| SB 245 The Alaska Health Care Transparency Act: Hearing Summary |
Introduction
On February 8, 2008, the Senate Health, Education, and Social Services Committee heard testimony on SB 245 "Health Care: Commission/Plan/Facilities." Also known as the Alaska Health Care Transparency Act, Governor Palin introduced the bill earlier this session. SB 245 is an important bill with three separate components, each of which have the potential for a major impact on health policy in Alaska. The three components include the creation of an Alaska Health Care Commission, the creation of a Health Information Office, and the repeal of the Certificate of Need program.
This was the second hearing for SB 245, and the first hearing in which a version of the committee substitute for the bill was used. While the final version of the committee substitute was not available at the time of last Friday's hearing, the testimonies given highlighted some of the changes to the bill that Senate HES is examining.
HES Chair Senator Bettye Davis presided, with committee members Senators Dyson, Elton, and Thomas also present. Senator Cowdery was present via teleconference.
Joel Gilbertson, Providence Health Services
Gilbertson noted that SB 245 was a very large bill with three complex pieces of legislation, and offered his opinion that proper examination might be easier to do in multiple bills. He brought up the Certificate of Need component as the first issue to deal with, saying that while he knows it is controversial, he and Providence firmly believe that "the program adds tremendous value to our health care system."
"To say that health care is ever going to be a free marketplace is probably asking a lot because it is probably the most regulated industry you will ever find." Gilbertson continued, "I will simply say that there is a lot of good faith work between organizations and between the state, that we thought was going to lead to a discussion this session around a compromise piece of legislation, and we hope we get to that. This certainly came as a surprise, the outright repeal of the Certificate of Need program."
Gilbertson also outlined some possible concerns that arise from the proposed Health Information Office. "While more useful information is good," he said, "what value will the specific information add to the individual consumer?" He talked about using data about cost and quality, warning that "to oversimplify is to distort. And to oversimplify and say that we can take the top 100 procedures by facility, for example, or the top 200 procedures, and believe that will allow us to get a clear snapshot of what it means for a consumer around cost or quality is not accurate, because there are many things that go into the cost."
He said that while he thought the idea of a health care commission was good, two questions need to be asked: is it designed to move reform forward and is it designed to succeed? "To do that, it needs to have individuals who have the ability -- sitting around the table -- to actually move the market."
Karleen Jackson, Department of Health and Social Services Commissioner
Jackson noted that she was working from the newly released committee substitute for SB 245, and said that while there were some aspects of Gilbertson's testimony that she agreed with "whole heartedly. The one perspective that I would offer is that the Certificate of Need program and the way that we've looked at health care in the past has primarily been through the lens of the provider, what we're doing to regulate providers, and what the provider's perspective is. The heart of this bill, and the reason that it's a health care transparency bill, is to really look at health care from the perspective of the consumer."
Before Jackson's testimony could continue, a motion was needed in order to properly acknowledge the use of the new committee substitute. Senator Davis heard the motion, and Senator Elton objected in order to ensure that the differences between the bills could be discussed, rather than simply being forced to refer to only one version.
With that matter cleared up, Jackson told the committee that the substitute offered changes to the makeup of the Health Care Commission by adding two more public members. She added that the Alaska Mental Health Trust Authority had requested a seat on the Commission, and Jackson testified that there were arguments to be made in favor of many people joining the Commission, a discussion she expected to continue as SB 245 was debated.
The second change, Jackson said, was to the section of the bill that dealt with the Health Information Office. The information presented would be categorized by access to health care, cost of health care, and quality of health care. Echoing Gilbertson's testimony, she said that the state would begin by gathering the data that is already available and pooling it together.
Responding to a question from Senator Elton, Jackson clarified where in the bill the definition of "health care facility" could be found. Jackson also specified the changes to the part of the bill that dealt with Certificate of Need, saying that "the amendment to that is to repeal, except with a two-year time delay of repeal for Certificate of Need for nursing homes, for residential psychiatric treatment centers, and for communities with critical access hospitals. And I have been assured by my staff that this language for health care facilities was drafted by Department of Law."
"I really believe that with this bill, and with the enactment of the Commission and of the [Health] Information Office, we're going to have new tools that are going to do a better job of helping us keep those costs down for health care, and [to] increase access," Jackson finished. "I can support this committee substitute as something that would continue to move us in the right direction."
