Legislature(2011 - 2012)HOUSE FINANCE 519

04/03/2012 01:30 PM FINANCE

Download Mp3. <- Right click and save file as

* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Scheduled But Not Heard
Moved CSHB 310(FIN) Out of Committee
Moved CSHB 296(JUD) Out of Committee
+ Bills Previously Heard/Scheduled TELECONFERENCED
Heard & Held
HOUSE BILL NO. 310                                                                                                            
     "An Act temporarily reinstating the child and adult                                                                        
     immunization program in the Department of Health and                                                                       
     Social Services; and providing for an effective date."                                                                     
1:39:35 PM                                                                                                                    
Vice-chair  Fairclough  MOVED  to ADOPT  proposed  committee                                                                    
substitute  for HB  310,  Work  Draft 27-LS1273\I  (Mischel,                                                                    
Co-Chair Stoltze OBJECTED for purpose of discussion.                                                                            
JOE MICHEL, STAFF, REPRESENTATIVE  BILL STOLTZE, stated that                                                                    
the changes  were all located on  page 3 of the  work draft.                                                                    
On  page  3, line  5  "meningococcal"  and "rotavirus"  were                                                                    
added. On  page 3, line  8 "zoster" was added;  "zoster" was                                                                    
another name for shingles. Section  2, subsection g, part 2,                                                                    
sub-parts A and B were added:                                                                                                   
     (2) subtract vaccines from inclusion in the program if                                                                     
      (A) the disease for which  the vaccine is provided has                                                                    
     been declared  eradicated in the  United States  by the                                                                    
     Centers  for  Disease  Control and  Prevention,  United                                                                    
    States Department of Health and Human Services; or                                                                          
      (B) the  commissioner finds that  available high-grade                                                                    
     scientific  evidence  indicates  that  subtracting  the                                                                    
     vaccine from  inclusion in the  program will  result in                                                                    
     optimal  efficacy and  efficiency  for  the benefit  of                                                                    
Mr. Michel stated that line 19, subsection h was added:                                                                         
     (h)  The  procurement  of vaccines  that  are  provided                                                                    
     under  the program  is subject  to the  availability of                                                                    
Co-Chair  Stoltze WITHDREW  his  OBJECTION.  There being  NO                                                                    
further OBJECTION, Work Draft 27-LS1273\I was ADOPTED.                                                                          
REPRESENTATIVE  BOB HERRON,  SPONSOR, described  SB 310.  He                                                                    
stated that  HB 310 is  a stop-gap measure to  reinstate the                                                                    
Alaska Immunization  Program (AIP),  which aimed  to prevent                                                                    
and control  vaccine-preventable diseases in Alaska,  to its                                                                    
former level  of coverage. Every  year, Alaskans  remember a                                                                    
storied  health emergency  - our  Iditarod commemorates  the                                                                    
1925 "Great  Race of  Mercy" serum run  to Nome.  Then, Nome                                                                    
and several surrounding communities were  in the throes of a                                                                    
diphtheria  epidemic,  and  dog teams  with  their  fearless                                                                    
mushers  braved  the  elements   to  deliver  a  life-saving                                                                    
antitoxin.  Today,  thanks  to  preventative  vaccines,  the                                                                    
disease  has been  nearly eradicated  in the  United States.                                                                    
Still,   Alaska  communities   are   highly  vulnerable   to                                                                    
debilitating  but entirely  preventable  health crises.  For                                                                    
decades,  Federal   funding  ensured  the  AIP   could  make                                                                    
preventative  vaccines accessible  to all  Alaskans desiring                                                                    
them.  But that  funding has  seen a  sharp downturn  - from                                                                    
$4.3 Million  in FY10,  to a mere  $700 thousand  in FY2013.                                                                    
These reductions  have cut the number  of vaccines available                                                                    
to children, and completely  discontinued those available to                                                                    
adults in our state.  Preventative vaccines control diseases                                                                    
such  as  whooping  cough, lockjaw,  pneumonia,  meningitis,                                                                    
polio,  and  others  -  silently  saving  lives  every  day.                                                                    
Prevention, generally,  is key -  and by far the  most cost-                                                                    
effective  way  to  address  health issues.  If  we  do  not                                                                    
prevent, we  will have  to treat, at  far greater  human and                                                                    
financial  cost.   HB  310  and  Senate   Companion  SB  144                                                                    
temporarily  substitute state  funding for  the decrease  in                                                                    
