Alaska Health Policy Review

Dear Subscriber:

Senate Bill 160 Mandatory Universal Health Care has had a bumpy, contentious ride through the legislature since it was first introduced on April 23, 2007. We are now passed the halfway point of the second session in the 25th Legislature, and SB 160 has generated multiple hearings, amendments, fiscal notes, two committee substitute bills, and has been referred to Senate Finance. The most recent changes to the structure of the bill came out of the Labor & Commerce Committee and reflect the ever-evolving nature of this addition to the health care debate in Alaska. We discuss the details in our lead article.

One might reasonably ask, "Just how does Governor Palin view the health care industry in Alaska?" We don't have the complete answer to that question here at the downtown Anchorage office of Alaska Health Policy Review, but we can present you with a few puzzle pieces of the picture. In this issue we reprint a letter from the governor that was included in the February issue of Alaska Economic Trends, which featured a special review of the health care industry in the state. Think: "big picture," "education," "budget." In addition, we reprint just a piece of the report to titillate your interest, but we recommend you take a look at the complete study.

Decades ago the federal government decided to leave regulation of the health insurance industry up to the states. However, most states, including Alaska, do not hold the health insurance industry to a very high standard of accountability -- a fact which itself contributes to some of the problems with the system of health care in the United States. We would like to briefly recount what our neighbors in the state of Washington have decided to do to wrest some control over the health insurance behemoth. Alaska policy makers take note!

Finally, we present our regular features including Bills on the Move and Alaska Health Policy Calendar. Your comments and suggestions regarding form and content of Alaska Health Policy Review are greatly appreciated.

Lawrence D. Weiss PhD MS
Editor, AHPR

SB 160: Morphing and Moving

Introduction

Senate Bill 160 Mandatory Universal Health Care has had an intense ride through the legislature since it was first introduced on April 23, 2007. We are now passed the halfway point of the second session in the 25th Legislature, and SB 160 has generated multiple hearings, amendments, fiscal notes, two committee substitute bills, and has been referred to Senate Finance. The most recent changes to the structure of the bill came out of the Labor & Commerce Committee and reflect the ever-evolving nature of this addition to the health care debate in Alaska.

SB 160 was introduced by Senators French, Ellis, and Wielechowski. The intent of the bill is to provide a private health insurance plan to every uninsured citizen in Alaska. It would do this by creating the Alaska Health Care Board to oversee a health care fund, and to recommend essential health care services and certify private health care plans. These plans would rest in a health care clearinghouse, a virtual warehouse where individual plans that are certified by the Board could be purchased by individuals using a voucher, also created by the bill.

The voucher system would help individuals buy one of several plans, and would be on a sliding scale for incomes that fall between 100 and 300% of the Federal Poverty Guidelines (FPG). A specified beneficiary fund would allow employers who want to offer subsidized health care to their employees but cannot afford the full price, to put money into the fund designated for their employees to help their employees purchase individual plans. Once a person has acquired their voucher, they may purchase the plan of their choice from the clearinghouse.

Committee Hearing March 11

The March 11 meeting of the Senate Labor & Commerce Committee provided the opportunity for Senator French to go through the changes made in the L&C committee substitute version of SB 160. Present for the meeting were Chair Ellis and Senators Davis and Hoffman.

Senator French, Prime Sponsor of SB 160

Senator French clarified that he was going through the "/T" version of the committee substitute. He detailed the six changes made, which covered several broad areas of concern in the bill.

Senator French explained the changes to the Alaska Health Care Board. "Essentially, this change broadens the viewpoints that are represented on the Health Care Board." This change comes as a response to concerns insurers had that the entities that would make up the insurance representatives on the board were too narrow. "In response to those concerns we've broken out those two representatives more specifically into a large-scale seller and a small-scale seller. A retailer, if you will, and a wholesaler. The language is a little bit confusing because the retailer is called an 'insurance producer.' That's a term of art in the industry that refers to the customer-oriented, on-the-ground insurance retailer." He said that while the number of board members has stayed the same, "we've instead assigned one to a small-scale retailer and one to a large-scale wholesaler to make certain that you have broader representation."

