Legislature(2017 - 2018)HOUSE FINANCE 519

02/12/2018 01:30 PM FINANCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ HB 302 EXTEND: BOARD OF PROFESSIONAL COUNSELORS TELECONFERENCED
Moved HB 302 Out of Committee
-- Public Testimony --
+ HB 318 EXTEND: BOARD OF SOCIAL WORK EXAMINERS TELECONFERENCED
Moved CSHB 318(FIN) Out of Committee
-- Public Testimony --
+ HB 299 EXTEND: ALCOHOLIC BEVERAGE CONTROL BOARD TELECONFERENCED
<Bill Hearing Canceled>
<Pending Referral>
-- Public Testimony --
+ HB 323 EXTEND: BOARD OF PHARMACY TELECONFERENCED
Moved HB 323 Out of Committee
-- Public Testimony --
+ Bills Previously Heard/Scheduled TELECONFERENCED
HOUSE BILL NO. 323                                                                                                            
                                                                                                                                
     "An Act extending the termination date of the Board of                                                                     
     Pharmacy; and providing for an effective date."                                                                            
                                                                                                                                
Co-Chair Foster  invited Representative  Sullivan-Leonard to                                                                    
proceed with her presentation.                                                                                                  
                                                                                                                                
2:01:27 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE COLLEEN  SULLIVAN-LEONARD, SPONSOR, explained                                                                    
that HB  323 extended the  Pharmacy Board from June  2018 to                                                                    
June 2022. The adoption of  the bill would continue existing                                                                    
activities  by  the  board and  the  administration  by  the                                                                    
division.  She  highlighted  that Legislative  Audit  did  a                                                                    
review  of the  board's  operations and  determined that  it                                                                    
would be  in the  best interest  to extend  the board  for 4                                                                    
years through  June 30, 2022.  The board was comprised  of 7                                                                    
members.  She   elaborated  that  5  of   the  members  were                                                                    
pharmacists and  the other 2  were public members.  In March                                                                    
2018 the board would have  a full composition for the board.                                                                    
The board met 4 times yearly.                                                                                                   
                                                                                                                                
Representative  Sullivan-Leonard  continued that  the  board                                                                    
regulated  admission into  the  practice  of pharmacy.  They                                                                    
established  and   enforced  compliance   with  professional                                                                    
standards   and   adopted   regulations.  The   board   also                                                                    
established   and   maintained    a   controlled   substance                                                                    
prescription  database  as  well as  the  administration  of                                                                    
vaccines, emergency medications,  and opioid overdose drugs.                                                                    
It  oversaw  licensing  of  pharmacists,  pharmacy  interns,                                                                    
pharmacy technicians,  and pharmacies. It  oversaw wholesale                                                                    
drug distributors located inside and  outside the state if a                                                                    
pharmacy  shipped, mailed,  or delivered  prescription drugs                                                                    
within Alaska. She conveyed the available testifiers.                                                                           
                                                                                                                                
Representative Wilson  asked the board  chair if he  saw any                                                                    
reason  why the  legislature  should not  provide an  8-year                                                                    
extension to the board.                                                                                                         
                                                                                                                                
LEIF  HOLM,  CHAIR,  BOARD  OF  PHARMACY,  NORTH  POLE  (via                                                                    
teleconference), offered  that he  would agree more  with an                                                                    
8-year extension. The board had  accepted a 4-year extension                                                                    
based on some  conversations back and forth.  Some wanted to                                                                    
see how the new  prescription drug monitoring program (PDMP)                                                                    
legislation  went  through.  how  it was  managed,  and  the                                                                    
effect  it had  on opioids  and the  general running  of the                                                                    
PDMP. It appeared that the  auditors would prefer to look at                                                                    
the  issue in  4 years  again as  opposed to  waiting for  8                                                                    
years. He  suggested that all  of the changes that  had been                                                                    
made legislatively  with the PDMP,  there was nothing  but a                                                                    
positive direction  it would go  in. He did not  foresee any                                                                    
issues going  forward. He  thought 8 years  would be  a fair                                                                    
number of year but would accept 4.                                                                                              
                                                                                                                                
