption in the Workers' Compensation program that a firefighter with at least seven years on the job who has passed health screening exams earlier in their careers will be provided with benefits if they contract certain forms of pulmonary or heart disease or cancers, as it will be presumed to be a result of their occupation. This presumption is restricted to diseases known to occur with greater frequency among firefighters, and is also capped so that claims cannot be made after sixty months from the firefighter's last date of employment." - Sen. French
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SB
147
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WORKER'S COMP EMPLOYER LIABILITY
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Sponsor: FRENCH
|
(S) L&C/
03/28/07
|
This bill seeks to remove the phrase "potentially liable" from the worker's compensation statute. Changes in 2004 to the statute allowed employers who are "potentially liable" for buying worker's compensation policies, but who do not actually do so, can still get the benefit of "exclusiveness of remedy," which means that employers who buy a policy know that there won't be court cases arising out of workplace accidents.
--AHPR--
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| Interview with Rosalie Nadeau |
Rosalie Nadeau is executive director of Akeela, Inc., "a non-profit organization offering a comprehensive array of services for the prevention and treatment of substance abuse, and alcohol abuse, in Anchorage, Alaska and other communities throughout the state." Akeela has a staff of nearly 75 professionals. It serves hundreds of clients in its treatment programs and hundreds more in its prevention programs. Ms. Nadeau is known within the treatment community as a critical policy analyst who "tells it like it is." She does not disappoint in this interview. After a preliminary discussion about programs and issues at Akeela, she goes on to comment on a wide range of policies spanning several administrations with unusual frankness, candor, and insight. Ms. Nadeau's office phone is 907.565.1215, and her email address is rnadeau@akeela.org. This interview was conducted January 8, 2008, and has been edited for length and clarity.
AHPR: Please tell us about Akeela, Inc. What is your mission? What does your organization do? How is it funded?
Rosalie Nadeau: Akeela is a 34 year-old substance abuse program in Anchorage but we [now] have programs throughout the state. We were designed, or set-up, as a therapeutic community, which is a particular kind of treatment modality aimed at engaging the client in running their own lives in the treatment program. You develop client leadership, and they really take on larger and larger roles in the operation of the residential facility as they progress through treatment. It is long-term treatment--meaning they are there 18 months or so--and we tend to take people who are extremely addicted. Some call [it] the ASAM [American Society of Addiction Medicine] criteria. ASAM is a four-point scale and we don't take anyone with less than 3.5 at Akeela House.
That's how Akeela started in Anchorage. Since then, we've branched out and we have a bustling outpatient program. We have a number of women's programs that have come to us in the last year. One is a residential program for women whose children are with them. There are only two of those programs in the state; the other is in Fairbanks.
We have a therapeutic court program that is aimed at women; it's called a Family Care Court. [It] is not a criminal court per se--although many of the people do have some criminal involvement--it is a partnership with OCS [Office of Children's Services] aimed at reuniting families and keeping families together. The judge plays a large part, sort of playing bully pulpit-to-mentor in that process. We do weekly meetings with the court on the clients who are with us.
AHPR: How does Akeela compare in size to any other comparable program in the state?
Rosalie Nadeau: If we exclude [programs] like Southcentral [Foundation], which is one of the large Native organizations, we have to be in the top, I would guess, third, statewide. Clitheroe is probably the only one here in Southcentral that is larger than we are.
We have a large prevention component that the majority of the treatment programs do not have. That makes us a little different. We also run transitional housing, which many of the other programs do not have. We're a bit more diversified. As a mission, we've talked about moving people from sickness to wellness [to] create a healthy, vibrant, resilient society. That is really our aim. Because of that, that continuum of service is very important to us. We have moved to get prevention, intervention, treatment, aftercare, transitional housing. We really do have that complete continuum now and that's unusual.
AHPR: What is your annual budget?
Rosalie Nadeau: It's about 4.5 [million dollars].
AHPR: You are a nonprofit?
Rosalie Nadeau: Yes.
AHPR: How is your organization funded?
Rosalie Nadeau: The largest chunk of funding is behavioral health grant monies, but we augment it with Medicaid, with fund raising, [and] with fees. Our major outpatient program does not have a grant--it is a fee-based program. We receive no state funds for that program. We have no funds to operate transitional housing. We are a combination of state grants. We have contracts, we have some state contracts, we have [a] contract with federal parole and probation.
My personal mission is to expand--by diversification--our funding. We're always going to need the state grant monies because we serve an indigent population. That is not a population that is able to pay for itself. Therefore, we have to find a funding source that will assist with that.
"I'm interested in: Do they have a job? Do they have a family--intact--that they are involved with? Have they stayed out of the criminal justice system? If they can answer, in the affirmative, those kinds of questions that tells me that they are clean and sober generally." AHPR: How do you know your organization is effective? In other words, how do you know that your activities bring about the desired or measured result?