The second change "has to do with making the health care plan clearly giving a duty to the board, if you will, to make certain is available a plan that can protect an individual from severe financial hardship in times of medical need, taking into account, of course, a household's income and other relevant financial criteria. It will make certain that insurance is meaningful for each Alaskan, since a $10,000 deductible to a health care plan isn't much use to a household that earns $15,000 a year."

The third change, Senator French explained, addressed some of the concerns that Senator Stevens had raised in the previous hearing about the way this bill would work with Indian Health Services. "The language did say that the IHS benefits had to meet or exceed the benefits for essential health care services as defined in the legislation. That's been removed to make it clear that individuals that are satisfied with the care they receive through IHS facilities won't be subject to the requirement to have additional coverage, even if the IHS benefits don't line up exactly with essential health care services."

He continued: "There's two important facts to keep in mind as you look at the interplay between SB 160 and the IHS system. The first is this: any third party payer, any private insurance payer, is going to come first in line. If an IHS beneficiary walks into a clinic anywhere, if they have third party insurance -- if they have Aetna, Premera, VA benefits, whatever that is -- that's going to be first in line. That's going to pay first. The second thing to keep in mind is that the amount of money dedicated to IHS beneficiaries is fixed every year. It's not limitless, so it's not as if we would ever back out federal dollars, because those federal dollars are distributed at the beginning of the year, and that's the end of them. So there is, in essence, a rationing that takes place in the IHS system. They have enough money for day-to-day clinic visits and taking care of people's checkups and so forth, but when it comes to bone marrow transplants or a knee replacement or heart surgery, you may find yourself in the position of having been rationed out because the amount of money allocated that year has been used up."

This change, Senator French said, is "probably the most complex change that we've made, even though it's just the reduction of a few words."

The next change was made after receiving concerned emails from many members of the Christian Science religion. These individuals eschew modern medical practices, and so an exemption was written into SB 160 where "if they can demonstrate to the board that their deeply held religious beliefs are contrary to this program, they don't have to participate."

"Conscientious medical objectors?" Chair Ellis remarked.

"Yes, CMOs," replied Senator French.

The fifth change was to the definitions of employee and employer levee. "We've defined employee as someone who is required to participate in the Alaska health care plan, and that means they don't have coverage anywhere else. So it's more than just an employee, it's an employee who doesn't have access to any other medical insurance. That's change number one. Change number two is: instead of counting the number of employees -- because you get into problems of defining what that is, how many hours a week is an employee, is it 10, is it 20, is it 30? -- we just went with a payroll number, which is roughly equal to what we had imagined a ten, full-time employee equivalence is." If an employer's total payroll of employees with no coverage anywhere else is less than $500,000, there is no levee at all. If the payroll of such employees is between $500,000 and $1 million, then the levee is 1%, and if it's over $1 million, it's 2%.

"We think it's more business-friendly, we think it's easier to understand, and it takes into account that many people get health insurance from their spouses."

The final change was to the effective dates in the bill, in response to some concerns Legislative Legal Affairs had regarding implementation difficulties relating to regulations.

March 11 Public Testimony

Mary Raymond, Homer

"After 28 years of listening to Health Task Force and the various bills trying to get affordable insurance, this is very exciting. My concern was that it was promoted as compulsory, and I see that most of my concerns about that have been addressed within the bill so that people who cannot afford it, that things have been taken care of so that it will be covered."

Raymond also said that she'd "been listening to some discussion of House Bill 407 with some concerns that the idea of taking five years to implement it is much too long. We have studied this and worked on it; there's information available and we should be able to proceed with a plan."

Patrick Dalton, Delta Junction

Dalton began by agreeing with the public oversight included at the beginning of the bill, and then addressed an issue he had about the Alaska Health Care Board. "I'd like to suggest that on the Health Care Board you need two alternative health care professionals, say a naturopath or herbologist."