Representative  Wilson asked  if  the board  had any  issues                                                                    
implementing new statutes or regulations in the past.                                                                           
                                                                                                                                
Mr.  Holm  responded  that  the   pharmacy  world  was  ever                                                                    
evolving. It was  difficult to keep up with  the changes. He                                                                    
hoped  to get  the  help  needed to  keep  up with  industry                                                                    
trends,  standards,  and  legislative changes.  Any  changes                                                                    
required of the industry  through Alaska's State Legislature                                                                    
had not been  difficult to get through  besides the standard                                                                    
hang-ups  of  legal and  law.  In  answer to  Representative                                                                    
Wilson's question he  would say no. However,  as an industry                                                                    
as a whole,  it was consistently struggling to  keep up with                                                                    
industry standards and changes.                                                                                                 
                                                                                                                                
2:06:36 PM                                                                                                                    
                                                                                                                                
Representative  Guttenberg   asked  if,  with   the  state's                                                                    
prescription  drug manager  dispensing  drugs, the  business                                                                    
bifurcated.  In  other  words,   was  one  side  a  licensed                                                                    
pharmacy and the other side a  PBM that was not regulated at                                                                    
all.                                                                                                                            
                                                                                                                                
Mr. Holm  responded affirmatively. It was  not necessarily a                                                                    
board issue,  but it was  the current  situation. Nationwide                                                                    
PBM were not  under any kind of regulation or  rules. It was                                                                    
an issue he was dealing with in pharmacy.                                                                                       
                                                                                                                                
2:07:29 PM                                                                                                                    
                                                                                                                                
Representative  Kawasaki asked  about the  Legislative Audit                                                                    
review. Mr.  Holm had relayed the  pharmacy regulations were                                                                    
changing rapidly. One of the  big changes that came under SB                                                                    
74  [Legislation  passed  in  2016,  Short  Title:  Medicaid                                                                    
Reform;  Telemedicine; Drug  Database] was  that pharmacists                                                                    
had  to  register  with   the  prescription  drug  database.                                                                    
Failure  to  do   so  was  against  the   law  and  required                                                                    
disciplinary  action.  He asked  if  the  board had  had  to                                                                    
discipline  any pharmacists  that were  not registered  with                                                                    
the database.                                                                                                                   
                                                                                                                                
Mr.  Holm responded  in the  negative.  The requirement  for                                                                    
everyone to register  was still fairly new.  They were still                                                                    
monitoring   who  had   not  registered   and  sending   out                                                                    
notifications about  registering. He  considered it  a grace                                                                    
period trying to get everyone  onboard. The board was having                                                                    
a good  response. However,  there were  people who  were not                                                                    
aware of the requirement presently.                                                                                             
                                                                                                                                
Representative Kawasaki  noted that  the division  had found                                                                    
it was difficult to find  out which specific dispensers were                                                                    
not submitting  the required  information. It  was difficult                                                                    
to determine who needed to  be sanctioned and brought to the                                                                    
board's  attention.  He asked  if  it  had been  Mr.  Holm's                                                                    
observation as a board member.                                                                                                  
                                                                                                                                
Mr. Holm  responded in  the negative.  He reported  that the                                                                    
board  was making  several changes  through the  vendor with                                                                    
the PDMP based on the  new requirements. He indicated it had                                                                    
not been that  long that the requirement had  been in place.                                                                    
However,  everyone  had been  required  to  upload for  some                                                                    
time. As  a board  member, he had  not received  any reports                                                                    
showing  who was  not uploading  data.  He had  not heard  a                                                                    
report from the  vendor or the state that  anyone was having                                                                    
trouble determining who  was not uploading. He  had not seen                                                                    
such a report.                                                                                                                  
                                                                                                                                
Co-Chair  Foster  asked  Ms. Curtis  to  present  the  audit                                                                    
findings.                                                                                                                       
                                                                                                                                