Rosalie Nadeau: Two-fold answer. Number one: with the population we serve in our treatment programs, our residential treatment programs, success is measured in very incremental steps because this is a highly addictive population. Therefore, there are lots of failures with a population that is that addicted. [Number two:] having said that however, we do a lot of follow-up, looking at: Are you clean and sober five years out? Do you have a job? I'm not as interested in: are they clean and sober, although that is the question everybody asks.
I'm interested in: Do they have a job? Do they have a family--intact--that they are involved with? Have they stayed out of the criminal justice system? If they can answer, in the affirmative, those kinds of questions, that tells me that they are clean and sober generally. I'm not suggesting some of our people don't relapse; they do. But [we have a] track record--going back for years--of these people who come through these programs. It's like high school graduation; they've stayed very involved. I speak primarily of Akeela House because my women's programs are too new to us. But the same kind of thing will carry through with them. I can look around the community and see women who I know were in those programs--who are out there--and they are doing ok. They have jobs. They have their children with them.
Treatment is really tough for women. We as a society are not nearly as judgmental about men who have substance abuse problems, as we are women. Women end up being the primary childcare-giver. The guy who fostered those children--that sperm donor--may have disappeared before the baby was ever born. He takes no responsibility, is not involved at all, and yet the woman--although she may be doing it badly--is the only piece of family that baby or those children have. We are very judgmental about how women perform and how they ought not to do whatever it is they're doing. I can be in a group and I can have a guy say, "I've got eleven kids." Are you paying child support for eleven kids? He looks at me as if I've lost my mind!
The woman who has eleven kids is still struggling trying to figure out how feed [them]. She may be doing a lousy job, but generally she is much more engaged and doing a much better job than is the father of those children. We make it tough for women to go into treatment because the pressure on them to stay with those kids and take care of the kids is real.
AHPR: This explains why you started this new program?
Rosalie Nadeau: That's why [we have] this program that is women with children-[to see] if we can get them clean and sober, keep them engaged with their children. We have women at Akeela House, which is a co-ed facility, where the women cannot have their children with them, and with rare exceptions, every woman over there has children. They are in foster care [or] they are living with relatives. The women have decided that they're going to lose them anyway if they don't do something, so they elect to get into treatment and they deserve credit for doing that.
The women in Stepping Stones, which is our women's residential program, have their children with them--or at least some of their children. Many of them have lots of kids. In the last ten weeks we've had three babies at Stepping Stones. Moms are clean and sober when those babies are born. That program gives women an opportunity they don't have elsewhere.
AHPR: How is that program funded?
Rosalie Nadeau: It's a state funded program. Every one of our grants, though, requires a 25% match. That [the 25% match] is really a 33% match [if you do the algebra]. We're coming up with a third of the money for those programs. It's tough to do that with those programs, come up with that extra money.
AHPR: Where does that [money] come from?
Rosalie Nadeau: We get people to donate, we twist the arms of our board members, we encourage staff to donate, we have a gaming permit [and] get a little money on that, [and] we get some fees that we collect from clients. There is no one source. It is a combination of sources.
"'Deferred maintenance' is our middle name because we just do not have the funds to do what we ought to be doing."
AHPR: And--I would assume--a constant struggle. Rosalie Nadeau: A constant struggle. "Deferred maintenance" is our middle name because we just do not have the funds to do what we ought to be doing. AHPR: What are some of the pressing policy issues that you are concerned about? Rosalie Nadeau: My concern is a policy issue that was adopted without really anybody identifying it as policy. We, in this state, made a decision to change the way we fund substance abuse programs--and mental health programs. It came out of the Murkowski administration, which was, "we are going to, by policy, maximize Medicaid in our funding of social services." Now, on its face, it sounds like a pretty good idea but, in reality, what it has done is decimate the whole substance abuse side of the world because the people who came up with that idea--and actually the legislators didn't know any better--did not understand that the majority of substance abuse clients and patients are not eligible for Medicaid. The majority of the folks are single; they are between 21 and 60 [years of age]. They are not Medicaid-eligible. That doesn't mean we don't have a few who are. In addition, there is a federal regulation that says, "If you run a residential program that has more than 15 beds, your program is not eligible for Medicaid." The result of that was particularly difficult for substance abuse. As more Medicaid dollars were dedicated to behavioral health, they took out a concomitant amount of general fund dollars, so if only Medicaid dollars are going in there, then the programs that are not eligible for Medicaid are the ones that get cut the worst. AHPR: I'm assuming this is because Medicaid has a substantial portion of federal money, so it's cheaper for the state to transfer whatever they can to Medicaid. Rosalie Nadeau: Absolutely. That was the thinking behind it; "Let's let the feds pay for our social services to the greatest extent possible." We do it through Medicaid. There were a couple of fallacies in that. One is that a substance abuse program really gets left out, and two: it grows like an amoeba because