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Governor's Committee Urges Saving CON |
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Introduction
The Certificate of Need program, administered by the Department of Health and Social Services (DHSS), monitors the development of health care facilities and 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.
During the final months of 2007, discussion about the state's controversial Certificate of Need program had reached an impasse. Hearings had been conducted and public forums had been held, but the no consensus on what to do with the program was reached. In an effort to finally reach a workable compromise on this contentious issue, Alaska Department of Health and Social Services Commissioner Karleen Jackson employed for only the second time in the state's history a process known as negotiated rulemaking.
Under AS 44.62.71-AS 44.62.800, an agency head is granted the authority to form a negotiated regulating committee if said agency head determines that such a committee is in the public's best interest. In this case, both Commissioner Jackson and Governor Sarah Palin were concerned about the proliferation of appeals and litigation spawned by the CON process, and felt that the negotiated rulemaking process might work. The goal was to include people on the committee who would represent the various interested parties in the CON debate, and have them work together in a new process designed to reach a consensus on a comprehensive package of CON reforms.
The committee met from October to December 2007, and released their report in early January 2008. The committee used a consensus model to reach their conclusions about various sticking points in the CON debate. The executive summary of the committee's findings are reprinted here.
Executive Summary
The Negotiated Rulemaking Committee meetings for the Certificate of Need (CON) held in October and November this year produced several strong recommendations based on high consensus of the group. They included;
- That the CON process as it is currently, is broken
- It should not be eliminated
- Clear definition and specificity on the Physician office exemption (POE)
- What should be in for CON and what should be out
- CON covered entities should be required to serve all comers regardless of their ability to pay
- CON should be in alignment with Medicare guidelines
Several other areas of consensus of the committee included;
- The need for an ad-hoc advisory group to support the state in reviewing equipment thresholds, new procedures and remodels/renovations related to CON
- The state would benefit from having an ad-hoc advisory group for technical expertise in disputed CON situations
- Recommendation that the state collect data that shows whether the CON process actually accomplishes its stated purpose of cost containment and access.
- The State be empowered to a higher level of enforcement and monitoring that providers are staying within their CON
- That for definition purposes Anchorage, Mat-Su, and Fairbanks would be considered large communities and all other areas in Alaska would be considered small communities.
Efficacy of the CON was a major discussion topic. Where the CON is designed to contain costs and improve access, the committee noted a lack of data on whether the CON process actually accomplishes its intended purpose. The committee acknowledged that any movement towards collecting data will be time consuming and that all providers of services should be included in data collection in order to get a more comprehensive picture. Concurrently, the committee also noted the need to protect smaller community hospitals in select areas from being driven out of business and that the CON process accomplishes that end. Failure to do so will leave the CON vulnerable to attack and elimination.
The Physician office exemption (POE) definition was the most discussed and contentious topic at every session. The committee debated throughout the sessions the definition of what a physician office is and is not for purposes of exemption from the CON. While the committee did reach consensus on specific language for the POE, it was based on the fear of the misuses of the POE process as perceived by many members versus a more positive outcome driven definition. The negotiated rulemaking committee has the distinct merits of bringing together stakeholders to derive consensus on issues that are of importance to their communities and the state. In this first attempt to reduce the litigious atmosphere surrounding the CON, there were two distinct stakeholders not represented on the committee:
- Patient / consumer representation was absent from the committee. The absence of patient viewpoint would be valuable in future committees to ensure that the committee stays focused more on what is best for the citizens of Alaska rather than healthcare business interests.
- State of Alaska Healthcare point of view and plan. Several times the lack of state and or community healthcare plans/ goals, vision was notably absent as needed information for the committee to use in making decisions. If a plan was developed the CON decisions could be made in reference to the community and state plans as a guide.
Finally, as a matter of improving the committee process it is recommended that once a committee member is selected that substitutions not be allowed as it interferes with the group dynamic and the ability of the group to reach consensus. |
Tough Questions: Alaska Health Care Transparency Act
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Introduction
On January 22, 2008, Governor Palin introduced the Alaska Health Care Transparency Act, designated HB 337 "Health Care: Plan/Commission/Facilities" by the Alaska House of Representatives. The bill proposes the formation of the Alaska Health Care Commission, the establishment of an Alaska health care information office, and the repeal of the Certificate of Need program. It was quickly referred to the House Health, Education, and Social Services Committee and House Finance Committee. After the addition of three fiscal notes done by the Department of Health and Social Services, HB 337 was referred to HES and the first hearing on the bill was held on January 24.
This hearing focused on explaining the three major sections of the bill, and answering questions that arose from this preliminary round of discussions. DHSS Commissioner Jackson and DHSS Chief Medical Officer Dr. Butler testified before the full committee, chaired by Representative Peggy Wilson.
Overview of the Bill
Commissioner Jackson began by summarizing the first two sections of HB 337. The fist section would require that DHSS implement a statewide health plan under AS 18.09, a new chapter of the current health statute. The second section would establish a ten-member Alaska Health Care Commission within DHSS. The purpose of the Commission, Jackson said, is to develop a statewide plan to address the quality, accessibility, and availability of health care for all citizens in the state. It would also review and improve health care facility information in the state for placement on an Internet database to be established under AS 18.09.110, discussed later in the bill.