federal  funding to  AIP, through  FY2015, while  we seek  a                                                                    
more permanent solution. It provides  a humane and business-                                                                    
smart  solution  to  the   growing  problem  of  unnecessary                                                                    
disease wracking our communities.                                                                                               
1:44:33 PM                                                                                                                    
Co-Chair Thomas pointed to page  2, line 5, and wondered why                                                                    
the word  "may" was  used.  Representative  Herron responded                                                                    
that  the bill  gave  the Department  of  Health and  Social                                                                    
Services (DHSS)  the authority to decide  which vaccines may                                                                    
be added or  subtracted to the program. He  stated that DHSS                                                                    
currently wanted  to add meningococcal and  rotavirus to the                                                                    
list of "recommended vaccines."                                                                                                 
Co-Chair  Thomas  reiterated  his question  about  the  term                                                                    
"may" included in the bill.                                                                                                     
Representative Gara  added that  the department  should have                                                                    
flexibility to determine the  recommended vaccines, and felt                                                                    
that perhaps the word, "shall", should be used instead.                                                                         
Representative   Herron  deferred   the   question  to   the                                                                    
Department of Health and Social Services (DHSS).                                                                                
Representative Gara  asked if the funding  for Chlamydia and                                                                    
Gonorrhea  prevention  would  disappear   if  the  bill  was                                                                    
passed. Representative Herron responded  that HB 310 did not                                                                    
have any effect on that funding.                                                                                                
Representative  Gara assumed  the  bill  would cover  public                                                                    
health center immunizations. He  asked for verification that                                                                    
the  bill would  not provide  immunizations for  individuals                                                                    
who  could pay  for them.  Representative Herron  replied in                                                                    
the affirmative.                                                                                                                
Co-Chair Stoltze  wondered if  the there  was a  subsidy for                                                                    
vaccinations  in   medical  facilities  other   than  health                                                                    
centers.    Representative   Herron    responded   in    the                                                                    
Representative  Gara wondered  if the  vaccination would  be                                                                    
subsidized,  if the  patient was  receiving the  vaccination                                                                    
from a private provider.                                                                                                        
Representative Herron  deferred the question to  the medical                                                                    
Representative Neuman  declared that  he had a  problem with                                                                    
mandatory immunizations  from the  government. He  looked at                                                                    
page  3, lines  4  and  5, which  stated  that the  vaccines                                                                    
included in the program:                                                                                                        
     (1) for a child under 19  years of age are all vaccines                                                                    
     required for  school attendance under AS  14.30.125 and                                                                    
     meningococcal,  rotavirus, influenza,  and pneumococcal                                                                    
Representative  Neuman  wondered  if the  vaccinations  were                                                                    
required for people who choose  to keep their children home-                                                                    
schooled  or  in  a correspondence  program.  Representative                                                                    
Herron responded that the bill  would not change any current                                                                    
practice or process.                                                                                                            
1:50:52 PM                                                                                                                    
LES MORSE, DEPUTY COMMISSIONER,  DEPARTMENT OF EDUCATION AND                                                                    
EARLY DEVELOPMENT,  believed that Representative  Herron was                                                                    
correct,  but he  would need  to follow  up on  the question                                                                    
with more information at a later date.                                                                                          
Co-Chair  Stoltze  asked who  would  verify  the issue.  Mr.                                                                    
Morse would make contact the  department and would follow up                                                                    
Representative Neuman  remarked that  his children  were not                                                                    
required  to  receive  vaccinations, because  they  did  not                                                                    
attend school buildings.                                                                                                        
Representative Neuman looked at page 3, line 9:                                                                                 
     In addition to the vaccines listed in (f) of this                                                                          