Jean Michelle, Legal Services at Legislative Affairs
Michelle testified to some of the changes between different versions of the committee substitute. "Version K," the version of the bill that was before the committee, only addressed changes to the Certificate of Need section. The new definition of health care facility expanded to include additional types of facilities. She also said that DHSS was discussing having residential psychiatric treatment facilities be certified statewide, which would require amending the bill's language. The phrase "skilled nursing facility" -- which had caused confusion over its definition -- was replaced with "nursing home."
"At the back of the bill, we added a transitional provision," Michelle said, "because we now have three categories of facilities that will still come under the Certificate of Need program for that two-year period." She addressed one of the sections that had been changed, saying, "It's modified by this new definition of health care facility, so that any pending appeals for the two-year effect of this act would be dismissed only if they don't meet the new definition." An additional section becomes effective "in 2010, when the whole Certificate of Need program is repealed, and that requires the Department to dismiss all pending administrative and court actions."
Senator Dyson questioned a particular turn of phrase in the new definition of health care facility. "It would be important to me -- and I think this is (important) for the Department -- to know what those constraints are under federal law because I don't want to be in a position in which the Department has sole discretion on whether or not they're going to include a facility, simply by designating it a critical access hospital or not."
Dr. Bob Urata, member of the Board of Directors of Bartlett Regional Hospital in Juneau
Urata spoke in support of SB 245, with the exception of the provisions that eliminate Certificate of Need. "Although elimination of CON will increase competition, it will do so only in services that are profitable, and only for those who have the best health care coverage."
Citing a University of Iowa study of Medicare recipients during the late 1990s, he added, "Mortality was about 20% lower in states with CON compared with states without CON. In addition, costs of health care per person were 33 to 160% lower in states with CON than those without." He also referenced studies done by the "Big Three" auto companies, which all found CON to be beneficial to controlling health care costs in some way.
Tom Piper, director of the Missouri Certificate of Need program
Piper gave a slideshow presentation that covered the history of the national Certificate of Need programs, and discussed a 2004 report issued by the Federal Trade Commission and the Department of Justice that summarized the findings and made recommendations based on hearings from 2003. Piper noted that "disgruntled private developers" dominated the hearings and that public interests weren't well represented. He noted that the American Health Planning Association, who did participate, was very critical of the report.
Piper moved on to discuss how Certificate of Need relates to and interacts with, the free market. "Like any business, capital investments are passed on to the consumer, either through charges, premiums, or taxes. Competition in health care is different, because providers control the supply of services. Medical practitioners define the demand for care. Consumers have insufficient information."
He compared health care to any other market good. "Consumers are not able to shop for most health care, particularly based on price, because where do you find the price list? Higher capacity costs create higher charges, as aptly demonstrated by the continuing escalation in health care insurance premiums. Consumers are insulated from the specific costs of care, but they suffer under the (often increased) costs in premiums and in taxes. Even with changing reimbursement systems, incentives for providers are ineffective. Policy makers like you have to continue to look for new answers."
Piper continued by outlining some of the major arguments against Certificate of Need, which include that CON restricts market entry and capital outlay, and that it does not take quality of care into account. "As a unique planning and regulatory tool, CON covers a broad range of important factors. It's planning-based, open process, market compensator, quality enhancer, (and a) competition promoter; it's practical as a doorway to excellence. What 'doorway to excellence' means is that the CON process often redirects resources into areas of greater need, and it helps providers to achieve higher and more efficient levels of performance. Piper also referred to the Big Three automakers' studies as examples of Certificate of Need successes, and discussed the value of publishing cost data to consumers.
Senator Dyson commented on the issue of cost data. He said that the public should have access to cost data, including the discounts health care providers give to different groups. "Those represented by a third-party payer often get a significant discount off the list price for the service, and those that are part of a large group that can come and bargain for a group discount get a significant discount -- and those who have a government payer get a discount, often an unfair one to their provider -- but the only people who pay the list price are the poor, benighted individuals who actually believe and are capable of paying their own bills."
Rod Bedit, CEO of the Alaska State Hospital and Nursing Home Association
Bedit said his organization supports adoption of the Health Plan. "We believe that's a very important and powerful thing for the state to do, to put in place something that has been missing for many years, around which we can begin to make decisions about what each community needs. And if that were there in concert with Certificate of Need, we would be having far fewer headaches because we've already talked about it in each community, in terms of what they want and what kind of resources are missing, and if we're going to add services and in what kind of a way we're going to add them, whether they're community or institutional."