KRIS  CURTIS,   LEGISLATIVE  AUDITOR,  ALASKA   DIVISION  OF                                                                    
LEGISLATIVE AUDIT,  referred to the legislative  audit dated                                                                    
August 2017.  She reported that Legislative  Audit concluded                                                                    
that  the  board  was  serving   the  public's  interest  by                                                                    
effectively licensing  and regulating  pharmacists, pharmacy                                                                    
interns,  pharmacy  technicians, in-state  pharmacies,  drug                                                                    
rooms,  and  wholesale  distributors.  Board  meetings  were                                                                    
conducted in accordance  with state law. The  board was also                                                                    
active in amending regulations to  improve the industry. She                                                                    
noted that  page 9 was  the schedule of  licensing activity.                                                                    
She reported that by the end  of March 2017 there were 3,447                                                                    
licensees,  a  33 percent  increase  since  the 2009  sunset                                                                    
audit.  She  indicated  that  a  schedule  of  revenues  and                                                                    
expenditures was  in page  10. There was  a surplus  of just                                                                    
over $275,000 at  the end of FY 17. The  schedule of license                                                                    
fees was  on page  11. According to  DCBPL management  a fee                                                                    
analysis was scheduled for the end of 2017.                                                                                     
                                                                                                                                
Ms. Curtis  continued that although her  division found that                                                                    
the board  was serving  the public's  interest, it  was only                                                                    
recommending a 4-year extension. It  was in recognition of a                                                                    
very  significant   statutory  changes  that   had  recently                                                                    
occurred  that expanded  the board's  duties in  relation to                                                                    
the   controlled   substance  prescription   database.   She                                                                    
highlighted   that   page   3   contained   the   background                                                                    
information section, which was  where Legislative audit went                                                                    
through  the  database.  She indicated  that  the  Board  of                                                                    
Pharmacy  was  required to  establish  a  database in  2008.                                                                    
Statutes required  that dispensers of  controlled substances                                                                    
electronically submit information  on each prescription that                                                                    
they dispensed.  The database collected the  information and                                                                    
was  supposed  to  allow pharmacists  and  practitioners  to                                                                    
review   prescription  history   prior  to   prescribing  or                                                                    
administering medication or controlled substances.                                                                              
                                                                                                                                
Ms.  Curtis  relayed  that  statute  also  stated  that  the                                                                    
database might be used to  monitor prescribing practices and                                                                    
patterns   to   identify    practitioners   who   prescribed                                                                    
controlled  substances  in  an  unlawful  or  unprofessional                                                                    
manner,   identify   individuals   who  might   be   abusing                                                                    
controlled  substances, and  identify individuals  who might                                                                    
be presenting forgeries or  otherwise false prescriptions to                                                                    
a pharmacy.                                                                                                                     
                                                                                                                                
Ms.  Curtis  reported  that there  were  several  structural                                                                    
problems  with  the  2008  law  and were  very  slow  to  be                                                                    
addressed. Legislative  Audit grouped  the problems in  to 2                                                                    
different areas beginning on page  4. The first area was the                                                                    
completeness of information.  As Representative Kawasaki had                                                                    
discussed,  there was  no way  to identify  the universe  of                                                                    
individuals  that  were  supposed  to be  reporting  to  the                                                                    
database. As  such, the board  stated that they  were unable                                                                    
to identify  the completeness of  the information.  They had                                                                    
to  report  annually to  the  legislature.  There were  some                                                                    
statistics  being  reported.  It  was clear  the  board  was                                                                    
having some  problems getting people to  submit information.                                                                    
Regulations that they put in  at that point required monthly                                                                    
reporting. It was in no way timely enough to be useful.                                                                         
                                                                                                                                
Ms.  Curtis  moved  to the  second  area  Legislative  Audit                                                                    
grouped was the use of  information. The law did not require                                                                    
practitioners or  pharmacists to consult the  database prior                                                                    
to prescribing or dispensing. It  was totally voluntary. The                                                                    
board was advised  by the Department of Law  that they could                                                                    
not forward  information to a  pharmacist or  a practitioner                                                                    
because  it would  be considered  an unsolicited  report and                                                                    
therefore, illegal. Consequently, the  board did not analyze                                                                    
the information  and it  was not  used to  identify unlawful                                                                    
practices or patterns.                                                                                                          
                                                                                                                                
