Alaska Health Policy Review - February 8, 2008

Dear Reader:

In this issue of the Alaska Health Policy Review, we have included a discussion about the process of shaping good public policy, with a focus on Senate Bill 160 Mandatory Universal Health Care. We applaud the attempt, but

... it appears that SB 160 was developed entirely in the absence of systematic comparison with other health reform approaches that might be less expensive, more effective, better able to meet the policy goals, and perhaps more likely to engender political support.

Guest commentator, John Riley, wrestles with a few words found in the Alaska Constitution that raise the issue of just how much involvement in health care the state should have. This has also been a long-standing controversy with the state's Certificate of Need process. Conveniently, this week we feature CON Watch, an overview of applications for a Certificate of Need, and their current status. Of course, the Bill Tracking and Calendar sections are included in this issue of the Review.

One more thing. The nice folks at the Anchorage Daily News have asked me to host a blog; they call it health4all. It is up and running now, so please take a look at it. There is lots of room to leave your ruminations, comments, suggestions, and two cents. I promise to read every one.

Lawrence D. Weiss
Editor, AHPR

Comments on Health Policy Reform

First, I want to congratulate the senators who have introduced Senate Bill 160: Senators French, Ellis, and Wielechowski. By introducing this bill, these legislators have shown serious interest in a very difficult problem, and they have put the whole question of access to health care for all Alaskans on the table for wide discussion. In light of that, I wanted to say a few words about the process of health policy formation. A sound, comparative, fact-based assessment of policy alternatives is more likely to lead to a policy that is actually effective and efficient. Policy driven by ideology and expedience is not.

Effective Public Policy

Based on the lack of any documented analysis, it appears that SB 160 was developed entirely in the absence of systematic comparison with other health reform approaches that might be less expensive, more effective, better able to meet the policy goals, and perhaps more likely to engender political support.

A few years ago, for example, the state of California was considering significant health care reform. State policy analysts invited nine different organizations to submit comprehensive proposals. On one side of the spectrum were proposals that recommended minor tinkering around the edges of the health-care industry. On the other end of the spectrum was a proposal that would create the California Health Service, a health plan in which all health care facilities would be publicly owned, and all health care providers would be civil servants. Here is a summary of the process and the criteria:

A competitive process was used to identify a contractor with experience in microsimulation modeling to conduct an economic analysis of the reform options developed by health policy experts. The State selected the Lewin Group from among the bidders. Their final report provides a detailed discussion of the cost and coverage implications of each of the proposals. To assist readers in comparing reform options, each option is modeled as if it were fully implemented in 2002. A ten-year budget for each proposal also is presented. Substantial additional analysis also is provided in the report, including information about changes in individual out-of-pocket costs (by demographic category), changes in costs to employers (by size), and changes in costs for safety-net programs. The final report, including separate appendices providing additional analysis of each option, can be found at the HCOP website, [http://www.health-access.org/expanding/hcop.htm]

The State selected a second contractor, AZA Consulting, to conduct a more qualitative analysis of the reform options. The report looked at potential impacts of the reform options in four areas: access, utilization and continuity of care; quality and appropriateness of care; safety net; and vulnerable groups. In performing the analysis, the contractor identified key questions and issues in each area of interest and reviewed how each proposal addressed the questions and issues identified.
[Source: Report by The Health Resources and Services Administration, U.S. Department of Health and Human Services on the state of the uninsured, the overall health care environment, the Healthcare Options Project, and recommendations for a federally run healthcare program.]

Senator French has stated in public that the SB 160 proposal was specifically designed by the bill sponsors to minimize political opposition to a substantial health reform proposal, and it was based on a similar plan in another state. I will leave the discussion to others about the assessment of political opposition to various approaches to health reform. However, I question the wisdom of basing health care reform in Alaska on the Massachusetts plan. The Massachusetts plan itself appears to have several serious structural problems and to be underperforming in terms of its goals. It also appears to be far more expensive than projected. This requires serious review because it may very well be that the Massachusetts plan is not a good health plan; and therefore, basing the Alaska plan on the Massachusetts plan would likewise not be a good idea.