He raised another concern, that "you have no constitutional authority to require a citizen to contract into any health care plan whatsoever, except possibly your constitutional authority to legislate laws. Secondly, there exists a hypocrisy, that is: you require everyone to have a health care card, and then you turn around and deny coverage to any Alaskan that does not have a card." Dalton suggested expanding health care coverage to anyone who can prove they're an Alaska resident, so that "you don't have to force compliance by people." He asked what kind of criminal penalties there were for not participating in the system.

"Finally, if you are going to have an opt-out, if you feel you do have to require mandatory health care coverage -- which I have alleged to you, you don't have the right to -- if you do, I would suggest that you have an opt-out like the gentleman before me or two people before was mentioning: you have an opt-out system. However, I heard him say that if they can demonstrate that they have a firmly-held religious belief against the system ... How can one demonstrate that they have a firmly-held religious belief? That's an objective truth, but a religiously held belief is a subjective matter. There's no way of you objectively determining whether someone has a firmly-held religious belief."

Senator Ellis said the plan was to hold SB 160 over until the next committee hearing when there would be enough members present to hold a quorum and vote on accepting the committee substitute and move the bill to the next committee. "I think we're nearing the end of our work in this committee on this bill."

The bill was held over, and after an unrelated announcement about committee procedure, the meeting was adjourned.

Committee Hearing March 13

SB 160 was the first item on the agenda during Labor & Commerce's March 13 meeting. Chair Ellis and Senators Davis and Stevens were present for the meeting. Chair Ellis immediately opened up the meeting by calling for a vote to adopt the committee substitute version of SB 160, which Senator French had explained in the March 11 meeting.

Chair Ellis reminded committee members that they were working with the "/T, Bailey version" and Senator Davis moved that "CS for Senate Bill number 160, /T, is adopted." With no objections or calls for further discussion, the adoption was so ordered by Chair Ellis.

"Are there any questions for Senator French?" Chair Ellis asked. "Any committee discussion? If not, I think we've put Senator French and his staffer through their paces on this legislation. To my satisfaction, we've covered the Senate Labor & Commerce Committee aspects of the bill and I hope the bill can go on to receive some further discussion during this session. Is there any further committee discussion?"

Senator Stevens raised one final point before the committee voted to move the CS to the next committee of referral. "I just wanted to comment, I'm very concerned about the bill. I'm concerned about the cost to the state; I'm concerned about how we pay for it. But I think it's legitimate that we have dealt with those issues that are our responsibility and it goes on to the next committee, which I assume is Finance. I will not oppose moving it, but I have grave concerns about the bill."

With no further committee discussion, Senator Davis made a motion to move the bill out of committee with individual recommendations and attachments. There was no objection to the motion to move the bill, and Chair Ellis deemed the motion "so ordered," and moved it on to the next committee of referral.

The Fiscal Notes

Four fiscal notes were added to SB 160 on March 14, bringing the total number to five. Three of the new notes are from HSS, and one is from the Department of Commerce, Community, and Economic Development (CED). One HSS note addresses the additional costs to the state as a result of hiring new employees to administer various aspects of the program. This note anticipates the creation of 23 new positions and a total expenditure of $15,097,000 for nine months in Fiscal Year 2009 and $17,637,000 per year for FY 2010-2014.

A second HSS note addresses the expected rise in Medicaid costs to the state. According to the estimates in this note, Medicaid costs will require an appropriation of $120,000,000 during FY 2009 and $240,000,000 per year for FY 2010-2014. These estimates are only for the health care services component of Medicaid and do not include behavioral health services.

A third HSS note addressed the behavioral health services component of Medicaid costs. The HSS estimates are for $30,000,000 in FY 2009 and $60,000,000 in FY 2010-2014.

The CED note does not include a fiscal analysis of SB 160. It was prepared by Linda Hall of the Division of Insurance and addresses the concern that by statute the Division regulates insurance providers and has not created or operated the types of programs implemented by the bill. The Division is not able to estimate the fiscal impact of the bill at the present time.