Ms. Curtis  spoke about there  being some recent  changes to                                                                    
address the problems.  Currently, prescribers and dispensers                                                                    
had  to  register  with  the  database,  and  the  Board  of                                                                    
Pharmacy was  required to  notify other  occupational boards                                                                    
that  they  were licensee  registered.  It  allowed for  the                                                                    
identification   of   non-compliance    in   a   check   for                                                                    
completeness.  In  2018,  dispensers would  be  required  to                                                                    
submit  information to  the database  daily. Dispensers  and                                                                    
practitioners were now required  to check the database prior                                                                    
to  dispensing and  prescribing  with  some exclusions.  The                                                                    
board could  now provide unsolicited reports.  She commented                                                                    
that there were quite a few significant changes.                                                                                
                                                                                                                                
                                                                                                                                
Ms. Curtis continued  to page 12 of  the report. Legislative                                                                    
Audit  stated  that  with  the changes  the  board  was  now                                                                    
empowered   to  help   combat   the   abuse  of   controlled                                                                    
substances.  Given   that  the  changes  were   recent,  the                                                                    
division was unable,  as part of the audit,  to evaluate the                                                                    
degree  to  which  the  board  was  going  to  use  its  new                                                                    
authority to help serve the  public's interest. However, the                                                                    
division  could  say  that  the  DCBPL  management  did  not                                                                    
believe the  board should be  proactively analyzing  data to                                                                    
serve public health objectives.  She relayed that Department                                                                    
of Commerce,  Community and Economic  Development management                                                                    
stated  that additional  resources  would be  needed if  the                                                                    
legislature intended  for the board  to analyze data  and to                                                                    
become proactive in enforcing prescription drug laws.                                                                           
                                                                                                                                
Ms.   Curtis   detailed   that   the   report   included   2                                                                    
recommendations  for operational  improvements beginning  on                                                                    
page  14.   The  division   recommended  that   DCBPL  chief                                                                    
investigator  work   with  the   director  to   improve  the                                                                    
timeliness of investigations. There  were 20 cases that were                                                                    
open  for  over  180  days  during  the  audit  period.  The                                                                    
division  tested  13 of  them,  6  of them  had  unjustified                                                                    
periods of inactivity.  Those periods ranged from  51 to 184                                                                    
days. She  reported that  the cause of  the delay,  at least                                                                    
partially,  was   the  competing  priorities  of   the  main                                                                    
investigator assigned  to the board because  that individual                                                                    
was also  assigned to help  manage the  controlled substance                                                                    
prescription database.                                                                                                          
                                                                                                                                
2:16:49 PM                                                                                                                    
                                                                                                                                
Ms. Curtis  moved to the second  recommendation. Legislative                                                                    
Audit recommended that DCBPL  director improve procedures to                                                                    
ensure required  licensure documentation was  obtained prior                                                                    
to licensing.  The division tested 20  facility licenses and                                                                    
found  3 errors.  First, in  one  case, the  self-inspection                                                                    
report was  not submitted. In  one case, a  background check                                                                    
was not submitted. In another  case, an applicant had marked                                                                    
"Yes"  to a  professional fitness  question indicating  that                                                                    
their out-of-state  license had received a  citation against                                                                    
it and the  DCBPL staff had not follow-up on  the issue. The                                                                    
board  had  approved   the  licenses  appropriately  pending                                                                    
receipt of certain documentation. It  was the staff that had                                                                    
not followed through  and obtain it. She  furthered that the                                                                    
division  tested  25  individual   licenses  and  found  one                                                                    
instance  regarding a  pharmacy  intern where  there was  no                                                                    
support that their education had been met.                                                                                      
                                                                                                                                