He moved onto the establishment of the Alaska Health Care Commission. "Again, we see that as a very important step to take," Bedit said. "We have some issues around the membership itself, in terms of who's on it, and then who gets to pick. We think that that's a topic we need to spend some more time on. There's several ways to address that and we're committed to working through it with the other parties that have interest in this."
Bedit said his organization believed the mandatory reporting requirement was also something to move forward with. "I would point out," he said, "that we've been voluntarily reporting information from the hospital side for a long time, and there's now a significant amount of information that's already available to the State and to the Department." He noted that the bill doesn't specify who would have to report such data. Quoting from an earlier version of the committee substitute, Bedit listed the types of facilities that would have to report data. These facilities included, but were not limited to, ambulatory surgical centers, assisted living centers, hospices, hospitals, and residential psychiatric treatments centers. He reiterated that to the best of his knowledge, only hospitals were currently reporting any cost data.
Senator Elton noted that pharmacies were missing from that list, and raised the question of whether the bill was written to make hospital pharmacies report cost data, while not requiring independent pharmacies to do so. Bedit agreed that such an argument could be made to read the bill that way.
Paul Fuhs, Alaska Open Imaging Centers
"In regards to the bill," Fuhs said, "we do continue to believe that competition in the large medical markets in Alaska can benefit consumers. In terms of the Commission, we agree with some of the comments that say you have to make sure you have the people, the stakeholders that are going to buy into this." He continued: "In terms of the information, it needs to be very clearly defined: what prices (are). A lot of things don't easily compare with each other, and I think that that would really have to be looked at. And again, like Senator Dyson brought up: what prices, and who's paying them?"
"We also really identify with the remarks of Senator Dyson in terms of the importance of definitions. The previous legislation that was passed has created a legal situation right now where we are bogged down -- to where, in terms of the imaging within the state of Alaska -- people cannot make a legitimate business decision on how to put this equipment in." Fuhs detailed his concerns about making sure all the definitions are correct in the final legislation. "Without these definitions, this situation is only going to get worse."
He added that the current CON lawsuits are tied up in the current definitions of imaging equipment. "What people are doing is they're looking for the oldest, most dilapidated, run-down, old technology, something that you can buy from somebody that you can use as imaging equipment, because if you can buy it for less than $1.2 million you come in under the threshold and you don't have to go to the CON. This is going backwards in terms of patient care, and that is completely unacceptable."
Shawn Morrow, CEO of Bartlett Regional Hospital
Morrow is opposed to the repeal of Certificate of Need, but finds the other elements of the bill "very encouraging," particularly those related to transparency.
"When it comes to the siphoning off of services, markets that are in the 10-60,000 population range are large enough, and have high enough volumes in surgery, in diagnostic imaging, in orthopedics, and in other high margin services, that they are very attractive to private investors. But hospitals in that market are also limited. We don't have eight or nine services that generate a profit; we have two or three. So when those go away, you're still left with a hospital in a very weakened financial state." He added that, "When there's talk about population thresholds, there's a big difference between the vulnerability of a critical access hospital, and a hospital that's in a community with a population between fifteen and sixty thousand, versus in Anchorage. I have not seen from my experience that repealing CON would benefit anyone in this state."
James Schill, CEO of Northstar Behavioral Health
Northstar provides psychiatric acute care hospitalization and residential care for adults and children. Schill testified in opposition to the CON provision because the state needs a balanced approach to mental health delivery.
"This is just one step, eventually eliminating the oversight altogether," he said.
Ryan Smith, CEO of Central Peninsula Hospital
Referencing a letter he had previously sent to the committee in regards to Certificate of Need, Smith said that Central Peninsula, while not a critical access hospital, is the "sole community provider that risks financial instability and irreparable harm to our community residents if the state does not ensure that there is a need for more health care infrastructure before it is introduced to our community." Over the years the residents have invested millions of dollars in bond projects and community property taxes into the expansion of the hospital with the protection of Certificate of Need. "They're invested in our future, and I feel like the repeal of CON threatens our hospital/community relationship."
Smith also spoke briefly about his participation in the negotiated regulation committee that convened last September to discuss the issues surrounding the Certificate of Need program. He said the group had met in good faith at the bequest of Commissioner Jackson and had reached a 90% consensus not to repeal Certificate of Need. "I was surprised when, on Saturday, January 19, I received an e-mail from Commissioner Jackson thanking me for my input to the process, and announcing that Senate Bill 245 was introduced on the floor, calling for the repeal of the CON program." He encouraged the committee to eliminate the portions of the bill that deal with the repeal of Certificate of Need.