Alaska Health Care: Big Dynamic Industry

Every month the Research and Analysis Section of the Alaska Department of Labor and Workforce Development produces Alaska Economic Trends. The February 2008 issue features a lengthy article titled, "Alaska's Health Care Industry: It's One Big Dynamic Industry," by Neal Fried, a well-known and popular Alaska economist. The last time Alaska Economic Trends featured the health care industry was half a dozen years ago. The industry is bigger than ever and shows no signs of slowing down.

In this article we feature a reprint of Governor Palin's opening comments on Alaska's health care industry and an excerpt from "Alaska's Health Care Industry" by Neal Fried. The excerpt, of course, does not do justice to the full article, but it is available both in hard copy and on-line. You can sign up with the department and get on their Trends mailing list so you receive a hard copy of this valuable publication in the mail every month. What follows is just a taste of "Alaska's Health Care Industry: It's One Big Dynamic Industry."

Governor Palin's opening comments on Alaska's health care industry

The health care industry is one of the largest and has been one of the fastest growing sectors of Alaska's economy. More than one in every 12 jobs in Alaska is in the health care industry. In the Sitka Borough almost one in every six jobs is in health care. With at least 29,000 jobs spread throughout the state, this industry is both ubiquitous and essential to Alaskans' economic and individual health.

Alaska employment in the health care industry increased 40 percent from 2000 to 2007, from 20,700 to 29,000. Health care in Alaska has been on a pathway of accelerated growth for at least three decades for several reasons. Technological advances continue to boost the demand for services. The number of medical procedures grows as more remedies are found for health problems. The aging of the population is also a significant factor impacting demand. Between 1996 and 2006, the number of Alaskans 65 and older grew about 50 percent, from 30,440 to 45,489, and this trend will only accelerate into the future. In addition, a greater proportion of Alaska's health care needs formerly taken care of in the Lower 48 are now met within the state.

The occupations in the industry have a wide variety of educational and skill requirements. More than 70 percent of the health-related jobs in 2014, including registered nurses and various technicians, will require at least an associate degree or significant postsecondary vocational training, and almost 30 percent of those, including occupations such as physical therapists, social workers and physicians, will require a bachelor's degree or higher.

While Alaska's health care industry job growth has slowed somewhat over the past two years, there is a need to train more Alaskans for health care careers. Significant numbers of job openings throughout the state reflect the demand for new workers, and retirements from the workforce play a major role in the future need for workers in the industry. The University of Alaska is taking a lead role in this effort and greater investments in education are necessary to deliver a prepared Alaska health care workforce.

My Fiscal Year 2009 budget proposal includes a $2.5 million general fund investment to expand primary care, allied health, behavioral health and public health programs through various University of Alaska campuses. Allied health investments include increasing the number of associate degree clinical nursing and baccalaureate degree nursing slots in Anchorage, expanding distance education programs for registered nursing and allied health students, expanding the dental hygiene programs in Anchorage and Fairbanks, and expanding the paramedic programs in Fairbanks, Mat-Su, Kenai and Anchorage. Behavioral health increases will enable expansion of the baccalaureate and master's psychology programs in Fairbanks and Anchorage as well as investments to continue the Training Academy for Rural Behavioral Health. My budget proposal also continues the effort to establish a physician assistant program in Alaska, as well as double the size of the WWAMI program, a collaborative medical school program between the University of Alaska Anchorage and the University of Washington.

The investment the state can make in education sets the foundation for healthy lives and productive, rewarding careers.

Excerpt from "It's One Big Dynamic Industry" by Neal Fried

There are few industries in Alaska as large or that have grown as much as health care. It has a presence nearly everywhere in the state and includes a broad spectrum of occupations, ranging from surgeons to home health aides. The industry employs more people in Alaska than the federal government, state government, oil industry or most other industries. The industry had at least 29,000 jobs in 2007 and its payroll was about $1.2 billion.