First Component: The Alaska Health Care Commission
The first section of HB 337 also specified that the health plan contain health care policy and strategy for encouraging personal responsibility for a reduction in health care costs; access to safe water and waste water systems; development of a sustainable health care workforce; accessible quality health care; and an increase in the number of residents who are covered by insurance.
Commissioner Jackson finished by saying that the Alaska Health Care Commission picks up in part on the work done by the Governor's Health Care Strategies Planning Council, and takes many of their recommendations and encourages the Commission by moving forward with those pieces.
The committee members asked questions at this point. Representative Roses asked for more information on how the composition of the board (Commission) was determined. He noted that it looked to be made up of a lot of "administrative types of folks," and was concerned about the lack of representation from care providers, physicians, and other stakeholders.
"The governor's Health Care Strategies Planning Council did have many members from different provider groups in the health care industry," Jackson responded. "And one of the things we learned in that process is that it really helps to be able to bring in subject matter experts on those issues and parts. So in the interest of not having a very large Commission, the suggestion here in this bill at this point in time is to have a ten-member commission that would basically pull in different departments of the state that would need to be engaged in the conversation, including the Department of Administration that, of course, does the state health plan, the Department of Commerce that has the Division of Insurance under it, the Department of Labor that deals with those issues around employers doing health care, and then, of course, our own department, with (Chief Medical Officer) Dr. Butler chairing that. It would also have a member appointed by the House, and a member appointed by the Senate, and three citizen members across the state that would be appointed by the governor, to give those inputs from three individuals, at least, that are consumers of health care services."
Rep. Roses reiterated his earlier concern that on boards that deal with policy-making decisions, he liked to see "stakeholders" on them. He commented that he doesn't see people representing the medical community and care providers, unless they are the people the governor picks. He believed that those people are likely to have he knowledge base to draw on that would be sorely needed on the issue.
Commissioner Jackson told the committee that part of the problem with trying to include the many medical or health care associations is, "Who do you exclude?"
"My position would be, if we have difficulty in trying to find who you would exclude, I don't suggest that the best way is to exclude everybody," Rep. Roses finished.
Representative Gardner agreed with her colleague, and added that she was most intrigued by HB 337's stipulation that one member of the Commission must be a small business owner in the state. Commissioner Jackson responded that in putting together the bill, one of the things they recognized was that small business owners aren't often given a voice in the health care arena.
Representative Cissna voiced concerns about the number of state personnel that are represented. She said that it often seemed like Juneau didn't hear enough voices from across the state, and that they haven't yet figured out how to successfully get the full range of state voices heard in the health care debate in Juneau.
"In wrestling with the Commission and trying to keep the costs down as low as possible for a commission by keeping the membership small, but wanting to address those issues," Commissioner Jackson explained, "there is a component for travel for the Commission to different areas of the state, to hear from community stakeholders."
There is a depth of problems in the state, Representative Cissna continued, and she wanted to know how the Commission would deal with the different studies that addressed behavioral health issues. She added that while she "love(s) the language" in the bill, it's very broad. She requested that the Committee send out a request for people to speak to this issue in order to find out what legislators should know and look at for the next hearing.
Second Component: The Alaska Health Care Information Office
Commissioner Jackson told the Committee that the health care information office would provide consistently updated information: health care facility information; health care services; and information to encourage personal responsibility in prevention and in healthy living. "That piece is probably the most nebulous piece in this bill," she acknowledged, and said that the Chief Medical Officer for DHSS would show the Committee a website that does what they anticipated the proposal in the bill would.
She added that health care transparency is a hot topic across the nation. Making sure consumers can identify when they need a particular service or drug, where it's available, costs, options, and procedures and what their outcomes have tended to be from different providers are all issues that HB 337 would address.
Dr. Butler used the state of Florida's website as an example of the kind of Internet database Alaska might use. He said that Florida's site provides different prices for prescriptions and the locations of the pharmacies that sell the prescriptions. He said that New Hampshire's website breaks down the state's three major insurance carriers. The New Hampshire site tells users what different procedures cost, what the patient would pay out of pocket, and provides information on the accuracy of estimates based on the volume of claims from a particular facility, as well as the complexity of patients seen at that facility.
Another component of the health care information office, Dr. Butler said, is to provide information on how to keep from being a patient. The office would provide information on promoting wellness and protecting health.
Legislators asked several questions at this point. Rep. Roses asked whether prescription information would state if the price differential is due to a drug being brand name versus generic. Dr. Butler said that he wasn't sure if the Florida site did that, but that it was something Alaska should consider for its own site. Representative Fairclough questioned how many definitions under a medical code a certain ailment is likely to be--she used the example of a broken limb. Dr. Butler answered that most states focus on the most common diagnoses and procedures, and that the goal has been to get data on the procedures that account for the greatest majority of health care costs. He admitted that it would be impossible to capture everything. He also said that a review of claims data for the most common procedures is the main criteria for clarifying the cost information to consumers.