when it is predicated on Medicaid eligibility rather than the philosophic basis for providing services, then you come up with people who qualify who may never have even needed it before, but now they qualify so we can serve them. We developed some services we may not have had or not had in large numbers because we now have a new funding source for them. I work in a substance abuse program. Yes, I come under behavioral health and the state, itself, did not really understand what would happen with that. It used to be, we had [the] mental health area and the substance abuse area. Now we have "behavioral health" and once that happened, even the people in the state to a large extent, lost track of how that money was dispersed through that system because you couldn't clearly identify which was which because we're all "behavioral health." They then came up with a lot of philosophic arguments to support that--"no wrong door." One of my colleagues in another agency said, "That's garbage. What they really mean is 'no door'". The whole "no wrong door" thing was: if you showed up with a behavioral health issue, we should be able to help you. Initially, that was translated as--and we're talking about the early days of the Murkowski administration--you had to be all things to all people. You had to be able to provide a behavioral health service if you were billing yourself as such a critter. We had never done that before. We had been substance abuse providers and we had been behavioral health providers and there were some [specializing] in dual diagnosis where people came with both problems. We may refer somebody to a mental health program, or they may refer somebody to a substance abuse program, but that "no wrong door" concept just wasn't there. The result is we've discovered that what we really mean by that is that you have to do better referrals, that if they come to you, you have to keep track of them until you can get them herded someplace else that would [be] more appropriate for what ails them. We're doing a de facto separation again, yet nobody wants to say that, so it's kind of interesting to watch what's happening. The real victim in all of this is the substance abuse side of the house because of the Medicaid implications. We did not increase the funding to those programs dramatically, what we did was supplement general fund money with Medicaid money. AHPR: Is the current administration following along with that same philosophy? Rosalie Nadeau: I can't tell you yet. We don't really have any sense of what the current administration's philosophy [is] on this area. The governor has said she was not willing to opine philosophically in any way on these questions pending a report coming to her from [ the Alaska Health Care Planning Strategies Council]. AHPR: That should be coming out pretty quick.
"We are our brother's keeper and we have an obligation to take care of people." I never say that. It doesn't really matter whether we have or not, we're going to take care of them, the only choice we have is: How?" Rosalie Nadeau: It should be coming out soon. That is not to say that there aren't some people within the administration that are thinking about it. We had a seminar with [the Anchorage Alliance for Health and Social Services]. The governor declined our invitation to attend that, and [she] declined the invitation for any of her governor's office administrative staff to attend, but the Commissioner (Department of Health and Social Services Commissioner Karleen Jackson) was there.
The commissioner delivered a speech that left everyone a little taken back. I'm not sure how much of that reflected direction, if any, from the administration. Again, one of my fellow directors said, "Gee, Karleen just told us that there are too many of us, and none of us are doing a good job anyway." That was from [the director of a program that] treats children, so [her agency] is eligible for Medicaid. That's not to say [her agency is] well funded, but her [agency's] funding isn't quite as dire as that of programs funding adult substance abusers.
We're hoping to have some impact on the philosophy coming out of the governor's office. She's been a little overwhelmed with oil and gas pipelines and corruption in the legislature--and otherwise occupied. But we're hoping that that will come about. I am concerned that she doesn't have any background at all in the field. She told me one time that she was convinced that if we could get more jobs in these little communities--she was speaking then of rural, primarily Native communities--we wouldn't have a substance abuse problem. That that would be the best treatment we could give people is to just give them a job.
That flies in the face of all the research. It sounds good. I can see why one might intuitively think that, but it just doesn't work that way, so I'm concerned that we have the opportunity to provide her with a bit more information about the field and some education about what is really going on out there. The interesting thing is her administration--at the prison level, the Department of Corrections level--is finding out what this lack of attention to substance abuse issues has done to their field. It's a booming business. It doesn't say something good about a state when the booming business is a prison business.
The interesting thing is that the first full year or year and a half into the Murkowski administration with that July fiscal year, he killed all substance abuse [programs] in the prisons, eliminated any substance abuse [programs] being provided in the prisons with two exceptions: they had a therapeutic community residential treatment, which meant they segregated them into one unit, [a] program at Hiland Mountain for women, and they had a similar one for men at Wildwood in Kenai.
At that point in time, we were the managers of those programs and that was able to stay intact because they were funded with federal money. They had [a] federal grant to do those. But the result is that, not even counting the cut in the prisons, the state funding for substance abuse programs has been cut--since 2002--about 57%. Somebody said to me, "Are you talking about a cut in the rate of increase?" I said, "No, I'm talking about dollar for dollar reduction in funding."