The University of Alaska Anchorage estimates that health care spending in the state tops $5 billion - nearly one-sixth the value of everything produced in Alaska's economy - and that health care spending could double again by 2013. Per capita health care spending in Alaska in 2005 was $6,450 - about $1,200 above the national average, according to the Kaiser Family Foundation. Nearly as impressive as the sheer size of the state's health care industry is the lightning speed at which it grows. The number of wage and salary jobs in the industry increased 40 percent between 2000 and 2007, from 20,700 jobs to 29,000.

There's also the omnipresent nature to Alaska's health care employment. Slightly more than half the industry's employment is in Anchorage, but nearly every corner of the state has a health care work force and health care is often a community's largest or second-largest employer. Examples include the Yukon-Kuskokwim Health Corporation in Bethel, Norton Sound Health Corporation in Nome, Banner Health in Fairbanks and Mat-Su Regional Medical Center between Palmer and Wasilla. Thirteen of the 100 largest private-sector employers in the state are health care providers.

The state's health care employment has grown more than three times as fast as all other industries since 2000 - health care's 40 percent versus 13 percent for all other industries. That rapid growth didn't just begin during the past decade - it's been the case for more than three decades. During Alaska's worst recession from 1986 to 1988, when the economy lost 20,000 jobs, health care employment growth stalled for only a year and then resumed its impressive upward trend.

And not only has health care employment grown considerably faster than the state's overall employment, it has also increased five times as fast as the state's population and more than twice as fast as the nation's health care sector.

Learning From Our Neighbors: Hold Insurance Companies Accountable

On February 29, 2008, the Washington State Legislature enacted SB 5261 which will restore state oversight of the individual health insurance market. The law authorizes the Insurance Commissioner to disapprove unreasonable rate increases and establishes a sliding-scale medical loss ratio for insurers.

As Families USA discusses, medical loss ratios require insurers to spend a certain amount of premium revenue on direct medical care. These laws help ensure more of our premiums are used on medical care and less on administrative costs, including profits and bonuses. The Washington bill sets up a tiered loss ratio that is tied to the number of people an insurer denies for coverage. For example, a rate of denial under 6% equals a loss ratio of 74%, meaning 74-cents of every premium dollar must be spent on medical care. Insurance companies that deny coverage to more people, more than 8% for example, face a loss ratio of 77%.

Washington State had ended rate review in 2000. But after years of premium increases and broken promises by insurers not to increase premiums, lawmakers decided to hold insurer's accountable. The debate was fueled by estimates that insurers have surpluses totaling $1.4 billion and a report by the Seattle Post-Intelligencer that a state-based non-profit insurer transferred $49 million in premium revenue over the past three years to a faltering for-profit subsidiary in Arizona.

The rate oversight bill was a key legislative goal of the Healthy Washington Coalition, a broad coalition of health care advocates and stakeholders working to "achieve secure, quality, affordable health care for all Washingtonians."

[Originally published in Stateside Dispatch]

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Alaska Health Policy Calendar

Bill Tracking: Bills on the Move

This has been an incredibly active week for health policy bills. Multiple bills have passed in either the House or the Senate, and one is now awaiting transmittal to the governor. Several bills are scheduled for hearings in the next week, and some bills have been moved to different committees or are awaiting new assignments. One new bill was introduced this week.

HB 420 Anatomical Gifts was introduced on March 13 and is scheduled to be heard in House Judiciary on March 26.

HB 319 Dentists & Dental Hygienists passed the House on March 19 with 36-0, with 3 exempt and 1 absent. It has moved to the Senate and is awaiting a committee assignment there. SB 149 Redistribution of Used Eyeglasses passed the Senate on March 14 with 19-0, with 1 excused and zero absent. It was referred to House L&C on March 17. SB 249 Capstone Avionics Fund/Loans passed the Senate on March 18 with 20-0, no exemptions or absences, and was referred to House Finance on March 19. SJR 11 Supporting US Veterans' Health Care passed the House on March18 with 37-0, with 3 exemptions and no absences, and is awaiting transmittal to the governor. SB 209 Extend Alaska Commission on Aging passed the Senate on March 18 with 20-0, with no exemptions or absences, and was referred to House Finance. SCR 14 Perianesthesia Nurses Week: February 2008 passed the Senate on March 14 with 19-0, with 1 exemption and no absences, and is scheduled to be heard in House HES on March 29.