     section, the commissioner may                                                                                              
     (1) add vaccines for inclusion in the program based on                                                                     
     recommendations by 11 the federal advisory committee                                                                       
     on immunization practices and the availability of                                                                          
Representative  Neuman  remarked  that although  there  were                                                                    
specific  vaccines listed,  the commissioner  could add  any                                                                    
immunizations, without statutory  authority or approval from                                                                    
the   legislature.  Representative   Herron  affirmed   that                                                                    
Representative  Neuman looked  at  page 3,  line  4, "for  a                                                                    
child under  19 years  of age." He  believed that  people in                                                                    
the state  of Alaska  became adults at  age 18.  He wondered                                                                    
why  an "adult"  would be  required to  have a  vaccination.                                                                    
Representative  Herron  deferred   to  the  department,  but                                                                    
assumed that language was currently written in statute.                                                                         
Co-Chair Stoltze remarked that  it was probably not uncommon                                                                    
for a 19-year-old to attend public high school.                                                                                 
Representative  Neuman stressed  that  the  statute did  not                                                                    
list the age of the vaccine recipient.                                                                                          
Representative  Guttenberg looked  at  page 2,  line 21.  He                                                                    
asked  who was  exempt from  licensure under  the provision.                                                                    
Representative Herron deferred the answer to DHSS.                                                                              
Representative Guttenberg wondered  if the screening records                                                                    
would  be in  compliance with  Health Insurance  Portability                                                                    
and Accountability  Act (HIPAA) laws.  Representative Herron                                                                    
responded in the affirmative.                                                                                                   
Representative  Wilson  asked  why  specific  language  "for                                                                    
vaccines"  was  added.  Representative Herron  deferred  the                                                                    
question to the  DHSS. He assumed that  diseases were common                                                                    
enough that  the department agreed  there should  be regular                                                                    
vaccinations for specific diseases.                                                                                             
Representative Wilson  looked at  the attached  fiscal note,                                                                    
and  pointed  out  that  the  explanation  showed  that  the                                                                    
federal funding had been cut  to $700,000 in 2010. She noted                                                                    
a  possible discrepancy  in  total  received federal  funds.                                                                    
Representative  Herron  replied that  he  had  not seen  the                                                                    
finance fiscal note.                                                                                                            
1:56:57 PM                                                                                                                    
WARD HURLBURT, DIRECTOR AND  CHIEF MEDICAL OFFICER, DIVISION                                                                    
OF PUBLIC  HEALTH, DEPARTMENT OF HEALTH  AND SOCIAL SERVICES                                                                    
(via teleconference),  explained that 50 percent  of Alaskan                                                                    
children  benefit  from  the  federally  funded  recommended                                                                    
immunizations. He  stated that  an additional 25  percent of                                                                    
Alaska's children  were in  families where  adequate private                                                                    
health insurance  was available to  cover most of  the costs                                                                    
of  the recommended  immunizations,  so the  bill would  not                                                                    
cover  vaccines for  any  of those  75  percent of  Alaska's                                                                    
children. Therefore,  25 percent  of Alaska's  children were                                                                    
not covered by private  health insurance or federal vaccines                                                                    
for  children program.  This 25  percent of  children places                                                                    
the  other 75  percent at  risk, because  of the  concept of                                                                    
"herd  immunity." If  the immunity  level for  a preventable                                                                    
contagious disease  was not  sufficiently high,  all members                                                                    
of  the community  were at  a  higher risk.  He stated  that                                                                    
there was  a low level  of mumps immunization  in California                                                                    
in 2010, more than 2000  babies and young children developed                                                                    
mumps.  So,   California  needed   to  engage  in   a  major                                                                    
immunization program.  Alaska had seen  remarkable successes                                                                    
related  to vaccines  that had  become available  during his                                                                    
professional tenure.                                                                                                            