That means several things. One: we're not picking up these people who end up being repeat offenders and going back to prison. They need to be in treatment. They're not. They come out [but] they've not had any treatment. They have no resources. We're finally beginning to see that. The commissioner of Corrections has talked a little bit about needing to do something about it, getting some treatment and some rehabilitation.
Under the Murkowski administration, although statute talked about rehabilitation, they took the word "rehabilitation" out of the mission statement for Corrections. It was to punish [inmates] and protect the public. Rehabilitation was removed as one of the tenets of Corrections. My understanding is that rehabilitation has been entered back into the mission statement for the prison system. When you have a system that operates on "lock 'em up and throw the key away," then there are some unexpected consequences. We don't "scare 'em straight." That doesn't happen--ever. We have overburdened social systems.
When I talk about this in public forums I always say to people, "I deal with a group of people you are going to pay for, and you can't escape it. You can cut my programs, you can say these are a waste of money, but you are going to pay for these people. You have a couple [of] choices. You can pay less money by addressing it in a preventive way and a treatment way at the front end of the cycle, or you can pay a tremendous amount for them by paying for child protection, by paying for additional cops, additional judges, additional prisons because it is the same group of people, and you are going to pay for them. You can elect not to at the front end and pay two and three times more overall by the time you get to the back end. The McDowell study [Economic Costs of Alcohol and Other Drug Abuse in Alaska, 2005 Update] talks about what substance abuse costs."
It's enlightening to watch the faces of the folks in the audience when you do that. I long ago gave up saying, "We are our brother's keeper and we have an obligation to take care of people." I never say that. It doesn't really matter whether we have or not, we're going to take care of them, the only choice we have is: How?
"DOC [Department of Corrections], just prior to the Murkowski administration, did a study that said 92% of everyone incarcerated had a substance abuse problem regardless of what crime they were convicted of." AHPR: Was the McDowell study done last year?
Rosalie Nadeau: Yes. It was done December 2005. It's an economic study of substance abuse: what does it cost the state? It's astounding what it costs us. It won't go away as a cost, but I can tell you that 80% of sexual assaults all have substance [abuse] involved with them, about 80% of the suicides--the suicider is involved with substance abuse, usually alcohol.
DOC [Department of Corrections], just prior to the Murkowski administration, did a study that said 92% of everyone incarcerated had a substance abuse problem regardless of what crime they were convicted of. It's a pervasive societal problem that we are just not very willing to address as a society.
AHPR: Are there state policy changes specifically that you believe would perhaps model best practices nationally or according to some associations professional that could be done to help remedy this? It sounds like financial support from the state could be enhanced. That would be one thing that can be done.
Rosalie Nadeau: The state needs to adopt a policy that would cost some money, but adopt a policy that says, "This is our over-riding social problem in this state. Therefore, we are going to address it." I think about it much like the tobacco campaigns--or drunk driving. When they started all kinds of folks said, "This is the craziest thing in the world, why should we do this?"
Now, it has flipped almost 180 degrees. We now are very scolding and disapproving of smoking. That was a policy shift--a real paradigm kind of thing happened there. It didn't happen overnight. I think that is the kind of thing that we as a state need to do and I think money will follow it if that happens. It's what happened with tobacco--money followed a lot of that. I think we as a state need to [make] some decisions about what the impacts of substance abuse, primarily alcohol, [are] on our society. It is worse in this state than in any other state in the nation. How do we address that?
I think we need to figure out how we address it, and then I think we need to talk about how we fund [it]. All of it does not cost money. One of the big things that the state did was all but eliminate prevention money. [Looking at a state funding comparison that ranges from 2002 to 2007 for Akeela] If you look under prevention in 2002, there was a lot of money there [over 1 million dollars] that was all part of the state grant funds. It diminished in '03 and '04. By '06 we're down to $98,000. We're not alone; that's what happened to prevention money.
Note where we picked up money. It's in the tobacco area: tobacco policy, tobacco [treatment and technical assistance]. That's the kind of paradigm shift, I think, we as a state need to make. We need to say, "We need to do prevention." Akeela has been very involved in that. We've been partners with PIRE [Pacific Institute of Research and Evaluation, a nation-wide research organization] the sub-grantee. We've been out in twenty communities in this state looking both at community-readiness and [at] school-readiness aimed at substance abuse kinds of issues. We started out principally focusing on huffing [inhalants].
AHPR: Are you talking about being involved with a grant that PIRE has?
Rosalie Nadeau: Yes. They had a grant. They had a NIDA [National Institute of Drug Abuse] grant, and we were a sub-grantee. I think it's been five years now. We've had a long partnership. In fact, they have offices downstairs.
What we've been doing is trying to assist small communities. We've been trying to come up with a process that is a scientific-proven best practice that could help small communities organize to fight these kinds of things. It could help schools--and it isn't just small [schools]. We have some large schools involved too because of the nature of Alaska: if you have twenty communities, you have a bunch of little ones.