Commissioner Jackson interjected at this point to add that one of the Department's fiscal notes did account for staff to handle the web-based and technical aspects of maintaining the site for the state, as well as for two health planners who would help get the information on best practices.
"How much, in totality, did Florida, or whatever example that you'd like to provide for us, actually expend to bring their system up?" Rep. Fairclough asked. "I am concerned with, as Representative Cissna has said, access issues for Alaskans, I'm concerned with the quality of care, but I've noticed that when we go into the software world, we seem to take a step, and then the cliff just starts and we get up in bureaucracy instead of helping people, and create barriers instead of windows. So I would just like to know, with a website that's up, the projection of when they started and how they actually got it up, and what was the cost in between."
"Can we buy it from them?" Rep. Gardner asked, in response to Rep. Fairclough's concerns. "Would we want to, rather than invent it ourselves?"
Commissioner Jackson said DHSS could get back to the Committee with the cost at a later date, and that it was worth examining to see of there was something "we can purchase off the shelf" to begin. She added that she anticipated introducing a committee substitute next week that would have more detail on this section.
Rep. Roses said that while he agreed with the principle behind the site, he was concerned about the accuracy of reporting. "Absent a strict protocol as to when certain services should or shouldn't be provided, I think what we do is we open up a great opportunity for our state website to advertise for somebody."
He gave an example: "If I put in there that I'm willing to set a broken arm and I'll do it for $200, and everybody else is charging $400, what I don't tell you is that I never get an X-ray, I always have you do an MRI. You're not going to know that by looking. And so absent a specific protocol as to when an appropriate procedure would be called for, there's no way to know that we're not doing advertising for somebody to set the patients up for considerable more expense than they would have if they maybe went to the person who charged the highest, because you don't know what's included in that procedure and what they're protocol status is in their office."
"Absent that kind of rigorousness in what we're doing," Rep. Roses finished, "I think we may be setting ourselves up to be a wonderful advertisement for somebody [who] isn't necessarily following what would be best practices in medicine, but would be best practices in economics."
Commissioner Jackson attempted to allay that fear by telling the Committee that such a situation is precisely why the health information office would be under the Chief Medical Officer, who would ensure that nothing went up on the website without proper protocols being in place.
Dr. Butler added that in many states, part of the data that gets disclosed is quality data, which can be difficult to get a handle on, but that there are certain benchmarks that can be used to incorporate that issue.
Rep. Fairclough brought up another potential abuse of the proposed system, saying that drug companies advertise a product, and then patients advocate for the use of that product to their doctors. She worried about what effect self-diagnosis or prescription abuse would have on a system that provides comparative drug price information. Rep. Wilson expressed that her understanding of the bill's purpose is to put up price information somewhere online so that people can make choices about their own health care. "It's the transparency so that people can help themselves better when they need health care."
At this time, Dr. Butler talked the Committee through some of the information on the Florida site.
Rep. Fairclough raised the issue of how to ensure that information on the website remains as accurate and up-do-date as possible. Dr. Butler explained that the office's phone number is there for calls to confirm the price of a drug before a patient attempts to purchase it. "I think addressing the quality of the data is critical," he said. "This is not easy. If this were easy, we would have done it already."
Representative Keller spoke about the price differential, and said that even if the website sets up "advertisement" for a pharmacy or provider without telling the entire story, it still allows people to take personal ownership over their health care. "If it's my $20, I'm going to be looking, and that's what I think we're shooting for more in our society is where we own our own health care systems, we own the responsibility for the price we pay for the drugs we buy."
Commissioner Jackson wrapped up the discussion about the first two sections of the bill. Health care facilities would need to provide DHSS with information related to the costs of consumer health care, location, and types of insurance. She said that the committee substitute bill would also address home and community services and PCA services.
"I realize that there's a lot of skepticism about prevention (and) outreach programs," Dr. Butler said, "but there are some emerging data to suggest that data that is customized for individual people and interactive can make a difference." He offered an anecdote about a similar website that went up in Kentucky that provided links to wellness websites; the website has been estimated to have prevented seven bariatric surgeries.
Third Component: Repealing Certificate of Need
Finishing up the first round of discussions on HB 337, Commissioner Jackson said that Part 3 of the bill called for a total repeal of the Certificate of Need program. CON was put in place to increase access to care and to keep facility cost of care down, she said, and she sees the Alaska Health Care Commission and the Alaska health information office as providing better tools than CON for these purposes. Part of the reason, she added, is due to the current cost of litigation associated with the program.
Rep. Roses expressed concerns he had heard that, given the enormous amount of time and energy that went into CON compromises achieved by the recently-convened negotiated rulemaking committee, doing away with certificate of need would be akin to having those efforts "flushed away."