                                                                                                                                
Ms. Curtis  conveyed that  responses to  the audit  began on                                                                    
page 45.  The governor's  office agreed  that the  board was                                                                    
serving the  public's interest and should  be extended. They                                                                    
did  not comment  on the  controlled substance  prescription                                                                    
database.  The department's  response was  on page  47. They                                                                    
agreed with  both recommendations.  Regarding recommendation                                                                    
1, the department reported  having implemented new procedure                                                                    
regarding  documentation  for  investigations  and  to  help                                                                    
ensure timeliness.  Regarding recommendation 2,  they agreed                                                                    
that additional  quality checks were  needed to  help ensure                                                                    
that  administrative records  were  complete. However,  they                                                                    
stated that additional supervisory  resources were needed in                                                                    
order to  ensure that  their standards  were met.  The board                                                                    
chair's response  was on page  49 and the chair  agreed with                                                                    
both recommendations.                                                                                                           
                                                                                                                                
2:18:37 PM                                                                                                                    
                                                                                                                                
Representative  Wilson commented  that both  recommendations                                                                    
had nothing  to do with what  the board was supposed  to do.                                                                    
It sounded like  it all came back to the  law passed in 2008                                                                    
that was  not written correctly.  She opined that  the board                                                                    
was being  penalized for a  law that  was made in  2008 that                                                                    
did not  give them all  of the  needed pieces. She  asked if                                                                    
her assessment was fair.                                                                                                        
                                                                                                                                
Ms.  Curtis  replied  that the  Legislative  Audit  Division                                                                    
viewed itself as a legislative  oversight agency. The sunset                                                                    
process was  designed to ensure  that the board  was serving                                                                    
the  public's  interest.  She   was  recommending  a  4-year                                                                    
extension because the  powers being given to  the board were                                                                    
very important powers. In the  audit process it was not able                                                                    
to  evaluate  the  degree  to   which  the  board  had  been                                                                    
effective  at  serving  the public's  interest.  It  was  an                                                                    
oversight mechanism  noting that Legislative  Audit believed                                                                    
it would be important to go  in earlier than 8 year. In this                                                                    
particular case,  given the importance  of the  opioid abuse                                                                    
in the public, the division thought  it was prudent to go in                                                                    
earlier.                                                                                                                        
                                                                                                                                
2:20:01 PM                                                                                                                    
                                                                                                                                
Representative Wilson wanted to return  to the issue that if                                                                    
the  law had  been  written correctly  in 2008,  Legislative                                                                    
Audit would have had enough time to make and evaluation.                                                                        
                                                                                                                                
Ms. Curtis was uncertain what  to say what Legislative Audit                                                                    
would have  done if  things had  been done  differently. She                                                                    
pointed  to page  6  which  had a  timeline  from 2008.  The                                                                    
board, legislature, and the  department were not responsive.                                                                    
All 3 entities  that worked together to ensure  that the law                                                                    
was carried  out did  not do  the best  job that  they could                                                                    
have. She  continued that  given where  society was  at, the                                                                    
division felt  it was  really important  to provide  as much                                                                    
information  to policy  makers as  possible as  part of  the                                                                    
audit.  She referred  to appendices  A  and B.  There was  a                                                                    
significant  amount of  where  things were  at  and to  what                                                                    
degree the original law had  been implemented. She indicated                                                                    
that board  was responsible  for procuring the  database and                                                                    
encountered  long  delays.  There  were  problems  with  the                                                                    
effectiveness  of the  database. Legislative  Audit believed                                                                    
that a  better job could  have been done during  those years                                                                    
but recognized  that part of  the issue was the  law itself.                                                                    
However,  the division  focused  going  forward. There  were                                                                    
currently in  place with additional legislation  proposed to                                                                    
further   assist   the   board   in   carrying   out   these                                                                    
responsibilities.                                                                                                               
                                                                                                                                