SB 280 Medicaid/Ins for Cancer Clinical Trials is scheduled for a hearing in Senate HES on March 26. SB 28 Limit Overtime for Registered Nurses is scheduled to be heard in Senate Finance on March 21. SB 179 Dependent Health Insurance: Age Limit is scheduled to be heard in Senate L&C on March 25. SB 245 Health Care: Plan/Commission/Facilities is scheduled to be heard in Senate HES on March 28. HB 190 Nursing Mothers in Workplace is scheduled to be heard in House L&C on March 28. SB 113 Nursing Mothers in Workplace is scheduled to be heard in Senate L&C on March 27. HB 320 Search & Rescue: Certification/Work. Comp is scheduled to be heard in House L&C on March 25. HB 400 Mitigating Factor: Care for Drug Overdose is scheduled to be heard in House Finance on March 26.

SB 107 Naturopaths was moved out of Senate HES on March 19 and is awaiting its next committee assignment. HB 312 Approp: Mental Health Budget was moved to House Rules on March 20. SB 160 Mandatory Universal Health Care was moved out of Senate L&C and referred to Senate Finance on March 14.

SB 300 Health Care: Plan/Commission/Facilities was referred to Senate Finance on March 18. HB 364 Notice & Consent for Minor's Abortion was referred to House Rules on March 18.

HB 301 Partial-Birth Abortion has been held until the House 3/25 calendar.

SB 170 Insurance Coverage for Well-Baby Exams was returned to the Senate Rules Committee on March 17.

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 March 20 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

Bill Tracking: Certificate of Need

HB 4 MEDICAL FACILITY CERTIFICATE OF NEED
Sponsor: Representative Lynn
Committee(s) and date of last action: (H) HES, 04/24/07

"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, 04/24/07

"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
Sponsors: Representatives Kelly and Kawasaki
Committee(s) and date of last action: (H) HES and (H) FIN, 02/26/08

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.

Bill Tracking: Drugs

HB 81 ALASKA PRESCRIPTION DRUG TASK FORCE
Sponsors: Representatives Guttenberg, Cissna, and Gruenberg
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 PRESCRIPTION DRUG REPOSITORY
Sponsors: Representatives Nelson, Lynn, Kerttula, and Gatto
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.

HB 400 MITIGATING FACTOR: CARE FOR DRUG OVERDOSE
Sponsor: Representative Kerttula
Committee(s) and date of last action: (H) FIN, 03/26/08

HB 400 amends the factors to be considered by a sentencing court against a person who seeks medical attention for another person experiencing a drug overdose.

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 and Ellis
Committee(s) and date of last action: (S) FIN, 02/27/08

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.

SB 280 MEDICAID/INS FOR CANCER CLINICAL TRIALS
Sponsor: Senator Davis
Committee(s) and date of last action: (S) HES, (S) L&C, and (S) FIN, 03/26/08

This bill would require health care insurers to provide insurance coverage for medical care received by a patient during certain approved clinical trials designed to test and improve prevention, diagnosis, treatment, or palliation of cancer. It would direct the Department of Health and Social Services to provide Medicaid services to persons who participate in clinical trials.

Bill Tracking: 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, 02/21/07

"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

Bill Tracking: 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
Sponsors: Representatives Coghill and Wilson
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

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 AND DENTAL HYGIENISTS
Sponsors: Representatives Ramras and Thomas

Committee(s) and date of last action: Senate, 03/19/08

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.

HB 340 CAPSTONE AVIONICS FUNDS/LOAN
Sponsor: Rules by request of the governor
Committee(s) and date of last action: (H) FIN, 02/13/08

HB 340 would establish the Alaska Capstone Avionics Revolving Loan Fund within the Department of Commerce, Community, and Economic Development. The bill declares it to be the policy of the state to increase the safety of air carrier, air taxi, and general aviation intrastate air transportation in the state by providing low interest loans to qualified applicants for the purpose of purchasing and installing capstone avionics equipment. The Fund would exist to provide loans towards that effect.