Commissioner Jackson said that the negotiated rulemaking committee had used a consensus model to come up with recommendation to make the program tighter and to collect data on the program, but said that part of the issue is that those recommendations would not remove the current or future lawsuits around certificate of need. The tools in HB 337, she said, "can get us to a better place to look at lowering cost and increasing access than the certificate of need program can."
Reps. Gardner and Fairclough helped close the hearing with some final questions. Rep. Gardner asked for clarification on how listing costs would make hospitals lower the cost of the services they have to provide. Rep. Fairclough asked why HB 337 was presented as three bills in one, when one section is so controversial.
Time ran out before those questions could be answered, and Rep. Wilson gave committee members time to look over the bill, and called for a meeting in one week, January 31, 2008, for a new debate. Rep. Wilson closed the meeting.
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| Guest Commentary: Don't Dump the Certificate of Need |
 A UAF emeritus professor of geophysics, Neil Davis has several fiction and nonfiction works published by the University of Alaska Press and McRoy & Blackburn Publishers. Mired in the Health Care Morass, his newest book (due March 2008), is about the US health care situation and how to fix it. He writes Dose of Reality, a column about health care and insurance, for The Ester Republic. You can read more about his books at his website, www.neildavisalaska.com.
We wish to thank Professor Davis and the Ester Republic for giving us
permission to publish this commentary. The views expressed by
Professor Davis are his own and do not necessarily reflect those of the
Alaska Center for Public Policy or the Alaska Health Policy Review. This article has been edited for length and clarity.
Toward the end of 2007, Commissioner Jackson of the Department of Health and Social Services established a Certificate of Need Negotiated Regulations Committee. This committee issued a report stating that the current CON legislation needed changing, but it reported a very strong consensus among members that the CON process "should not be eliminated" and offered several suggestions for strengthening and clarifying the current regulations.
So what happened then? Commissioner Karleen Jackson ignored these recommendations, and concluded that the CON program does not benefit the citizens of Alaska, "given the litigious environment surrounding it." Then awarding the council members a second kick in the teeth for their efforts, Governor Palin, as part of her Alaska Health Care Transparency Act presented to the legislature, called for the repeal of Alaska's certificate of need legislation in entirety.
What will happen now is anybody's guess, but let's hope the legislature follows its conscience and stands up to the governor on this issue. Legislators would do well to listen to what the Alaska Health Care Strategies Planning Council had to say about how to improve the CON legislation and then take steps to do it.
Governor Palin argued that eliminating CON altogether will increase choice and manage rising costs. This statement is really just meaningless verbiage, however, because elimination of CON will not increase choice for many Alaskans and will do nothing to control the rising cost of health care. If anything, it will increase the overall cost of health care for Alaskans in the long run. The issue of affecting choice was one of the concerns of the Alaska Health Care Strategies Planning Council: if CON were eliminated, residents of the smaller towns in Alaska likely would have even less choice in health care facilities than they already have, simply because their hospitals might have to reduce services.
Controversy over certificate of need legislation goes way back to 1974. In that year, the federal government established a requirement for all 50 states to submit proposals and obtain approval from a state health-planning agency before beginning any capital projects. Dangling as an incentive, was the possibility of receiving federal financing if the rules were followed. That federal mandate was repealed in 1987 and the funding withdrawn, but the result is that now some 36 states have some sort of certificate of need legislation in effect.
In my book coming available this month, Mired in the Health Care Morass, an Alaskan Takes on America's Dysfunctional Medical System for his Uninsured Daughter (Ester Republic Press), I argue that health care is not suitable for the marketplace, and that our allowing unregulated for-profit enterprise to play such a large role in the United States is the major reason why health care costs are rising out of sight and our system is failing to serve the public interest.
Where does the Certificate of Need issue fit in all this? The original idea for putting into effect CON legislation was the hope that it would help cut health care costs by limiting the inflation that comes from overbuilding health care facilities beyond the level of actual need. The public, represented by its federal and state agencies, has a vested interest here because the public ultimately pays for health care, and if we overbuild our health care facilities then we pay more than we should to operate them. Part of what we pay is through our Medicare and Medicaid programs, which dole out money to hospitals and other health care providers in amounts meant to match their costs. If those costs escalate though overbuilding of facilities, then we pay too much.
Complicating the matter is that we require full-service hospitals to give emergency care to all comers, regardless of ability to pay. In order to continue to provide that required service, our hospitals need to take in enough money to at least break even. They do it in part by charging more than actual costs for some services to make up for underpayments in other areas. Hospitals tend to lose money on emergency services and on patients requiring extensive care, so they make up the difference by charging more than actual cost for certain items. Some for-profit hospitals have huge markups, running up as high as ten times the actual costs of operating rooms, supplies, and pharmaceuticals, and the average markup for these items in the United States is 2.44 times cost. Curiously enough, Alaska's nonprofit hospitals tend to have very low markups. Both Providence Hospital in Anchorage and Fairbanks Memorial Hospital have markups well below average. In fact when it comes to markups, Alaska hospitals rate as a whole as among the lowest in the union.