2:01:50 PM                                                                                                                    
Dr.  Hurlburt suggested  that  the  decisions regarding  the                                                                    
specific recommended vaccines should  be made on the medical                                                                    
and   clinical  level.   He  remarked   that  vaccines   are                                                                    
constantly changing and improving.                                                                                              
Co-Chair  Stoltze  acknowledged Rotary  Clubs  International                                                                    
for their effort to eradicate polio.                                                                                            
Dr.  Hurlburt  agreed.  He  pointed   out  that  the  policy                                                                    
requirements were  specific for "school entry."  He stressed                                                                    
that  there  was no  intent  to  change current  policy.  He                                                                    
stated  that military  physicians or  public health  service                                                                    
physicians were not required to  have an Alaska license, but                                                                    
were  required to  have  a license  from  another state.  He                                                                    
remarked  that  the  four   new  vaccines  were  recommended                                                                    
because they  are not  required for  school entry,  but were                                                                    
recommended by the American  College of Emergency Physicians                                                                    
(ACEP).  The  meningococcal  vaccine  was  used  to  prevent                                                                    
meningitis.  The  rotavirus  vaccine  was  used  to  prevent                                                                    
diarrhea, and that vaccine was  not as cost effective at the                                                                    
nationally,  but   Alaska  had   many  cases   of  infantile                                                                    
diarrhea.   Influenza   and   pneumococcal   vaccines   were                                                                    
recommended  annual vaccines,  and he  remarked that  babies                                                                    
and   older   adults   were  particularly   susceptible   to                                                                    
influenza. He  addressed the fiscal  note, and  stated there                                                                    
were two  $700,000 figures.  The federal  government funding                                                                    
had  been   reduced  to  $700,000,  and   the  governor  had                                                                    
requested an additional $700,000.                                                                                               
2:06:13 PM                                                                                                                    
Representative Wilson  wondered who determined  the required                                                                    
vaccinations for  schools. Dr.  Hurlburt responded  that the                                                                    
vaccines  required for  school  entry were  specific to  the                                                                    
risk  and susceptibility  of the  specific diseases  for the                                                                    
particular ages of the children.                                                                                                
Representative  Wilson  asked  whether the  doctor  believed                                                                    
that  children  should  receive  the  influenza  vaccination                                                                    
annually. Dr. Hurlburt responded in the affirmative.                                                                            
Vice-chair  Fairclough  wondered   if  the  commissioner  of                                                                    
Department of Health  and Social Services was  the person in                                                                    
charge to  determine vaccinations  at schools.  Dr. Hurlburt                                                                    
responded in the affirmative.                                                                                                   
Vice-chair Fairclough  did not  know why  lines 3  through 8                                                                    
needed to be  in statute, as the  commissioner currently had                                                                    
the ability to make the decision.                                                                                               
2:09:58 PM                                                                                                                    
Dr. Hurlburt  believed that the  language had  been included                                                                    
to  clarify the  current  practice. He  understood that  the                                                                    
decision-making authority was with the DHSS commissioner.                                                                       
Vice-chair Fairclough  declared that she  had a son  who had                                                                    
been  adversely affected  by an  immunization.  She did  not                                                                    
want to be put in  the position of recommending a particular                                                                    
immunization; she  would leave that to  the commissioner and                                                                    
medical professionals to make the decision.                                                                                     
Representative  Gara  asked  what  the  added  $4.4  million                                                                    
covered, that  the governor's request  of $700,000  did not.                                                                    
Dr.   Hurlburt  responded   that   vaccinations  were   very                                                                    
expensive. The  total cost for a  2-year-old's vaccines, not                                                                    
including  administration, was  $18,000.  He furthered  that                                                                    
the  shingles vaccine,  that was  currently recommended  for                                                                    
those 55-years-old and older,  was very expensive. He stated                                                                    