HB 360 CERTIFIED DIALYSIS TECHNICIANS
Sponsor: Representative LeDoux
Committee(s) and date of last action: (H) HES, (H) L&C, (H) FIN, 02/08/08

"HB 360 develops uniform standards for the training and certification of Dialysis Technicians in the state. . . HB 360 would create a consistent procedure for the application, examination, certification, suspension and severance of patient care dialysis technicians. Under the bill it becomes illegal for anyone to perform in such a capacity without having first completed the certification process under the auspices of the Board of Nursing or the Department of Commerce, Community, and Economic Development.

"The bill provides for the regulation of the education, training and practice of patient care dialysis technicians. It also creates a registry of certified technicians by the Board of Nursing or the Department of Commerce, Community, and Economic Development. The board will also have the authority to conduct hearings against alleged violators and the ability to impose disciplinary measures." -Rep. LeDoux

HJR 26 CONST AM: CONTROL OF MINOR'S MEDICAL CARE
Sponsors: 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, 03/21/08

"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: moved out of (S) HES, 03/19/08

"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 149 REDUSTRIBUTION OF USED EYEGLASSES

Sponsor: Senator Therriault
Committee(s) and date of last action: (H) L&C, 03/17/08

SB 149 would amend the current statute relating to the redistribution of used eyeglasses, as well as amend the language to refer to the Board of Dispensing Opticians. The bill would give the Board the power to approve nonprofit organizations for the redistribution and fitting of used eyeglasses. It would also limit the authority of a nonprofit organization approved by the department to distribute and fit used eyeglasses if the eyeglasses are distributed and fitted free of charge and the fitting of the eyeglasses conforms, to the extent possible, with a written prescription from a licensed physician or optometrist.

SB 181 ANATOMICAL GIFTS
Sponsor: Senator McGuire
Committee(s) and date of last action: (S) STA, then (S) JUD, 02/26/08

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.

SB 249 CAPSTONE AVIONICS FUND/LOANS
Sponsor: Rules by request of the governor
Committee(s) and date of last action: moved out of (H) FIN, 03/19/08

SB 248 would establish the Alaska Capstone Avionics Revolving Loan Fund within the Department of Commerce, Community, and Economic Development. The bill declares it to be the policy of the state to increase the safety of air carrier, air taxi, and general aviation intrastate air transportation in the state by providing low interest loans to qualified applicants for the purpose of purchasing and installing capstone avionics equipment. The Fund would exist to provide loans towards that effect.

HB 252 LEAVE FOR ORGAN/BONE MARROW DONATIONS
Sponsors: Senators LeDoux, Foster, Lynn, Doogan, Kohring, and Thomas
Committee(s) and date of last action: (H) STA, and (H) FIN, 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

SB 286 PHARMACY BENEFITS MANAGERS
Sponsor: Senator Elton
Committee(s) and date of last action: (S) L&C and (S) FIN, 03/27/08

This bill would create and regulate pharmacy benefits managers, and authorize the Board of Pharmacy to cooperate with the Division of Insurance to regulate pharmacy benefits managers."

HB 420 ANATOMICAL GIFTS
Sponsor: House Health, Education, and Social Services Committee
Committee(s) and date of last action: (H) HES and (H) JUD, 03/26/08

This bill relates to the Uniform Anatomical Gift Act, to anatomical gifts, to donations to the anatomical gift awareness fund, to a registry of anatomical gifts, and to organizations that handle the procurement, distribution, or storage of all or a part of an individual's body."

Bill Tracking: Medical Assistance and Health Insurance

"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: moved out of (S) RLS, 03/17/08

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, 03/25/08

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% of the federal poverty level (FPL) to 200% 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% FPL to 200% FPL.