Even so, the markup over cost of certain facilities, especially of operating rooms, scanners and labs, is high enough to provide opportunity for entrepreneurs to enter these arenas and earn profit from operating stand-alone surgical facilities and scanners, perhaps even charging patients lower rates for these particular services than can the nonprofit hospitals.
Making it easier for the for-profit entrepreneurs in this regard is our federal income tax law that allows them to write off against taxes the cost of equipment such as X-ray, ultrasound, MRI, and PET scanners. And of course the non-profit hospitals do not get this subsidy. Furthermore, they have to stay open 24 hours each day and provide services to patients unable to pay or who pay less than their care costs. It is a good deal for the cherry-picking for-profit entrepreneurs, but a bad deal for the nonprofit hospitals. If the hospitals lose scanner and operating room customers to the competing for-profit stand-alone facilities, their only recourse is to compensate by raising rates overall or cutting some services and no longer being full service hospitals.
A major argument of those wishing to eliminate CON regulations is that they hamper the establishment of new facilities that provide more customer choice, and that this ability to choose between providers can hold health care costs down. However, negating this argument are findings that in those states having dropped their CON regulations, many health care customers have fewer options and are paying more for what health care they do receive. That is because many of the entrepreneurs entering the field to compete with acute care nonprofit hospitals are cherry-picking their clientele. For example, The New York Times reported some years ago that operators of stand-alone imaging facilities in New York City were tending to shun Medicare and Medicaid beneficiaries because those programs paid about 25 percent less for scanning procedures than did private health insurers. They were also serving a smaller percentage of the Medicare and Medicaid beneficiaries than were the nonprofit hospitals.
The truth is that the CON laws probably do not have dramatic effect on the containment of health care costs, one way or the other. Proponents of privatization of health care argue that CON requirements actually increase costs by preventing competition, but this argument has to be predicated on the assumption that health care is a suitable commodity for the marketplace. It is not, and over the years, for-profit private enterprise has proven itself incapable of providing the quality of health care available to Americans from nonprofits, such as our community hospitals. The for-profits are in business primarily to make money, whereas the primary goal of the nonprofits is to serve the community interest. For the two to coexist and best serve the public interest, it really is necessary to regulate the activities of the for-profits sufficiently to avoid damage to our nonprofits dedicated only to serving the public welfare. In principle and in practice, certificate of need requirements accomplish this end.
As an Alaskan consumer of health care without any professional involvement on either side of the certificate of need issue, I am strongly in favor of retaining Alaska's certificate of need legislation. I also am a strong proponent of establishing a system of universal health care in this country, and I consider elimination of certificate of need legislation to be a backward step in this direction. I recognize that many will not agree with my personal views, but I do think it highly significant that after decades of debate on the issue and the federal government dropping its requirement to maintain certificate of need regulation at the state level, 36 of the initial 50 states adopting certificate of need legislation still do retain it.
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| Alaska Health Policy Calendar |
This calendar of health policy-related legislative meetings is current as of January 30, 2008 at 5 PM. Please visit the Alaska State Legislature's list of committee hearings for the most current listings, as they are subject to change.
February 1, 2008, 7:30 AM
What: House Health & Social Services Committee finance subcommittee
Where: House Finance 519, Capitol, Juneau
Other information: Departmental Support Services; Office of Faith-Based & Community Initiative; teleconferenced
February 4, 2008, 7:30 AM
What: House Health & Social Services Committee finance subcommittee
Where: House Finance 519, Capitol, Juneau
Other information: Alaska Mental Health Trust Authority; teleconferenced
February 6, 2008, 7:30 AM
What: House Health & Social Services Committee finance subcommittee
Where: House Finance 519, Capitol, Juneau
Other information: Division of Behavioral Health; teleconferenced
February 8, 2008, 7:30 AM
What: House Health & Social Services Committee finance subcommittee
Where: House Finance 519, Capitol, Juneau
Other information: topic TBA; teleconferenced
February 9, 2008, 10 AM
What: House Revenue Committee finance subcommittee
Where: House Finance 519, Capitol, Juneau
Other information: topics include the Mental Health Authority; teleconferenced
February 11, 2008, 7:30 AM
What: House Health & Social Services Committee finance subcommittee
Where: House Finance 519, Capitol, Juneau
Other information: topic draft closeout; teleconferenced
February 13, 2008, 7:30 AM
What: House Health & Social Services Committee finance subcommittee
Where: House Finance 519, Capitol, Juneau
Other information: topic TBA; teleconference
February 15, 2008, 7:30 AM
What: House Health & Social Services Committee finance subcommittee
Where: House Finance 519, Capitol, Juneau
Other information: closeout; teleconference
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| Bill Watch |
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Bills on the Move
This week only saw the introduction of one new health-related bill, HB 345 "Medical Facility Certificate of Need." Several bills did see action, however, including one old piece of legislation that had been sitting in committee since the last session.
SB 107 "Naturopaths," initially in three Senate committees, was referred out of Labor & Commerce, and into to Health, Education, and Social Services. A fiscal note was also attached to the bill.
