02/21/2014 01:30 PM Senate HEALTH & SOCIAL SERVICES

             SB 169-STATEWIDE IMMUNIZATION PROGRAM                                                                          
                                                                                                                                
1:32:41 PM                                                                                                                    
CHAIR STEDMAN  announced that the  first order of  business would                                                               
be SB  169. He  said it  is the  first hearing  on the  bill. The                                                               
intent is to  adopt a new Committee Substitute,  have the sponsor                                                               
introduce the bill, take public  testimony, and then set the bill                                                               
aside for further review.                                                                                                       
                                                                                                                                
1:32:47 PM                                                                                                                    
SENATOR  MEYER moved  to adopt  the CS  for SB  169, labeled  28-                                                               
LS1219\P, as the working document.                                                                                              
                                                                                                                                
CHAIR STEDMAN objected for discussion purposes.                                                                                 
                                                                                                                                
SENATOR CATHY GIESSEL, Alaska  State Legislature, Juneau, Alaska,                                                               
sponsor of  SB 169, introduced the  bill. She stated that  SB 169                                                               
would permanently  put the  state vaccine  program in  place with                                                               
monies  other than  the  state's money.  She  related that  after                                                               
Senator  Stevens left  the U.S.  Senate, the  Center for  Disease                                                               
Control changed how  they viewed Alaska. Alaska  had been getting                                                               
$4.3  million per  year to  provide vaccines  for all  residents.                                                               
That  funding  decreased  to $700,000.  The  state's  vaccination                                                               
program  was   greatly  curtailed.  She  recalled   the  vaccine-                                                               
preventable diseases that the program targeted.                                                                                 
                                                                                                                                
SENATOR GIESSEL  related that two  years ago, after  hearing this                                                               
same bill, the  state funded the program for $4  million per year                                                               
for 3 years. At the end of  3 years, the Department of Health and                                                               
Social Services  (DHSS) was  charged with finding  a way  to fund                                                               
the  program,   in  collaboration  with  the   state's  insurance                                                               
companies. She said that is what this bill does.                                                                                
                                                                                                                                
1:35:45 PM                                                                                                                    
JANE  CONWAY,   Staff,  Senator   Cathy  Giessel,   Alaska  State                                                               
Legislature, Juneau, Alaska,  described the changes in  SB 169 on                                                               
behalf of the sponsor. She said  changes were made from version O                                                               
to version  P, the current CS.  She noted the original  bill used                                                               
the  name "State  Vaccine Assessment  Commission"  for the  group                                                               
being set  up to  administer the vaccine  program. That  name was                                                               
changed to  the "State  Vaccine Assessment  Council" so  it would                                                               
not be confused with the  current "State Health Care Commission."                                                               
All throughout  the bill the  term was changed. Another  term was                                                               
changed in  version P; "health  care insurer" was changed  to "an                                                               
assessable entity"  for a  broader usage.  It is  a term  used by                                                               
other states for their vaccine assessment programs.                                                                             
                                                                                                                                
MS. CONWAY referred  to page 5, line 18; the  manner in which the                                                               
definition  "assessable  entity"  is written  is  different  than                                                               
version O, but  is using the same reference by  definition and it                                                               
encompasses  the  detail  list  from  version  O.  This  language                                                               
recommended by legislative legal services.                                                                                      
                                                                                                                                
CHAIR STEDMAN removed his objection  to adopting version P. There                                                               
being no objection, version P was before the committee.                                                                         
                                                                                                                                
1:38:10 PM                                                                                                                    
At ease                                                                                                                         
                                                                                                                                
1:39:42 PM                                                                                                                    
SENATOR  MEYER   inquired  about  the  change   in  wording  from                                                               
"commission"  to "council."  He  asked if  the  council would  be                                                               
treated like a commission in the  sense that people from all over                                                               
the state make up the members,  they meet on a regular basis, and                                                               
are subject to an audit.                                                                                                        
                                                                                                                                
MS.  CONWAY  explained  that  the  council is  a  group  that  is                                                               
appointed  by the  commissioner of  Public  Health; it  is not  a                                                               
board. The  council will meet throughout  the year to set  up the                                                               
program  and  assess  the  entities. They  will  work  under  the                                                               
auspices  of DHSS  and they  will serve  without compensation  or                                                               
reimbursement.                                                                                                                  
                                                                                                                                