that  the amount  of the  federal money  and the  governor's                                                                    
budget totaled  $1.4 million, and was  very limited compared                                                                    
to the actual cost of  vaccinations. He stressed that it was                                                                    
appropriate  to examine  vaccines from  a cost-effectiveness                                                                    
perspective. He  felt that the  money spent  on vaccinations                                                                    
was money spent to save human lives.                                                                                            
Representative  Gara  wondered   how  the  department  would                                                                    
prevent  "duplicate vaccines"  that were  available at  city                                                                    
health centers, schools, and community health clinics.                                                                          
2:15:09 PM                                                                                                                    
Dr.   Hurlburt  believed   that  DHSS   would  procure   the                                                                    
immunizations  in   all  of   the  mentioned   examples.  He                                                                    
understood that  there were some  duplication issues,  so he                                                                    
felt that  there needed to  be only one  procurement source.                                                                    
He furthered that  DHSS continued to look  at different ways                                                                    
to  obtain  funding.  He   understood  that  the  three-year                                                                    
initial  authorization was  intended for  the department  to                                                                    
examine  funding  alternatives.  The public  health  nursing                                                                    
centers  had  been  designated by  the  Anchorage  Community                                                                    
Health  Center, so  therefore  uninsured  children would  be                                                                    
qualified under the Federal Vaccines for Children Program.                                                                      
Vice-chair Fairclough referred to  a question related to the                                                                    
overall subsidy of vaccines. She  wondered if the subsidy of                                                                    
vaccines was  reflected in his previous  statement about the                                                                    
State providing vaccines  at a lower cost  to health clinics                                                                    
and municipalities.                                                                                                             
Dr. Hurlburt responded that  vaccinations that were procured                                                                    
under this  legislation to providers were  given to eligible                                                                    
children   at  no   cost  for   the  vaccine.   However,  an                                                                    
administrative fee may be charged.                                                                                              
2:19:28 PM                                                                                                                    
DAVID D'AMATO,  GOVERNMENT AFFAIRS DIRECTOR,  ALASKA PRIMARY                                                                    
CARE  ASSOCIATION  (APCA)  (via  teleconference),  spoke  in                                                                    
strong support of  HB 310. He discussed that  there had been                                                                    
a profound  shortage of vaccinations  in recent  years. Some                                                                    
of  the more  capable locations  had bought  vaccinations to                                                                    
provide; however,  others had not. The  APCA was "delighted"                                                                    
the bill had been introduced.                                                                                                   
ROSALYN  SINGLETON,   PEDIATRICIAN,  ALASKA   NATIVE  TRIBAL                                                                    
HEALTH   CONSORTIUM  (via   teleconference),  testified   in                                                                    
support  of HB  210.  She remembered  treating  a very  high                                                                    
number of  infants with meningitis,  who had either  died or                                                                    
developed   severe  brain   damage  as   a  result   of  the                                                                    
meningitis. Alaska had a very  high rate of the disease, but                                                                    
since  1990 the  rate of  the  disease had  decreased by  95                                                                    
percent.  In  the  year  prior   to  the  licensure  of  the                                                                    
vaccination,  four  people  had   been  lost  including  two                                                                    
teenagers.  She  discussed  hospitalization  of  individuals                                                                    
with measles,  was very concerned  about the  growing number                                                                    
of  communities that  were under  vaccinated. She  urged the                                                                    
passage of the bill.                                                                                                            
Co-Chair Stoltze  remembered a family member  that had dealt                                                                    
with a measles outbreak.                                                                                                        
2:25:03 PM                                                                                                                    
DENISE  DANIELLO, EXECUTIVE  DIRECTOR, ALASKA  COMMISSION ON                                                                    
AGING, spoke in support of  HB 310. The commission felt that                                                                    
the legislation was important for  Alaskans of all ages. The                                                                    
vaccinations would  help to keep  people healthy.  As people                                                                    
age,  their immune  systems  deplete  and the  immunizations                                                                    