"I heard Commissioner Jackson talk about -- and in all due respect -- that the three components of this bill were put together in the view of the consumer perspective and that previously the CON and the CON laws were from the provider perspective. I'm having a little bit of a disconnect as to why, then, we put 21 providers in a room on the negotiated regulation making committee, and not 21 consumers in a room to deal with that. I think that we did do our job, and would like to see that the things that we recommended be taken into account in this legislation."
Mike McNamara, orthopedic hand surgeon and the president of an advisory board that represents 26 limited partners to the Alaska Surgical Center in Anchorage
McNamara testified in opposition to the repeal of Certificate of Need. He had four specific comments that related to this.
"First, as others have testified, I too am disappointed that the governor is not paying more attention to the recommendations made by the task force for negotiated rulemaking." He added, "I hope that this was not simply a facade for a foregone conclusion."
His second comment was that the primary surgical centers in Anchorage are rarely at full capacity. McNamara also attested to the level of excellence found in the surgeons at these centers, saying that they are among the best in the state, and perhaps even the country. "Allowing additional surgical facilities to develop when our present centers are not at full capacity would likely reduce vital peer oversight."
McNamara continued, arguing that there is a national shortage of operating room nursing. Removing Certificate of Need would likely create undue competition for OR staff and skilled nurses where there's already a critical shortage. "What we're already seeing in our communities is that competition does not lower costs, but creates greater costs in overhead while competing for these limited resources."
He finished his testimony by noting that the larger centers as they currently exist can negotiate contracts with insurance companies, unions, and other third-party payers, which allows for reduced costs to the public. "Unchecked development would likely reduce the negotiating power of these centers, and additional centers would drive the price of care upward."
Wes Cleveland, attorney for the American Medical Association's Department of State Legislation
The AMA's Department of State legislation tracks national regulatory and Certificate of Need developments around the country. He argued that the general consensus from peer reviewed academic research is that Certificate of Need programs have failed to achieve their intended purpose of restraining health care costs.
The meeting was nearing its closing time, and Senator Davis was forced to ask Cleveland to submit his written testimony to the committee so the members could give it full consideration.
Paula Easly, member of the Alaska Mental Health Trust Authority
Easly requested an amendment to the committee substitute that would authorize including a Trust representative on the Alaska Health Care Commission. She reminded the committee about the United Way's recently activated social services referral hotline, Alaska 211. Regarding the information office, she said, "Rather than duplicating services, it would be cost effective to link the state site to Alaska 211 for the referrals it provides."
Ward Hinger, administrator for Diagnostic Health in Anchorage
Hinger was the final person to testify during the hearing. He was one of the members of the negotiated rulemaking committee, and said his many years of experience as a health care administrator who currently works in diagnostic health have given him "some grave concerns in regards to the legislation that aims to remove CON in Alaska."
He informed the committee that one of the chief concerns of the negotiated rulemaking committee was the definition of physician's offices, but that a 71% consensus defined it as 100% physician owned. He requested that, since the committee was short on time, he be allowed to forward a memo from his organization that addressed their concerns.
Senator Davis gave the committee members copies of additional amendments for consideration. With no other comments, she adjourned the meeting.
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Letter to Commissioner Jackson Addressing Policy Concerns
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The following is a reproduction of a letter sent jointly by
Walter Majoros of the Alaska Behavioral Health Association and Lorie Morris of the Alaska Association of
Homes for Children to DHSS Commissioner Karleen Jackson. The letter presents
a snapshot of public policy, bureaucratic, and administrative
issues at the time it was sent late last year. October 29, 2007
Karleen Jackson, Commissioner
Department of Health and Social Services
P.O. Box 110601
Juneau, AK. 99801-0601
Dear Commissioner Jackson,
We want to thank you for attending the joint meeting of our memberships in Anchorage last month. Our two organizations want to continue to work with the department to improve the services for the people we mutually serve. We have summarized below the issues and proposed follow-up that we discussed with you at our September 18 meeting.
Communication/Coordination Issues
1. Unified Vision: The information that we receive from the different divisions is often not consistent or cohesive.
- The associations desire a more unified vision from the department. We are hopeful that the recent leadership restructuring in the department will result in a more clear and consistent vision.