Alternative Approaches to Consider

Finally, there is the question of what alternative approaches to health reform in Alaska could and should be compared with SB 160? In light of the costs to the state and the social consequences for Alaska families, a systematic and comprehensive analysis of various health policy alternatives is crucial to the development of good health reform policy. I suggest an approach that, in and of itself, could have a huge impact on the real issues of access to health care for tens of thousands of Alaskans--and I suspect would cost a fraction of what SB 160 is going to cost. In short, I suggest taking a serious look at the expansion of programs that we already have, that we know work, that we know are cost effective, and that have some quality of care elements built in:

Expand Medicaid to the maximum extent possible to serve Alaskans. A Medicaid insurance policy is much less expensive for the state than a comparable private health insurance policy, it costs the recipient nothing, co-payments and deductibles are minimal, and the federal government pays at least half of all the state's Medicaid costs.
Expand Denali KidCare to the maximum extent possible, to serve as many Alaska children as possible. This has all the benefits of expanding Medicaid as noted above. In addition, recruitment for Denali KidCare was seriously hampered under the Murkowski administration by the firing of all five state recruiters for the program. As a result, there are perhaps 10,000 children who qualify for Denali KidCare but remain uninsured because they are not in the program. Hire back the recruiters.
Develop a comprehensive package of funding for the 130 community health clinics scattered across Alaska to enable these nonprofit, federally-subsidized clinics to recruit and retain staff, and to directly serve those who need health care. This approach would completely eliminate the unnecessary administrative and other costs of private health insurance, and at the same time directly provide medical care to those in need. Patient care costs have been documented to be far below those in a for-profit health care setting.

Additional Supplementary Approaches

Require all commercial health insurers to submit documents for public review and to attend public hearings justifying premium raises.
Require all health care providers, all pharmacists, all medical implement providers, and others in related health industries to publicly post prices.
Sponsor a website that aggregates all available quality of care data for the public to evaluate.
To the greatest extent justified, coordinate and support the training and recruitment of health care providers and public health professionals in the state of Alaska.
To the greatest extent justified, support and expand the traditional preventive public health programs such as clean air, clean water, food inspections, job safety and health, etc.

There is available factual information, and often formal research on all these proposals. It makes sense to spend a million dollars on health policy evaluation alternatives rather than hundreds of millions of dollars on a program that may prove to be expensive, inept, and unworkable.

Lawrence D. Weiss
Editor, AHPR

Commentary: What is the State's Role for the Health of the People?

John Riley prepared this short but thought-provoking statement for presentation at the February 6, 2008 meeting of the Legislative Health Caucus. Mr. Riley has a faculty appointment at the University of Alaska Department of Health Sciences. He is a practicing physician assistant, and former medical director at the Anchorage Neighborhood Health Center. This commentary has been edited for clarity.

The constitutions of most of the Western states were written in the late 19th and early 20th centuries. Many were heavily influenced by populism and progressivism. The states of Alaska and Hawaii adopted constitutions characteristic of post-World War II managerial approaches to federalism. They granted broad powers to the executive branch, placed few restrictions on legislative activity and stressed the importance of government responsibility for welfare and natural resources. (From Political Geography of the United States by Fred Shelley)

Article VII of the Alaska Constitution: Health, Education and Welfare states that "The legislature shall provide for the promotion and protection of the public health." If we interpret that the intention of this article was to emphasize the responsibility of the legislature to protect the public health of the citizens of Alaska:

How does this inform the health-related debates of today?
What is the responsibility of the individual versus the responsibility of the state with regard to public health and health care access?
Is health care a right or privilege?
What is the responsibility of the state to control health care costs and ensure access to preventive services and health care?

My professional career as a PA has been mostly spent working at Community Health Centers with people who otherwise would not have access to care. There is a widely held misperception, even among medical providers, that programs are available to cover everyone who needs health care services. However, the truth is, access to preventive care and medical treatment is a real problem for tens of thousands of Alaskans, most of them the working poor.