SENATOR MEYER  asked if they would  serve at the pleasure  of the                                                               
commissioner.                                                                                                                   
                                                                                                                                
MS.  CONWAY said  the commissioner  of DHSS  would appoint  an 8-                                                               
member board.                                                                                                                   
                                                                                                                                
1:42:04 PM                                                                                                                    
WARD HURLBERT, Chief Medical Officer,  Division of Public Health,                                                               
Department of Health and Social  Services (DHSS), Juneau, Alaska,                                                               
provided  information related  to SB  169. He  shared a  story to                                                               
highlight the vast  changes from vaccinations in  Alaska. He said                                                               
in 1953  in Ketchikan there were  93 cases of polio,  83 of which                                                               
were  paralytic. Today,  a woman  came  in and  was resistant  to                                                               
having her  child immunized because  she did not know  what polio                                                               
was. He  told a story about  a measles outbreak in  Dillingham in                                                               
1961 when children  died from the disease. He said  it has been a                                                               
long  time since  an Alaskan  has been  lost to  measles, due  to                                                               
vaccinations.                                                                                                                   
                                                                                                                                
DR.   HURLBERT   shared   data   about   the   effectiveness   of                                                               
vaccinations.  The flu  vaccine is  only about  50 percent  to 60                                                               
percent  effective  for  those  over  65  years  old.  Worldwide,                                                               
smallpox no longer  exists. It is nearly the same  with polio. He                                                               
concluded that immunizations have made a big difference.                                                                        
                                                                                                                                
1:44:56 PM                                                                                                                    
He explained  that the proposed  methodology in the bill  is used                                                               
by 9  other states. He called  it a "win/win" because  the payers                                                               
have  to pay  less because  the  state will  buy vaccinations  at                                                               
wholesale rates. The  modest surcharge will pay  for vaccines for                                                               
underinsured  children.  About five  years  ago  Alaska was  49th                                                               
among  states  in immunization  rates  for  ages two  and  under.                                                               
Currently, Alaska  is 37th or 38th  and about 65 percent  of kids                                                               
are immunized.  He predicted that this  legislation would improve                                                               
these numbers much like New Hampshire was able to do.                                                                           
                                                                                                                                
1:46:29 PM                                                                                                                    
ROSALYN   SINGLETON,  M.D.,   representing  herself,   Anchorage,                                                               
Alaska, testified  in support of  SB 169.  She called the  bill a                                                               
cost-saving model which  will improve access to  vaccines for all                                                               
Alaskans,  streamline the  distribution of  vaccines, and  reduce                                                               
the huge  administrative burden  that health  providers currently                                                               
have. She  said vaccinations demonstrated the  dramatic effect of                                                               
reducing Hepatitis A  from the highest to the lowest  rate in the                                                               
country. Also, Alaska has been free of measles since 2000.                                                                      
                                                                                                                                
She said Alaska's  expanse challenges the ability  to provide on-                                                               
time immunizations, so ready access  to vaccines is critical. Due                                                               
to   the  administrative   burden,   some   providers  in   small                                                               
communities  no  longer  can  provide   all  of  the  recommended                                                               
vaccines due  to having to  front costs and keep  separate stocks                                                               
of vaccine  from state and  private purchases. She  remarked that                                                               
she  has received  calls from  providers and  parents who  cannot                                                               
access vaccines.                                                                                                                
                                                                                                                                
She  said   other  states  have  experienced   cost  savings  and                                                               
streamlined  distribution when  using  the model  the bill  would                                                               
create.                                                                                                                         
                                                                                                                                
1:49:28 PM                                                                                                                    
LILY LOU,  M.D., Medical Director,  Newborn Intensive  Care Unit,                                                               
Providence Children's  Hospital, Anchorage, Alaska,  testified in                                                               
support of  SB 169. She shared  that she is the  president of the                                                               
Alaska Chapter  of the American  Academy of Pediatrics  (AAP) and                                                               
the District 8 representative, for  the Western United States and                                                               
Canada,  to  the  executive  committee  of  the  AAP  section  on                                                               
perinatal pediatrics. She  said she is speaking  as an individual                                                               
in  favor   of  the  bill   for  four  reasons.  First,   is  the                                                               
effectiveness of  vaccines, second,  is good  stewardship, third,                                                               
is access to care, and fourth, is the future.                                                                                   
                                                                                                                                