The state was blithely unaware of that for a very long time. They only--in this last year--figured out what we were about; [they] didn't know we were even doing that. They do not, as a state, have a philosophy that says, "We're a partnership and we ought to be looking at what everyone is doing regardless of who is funding them." It doesn't exist if they didn't fund it.
We used to do a program in the schools called "Primed for Life," which was really aimed at picking up kids who had gotten caught drinking at some school function, and get them involved in a program. That's been de-funded.
AHPR: Particularly in this time and in this age--where prevention is constantly discussed, probably more so than ever before in my recollection--and yet the actual trend for state funding is declining very dramatically, at least to your organization. How do you explain that?
Rosalie Nadeau: I hate to beat up on the Murkowski administration but that's where that happened. It was sort of the "don't confuse me with the facts; my mind is made up. None of that works." It is very difficult to prove, in the short term, that prevention works. Prevention is not one of those things where you get an "aha" light that comes on. It's a process, and processes do not happen quickly.
We had a big push in that administration, and we have with the Legislature saying, "Prove to me it works. Demonstrate to me it is effective." If I'm working with a bunch of junior high kids and then into high school, we're probably looking 10, 15 years out before you can do a trend across society to see if you have less of the aberrant behaviors that you used to have. You can't really prove it is effective--not at time they're funding. You can have a lot of studies that indicate it is effective, but for our population--we can't prove that, especially with prevention.
It comes a little easier to prove with treatment. We can follow Johnny Jones, who is in treatment, and five years out he's got a job and a family, and he's still obviously clean and sober, and he hasn't been back in jail. That's a success. Your trend line is much shorter when you are trying to measure success. I think that's one of the reasons that prevention [funds] go away. We just have a much shorter timeline to prove to our funders that it works.
Tobacco became the thing we wanted to go away when we began to tie tobacco to deaths. If you think about where the country was fifty years ago, sixty years ago, we were putting packs of cigarettes in the GI's bag as he goes to war and passing them out for free on street corners.
When I was a little kid, I bought packages of cigarettes that were really bubblegum--white bubblegum with a little pink. You don't see those any more. You don't see them because there's been a shift in public perception. The shift was driven by science that said, "Hey, this isn't good for you." We began to say, "We don't want to be exposed to that." I think we're looking at the same kind of thing with alcoholism. I focus more on alcoholism than I do on the hard drugs. They [hard drugs] are the ones that get the headlines, but the one that kills us is alcohol.
"If you want to have a private prison, you also have to promote public safety and so you work real hard to make lots of things crimes punishable by jail. You look for increased jail time, mandatory minimum sentencing." AHPR: You had talked with me at another time about the relationship between funding your programs versus funding new jails. Would you consider speaking about that? Building and running jails, particularly private versus public ones, is very big business across the United States. Preventive programs, especially if they are run by nonprofit organizations, [are not] big business.
Private jails, for example, nationally, are a special interest group that has a lot of money and they have a lot of influence on politicians, whereas prevention programs run by nonprofit organizations have fewer resources to devote to political influence. Would you address that in your discussion? If it's true?
Rosalie Nadeau: It is true. Private prisons were not a part of our landscape thirty years ago, with rare exceptions. They're everywhere now. There are several things that I think that factor into that. Number one: lobby. People lobby to make a buck. When these private prisons are traded on Wall Street, and you can invest in them, and I can invest in them, their goal is to do this as cheaply as they can and promote them as much as they can because they make money doing that.
They make money by touting safety. We have to scare people to death first and so we do a lot of that. My favorite hobbyhorse is the sex abuse registrant. If you're a sex abuser you have to register. I think we have, nationwide, over-used that so much that it has become useless. If you ask Joe Blow down on the street what a sex abuser is, he's going to tell you it's a pedophile who rapes a baby or a little kid. Or it is the violent rapist who breaks into your home and rapes you. That is, I think, the public's perception of what sex abusers are.
The largest segment of those people on our sex [offender] register in this state, are consensual sex folks. They tend to be young, meaning 18 to 22, 23 year-old men and underage girls. Most people, if they saw them out somewhere together, would not say, "What is that old pervert doing with that kid." That is not our perception and yet, the largest percentage, in this state and it's nationwide too, of sex offenders are those who fit that category.
If you want to have a private prison, you also have to promote public safety, and so you work real hard to make lots of things crimes punishable by jail. You look for increased jail time, mandatory minimum sentencing. That is a relatively new phenomenon. The young guy who got caught [committing] a crime when I was a kid or my dad was a kid, got hauled before a judge and generally told some version of, "Kid, here's your choice. You join the army or you go to jail."
We don't have that choice available to them now. The theory was that the army would straighten them out, and often it did. We have this revolving door because it's something like two-and-a-half years is the average stay in jail, and that includes all the lifers there, so we're putting them in, and they're coming right back out, and we're paying a tremendous amount of money to have them in there.
