04/16/2014 08:30 AM House FINANCE

CS FOR SENATE BILL NO. 169(FIN)                                                                                               
                                                                                                                                
     "An Act  establishing in the  Department of  Health and                                                                    
     Social  Services a  statewide immunization  program and                                                                    
     the  State  Vaccine   Assessment  Council;  creating  a                                                                    
     vaccine   assessment  account;   requiring  a   vaccine                                                                    
     assessment from  assessable entities and  other program                                                                    
     participants  for   statewide  immunization  purchases;                                                                    
     repealing  the temporary  child and  adult immunization                                                                    
     program; and providing for an effective date."                                                                             
                                                                                                                                
9:40:13 AM                                                                                                                    
                                                                                                                                
SENATOR CATHY  GEISSEL, SPONSOR,  spoke to the  graphic, "SB
 Vaccine Assessment Program"  (copy on file). The graphic                                                                    
charted the  various fund  transfers that  would occur  as a                                                                    
result  of  the  vaccine   assessment  program.  She  turned                                                                    
committee attention  to another  graphic, "SB  169 Statewide                                                                    
Immunization Program"(copy  on file), which  emphasized that                                                                    
the  program  was  optional  for   all  providers,  with  an                                                                    
additional provision  to opt out  of the program  within the                                                                    
first 3 years. She said that  one of the goals of the Alaska                                                                    
Healthcare  Commission was  to purchase  healthcare services                                                                    
with public funds and the  bill was a representation of that                                                                    
goal. She stated that homeless  teens and young adults would                                                                    
benefit  from  the  legislation. She  added  that  community                                                                    
healthcare clinics  in rural Alaska would  also benefit from                                                                    
the bill.                                                                                                                       
                                                                                                                                
                                                                                                                                
9:45:41 AM                                                                                                                    
                                                                                                                                
Senator   Geissel    discussed   her   response    memo   to                                                                    
Representative Wilson's  question in the last  hearing (copy                                                                    
on file):                                                                                                                       
                                                                                                                                
     Dear Finance Committee Members:                                                                                            
                                                                                                                                
     I was  asked by Representative Tammy  Wilson's aide how                                                                    
     many Alaskans  would be  affected of  SB 169  fails and                                                                    
     received  the below  information from  the Division  of                                                                    
     Public Health. The impact would be huge:                                                                                   
                                                                                                                                
     Without SB169  and once HB310 funds  fun out, providers                                                                    
     will have  to purchase  vaccine for  50 percent  of the                                                                    
     children  and  100  percent  of  the  adults.  That  is                                                                    
     estimated  to be  about  310,000  individuals of  which                                                                    
     80,000  are children  and 230,000  are adults.  This is                                                                    
     based  on current  population  and immunization  rates.                                                                    
     Only  the 50  percent  of children  covered by  federal                                                                    
     Vaccines for  Children and a small  number of high-risk                                                                    
     children  and  adults  covered  with  other  state  and                                                                    
     federal funds  will continue to  receive state-supplied                                                                    
     vaccine.                                                                                                                   
                                                                                                                                
     In  terms of  dollars,  without  SB169, the  providers'                                                                    
     share of  vaccine spending will increase  from about 50                                                                    
     percent currently to about 75  percent, or an extra $12                                                                    
     million, increasing  from $23  million to  $35 million.                                                                    
     This assumes  immunization rates  stay steady  and that                                                                    
     providers continue to purchase  vaccine for the insured                                                                    
     and uninsured.                                                                                                             
                                                                                                                                
Senator  Giessel  spoke to  the  cost  of vaccinations.  She                                                                    
stated that  the measles,  mumps, rubella  (MMR) vaccination                                                                    
for  children, under  the Center  for Disease  Control (CDC)                                                                    
purchasing  plan,  costs  $20  per  dose.  She  shared  that                                                                    
individual providers purchasing the  same dosage on the open                                                                    
market paid  $56 per dose.  She said that one  adult vaccine                                                                    
dose  for pneumonia  purchased  through  the CDC  purchasing                                                                    
would  be  $23;  individual  providers would  pay  $68.  She                                                                    
discussed the cost discrepancies for various vaccinations.                                                                      
                                                                                                                                
9:49:39 AM                                                                                                                    
                                                                                                                                
Representative  Wilson   asked  whether  the   current  bill                                                                    
version required mandatory participation after 3 years.                                                                         
Senator Giessel replied that no  one would be mandated to be                                                                    
part of the program.                                                                                                            
                                                                                                                                
