Alaska Health Policy Review

Dear Subscriber,

The Governor's proposed 2009 Department of Health and Social Services (DHSS) operating budget is over two billion dollars. DHSS has the largest budget of any state department, nearly twice the amount proposed for the Department of Education and Early Development, the next most costly budget, and close to a third of the entire operating budget. Moreover, the DHSS budget grows significantly each year. The legislature closely monitors this budget and attempts to control costs, but their efforts may be having the opposite effect. How can that be?

This week I am pleased to present a guest feature article by Angela Salerno who has been analyzing budgets for a couple of decades. In this article she explains why "The state has lost the capacity to intervene early, effectively, and relatively cheaply to address the behavioral health problems of citizens."

SB 28, also known as the "Alaska Safe Nursing and Patient Care Act" was passed by the Senate on March 27, 17-3, and has been referred to the House for further debate. The bill has had something of a wild ride through the Senate. Sponsored by Senator Davis, SB 28 is designed to limit the use of mandatory overtime for registered nurses--that is, overtime that is compulsory in excess of an "agreed to, predetermined, and regularly-scheduled shift."

Pre-filed on January 5, 2007 and read for the first time on January 16, 2007, SB 28 was heard in the Health, Education, and Social Services, Labor & Commerce, and Finance Committees over the course of both sessions of the 25th Legislature. The bill has undergone committee substitutions and had fiscal notes attached, finally culminating in Thursday's vote. SB 28 now moves to the House where it is scheduled to be heard in House HES on April 1, 2008. In the next issue of the Review, we will present a detailed summary of the hearings and the controversy surrounding the issues in this bill.

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

Growth in the Health and Social Services Budget

Angela Salerno is a Masters-level Social Worker with 20 years experience in budget analysis and legislative advocacy. She is currently employed as the Advocacy Coordinator for the Alaska Mental Health Board and the Advisory Board on Alcoholism and Drug Abuse. She can be reached at Angela.Salerno@alaska.gov.

The Governor's proposed 2009 Department of Health and Social Services (DHSS) operating budget includes over two billion dollars in general funds (GF), federal matching funds and Mental Health Trust Authorized Receipts (MHTAAR) and includes support for Alaska's poor, disabled, sick and elderly. DHSS has the largest budget of any state department, nearly twice the amount proposed for the Department of Education and Early Development, the next most costly budget, and close to a third of the entire operating budget. Moreover, the DHSS budget grows significantly each year-the Governor's FY 09 request included $160 million in new spending and in the past decade, the DHSS budget has grown by 130%. Therefore, it is no wonder that the legislature closely monitors this budget and vigorously attempts to control cost. But ironically, decisions made by the legislature and state officials may be having the opposite effect.

Driving the Growth of the Budget: The Role of Medicaid

What causes the growth? What you might expect: facilities need maintenance, the cost of energy rises, and state workers get raises. Nevertheless, the granddaddy of growth factors in the DHSS budget is increases in "formula programs" or entitlements. Entitlements are programs that guarantee benefits to those individuals or families who qualify and apply for the benefit. And among entitlements, Medicaid is the growth heavyweight.

Medicaid is health, behavioral health and dental insurance for very low-income families and people with severe disabilities. The majority of spending--58%--goes to health care services, 27% to services for the disabled and elderly and about 16% to behavioral health services.(1)

In their FY 09 Budget Overview, DHSS cites Medicaid in four out of five causes for the FY 09 budget increase.

First, DHSS estimates that "regular growth" in Medicaid will cost $26.4 million in general funds (GF). Yet data from DHSS show enrollment in the program declined by almost 3% in FY 07, as did the number of people receiving benefits. So what is causing the growth? DHSS cites increased cost of medical services and increased utilization of inpatient psychiatric treatment for youth, and home and community based services for the elderly and disabled.

Additionally, the amount that the State of Alaska will have to contribute to Medicaid in 2009 is going up. State and federal governments fund Medicaid jointly. The federal share, known as the Federal Medical Assistance Percentage or FMAP, has been propped up at 57.78% for Alaska since passage of a special 2005 federal legislative provision. When that legislation expires in 2009, Alaska's FMAP will drop to an all time low of 50.53%. This accounts for over $29 million in the requested GF increases.

Next, the state will need to spend over $16 million to replace "ProShare," a complicated Medicaid funding scheme designed to maximize the state's ability to get [a] federal match for its Medicaid dollars. After previously endorsing ProShare, in July 2007 the federal Centers for Medicare and Medicaid (CMS) disallowed its use, leaving the state to back-fill with GF.

Finally, DHSS requested $24 million to increase the rates paid to Medicaid providers. These largely non-profit, community-based businesses, some of which have not had a rate increase in over a decade, are finding it increasingly difficult to keep their doors open. The rate increase will help with growing energy costs, staff recruitment and retention and other costs of doing business.

One additional factor in Medicaid growth will not be found in the budget, but can be traced back to an early 1990s strategic decision to "refinance" the cost of mental health services with Medicaid. Prior to the 1990s, most state-sponsored mental health services were paid for with GF grants made to community-based services providers. Under the new strategy, DHSS officials began urging service providers to aggressively bill Medicaid for mental health services. As the Medicaid budget grew--from $174 million in 1991 to $1.2 billion in 2008--the GF grants that once covered mental health services went into decline. This cost-shifting strategy continues to the present day.