would help  keep people healthy. Also  thanked committee for                                                                    
adding the shingles vaccine.                                                                                                    
MARIE  DARLIN,  AMERICAN  ASSOCIATION  OF  RETIRED  PERSONS-                                                                    
ALASKA, testified  in support of  HB 310. She  stressed that                                                                    
vaccinations  of  older  citizens was  an  effective  health                                                                    
procedure.   She   also   mentioned   grandparents   raising                                                                    
grandchildren,  and  felt  that this  legislation  was  very                                                                    
important for them and the state.                                                                                               
2:30:21 PM                                                                                                                    
Co-Chair Stoltze CLOSED public testimony.                                                                                       
Representative Edgmon  stated that  Dr. Hurlburt  had worked                                                                    
with one of his relatives.                                                                                                      
Vice-chair Fairclough  remarked that the fiscal  note stated                                                                    
that the State would replace  federal funds, so she wondered                                                                    
if there were  new listings in the area of  illness that had                                                                    
been added  or if were  they all covered under  the previous                                                                    
federal  program. Dr.  Hurlburt asked  to hear  the question                                                                    
Vice-chair  Fairclough restated  her question.  Dr. Hurlburt                                                                    
stated that the only added immunization was for HPV.                                                                            
Representative   Costello   spoke    in   support   of   the                                                                    
legislation.  She discussed  receiving immunizations  in the                                                                    
family  health  clinic.  She  asked   whether  there  was  a                                                                    
provision included  that would  allow people  with insurance                                                                    
to visit the public health clinic.                                                                                              
Dr. Hurlburt  responded that if an  individual had insurance                                                                    
that covered  the immunizations the  bill would  not provide                                                                    
funding for  those individuals. He  added that no  one would                                                                    
be denied care at a public health center.                                                                                       
2:38:07 PM                                                                                                                    
Representative  Neuman pointed  to  a vaccination  exemption                                                                    
form  that  listed  administrative  codes.  He  wondered  if                                                                    
refusal  to vaccinate  based on  a philosophical  standpoint                                                                    
would  be considered  an exemption  based  on religion.  Dr.                                                                    
Hurlburt   stated  that   some   parents  have   vaccination                                                                    
hesitancy. He  stressed that the  vaccine hesitancy  rate in                                                                    
Alaska was  9 percent, which  was the highest of  any state.                                                                    
He remarked  that Alaska  was number 42  in the  country for                                                                    
immunizations, and stressed that  there was work to continue                                                                    
efforts in thorough vaccinations.                                                                                               
Representative Neuman wondered  why there were immunizations                                                                    
required  as  listed on  page  3,  lines  4 through  9.  Dr.                                                                    
Hurlburt answered that the items  had been listed to clarify                                                                    
that there would not be a  change. He stressed that the list                                                                    
included  vaccinations  required   for  school  entries  and                                                                    
federal recommendations.  He furthered that  the recommended                                                                    
vaccinations for  adults were based  on the  perceived level                                                                    
of importance.                                                                                                                  
Representative  Doogan  referenced  the repeal  language  on                                                                    
page 4.  He wondered why  the program would  be discontinued                                                                    
in 2015.                                                                                                                        
2:45:44 PM                                                                                                                    
Co-Chair Stoltze  assumed that the sunset  date was standard                                                                    
for this kind of legislation.                                                                                                   
Representative Herron looked  to page 2, line  1, and stated                                                                    
that  the act  is  considered temporary.  He furthered  that                                                                    
time was needed to determine  what is best for Alaskans. The                                                                    
next  legislature  and  administration would  be  given  the                                                                    
chance to determine the next step.                                                                                              
Representative  Gara asked  about the  "shall" language.  He                                                                    