SB 212 "Medical Assistance Eligibility" had its referral to the Senate Labor & Commerce Committee waived, and was referred to the Finance Committee, and picked up three fiscal notes along the way. HB 337 "Health Care: Plan/Commission/Facilities" had its first hearing in the Health, Education, and Social Services Committee on January 24, with a second HES hearing scheduled for January 31.
Bill Tracking Methodology
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 have been introduced during the second session. Bill information is current as of January 30, 2008 at 5 PM.
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
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Certificate of Need |
HB 4 HB MEDICAL FACILITY CERTIFICATE OF NEED
Sponsor: Representative Lynn
Committee(s) and date of last action: (H) HES, 01/16/07
"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
SB 65 MEDICAL FACILITY CERTIFICATE OF NEED
Sponsor: Senator Huggins
Committee(s) and date of last action: (S) HES, 01/26/07
"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
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| Drugs |
HB 81 ALASKA PRESCRIPTION DRUG TASK FORCE
Sponsors: Representatives Guttenberg and Cissna
Committee(s) and date of last action: (H) HES, 01/16/07
"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
HB 82 PRESCRIPTION DRUG DISCOUNTS
Sponsors: Representatives Guttenberg, Cissna, and Greunberg
Committee(s) and date of last action: (H) HES, 01/16/07
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.
HB 208 DRUG PRODUCT SUBSTITUTION
Sponsor: House Health, Education, and Social Services committee
Committee(s) and date of last action: (H) HES, 03/19/07
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.
HB 300 DOCUMENT PRENATAL ALCOHOL EXPOSURE
Sponsor: Representative Doll
Committee(s) and date of last action: (H) HES and (H) L&C, 01/15/08
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.
HB 304 CANCER DRUG REPOSITORY
Sponsor: Representative Nelson
Committee(s) and date of last action: (H) HES and (H) FIN, 01/15/08
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.
SB 114 DRUG PRODUCT SUBSTITUTION
Sponsor: Senate Health, Education, and Social Services committee
Committee(s) and date of last action: (S) L&C, 03/12/07
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.
SB 196 PRESCRIPTION DATABASE
Sponsor: Senator Green
Committee(s) and date of last action: (S) L&C and (S) FIN, 01/16/08
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, II 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 practitioners 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.
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Education |
HB 55 WWAMI MEDICAL SCHOOL
Sponsor: Representative Kelly
Committee(s) and date of last action: (H) HES, 01/16/07
"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
HB 66 REQUIRE CPR FOR HIGH SCHOOL GRADUATION
Sponsor: Representative Gruenberg
Committee(s) and date of last action: (H) HES, 01/16/07
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.
SB 32 WWAMI/NURSE EDUC LOAN REPAYMENT PROGRAM
Sponsor: Senator Wilken
Committee(s) and date of last action: (S) HES, 01/16/07
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.
SB 73 WWAMI MEDICAL SCHOOL
Sponsor: Senator Ellis
Committee(s) and date of last action: (S) SED, (S) HES, and (S) FIN, 02/02/07
"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
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General Health Policy
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HB 36 NURSE SUPERVISION OF EMT TRAINING
Sponsor: Representative Kawasaki
Committee(s) and date of last action: (H) L&C and (H) HES, 03/28/07
"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
HB 100 AIR AMBULANCE SERVICES
Sponsor: Representative Coghill
Committee(s) and date of last action: (H) HES and (H) L&C, 02/15/07
"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
HB 124 INTENSIVE SERVICES FUNDING
Sponsor: Representative Nelson
Committee(s) and date of last action: (H) HES and (H) FIN, 02/07/07
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.
HB 136 DENTAL HYGIENISTS
Sponsor: Senator Stoltze
Committee(s) and date of last action: (S) FIN, 05/04/07
"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
HB 319 DENTAL HYGIENISTS/DENTAL PRACTICE
Sponsors: Representatives Ramras, Salmon and Thomas
Committee(s) and date of last action: (H) HES) and (H) L&C, 01/22/08
HB 319 would amend the statute regulating the use of dental radiological equipment. The bill would specify the prohibitions under the statute to include the dentist's "direct or indirect" supervision of the use of such equipment. HB 319 would also extend the "direct or indirect" supervision clause to the grounds for discipline, suspension, or revocation of license. New sections are added to the statute regarding dental assistants, including certain certifications and delegation to dental assistants; and definitions of certain terms used in the legislative language.
HB 329 ABORTION NOTIFICATION
Sponsor: Representative Doogan
Committee(s) and date of last action: (H) HES and (H) JUD, 01/17/08
HB 329 would amend several aspects to the current statute governing parental notification of an abortion on a minor, as well as repeal the judicial bypass provisions relating to abortions. Specifically, the bill would lower the age of notification from 17 to 16, and would more clearly define who is capable of giving consent. The bill would also redefine "medical necessity" for abortions and amends the duties of the Office of Public Advocacy in cases involving minors' abortions.
HJR 26 CONST AM: CONTROL OF MINOR'S MEDICAL CARE
Sponsor: Representatives Coghill and Lynn
Committee(s) and date of last action: (H) HES and (H) JUD, 01/15/08
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.