2. Collaboration and Technical Assistance: The associations would like to see a greater emphasis on collaboration with providers and technical assistance to providers in need.
- We request that the department use more formalized coordination and technical assistance structures to work effectively with providers. The recent Division of Behavioral Health (DBH) change agent meeting and PERM [Payment Error Rate Measurement] audit trainings are examples of positive collaboration and technical assistance efforts by the department.
Grant Issues
1. Grant Cuts: The associations are concerned about grant cuts and service reductions. In particular, the associations are concerned about the impact of the $1 million in DBH grant cuts in FY 08.
- We request that the department restore the $1 million in DBH grant reductions within the FY 09 operating budget.
2. Performance-Based Funding: The associations are concerned that the DBH performance-based funding system measures grant compliance rather than outcomes.
- We request that the DBH Performance Measure Work Group be re-established as an equal partnership with providers, and the focus be the development of meaningful and consistent outcome measures.
3. Grants Management: The associations are concerned that several FY 08 grants included Special Conditions that were not discussed or negotiated with the providers prior to the Notice of Grant Awards (NGA's) being issued. In addition, NGA's for FY08 had still not been received by some providers as of our September 18 meeting; this resulted in those providers not knowing about special conditions in a timely fashion, as well as some providers needing to pursue bank loans to cover late grant payments.
- We ask that the department improve its current practices regarding grant special conditions, grant awards and grant payments.
4. AKAIMS [Alaska Automated Information Management System]: The associations are concerned that AKAIMS is still not capable of generating outcome data and lacks the resources needed for its success.
- We request that the department dramatically increase the resources being devoted to AKAIMS. In addition, we propose that the department and division consider contracting with a third party to manage AKAIMS and to deliver the needed reports on a regularly scheduled basis.
Medicaid Issues
1. State Medicaid Audits: The associations have several concerns regarding state
Medicaid audits.
a. There is a need to differentiate between administrative errors and overpayments in future state audits. Extrapolation should not be applied to administrative errors.
b. A "safe harbor" needs to be established regarding extrapolation. Providers who score in the safe harbor zone for the sample claims being reviewed should not be subjected to extrapolation.
c. Documentation standards in the department's Medicaid regulations are not consistent with the OCS BRS [Office of Children's Services] [Behavioral Rehabilitation Services] Handbook. This resulted in several BRS providers being required to pay back Medicaid claims, even when they were compliant with the BRS standards.
- We request that the department follow the FY 08 legislative intent regarding Medicaid audits by establishing safe harbors and differentiating between administrative errors and overpayments. These standards should be established by regulation and be completed prior to the next round of Medicaid audits.
2. Integrated Behavioral Health Regulations: The associations are concerned that there are still separate Medicaid and grant regulations for mental health and substance abuse. This has created barriers to integration due to inequities in reimbursement to providers and extremely burdensome documentation requirements.
- We request that the department expedite the proposed integrated behavioral health Medicaid and grant regulations. The Medicaid regulations should reduce documentation requirements, and address only those requirements that are essential to reimbursement. Administrative requirements should be addressed within the grant regulations and not be tied to Medicaid reimbursement.
3. Rate Reviews: The department initiated a rate increase for BRS services in FY 07 and is currently conducting a rate review for Medicaid behavioral health rehabilitation services. Unfortunately there is no regular rate review process for residential and behavioral health services, which has placed great financial strain on providers within our associations.
- We ask that the department establish by regulation a framework for regular rate reviews for community-based behavioral health and residential services. We understand from our meeting with you on September 18 that the department is in the process of developing unified standards for Medicaid rate reviews, and we commend you for those efforts.
4. Federal Medicaid Changes: We are very concerned that currently proposed federal changes to Medicaid rehabilitation services will potentially have a catastrophic impact on community based residential and behavioral health services. Several core services in our state's residential and behavioral health systems would potentially be non-reimbursable under the proposed changes.
- Our associations coordinated closely with the department in developing our responses regarding the proposed federal changes. If the proposed changes are approved, we request that the department coordinate closely with providers to assess and mitigate the negative impact of the changes.
Other Issues
1. Integration of Behavioral Health and Primary Care: There are several current efforts to integrate primary care and behavioral health that are taking place throughout the state.
- We would like to partner with the department to ensure that these integration efforts continue to proceed in a positive manner.
2. Workforce Development: Providers throughout the state are experiencing severe workforce shortages in both professional and paraprofessional positions.