I believe that Article VII of the Constitution directing the state to provide for the public health means it is the responsibility of the state of Alaska to assure Alaskans work in safe environments, have access to food and water free from contamination, and that they have access to quality preventive healthcare. This article enshrined in our constitution should help inform the health policy debates on both sides of the aisle.

The Alaska Health Care Commission, proposed by the Alaska Health Strategies Planning Council and created in House Bill 337, would be a good first step to explore the possible strategies for Alaska. However, it is important this commission be designed so that that its work is "ongoing, quasi-independent and nonpartisan" as recommended by the Planning Council.

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CON Watch

Alaska Health Policy Calendar

Bill Watch

Bills on the Move

This was a quiet week for health policy legislation in Alaska. No new bills were introduced, but several have received committee hearings during the past week. Several bills have also been moved from their previous committees and are currently awaiting new assignments.

SB 196 Prescription Database received new fiscal notes and new cosponsors, and was referred to the Senate Finance Committee, the only committee currently examining it. SJR 11 Supporting US Veterans' Health Care also received a new fiscal note and committee referral, and now sits only in Senate Rules. SB 117 Workers' Comp: Disease Presumption moved out of Senate Labor & Commerce, received new fiscal notes, and was referred to Senate HES.

SB 8 Mental Health Patient Rights: Staff Gender was heard and held by the Senate Finance committee on February 6. SB 160 Mandatory Universal Health Care had a hearing in the Senate HES committee on January 30. HB 312 Approp: Mental Health Budget was heard and held by the House Finance committee on January 31. HB 319 Dentists and Dental Hygienists was scheduled for two hearings this week, one on February 7, with the second scheduled for February 12 at 3 PM (to be teleconferenced).

HB 252 Leave for Organ/Bone Marrow Donations was heard for the first time this session during the House HES committee meeting on February 6, and was referred out; it currently awaits its next assignment. SCR 17 Brain Injury Awareness Month: March 2008 was heard by Senate HES and subsequently moved out of that committee on February 6, and it now awaits a new assignment.

HB 200 Workers' Comp: Disease Prevention received several new cosponsors this week.

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 February 7 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

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

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
Sponsors: Senators Green, Ellis, Davis, Dyson, and Stevens
Committee(s) and date of last action: (S) FIN, 02/06/08

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.

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

General Health Policy

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, 02/12/08

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, Foster, Lynn, Doogan, Kohring, Thomas, Kawasaki, Gruenberg, Cissna, Roses, Kerttula, Gardner
Committee(s) and date of last action: (S) HES, (H) STA, and (H) FIN, and awaiting next committee, 02/08/08

"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

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, 01/30/07

"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) RLS, 02/04/08

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

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, 02/06/08

"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

HB 312 APPROP: MENTAL HEALTH BUDGET
Sponsor: Senate Rules by request of the governor
Committee(s) and date of last action: (S) FIN, 01/31/08

This bill would make appropriations for the operating and capital expenses of the state's integrated comprehensive mental health program.

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.

State Boards and Issues

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

Workers Compensation

HB 200 WORKER'S COMP: DISEASE PRESUMPTION
Bill: HB 200 WORKER'S COMP: DISEASE PRESUMPTION
Sponsor: Representative Dahlstrom, Doll, Buch, Kerttula, Crawford, Gatto, Lynn, Hawker, Holmes, Johnson, LeDoux, Ramras, Roses, Gruenberg, Stoltze, Gardner, Johansen, Gara, Keller, Wilson, Kawasaki, Guttenberg, Doogan, Harris, Nelson
Committee(s) and date of last action: (H) FIN, 02/06/08

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) HES and (S) FIN, 02/06/08

"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, 01/25/08

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 Staff

Lawrence D. Weiss Ph.D., M.S., Editor
Jacqueline Yeagle, Marketing and Communications Manager
Elizabeth Agi, Research Associate

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