SB 28 LIMIT OVERTIME FOR REGISTERED NURSES
Sponsor: Senator Davis
Committee(s) and date of last action: (S) FIN, 01/23/08
"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
SB 29 MEDICAL PATIENT BILLING DISCLOSURES
Sponsor: Senator Dyson
Committee(s) and date of last action: (S) HES, 01/16/07
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."
SB 98 DENTAL HYGIENISTS
Sponsor: Senator Davis
Committee(s) and date of last action: (S) HES, 02/28/07
"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
SB 107 NATUROPATHS
Sponsor: Senator Davis by request
Committee(s) and date of last action: (S) HES and (S) FIN, 01/28/08
"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
SB 181 ANATOMICAL GIFTS
Sponsor: Senator McGuire
Committee(s) and date of last action: (S) HES, 05/15/07
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.
SB 244 CONSUMER HEALTH INFORMATION WEBSITE Sponsor: Senator Dyson
Committee(s) and date of last action: (S) HES and (S) FIN, 01/19/08
SB 224 would establish a consumer health information website to be operated by the Alaska Department of Health and Social Services. Included in the information to be made available would be a list of preferred drugs approved by DHSS for reimbursement; a list of the 100 most commonly prescribed medications in the state and the source and price, updated monthly; available hospital ratings, including the rates of hospital acquired infection and mortality occurring at each hospital in the state; and a list of primary care clinics that cater to uninsured and self-pay patients.
HB 252 LEAVE FOR ORGAN/BONE MARROW DONATIONS
Sponsor: Senator LeDoux
Committee(s) and date of last action: (S) HES, 05/15/07
"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
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| Medical Assistance and Health Insurance |
HB 140 MEDICAL ASSISTANCE ELIGIBILITY
Sponsor: Representative Gara
Committee(s) and date of last action: (H) HES, 02/28/07
"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
HB 198 SENIOR BENEFITS/MED. ASSISTANCE ELIG.
Sponsor: Representative Hawker
Committee(s) and date of last action: (H) RLS, 04/10/07
"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
HB 231 MEDICAL ASSISTANCE: KIDS/DISABLED/PREGNANT
Sponsor: Representative Doll
Committee(s) and date of last action: (H) HES and (H) FIN, 04/02/07
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 if household income does not exceed 200 percent of the federal poverty line for Alaska, as set by the US DHHS.
HB 242 MANDATORY UNIVERSAL HEALTH CARE
Sponsor: Representative LeDoux
Committee(s) and date of last action: (H) HES, (H) L&C, and (H) FIN, 04/26/07
"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
HCR 2 HEALTH INFORMATION & REFERRAL SYSTEM
Sponsor: Representative Cissna
Committee(s) and date of last action: (H) HES, 01/22/07
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 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.
HJR 10 MEDICAL ASSISTANCE FOR CHILDREN
Sponsor: House Health, Education, and Social Services committee
Committee(s) and date of last action: (H) FIN, 03/05/07
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
SB 87 MEDICAL ASSISTANCE ELIGIBILITY
Sponsor: Senator Wielechowski
Committee(s) and date of last action: (H) FIN, 03/05/07
"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
SB 106 APPROP: COMMUNITY HEALTH CENTERS
Sponsor: Senator Davis
Committee(s) and date of last action: (S) FIN, 03/07/07
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.
SB 160 MANDATORY UNIVERSAL HEALTH CARE
Sponsor: Senator French
Committee(s) and date of last action: (S) HES, (S) FIN, and (S) L&C, 04/23/07
"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
SB 170 INSURANCE COVERAGE FOR WELL-BABY EXAMS
Sponsor: Senator McGuire
Committee(s) and date of last action: (S) HES and (S) FIN, 05/10/07
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.
SB 179 DEPENDENT HEALTH INSURANCE; AGE LIMIT
Sponsor: Senator Davis
Committee(s) and date of last action: (S) L&C, (S) HES, and (S) FIN, 05/14/07
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.
SB 212 MEDICAL ASSISTANCE ELIGIBILITY
Sponsor: Senator Davis
Committee(s) and date of last action: FIN, 01/30/08
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.
SJR 11 SUPPORTING U.S. VETERANS' HEALTH CARE
Sponsor: Senator Wielechowski
Committee(s) and date of last action: (S) HES, 05/09/07
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
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| Mental Health |
HB 173 INVOLUNTARY PSYCHOTROPIC DRUG TREATMENT
Sponsor: Alaska Department of Health and Social Services
Committee(s) and date of last action: (H) HES and (H) JUD, 03/05/07
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.
HB 239 SUBSTANCE ABUSE/MENTAL HEALTH PROGRAMS
Sponsor: Representative Dahlstrom
Committee(s) and date of last action: (H) HES and (H) FIN, 04/17/07
"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
SB 8 MENTAL HEALTH PATIENTS RIGHTS: STAFF GENDER
Sponsor: Senator Davis
Committee(s) and date of last action: (S) FIN, 05/02/07
"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
SB 51 APPROP: MENTAL HEALTH BUDGET
Sponsor: Rules by request of the governor
Committee(s) and date of last action: (S) FIN, 01/19/07
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.