The funny thing about residential substance abuse: [there] have been several studies done nationwide in terms of cost of [a] non-crime day. It is far more cost-effective to have them [in treatment]. Every day they are in treatment is a non-crime day. They're not out there burglarizing. Ninety percent plus, of the people we have in Akeela House, are felons. They have a criminal record; they are still on probation or parole, or maybe they got furloughed directly to us from the prisons. That group doesn't commit a crime when it's in a treatment facility.
The irony [is] in 26 years that Akeela has been in [the] location we are now--Akeela House residential program--never had a police call. Twenty-six years. And we're not atypical. That's pretty much the case with all the treatment programs, and yet we're all afraid to have them in our neighborhoods because, "Oh, my gosh, we've got all these criminals in there." Yet, they don't commit crimes when they're there.
It's a real interesting phenomenon. There have been some interesting research studies done on the crime-free days. If I have 25 criminals in my facility and I have them there for a year, that's 25 [times] 365 days that those folks are not committing crimes.
AHPR: What are some of the most important policy changes you would like to see in the coming years? Maybe a list of three?
Rosalie Nadeau: I would like to see a return to general funding for behavioral health programs. By reducing general fund monies from those programs, we dilute the monies available to address them in any kind of an emergency. If Medicaid money were to go away, this state would be in huge trouble providing even basic services in the behavioral health areas.
I think that, as a policy, the legislature and the administration need to make sure they are keeping [a] sufficient amount of general fund monies in those services. To not do so, is to leave us at the mercy of federal funders, and I don't think that is a good place for us to be. That's one thing I would like to see change.
The other thing I would like to see addressed is a state-driven adequate needs-assessment. There ought to be a policy that the state does a needs-assessment in behavioral health areas. We have segments where some of that is done.
For instance, the Mental Health Trust, which is not really a state agency, has done things around its newest initiative, which is the "Bring the kids home" initiative. They talked about the need, and they quantified it with the number of children who were Outside in facilities. Because they have to have a state referral to get there, it's pretty easy [to assess the need].
I can't point you to a needs-assessment done in my 16 years working in this field, where this state has taken a consistent look at the substance abuse needs and where they are. We have a lot of statistics that talk in terms of, "We have more alcohol-related suicides, we consume more alcohol than any other state." [We have] all the indicators that say we are number one, two, or three in terms of social problems related to substance abuse.
But the state itself has never led a needs-assessment. The interesting thing about that is they put out a request for proposals for grants, and they always say, "And you need to do a needs-assessment." None of us has the means to do a real needs-assessment. We just do not have that capacity, nor do we have the funding. In fact, I've been talking with PIRE about doing some research around that area. Can we move it some funding that we could tap in to do that kind of thing?
The state ought to be championing that kind of thing because we go around, either saying," The sky is falling, the sky is falling, look at all these people going into prison who have drinking problems, mental health problems," or we say, "Oh, it's the same people, we pick up the same people 89 times." It's a little of both, but nobody really knows.
Government has a role in helping, in my view, to forge where we need to focus our services.
AHPR: Do you believe that this, and perhaps other problems, in terms of state policy and consistency might arise from the fact that there isn't a central behavioral health planning body?
Rosalie Nadeau: There is no planning body. I think it's absolutely that. We do [it in] spurts, which tend to be driven by legislators on the Finance Committee saying, "By God, I'm not going to fund this if I can't see this." [The Division of] Behavioral Health, which has suffered massive staff cuts itself, by the way, goes into spasms of, "Oh my God, oh my God, oh my God."
They started saying we're going to do outcome-based funding for substance abuse. The language has shifted slightly because they figured out they didn't know how to measure outcome, or they didn't have the capacity. Now they are talking performance-based. The subtle difference is we're no longer measuring outcomes; we're measuring processes in numbers.
"I happen to think that 30-day programs probably are not worth the money ... [If] they go into a 30-day program, with rare exceptions, they lose their job, [and] they go into debt ... Maybe they are not drinking when they leave but they have huge pressures that hit them as soon as they go out the door. I think that works counter to the goal."