pointed to  page 2,  line 5. He  wondered whether  there was                                                                    
objection to  change "may" to "shall."  Dr. Hurlburt replied                                                                    
that  he was  not an  attorney. As  a reasonable  person, he                                                                    
believed the change would allow for flexibility.                                                                                
WILDA   LAUGHLIN,  LEGISLATIVE   LIAISON,   OFFICE  OF   THE                                                                    
COMMISSIONER,  DEPARTMENT  OF  HEALTH AND  SOCIAL  SERVICES,                                                                    
asked for a restatement of the question.                                                                                        
Representative Gara repeated his question.                                                                                      
Ms.  Laughlin deferred  the question  to  the Department  of                                                                    
Representative Gara  stated that he would  discuss the issue                                                                    
with  the Department  of  Law after  the  meeting, and  also                                                                    
speak to the issue on the  House floor, if the bill reported                                                                    
out of committee.                                                                                                               
Representative Neuman  asked whether anyone in  Alaska could                                                                    
visit a clinic and ask to receive the vaccinations                                                                              
2:49:53 PM                                                                                                                    
Ms. Laughlin deferred the question to Dr. Hurlburt.                                                                             
Dr.  Hurlburt  responded  that the  bill's  intent  was  for                                                                    
services for  Alaskan residents.  He believed the  issue may                                                                    
not be  clear and  that visitors  could potentially  get the                                                                    
Representative Neuman asked how the program would work.                                                                         
Dr.   Hurlburt   responded   that  the   vaccinations   were                                                                    
distributed to  the providers  at no  cost to  the recipient                                                                    
and  by  the  agreement  the provider  could  not  charge  a                                                                    
vaccination  fee; however  an  administration  fee could  be                                                                    
Ms.  Laughlin  noted  that the  department  was  working  on                                                                    
getting an answer from DOL.                                                                                                     
Mr. Morse  addressed an earlier  question, and  he discussed                                                                    
medical and religious waivers. He  stated that every student                                                                    
that was enrolled  in the public and  private school systems                                                                    
was  required to  be immunized,  therefore, the  requirement                                                                    
also  applied  to  correspondent students.  He  addressed  a                                                                    
question  related to  school age.  He explained  that school                                                                    
age was defined as age 6 through 19.                                                                                            
Representative  Wilson  asked   whether  children  receiving                                                                    
homeschooling  would  be exempt.  Mr.  Morse  read from  the                                                                    
bill, "before entry  into a state public  school district or                                                                    
a  non-public school  offering pre-elementary  through grade                                                                    
12." He stressed that the  requirement spoke of entry into a                                                                    
Co-Chair Stoltze  asked whether it  was entry into  a school                                                                    
building or  the system. Mr.  Morse clarified that it  was a                                                                    
school  system and  not a  "brick and  mortar" building.  He                                                                    
felt  that  if a  child  was  privately home-schooled,  that                                                                    
would not apply to a "school system."                                                                                           
2:55:30 PM                                                                                                                    
Vice-chair Fairclough  directed attention to  the Department                                                                    
of  Health  and  Social  Services fiscal  impact  note.  She                                                                    
detailed that  FY 13 through  FY 15 included  $4.496 million                                                                    
per year,  with $700,000  added from the  governor's current                                                                    
budget request.                                                                                                                 
Representative   Doogan  discussed   the  fiscal   note.  He                                                                    
wondered  whether the  money in  the  governor's budget  was                                                                    
subtracted or  added to the  $4.5 million.  Co-Chair Stoltze                                                                    
interjected that it was $5.1 million.                                                                                           
JILL  LEWIS, DEPUTY  DIRECTOR,  DIVISION  OF PUBLIC  HEALTH,                                                                    
DEPARTMENT  OF  HEALTH  AND SOCIAL  SERVICES,  asked  for  a                                                                    
repeat of the question.                                                                                                         
Representative  Doogan wondered  whether  the  money in  the                                                                    
governor's  budget  was  subtracted  or added  to  the  $4.5                                                                    