SB 186 MENTAL HEALTH PATIENT GRIEVANCES
Sponsor: Senator Davis
Committee(s) and date of last action: (S) HES and (S) FIN, 01/16/08
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 may 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.
SB 195 MENTAL HEALTH CARE INSURANCE BENEFIT
Sponsor: Senator Davis
Committee(s) and date of last action: (S) HES, (S) L&C, and (S) FIN, 01/16/08
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.
SB 222 APPROP: MENTAL HEALTH BUDGET
Sponsor: Rules by request of the governor
Committee(s) and date of last action: (S) FIN, 01/16/08
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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| State Boards and Issues |
HB 50 CHILD PLACEMENT COMPACT
Sponsor: Representatives Coghill and Neuman
Committee(s) and date of last action: (H) HES and (H) JUD, 01/16/07
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.
HB 114 EXTEND STATE MEDICAL BOARD
Sponsor: House Labor & Commerce committee
Committee(s) and /date of last action: (H) HES and (H) FIN, 01/30/07
This bill would extend the termination date of the State Medical Board through June 30, 2013.
HB 263 CITIZEN HEALTH ADVISORY BOARD
Sponsor: Representative Cissna
Committee(s) and date of last action: (H) HES and (H) FIN, 05/15/07
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.
HB 276 EXTEND ALASKA COMMISSION ON AGING
Sponsors: Representative Doll
Committee(s) and date of last action: (H) HES and (H) FIN, 01/15/08
HB 276 would extend the termination date of the Alaska Commission on Aging to June 30, 2016.
HB 279 COMMISSION ON AGING
Sponsors: Representatives Doll and Kerttula
Committee(s) and date of last action: (H) HES and (H) FIN, 01/15/08
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.
HB 337 HEALTH CARE: PLAN/COMMISSION/FACILITIES
Sponsor: Rules by request of the governor
Committee(s) and date of last action: (H) HES and (H) FIN, 01/31/08
HB 337 would establish the Alaska Health Care Commission and the Alaska health care information office, and would repeal or annul certain regulations of the Certificate of Need program. The Alaska Health Care Commission would exist within the Alaska Department of Health and Social Services and would promote the development of a statewide plan to address the quality, accessibility, and availability of health care in the state, and would review and approve facility health care information to be placed in a database maintained by the Alaska health care information office. The Alaska health care information office would be responsible for maintaining an internet database of all health care facilities in the state to provide objective, unbiased, and factually-based information on such facilities.
HCR 1 PUBLIC HEALTH AND HEALTH COMPACT
Sponsor: Representative Cissna
Committee(s) and date of last action: (H) HES, 01/22/07
"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
SB 188 EXTEND ALASKA COMMISSION ON AGING
Sponsor: Senator Therriault
Committee(s) and date of last action: (S) L&C and (S) FIN, 01/16/08
SB 188 would extend the termination date of the Alaska Commission on Aging to June 30, 2016.
SB 209 EXTEND ALASKA COMMISSION ON AGING
Sponsor: Senator Davis
Committee(s) and date of last action: (S) L&C and (S) FIN, 01/16/08
SB 209 would extend the termination date of the Alaska Commission on Aging to June 30, 2016.
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| Women's Health Issues |
HB 190 NURSING MOTHERS IN WORKPLACE
Sponsor: Representative Cissna
Committee(s) and date of last action: (H) HES and (H) L&C, 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 not 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
Sponsors: Representatives Keller and Coghill
Committee(s) and date of last action: (H) RLS, 01/22/08
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: Senator Elton
Committee(s) and date of last action: (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 LICENSING/ABORTION
Sponsor: Representative Coghill
Committee(s) and date of last action: (H) HES and (H) JUD, 01/15/08
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: Senator Ellis
Committee(s) and date of last action: (S) L&C and (S) HES, 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
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| Workers Compensation |
HB 200 WORKER'S COMP: DISEASE PRESUMPTION
Sponsor: Representative Dahlstrom
Committee(s) and date of last action: (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
HB 345 MEDICAL FACILITY CERTIFICATE OF NEED
Sponsor: Representatives Kelly and Kawasaki
Committee(s) and date of last action: (H) HES and (H) FIN, 01/30/08
HB 345 would amend the current certificate of need statute to exclude expenditures for diagnostic imaging equipment in certain circumstances. The bill defines "critical access hospital" for the purposes of certificate of need applications, and adds a section to the uncodified law of the state regarding the applicability of the new statute to facilities.
SB 117 WORKER'S COMP: DISEASE PRESUMPTION
Sponsor: Senator French
Committee(s) and date of last action: (S) L&C and (S) FIN, 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
SB 147 WORKER'S COMP EMPLOYER LIABILITY
Sponsor: Senator French
Committee(s) and date of last action: (S) L&C and (S) FIN, 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.
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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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