2:22:18 PM                                                                                                                    
                                                                                                                                
Representative   Kawasaki  thought   that  when   the  board                                                                    
extension came up  in 2009 and has had  an 8-year extension,                                                                    
the  legislature probably  should  not have  extended it  as                                                                    
long as it  did because of the current  issues. He furthered                                                                    
that it  was not just the  bill that passed in  2008, it was                                                                    
all the bills  subsequent to that time that  had changed the                                                                    
system  significantly,  including   SB  74  which  radically                                                                    
changed who got access to the  database. He added that SB 74                                                                    
also  had   the  pharmacy   registration  that   required  a                                                                    
pharmacist had  to become involved with  the database. There                                                                    
were many  changes that had occurred  recently. He concurred                                                                    
that a  4-year board  extension made  sense. He  preferred a                                                                    
shorter extension due  all that had been  done subsequent to                                                                    
the prescription drug database.                                                                                                 
                                                                                                                                
2:23:49 PM                                                                                                                    
                                                                                                                                
Representative Guttenberg  asked about Ms.  Curtis' comments                                                                    
about the board  not being proactive and did  not believe it                                                                    
should  be  proactive.  He  asked   Ms.  Curtis  to  further                                                                    
comment.                                                                                                                        
                                                                                                                                
Ms. Curtis  indicated that essentially the  database did not                                                                    
operate  as it  was  intended.  The board  was  not able  to                                                                    
analyze the data until the  legislative fixes happened. What                                                                    
she had said was that the  department did not believe it was                                                                    
the  board's responsibility  to  be  proactive in  analyzing                                                                    
data to help further  public health objectives. She reported                                                                    
that the staff  of Legislative Audit had  an internal debate                                                                    
about   whether   the   board   was  the   right   for   the                                                                    
responsibility.  Many   other  states  had   the  controlled                                                                    
substance database under  the board. She opined  that it was                                                                    
a policy  question. She did  not believe the board  had been                                                                    
effective.                                                                                                                      
                                                                                                                                
2:25:44 PM                                                                                                                    
                                                                                                                                
Representative Guttenberg  asked if it would  really make it                                                                    
effective.                                                                                                                      
                                                                                                                                
2:25:59 PM                                                                                                                    
                                                                                                                                
Co-Chair  Seaton mentioned  the  prescription drug  database                                                                    
and the procedures to analyze  them. The legislature had not                                                                    
mandated those  things at  the time. He  asked if  there was                                                                    
anything  that   had  prevented   the  board   from  passing                                                                    
regulations  to  implement  more strict  adherences  to  the                                                                    
intent of the database.                                                                                                         
                                                                                                                                
Ms. Curtis  responded that only regulations  could be passed                                                                    
to  implement the  statutes. The  statues, themselves,  were                                                                    
flawed by  not providing  them certain authority  or certain                                                                    
capabilities.                                                                                                                   
                                                                                                                                
2:26:49 PM                                                                                                                    
                                                                                                                                
SARA  CHAMBERS,  ACTING   DIRECTOR,  ALCOHOL  AND  MARIJUANA                                                                    
CONTROL  OFFICE,  DEPARTMENT   OF  COMMERCE,  COMMUNITY  AND                                                                    
ECONOMIC  DEVELOPMENT,  relayed  that the  fiscal  note  was                                                                    
similar  to the  previous 2  board extensions  heard in  the                                                                    
current day's  committee. The  amount was  $27,900, slightly                                                                    
more  than the  previous 2  bills, because  the board  had 7                                                                    
members  rather than  5.  The authority,  since  it was  all                                                                    
funded by  license fees, would  provide the  opportunity for                                                                    
the board  to meet 4  times a  year as required  in statute.                                                                    
The  money  also  paid  for  public  notices,  board  member                                                                    
training at conferences, and per diem.                                                                                          
                                                                                                                                
                                                                                                                                
2:27:47 PM                                                                                                                    
                                                                                                                                
Representative Wilson asked why the  board did not come back                                                                    
to the  legislature to  inform members  with an  update. She                                                                    
asked if the department had the ability to do so.                                                                               
                                                                                                                                