million. Ms.  Lewis replied that  the total amount  was $5.8                                                                    
million.  The current  budget included  $700,000 of  federal                                                                    
funds  and the  governor's budget  included $700,000  - both                                                                    
were subtracted from the amount which equaled $4.5 million.                                                                     
Representative Doogan  surmised that the actual  fiscal note                                                                    
would  include  amounts  that   were  actually  above  $$4.5                                                                    
million.  Ms. Lewis  replied that  there  was an  assumption                                                                    
that the federal funds would  continue to be provided, along                                                                    
with the governor's request.                                                                                                    
Representative Doogan believed it was a big assumption.                                                                         
Vice-chair Fairclough  stressed that the  governor's request                                                                    
for  the $700,000  was part  of  the base,  so it  currently                                                                    
existed in the  operating budget that had  passed the House.                                                                    
Ms. Lewis affirmed Vice-chair Fairclough's statement.                                                                           
Vice-chair Fairclough asked if  the fiscal note added $4.456                                                                    
million in  FY 13  through FY  15 to  the $700,000  from the                                                                    
federal  government,  the  additional  $630,000  of  general                                                                    
funds, plus the $70,000 of  federal match funds, for a grand                                                                    
total  of  $770,000  of federal  receipts  and  $630,000  of                                                                    
general fund receipts.                                                                                                          
Representative Wilson asked                                                                                                     
Ms. Lewis replied that the  bill provided flexibility to add                                                                    
or subtract vaccines to fit the available funding                                                                               
3:01:53 PM                                                                                                                    
Representative Wilson  asked if  there would  be flexibility                                                                    
in the  required list of  vaccinations. Ms.  Lewis responded                                                                    
that  under   the  conditions  listed   in  the   bill,  the                                                                    
flexibility was provided.                                                                                                       
Ms.  Laughlin  informed   the  committee  that  Commissioner                                                                    
Streur preferred  the "may" language,  but he  was concerned                                                                    
that  if there  was  a  lack of  funding  there  would be  a                                                                    
Representative Herron  stated that  the language on  page 3,                                                                    
line 19 was very important for the legislation.                                                                                 
Representative   Neuman  asked   whether  the   fiscal  note                                                                    
included money for advertising the immunizations.                                                                               
Ms. Lewis responded in the negative.                                                                                            
Representative Doogan  commented that the total  fiscal note                                                                    
was $5.9 million. He wanted  to make sure that the committee                                                                    
understood that there was a $6 million total.                                                                                   
Co-Chair Stoltze  believed the  comment was a  relevant part                                                                    
of the fiscal discussion.                                                                                                       
Vice-chair Fairclough  MOVED to report CSHB  310(FIN) out of                                                                    
committee   with   individual    recommendations   and   the                                                                    
accompanying fiscal  note. There being NO  OBJECTION, it was                                                                    
so ordered.                                                                                                                     
CSHB  310(FIN) was  REPORTED  out of  committee  with a  "do                                                                    
pass"  recommendation and  with one  new fiscal  impact note                                                                    
from Department of Health and Social Services.                                                                                  
3:05:24 PM                                                                                                                    
AT EASE                                                                                                                         
3:17:59 PM                                                                                                                    

Document Name Date/Time Subjects
HB310 Support Letters.pdf HFIN 4/3/2012 1:30:00 PM
HB 310
09 - HB 310 support letter Alaska Commission on Aging.pdf HFIN 4/3/2012 1:30:00 PM
HB 310
03 - HB 310 Leg Legal sectional analysis 37-LS1273.A.pdf HFIN 4/3/2012 1:30:00 PM
HB 310
02 - CS HB 310 (HSS) sponsor statement 27-LS1273.M.pdf HFIN 4/3/2012 1:30:00 PM
HB 310
05 - Alaska Health Care Commission 2011 Report exerpt.pdf HFIN 4/3/2012 1:30:00 PM
HB 310
4.5 - DHSSdph Epidemiology Bulletin 2010.10.19.pdf HFIN 4/3/2012 1:30:00 PM
HB 310
04 - DHSSdph Epidemiology Bulletin 2010.10.06.pdf HFIN 4/3/2012 1:30:00 PM
HB 310
HB310 CS WORKDRAFT 27-LS1273-I.pdf HFIN 4/3/2012 1:30:00 PM
HB 310
HB330 Amendments 1-2 Stoltze Gara.pdf HFIN 4/3/2012 1:30:00 PM
HB 330
CS HB 330 sponsor statement Version O 040312.pdf HFIN 4/3/2012 1:30:00 PM
HB 330
CS HB 330 sectional analysis Version O 040312.pdf HFIN 4/3/2012 1:30:00 PM
HB 330
CS HB 330 differences between EDC and FIN Version O 040312.pdf HFIN 4/3/2012 1:30:00 PM
HB 330
HB330 CS WORKDRAFT 27-LS110-O.pdf HFIN 4/3/2012 1:30:00 PM
HB 330