AHPR: That's actually a big difference, not a subtle difference. Rosalie Nadeau: It's a huge difference. Here are some of the things that happen with that. Funding decision: what is your per-day cost to provide the service we're getting from you? I said, "Have you factored acuity into that." [They said,] "We haven't figured out how to do that. But we've got all the residential programs together." [I said,] "That's good. We have a thirty-day [residential treatment program], and we're measuring it against one that is 18-months. You're not measuring outcome; you're measuring process. I'm here to tell you the 30-day guy is going to look a whole lot better than I will." They said, "Well, we're trying to account for that." Without doing the needs assessment, they don't have any feel for what services they really need. I'm like every other director, I think we're providing what is needed out there. Maybe we're not, but we don't have any way of knowing, and neither does the state because we've not done an assessment. I will tell you I have some biases [but] I would like to see the state study this. I happen to think that 30-day programs probably are not worth the money. The individual who has any kind of a support system, i.e. a job, family, friends, but has a fairly serious substance abuse problem is probably better off in intensive outpatient care than in a 30-day program. [If] they go into a 30-day program, with rare exceptions, they lose their job, [and] they go into debt. They leave it [the residential program]. Maybe they are not drinking when they leave but they have huge pressures that hit them as soon as they go out the door. I think that works counter to the goal. I think that we need to be funding some long-term program for the severely addicted, long-term programs of the kind we're using, but we're not the only ones that have those. We probably need to do fewer, if any, 30-day programs. We need to concentrate on intensive outpatient and some general outpatient. AHPR: I imagine that there is national data and national research that buttresses what you are saying. Rosalie Nadeau: Yes, there is. But we have continued to fund what we've continued to fund. We do so because we don't have any needs assessment, any definitive kinds of studies that tells us if there is a better way to build this mousetrap. The other thing that policy needs to address is what the funding is doing, the way the funding is handled. The Medicaid approach is decimating small providers out in the rural areas. It's doing that in a couple of ways. If you're absolutely dependent on Medicaid, then what you are looking at is having some higher-level clinician--a master's level--to sign off on the billing and that kind of thing. They don't have that in most of the rural areas. It becomes very problematic to effectively bill, so you end up with a state that has a great error rate when it comes to Medicaid records. It's because we don't have the manpower, nor do we have the manpower to go out there, so you have migration of clients. My women's program is a classic example of that. It is about 85% Alaska Native, from very rural areas. Ten, fifteen years ago, it was local women. It was women from Anchorage. The way we're funding has eliminated general mental health services. You cannot go to the Community Mental Health Center if you're having marital problems, and you just feel you have got to talk to a counselor, you have to be seriously mental ill--diagnosed as seriously mentally ill. General mental health is almost preventive in nature in that it keeps people from spiraling into deep depressions and that kind of thing. We don't offer that through a Community Mental Health Center with the sliding fee scale anymore. Only seriously mentally ill--and it's because of the funding. The funding has depressed wages, so that we don't have people going into the field in the same way they used to. It means that workforce issues are tremendous issues in this field. We always have openings, and so does every organization I know. Unless we do a state-wide study that is the basis for some policy around what we need, how we want to provide it, and what our best vehicles are for doing so, we're not going to get better. In fact, we'll probably get worse.
AHPR: Are you tracking any particular bills that are of importance in the coming legislative session or are there any bills that came up in the last legislature that might pop up again?
Rosalie Nadeau: There is one that is kind of funny. Senate Bill 100 is a Johnny Ellis bill that was aimed at creating a facility, here in Anchorage, (the idea was that if it worked, they would like to do it elsewhere) for involuntary commitment for substance abuse. They created the vehicle; they did not fund it. That one is going to be interesting to see if any funding comes to it. I was one of those who--reluctantly--was drawn to support that because all I saw was a delusion in funding.
I can tell you that generally, those of us who follow what the legislature is doing, play patty cake with the Finance Committee. We follow what Finance is doing, particularly Finance in the House. That means our own homegrown Mike Hawker. Mike is the guy who really makes the wagon roll in that setting. He is well regarded, he is very bright, [and] he knows the numbers forward, backwards and sideways. It doesn't mean he knows programs. He knows the numbers.
We're going to be in Juneau the end of this month, and I can tell you we will all [make] calls on Mike's office. It's a ritual we go through now. With these kinds of programs, unless we get funding, there's no use talking about anything else because any funding that is not just bare maintenance, is probably not going to happen, and we all know that. Everybody is doing what I'm doing, trying to see if they can find sources, other sources of money. Of course the feds have pretty much dried up too. We have to fight a war; we can't fund social programs.
We had one of those infamous earmarks and that was nice for a while.
"I think what we need to understand is that human services policies really impact all of us. I don't have to be a user of some of the services that are out there, but unless I help make those services available, the likelihood of there being a negative impact on my family, or in my life, is there." AHPR: I guess those days are numbered or gone.
Rosalie Nadeau: Well, at least diminished. Depending on what Senator Stevens does, Alaska may get beat up on more than usual over that area. I really think planning is crucial, and I don't see the state doing much of it although they give lip service to it.
AHPR: Do you any final words you would like to give the readership of the Alaska Health Policy Review?
Rosalie Nadeau: I think what we need to understand is that human services policies really impact all of us. I don't have to be a user of some of the services that are out there, but unless I help make those services available, the likelihood of there being a negative impact on my family, or in my life, is there. I don't think we do a good job of telling that story. And I don't think Alaska is doing a good job of listening to that story. We still are really convinced that--to quote my once two-year old, "I can do it [on my own]."