Representative  Wilson  understood  that  private  insurance                                                                    
companies would  also have the  ability to opt in,  but that                                                                    
the state was exempt.                                                                                                           
                                                                                                                                
Senator  Giessel  replied  requests  for  the  program  from                                                                    
insurance companies had led to the legislation.                                                                                 
                                                                                                                                
9:51:22 AM                                                                                                                    
                                                                                                                                
Representative  Munoz  asked  if   all  providers  would  be                                                                    
charged the same rate per vaccine.                                                                                              
                                                                                                                                
Senator Giessel replied yes.                                                                                                    
                                                                                                                                
9:52:14 AM                                                                                                                    
                                                                                                                                
Representative Holmes discussed the  5 fiscal notes attached                                                                    
to the bill.                                                                                                                    
                                                                                                                                
9:55:07 AM                                                                                                                    
                                                                                                                                
JILL  LEWIS, DEPUTY  DIRECTOR,  DIVISION  OF PUBLIC  HEALTH,                                                                    
DEPARTMENT OF  HEALTH AND SOCIAL  SERVICES, stated  that the                                                                    
fiscal notes  netted to zero  because for every  dollar that                                                                    
was  spent,  there  was  a  new  dollar  coming  in  of  new                                                                    
assessment  fees. She  directed committee  attention to  the                                                                    
hand  out,   "SB  169   Vaccine  Assessment   Program."  She                                                                    
recommended comparing  the first  two fiscal  notes side-by-                                                                    
side. She  said that  the money would  flow between  the two                                                                    
notes and  net to zero. She  stated that the first  note was                                                                    
for  informational purposes  only and  likened to  a deposit                                                                    
slip from the bank, the  "checking account" being the fiscal                                                                    
note for epidemiology. She relayed  that the $4 million from                                                                    
note 2 would  be subtracted under the fund  source and would                                                                    
be  moved  into  an  account  outside  of  the  department's                                                                    
budget. She  furthered that  assessments would  be collected                                                                    
in advance from the assessable  entities and the money would                                                                    
be used to purchase additional vaccine.                                                                                         
                                                                                                                                
9:59:57 AM                                                                                                                    
                                                                                                                                
Representative  Wilson surmised  that there  was no  request                                                                    
being made for new revenue.                                                                                                     
                                                                                                                                
Ms. Lewis replied in the affirmative.                                                                                           
                                                                                                                                
10:01:32 AM                                                                                                                   
                                                                                                                                
Representative  Wilson said  that the  other figures  in the                                                                    
notes  appeared in  anticipation  of  the best  mathematical                                                                    
estimates.                                                                                                                      
                                                                                                                                
Ms. Lewis  said that  there was  a lot  of math  involved in                                                                    
calculating  and  estimating  the   costs  involved  in  the                                                                    
program. She stated that entities  would phase in during the                                                                    
first 3  years and that some  could opt out. She  added that                                                                    
there  could be  providers that  might  want to  opt in  for                                                                    
vaccine that they would otherwise  have to purchase on their                                                                    
own.                                                                                                                            
                                                                                                                                
Representative Wilson  asked whether  the change  could have                                                                    
negative impact on the department.                                                                                              
                                                                                                                                
Ms.  Lewis  replied  no.  She  acknowledged  that  federally                                                                    
funded  entities had  additional obstacles,  which had  been                                                                    
accounted for by allowing the 3 year phase in option.                                                                           
                                                                                                                                
Representative Holmes MOVED to  REPORT HCS CSSB 169(HSS) out                                                                    
of  committee   with  individual  recommendations   and  the                                                                    
accompanying fiscal notes. There  being NO OBJECTION, it was                                                                    
so ordered.                                                                                                                     
                                                                                                                                
HCS CSSB 169(HSS)  was REPORTED out of committee  with a "do                                                                    
pass" recommendation and with one  new fiscal note from Fund                                                                    
Transfers for the Department of  Health and Social Services,                                                                    
one  new  fiscal note  from  the  Department of  Health  and                                                                    
Social Services, one new indeterminate  fiscal note from the                                                                    
Department  of Health  and Social  Services, one  previously                                                                    
published zero  fiscal note: FN4  (CED), and  one previously                                                                    
published indeterminate fiscal note: FN5 (ADM).