- The associations request that the department initiate policy changes to enhance workforce development. For example, the associations request that the department review credentialing requirements and provide more flexibility by placing a greater emphasis on competency-based, as an alternative to educationally-based, requirements.
3. Accreditation: The Division of Behavioral Health (DBH) has announced its intent to require national accreditation for its grantee agencies. Our association members -- many of which are accredited -- are concerned about costs associated with accreditation and the ability of very small programs to pursue and maintain accreditation.
- The associations request that funding, technical assistance, and continued provider collaboration be the keystones to future work in this area. The associations also request that current provider documentation requirements be lessened in exchange for meeting accreditation standards.
4. BRS Provider Concerns: BRS providers are concerned about the Office of Children's Services (OCS) intent to require providers to directly bill Medicaid and move BRS services from OCS to DBH. While we support service integration at the state level, these changes, if implemented, will potentially have a great impact on provider risk and service delivery.
- We request that these developments be addressed in a collaborative manner with BRS providers. The success of these initiatives will be dependent on a thoughtful, deliberative planning process between the department and provider agencies.
5. Background Checks and Licensing Concerns: Providers are currently experiencing difficulties with the new background check and licensing systems.
a. Background Checks: The primary problem with the background check system is that it takes too long to obtain provisional clearances for new staff. In several cases across the state, candidates have taken other jobs because of the protracted time required for the provisional clearances.
- We request that the department address the bottleneck for provisional clearances, including the addition of more staff resources, if this is needed for more timely reviews.
b. Licensing: A problem with the new licensing system is the loss of programmatic knowledge that was present when childcare facility licensing was part of OCS. This has led to tension and disagreements between providers and licensing personnel regarding programming aspects of the regulatory framework.
- We request that licensing personnel learn more about service delivery aspects of the programs they license. We also request that more attention be placed on technical assistance and collaborative problem solving with provider agencies.
While this is not an exhaustive list of issues, it represents the major areas of concern for our associations, and areas where we seek a stronger and more productive relationship with the department. Our associations represent 49 providers and grantees providing services to thousands of children and adults in Alaska; we stand willing to continue working toward the goal of providing quality behavioral health and residential care services to those in need across our state. We look to you and your leadership team to help address any barriers to moving forward on these issues. Thank you for your commitment to increased collaboration between the department and the provider associations.
Sincerely,
Walter Majoros
President, ABHA
Lorie Morris
President, AAHC |
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| Alaska Health Policy Calendar |
This calendar of health policy-related legislative meetings is current as of February 14, 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 15, 2008, 7:30 AM
What: House Health Education and Social Services Committee finance subcommittee
Where: House Finance 519, Capitol, Juneau
Other information: closeout; teleconference
February 15, 2008, 1:30 PM
What: House Health Education and Social Services Committee
Where: Capitol 106, Juneau
Other information: joint with Senate HES; presentation: "Bring the Kids Home"; teleconferenced
February 15, 2008, 1:30 PM
What: Senate Health Education and Social Services Committee
Where: Capitol 106, Juneau
Other information: joint with House HES; presentation: "Bring the Kids Home"; SB 239 Dentists & Dental Hygienists continued from 02/13/08; teleconferenced
February 19, 2008, 3 PM
What: House Health Education and Social Services Committee
Where: Capitol 106, Juneau
Other information: HB 337 Health Care: Plan/Commission/Facilities; HB 345 Medical Facility Certificate of Need; bills previously heard/scheduled; teleconferenced
February 21, 2008, 3:30 PM
What: House Health Education and Social Services Committee
Where: Capitol 106, Juneau
Other information: SCR 17 Brain Injury Awareness Month: March 2008; HB 50 Child Placement Compact; teleconferenced
February 23, 2008, 9 AM
What: House Health Education and Social Services Committee
Where: Capitol 106, Juneau
Other information: HB 337 Health Care: Plan/Commission/Facilities; HB 345 Medical Facility Certificate of Need; bills previously heard/scheduled; teleconferenced
February 28, 2008, 8 AM
What: Senate Health Education and Social Services Committee finance subcommittee
Where: Fahrenkamp 203, Capitol, Juneau
Other information: Department budget - questions and answers; invitation-only testimony; teleconferenced
March 6, 2008, 12:30 PM
What: Senate Health Education and Social Services Committee finance subcommittee
Where: Senate Finance 532, Capitol, Juneau
Other information: Department budget close-out; invitation-only testimony; teleconferenced
March 19, 2008, 12 Noon
What: House Joint Legislative Health Caucus
Where: Butrovich 205, Capitol, Juneau
Other information: "Measuring Success: Improving Health Indicators"
March 19, 2008 12 Noon
What: Senate Joint Legislative Health Caucus
Where: Burtovich 205, Capitol, Juneau
Other information: "Measuring Success: Improving Health Indicators"
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| Bill Watch |
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Bills on the Move
There was quite a bit of movement this week on health bills, including a few being transmitted from the House to the Senate, and vice-versa.