AHPR: Thank you very much for taking time to do this interview.
--AHPR-- |
| CON Watch |
Certificate of Need is a program administered by the Alaska Department of Health and Social Services that monitors the development of health care facilities. It was established to prevent excessive, unnecessary, or duplicative development of such structures. In addition to providing governmental oversight of the construction of high-cost medical facilities, the certificate of need program also allows for public scrutiny of the proposed projects.
The following are listed on the state's CON website as current projects in various stages of the application process. This list includes only projects that have been updated in some way after September 1, 2007. Projects that have not been updated since before that point were left out, although they are listed on the CON website. Each project name is linked to the project's individual CON page.
Certificate of Need information is current as of January 11, 2008.
--AHPR-- |
Alaska Health Policy Calendar
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This calendar of health policy-related legislative meetings is current as of January 11, 2008. Please visit the Alaska State Legislature's list of committee hearings for the most current listings, as they are subject to change.
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January 15, 2008 - Senate Labor & Commerce Committee |
What: standing committee
When: 1:30 PM
Where: Beltz 211, Capitol, Juneau
Other information: bills previously heard or scheduled - SB 28 Limit Overtime for Nurses; and SB 107 Naturopaths |
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January 16, 2008 - House Health & Social Services Committee |
What: finance subcommittee
When: 7:30 AM
Where: House Finance 519, Capitol, Juneau
Other information: progress review for Fiscal Year 08 budgets and programs |
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January 17, 2008 - Senate Labor & Commerce Committee |
What: standing committee
When: 1:30 PM
Where: Beltz 211, Capitol, Juneau
Other information: bills previously heard or scheduled - SB 147 Worker's Comp Employer Liability; and SB 120 Unemployment Compensation Benefits |
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January 18, 2008 - House Health & Social Services Committee |
What: finance subcommittee
When: 7:30 AM
Where: House Finance 519, Capitol, Juneau
Other information: Governor's FY 09 budget proposal |
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January 21, 2008 - House Health & Social Services Committee |
What: finance subcommittee
When: 7:30 AM
Where: House Finance 519, Capitol, Juneau
Other information: Division of Health Care Services programs; Legislative Medicaid Program Review SB 61 |
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January 23, 2008 - House Health & Social Services Committee |
What: finance subcommittee
When: 7:00 AM
Where: House Finance 519, Capitol, Juneau
Other information: Rate review & rate adjustments; Division of Senior and Disabilities Services/DD waitlist |
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January 25, 2008 -House Health & Social Services Committee |
What: finance subcommittee
When: 7:30 AM
Where: House Finance 519, Capitol, Juneau
Other information: Alaska Pioneer Homes; Division of Public Assistance |
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January 28, 2008 - House Health & Social Services Committee |
What: finance subcommittee
When: 7:30 AM
Where: House Finance 519, Capitol, Juneau
Other information: Division of Public Health |
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January 30, 2008 - House Health & Social Services Committee |
What: finance subcommittee
When: 7:30 AM
Where: House Finance 519, Capitol, Juneau
Other information: Office of Children's Services; Division of Juvenile Justice |
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February 1, 2008 - House Health & Social Services Committee |
What: finance subcommittee
When: 7:30 AM
Where: House Finance 519, Capitol, Juneau
Other information: Departmental Support Services; Office of Faith-Based & Community Initiative |
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February 4, 2008 - House Health & Social Services Committee |
What: finance subcommittee
When: 7:30 AM
Where: House Finance 519, Capitol, Juneau
Other information: Alaska Mental Health Trust Authority |
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February 6, 2008 - House Health & Social Services Committee |
What: finance subcommittee
When: 7:30 AM
Where: House Finance 519, Capitol, Juneau
Other information: Division of Behavioral Health |
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February 8, 2008 - House Health & Social Services Committee |
What: finance subcommittee
When: 7:30 AM
Where: House Finance 519, Capitol, Juneau
Other information: topic TBA |
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February 11, 2008 - House Health & Social Services Committee |
What: finance subcommittee
When: 7:30 AM
Where: House Finance 519, Capitol, Juneau
Other information: topic TBA |
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February 13, 2008 - House Health & Social Services Committee |
What: finance subcommittee
When: 7:30 AM
Where: House Finance 519, Capitol, Juneau
Other information: topic TBA |
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February 15, 2008 - House Health & Social Services Committee |
What: finance subcommittee
When: 7:30 AM
Where: House Finance 519, Capitol, Juneau
Other information: closeout |
--AHPR--
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| AHPR Staff |
Lawrence D. Weiss Ph.D., M.S., Editor Jacqueline Yeagle, Marketing and Communications Manager Elizabeth Agi, Research Associate
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