SJR 11 SUPPORTING U.S. VETERANS' HEALTH CARE
Sponsor: Senator Wielechowski
Committee(s) and date of last action: awaiting transmittal to governor, 03/21/08

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

SB 259 EFFECTIVE DATE: MEDICAL ASSISTANCE LAWS
Sponsor: Rules by request of Legislative Council
Committee(s) and date of last action: (S) STA and (S) FIN, 03/24/08

This bill would repeal certain provisions relating to applications for medical assistance coverage; make certain provisions of ch. 96, SLA 2006, retroactive; provide for an effective date by repealing an effective date section in ch. 96, SLA 2006; provide for an effective date for certain sections of ch. 96, SLA 2006; and provide for an effective date."

Bill Tracking: 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, 04/12/07

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
Sponsors: Senators Davis, Ellis, and Elton
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) RLS pending referral, 03/20/08

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
Sponsors: Senator Davis and Ellis

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.

Bill Tracking: State Boards and Issues

Bill Tracking: Family Health Issues

HB 190 NURSING MOTHERS IN WORKPLACE
Sponsor: Representative Cissna
Committee(s) and date of last action: (H) HES, 03/13/08

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, Coghill, Lynn, Wilson, and Gatto
Committee(s) and date of last action: House, held to calendar 03/25/08

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
Sponsors: Representatives Coghill and Wilson
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.

HB 364 NOTICE AND CONSENT FOR MINOR'S ABORTION
Sponsors: Representatives Coghill, Keller, Meyer, Stoltze, Lynn, Johnson, and Dahlstrom
Committee(s) and date of last action: (S) RLS, 03/18/08

This bill would amend the state's abortion laws to require unmarried, unemancipated women under the age of 17 to provide parental consent before obtaining an abortion. It amends the affirmative defense a physician may provide to define the "best clinical judgment of the physician or surgeon" when the abortion was performed because of serious life or physical health risk to the minor. HB 364 also discusses legal avenues that violations might take.

SB 113 NURSING MOTHERS IN WORKPLACE
Sponsor: Senator Ellis
Committee(s) and date of last action: (S) L&C and (S) HES, 03/27/08

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

SB 264 PARTIAL-BIRTH ABORTION
Sponsor: Senators Olsen, Green, and Huggins
Committee(s) and date of last action: (S) JUD, 03/12/08

This bill would define the term "partial-birth abortion," as well as define several acts which are related to the larger definition.

Bill Tracking: Workers Compensation

HB 200 WORKER'S COMP: DISEASE PRESUMPTION
Sponsor: Representative Dahlstrom
Committee(s) and date of last action: (H) RLS, 03/04/08

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 361 WORKERS' COMPENSATION
Sponsor: Representative Crawford
Committee(s) and date of last action: (H) L&C, then (H) FIN, 02/08/08

HB 361 would require subcontractors without employees acting as independent contractors to secure payment for workers' compensation.

SB 117 WORKER'S COMP: DISEASE PRESUMPTION
Sponsors: Senators French and McGuire
Committee(s) and date of last action: (S) HES and (S) FIN, 02/19/08

"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
Sponsors: Senators French, Wagoner, Thomas, Elton, Wielechowski, and Dyson
Committee(s) and date of last action: moved out of (S) L&C, 03/04/08

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.

SB 287 WORKERS' COMPENSATION
Sponsor: Senator Wielechowski
Committee(s) and date of last action: (S) L&C, then (S) FIN, 02/19/08

SB 287 would require subcontractors without employees acting as independent contractors to secure payment for workers' compensation.

HB 320 SEARCH & RESCUE: CERTIFICATION/WORK.COMP
Sponsor: Representatives Meyer and Buch
Committee(s) and date of last action: (H) L&C and (H) FIN, 03/25/08

"House Bill 320 extends workers compensation coverage to volunteers during the course of providing a search and rescue service. HB 320 also allows municipalities to extend the same coverage they provide to search and rescue volunteers that they extend to volunteer firefighters, police officers and ambulance attendants. HB 320 however does not require a municipality to extend workers compensation coverage." -Rep. Meyer

AHPR Staff

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

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