DR. LOU  related that  the prevention  of infectious  diseases by                                                               
immunization has  been one  of the  most significant  advances in                                                               
health care  in human history.  She shared statistics  related to                                                               
16 measles outbreaks in 2011, the  cost of which was estimated to                                                               
be $5.3  million. She maintained  that vaccinations  will protect                                                               
everyone and  a universal  purchase program  will likely  lead to                                                               
savings.                                                                                                                        
                                                                                                                                
She said  a vaccine  assessment account will  allow the  state to                                                               
benefit  from  volume  purchasing at  discounted  federal  rates.                                                               
Other states have shown significant  savings and have streamlined                                                               
the process.  The new  system will provide  more access  to care,                                                               
especially in  small communities.  It will  also have  a positive                                                               
effect on the future.                                                                                                           
                                                                                                                                
1:54:04 PM                                                                                                                    
PATRICIA SENNER, Director,  Professional Practices, Alaska Nurses                                                               
Association, Anchorage,  Alaska, testified in support  of SB 169.                                                               
She  spoke  of  frustrations  she   has  experience  as  a  nurse                                                               
practitioner providing  immunizations since the state  moved away                                                               
from universal coverage.  She said she had to  keep separate sets                                                               
of  vaccines for  those eligible  and not  eligible for  vaccines                                                               
through the  state. That made  for increased costs  and increased                                                               
administrative difficulties, as well as for waste.                                                                              
                                                                                                                                
1:55:54 PM                                                                                                                    
RANDI SWEET,  representing herself, Anchorage,  Alaska, testified                                                               
in support of SB 169.                                                                                                           
                                                                                                                                
1:56:37 PM                                                                                                                    
AMY DRESSEL,  Pediatrician, Juneau, Alaska, testified  in support                                                               
of SB 169.  She listed many reasons for supporting  the bill. She                                                               
said  vaccines are  very expensive  and there  are problems  with                                                               
access. The  bill helps all vaccine-eligible  children in Alaska.                                                               
Alaska is lowest  on the national vaccine record.  The bill would                                                               
help  all  Alaskans,  provide   favorable  rates,  and  universal                                                               
access, decrease the  administrative burden, and make  for a more                                                               
efficient system.                                                                                                               
                                                                                                                                
1:59:06 PM                                                                                                                    
CHAIR STEDMAN closed public testimony.                                                                                          
                                                                                                                                
CHAIR STEDMAN  detailed five fiscal  notes: one fiscal  note that                                                               
reflects the fund transfer to  the new vaccine assessment account                                                               
in  the  amount  of  $4,496,000  from  an  appropriation  in  the                                                               
Governor's current  FY 15 budget;  one net zero fiscal  note from                                                               
the  Department  of Health  and  Social  Services (DHSS),  Public                                                               
Health Division,  showing the  program's expenses  of $26,950,000                                                               
and the  same amount  in program  revenue; and  one indeterminate                                                               
fiscal note  from the  Department of  Health and  Social Services                                                               
(DHSS), Medicaid Service Division; one  zero fiscal note from the                                                               
Department  of  Commerce,   Community  and  Economic  Development                                                               
(DCCED); and  one indeterminate fiscal  note from  the Department                                                               
of Administration.                                                                                                              
                                                                                                                                
2:00:34 PM                                                                                                                    
SENATOR MICCICHE asked if it was  an initial $4.4 million to fund                                                               
the  program  and   then  about  $33,000  in  fees   to  make  it                                                               
sustainable.                                                                                                                    
                                                                                                                                
MS. CONWAY clarified that $4 million  is left over in the vaccine                                                               
program  now and  will  be  transferred to  the  new model.  That                                                               
amount will  help to  purchase the initial  vaccine for  the next                                                               
year. The department  will then use a formula to  assess how many                                                               
vaccines will be needed statewide  and purchase them in bulk with                                                               
money from the assessable entities.  After the initial $4 million                                                               
the program becomes funded by insurance payers.                                                                                 
                                                                                                                                
SENATOR MICCICHE  stated that $4.4  million is  leftover previous                                                               
funding.                                                                                                                        
                                                                                                                                
MS. CONWAY said correct.                                                                                                        
                                                                                                                                
CHAIR STEDMAN held SB 169 in committee.