Medicaid Growth: The Fallout

The expansion of Medicaid, caused by refinancing, federal cost shifting to the states and regular growth, has had a chilling effect on the legislature's willingness to invest in other parts of the DHSS budget and, unintended outcomes for the state's capacity to provide timely and effective services. For example, behavioral health grant funding continues to decline. Data from the Legislative Finance agency shows that between FY 03 and FY 09, GF appropriations for general mental health and substance abuse treatment dropped by 22% and appropriations for emergency psychiatric services dropped by 31%. In FY 2008, a $1 million shortfall heavily impacted behavioral health grant funding. However, ever-increasing Medicaid funds are not able to fill the gap. Medicaid serves only those individuals who are incapacitated by their disability and unable to work, and will not cover prevention or early intervention into moderate mental health problems. Moreover, a 1996 federal initiative barred the use of Medicaid for the treatment of alcoholism and substance abuse disorders. Consequently, Alaskans needing treatment for alcoholism or for moderate mental health problems can no longer access these services in the community.

The result? The state has lost the capacity to intervene early, effectively, and relatively cheaply to address the behavioral health problems of citizens. Data reported by the federal Substance Abuse and Mental Health Services Administration (SAMHSA) reveal that in 2005, 37,000 Alaskans needed but did not receive substance abuse services.(2) The state's network of Community Mental Health Centers, created in the 1960's to provide ready access to mental health services outside of hospitals, are by policy seeing only those clients with Medicaid. Unchecked alcoholism and untreated mental illness are escalating, raising the costs to business and to the state, and raising the level of distress and danger to families and communities.

One agency seeing the fallout is the Alaska Department of Corrections (DOC). A recent study completed by DOC and the Alaska Mental Health Trust shows that almost 50% of those incarcerated in Alaska have mental illness or substance abuse problems.(3) In testimony given to the Alaska Mental Health Trust Board, DOC Deputy Director Dwayne Peeples referred to DOC as the "largest provider of mental health services in Alaska." In their long-range budget forecasting, DOC has advised the legislature to expect up to $20 billion in additional spending for new correctional facilities, expanding workforce and medical care for inmates.

So in the end, concern over the growing Medicaid budget resulting in cutbacks in behavioral health prevention, early intervention and treatment services may have exerted some control over the DHSS budget, but it has not worked to control the overall cost of government. Unchecked personal woes turn into public problems that affect the economy and the quality of life for Alaskan families while demanding ever-increasing funds for public safety and corrections.

(1) Fiscal Year 2009 Overview. State of Alaska Department of Health and Social Services.

(2) National Survey on Drug Use and Health, 2004 and 2005. SAMHSA Office of Applied Studies.

(3) A Study of Trust Beneficiaries in the Alaska Department of Corrections. December 2007. Hornby Zeller Associates, Inc.

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Alaska Health Policy Calendar

Bill Tracking: Bills on the Move

It was another busy week for health policy bills, including four bills passing in their chamber and being passed along to the other chamber for consideration. Several more bills cycled through different committees this week as the Legislature examines them, and one bill is scheduled for a hearing on Friday.

SB 28 Limit Overtime for Registered Nurses passed the Senate on March 27 with 17-3. SB 259 Effective Date: Medical Assistance Laws passed the Senate on March 25, 19-0 with one absence, and was referred to House HES on March 27. HB 312 Approp: Mental Health Budget passed the Senate on March 24, 19-0 with one exemption, and was transmitted back to the House on the same day, where it is currently being held under "unfinished business." HB 301 Partial-Birth Abortion passed the House on March 25, 21-15 with four exemptions, and was referred to Senate Judiciary on March 27.

HB 319 Dentists & Dental Hygienists was referred to the Senate HES Committee on March 21. SB 107 Naturopaths was referred to Senate Finance on March 21. SB 249 Capstone Avionics Fund/Loans was referred to the House Rules Committee on March 27.

SB 149 Redistribution of Used Eyeglasses was moved out of House L&C on March 26. HB 420 Anatomical Gifts was moved out of House HES on March 18 and out of House Judiciary on March 26, and was referred to House Rules on March 27. SB 179 Dependent Health Insurance; Age Limit was moved out of Senate L&C on March 25 and referred to Senate HES on March 26. HB 320 Search & Rescue: Certification/Work. Comp was moved out of House L&C on March 25 and referred to House Finance on March 26.

HB 400 Mitigating Factor: Care for Drug Overdose was heard in House Finance on March 27.

HB 190 Nursing Mothers in Workplace is scheduled to be heard in House L&C on March 28.

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 27 at 4 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, 03/27/08

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: (S) HES, 03/21/08

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: passed Senate, 03/27/08

"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) FIN, 03/21/08

"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: moved out of (H) L&C, 03/26/08

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: (H) RLS, 03/27/08

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) RLS, 03/27/08

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."

HB 383 DENTIST LICENSE EXAM EXEMPTION
Sponsor: Representative Coghill
Committee(s) and date of last action: (H) L&C, 04/02/08

This Bill seeks to add an exception to the requirement of continuous active clinical practice averaging at least 20 hours a week for dentists who wish to practice in the state of Alaska. This exemption would apply to the men and women in the armed services who have been promoted to full-time supervisory positions in either the armed forced or an agency of the United States.

HB 363 NATUROPATHS/NATUROPATHIC BD
Sponsor: Representative Guttenburg
Committee(s) and date of last action: (H) HES, 03/18/08

This bill would create the Alaska Naturopathic Board. It details the functions and powers of the board.

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) HES, and (S) FIN, 03/26/08

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: (H) HES, 03/27/08

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: House under unfinished business, 03/25/08

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) L&C, 03/28/08

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: (S) JUD), 03/27/08

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) FIN, 03/26/08

"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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