SJR 11 Supporting US Veterans' Health Care passed the Senate 19-1 with one legislator excused, and was transmitted to the House. It was referred to the Military & Veterans' Affairs and HES committees. SCR 17 Brain Injury Awareness Month: March 2008 passed the Senate 19-0 with one legislator excused, and was transmitted to the House. It was referred to HES and is scheduled for a hearing on February 21.
SB 196 Prescription Database was heard in the Senate Finance committee on February 14. SB 107 Naturopaths was heard in Senate HES for the first time on February 13. HB 337 Health Care: Plan/Commission/Facilities was heard on February 9 and is scheduled for another hearing on February 19. HB 200 Workers' Comp: Disease Presumption was heard in the Senate Finance Committee on February 14. HB 345 Medical Facility Certificate of Need was heard in House HES on February 9, and is scheduled for additional hearings on February 19 and February 23. HB 50 Child Placement Compact is scheduled for a hearing in House HES on February 21.
The committee substitute for HB 319 Dentists & Dental Hygienists was moved out of House HES and the bill is now awaiting its next committee assignment, Labor & Commerce. The committee substitute for SB 181 Anatomical Gifts was moved out of Senate HES and the bill is now awaiting its next committee assignment, State Affairs and Judiciary. The committee substitute for HB 279 Commission on Aging was moved out of House HES and is now awaiting its next committee assignment, Finance.
SB 170 Insurance Coverage for Well-Baby Exams was referred to Senate Finance, and a Senate HES letter of intent was received on February 15. HB 276 Extend Alaska Commission on Aging was referred to the Finance Committee.
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 · (H) MLV: House Military & Veterans' Affairs Committee
· (S) STA: Senate State Affairs 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
HB 345 MEDICAL FACILITY CERTIFICATE OF NEED
Sponsor: Representatives Kelly and Kawasaki
Committee(s) and date of last action: (H) HES and (H) FIN, 02/09/08
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.
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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
Sponsors: Senators Green, Ellis, Davis, Dyson, and Stevens
Committee(s) and date of last action: (S) FIN, 02/14/08
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 in-patient at a licensed health care facility. The bill also establishes guidelines for the pharmacist-in-charge of each covered pharmacy to submit certain information regarding such prescriptions to the board for inclusion in the database. Such information would include the names of prescribing prescriptions and individuals who receive prescriptions for controlled substances from licensed practitioners and who subsequently obtain dispensed controlled substances from a drug outlet in quantities or with a frequency inconsistent with generally recognized standards of dosage for that controlled substance.
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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 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: awaiting next committee, then (H) L&C, 02/14/08
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, 03/26/07
"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, 02/13/08
"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: awaiting next committee, then (S) STA and (S) JUD, 02/14/08
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
HB 100 AIR AMBULANCE SERVICES
Sponsor: Representative Coghill
Committee(s) and date of last action: (H) HES and (H) L&C, 04/03/07
"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
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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, 03/15/07
"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) FIN, 02/15/08
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: (H) MLV and (H) HES, 02/14/08
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
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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, 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.
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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, 02/21/08
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) FIN, 02/13/08
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: awaiting next committee, then (H) FIN, 02/14/08
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, 02/09/08
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, 04/17//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.
SCR 14 PERIANESTHESIA NURSES WEEK: FEB 2008
Sponsor: Senator Green
Committee(s) and date of last action: (S) HES, 01/18/08
SCR 14 would proclaim February 14-10, 2008 as Perianesthesia Nurses Week.
SCR 17 BRAIN INJURY AWARENESS MONTH: MARCH 2008
Sponsor: Senator McGuire
Committee(s) and date of last action: (H) HES, 02/13/08
SCR 17 would establish March 2008 as Brain Injury Awareness Month.
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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, 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
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: (H) FIN, 02/14/08
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.
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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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