Ms.  Chambers   replied  that  until   SB  74  and   HB  159                                                                    
[Legislation    passed    in    2017    -    Short    Title:                                                                    
Opioids; Prescriptions;  Database;  Licenses] came  forward,                                                                    
the administrative support for the  board had not dug deeply                                                                    
into the intent.  The department was working  with the tools                                                                    
it   had.  The   legislature's   movement   to  expand   the                                                                    
prescription  drug  monitoring  program,  in  light  of  the                                                                    
public crisis,  helped reframe the  tools and  the abilities                                                                    
to  accomplish  those things.  The  question  that had  been                                                                    
posed  was whether  the Board  of Pharmacies  to proactively                                                                    
solve the opioid  crisis was the right place.  The board was                                                                    
a licensing board  made of pharmacists. The  2 very powerful                                                                    
bills   that   were   passed   brought   other   boards   of                                                                    
practitioners into the conversation.  However, at the end of                                                                    
the day, it was a question  of whether the Board of Pharmacy                                                                    
proactively  trying to  solve the  opioid crisis.  The board                                                                    
and  the department  were  working in  tandem  to work  with                                                                    
Department  of Health  and Social  Services to  provide them                                                                    
epidemiological experts  and the data they  needed to assist                                                                    
in moving the objective  forward. HoweverShe reported that a                                                                    
handful of  pharmacists and a  few public members  found the                                                                    
task to be  daunting. The department was looking  at ways to                                                                    
collaborate  and  accomplish  the   goals  within  the  new,                                                                    
reframed mandate.                                                                                                               
                                                                                                                                
2:30:18 PM                                                                                                                    
                                                                                                                                
Representative  Wilson  commented   that  a  shorter  sunset                                                                    
period  was not  needed to  be  proactive in  make a  policy                                                                    
call. It  was a policy call  by the legislature and  not the                                                                    
board. She asked if she was correct.                                                                                            
                                                                                                                                
Ms. Chambers responded affirmatively.                                                                                           
                                                                                                                                
Representative Wilson suggested that  whether the sunset was                                                                    
in 4 years  or 8 years, the department  could always suggest                                                                    
legislation or suggest  to the legislature to look  at it if                                                                    
it was  not the right policy.   She thought it  was separate                                                                    
from looking  at whether  it was  in the  public's interest.                                                                    
She was  certain that in  4 years it  would still be  in the                                                                    
public's  interest to  have  the board.  She  wondered if  a                                                                    
longer sunset  would prevent the department  or the governor                                                                    
from coming back and suggesting needed changes.                                                                                 
                                                                                                                                
Ms.   Chambers   responded   that  those   decisions   would                                                                    
ultimately be  made at the  level of the  governor's office.                                                                    
Until  those  decisions   and  priorities  were  articulated                                                                    
through   the  governor's   office,  the   department  would                                                                    
continue with the mandate before the department.                                                                                
                                                                                                                                
2:31:46 PM                                                                                                                    
                                                                                                                                
Co-Chair  Seaton noted  the  policy question  Representative                                                                    
Wilson  was  discussing  was  where   the  board  should  be                                                                    
located. He asked how things were normally handled.                                                                             
                                                                                                                                
Ms.  Chambers   replied  that   the  department   very  much                                                                    
appreciated the  work of the legislative  auditors. Feedback                                                                    
was a  gift of  awareness. She  informed the  committee that                                                                    
there  were several  federal grants  through DHSS  which set                                                                    
forward  performance   measures  to  test   against  whether                                                                    
policies,  procedures,  data  collection, and  the  analysis                                                                    
were  working  well.  She  noted   that  with  the  enhanced                                                                    
responsibilities, the division had  retched up analyzing the                                                                    
job being done by the  depart and board together. There were                                                                    
internal mechanisms  to determine how things  were going. It                                                                    
was an  early stage  with the new  expanded responsibilities                                                                    
that it would  likely take another year or  so before having                                                                    
comprehensive data to see how  things were working. If there                                                                    
was  a fundamental  breakdown or  an inability  to meet  the                                                                    
requirements of  statute the  department would  likely bring                                                                    
forward to address the public health needs of the state.                                                                        
                                                                                                                                
2:34:23 PM                                                                                                                    
                                                                                                                                
Co-Chair Foster OPENED and CLOSED Public Testimony.                                                                             
                                                                                                                                
Representative    Wilson   MOVED    to   ADOPT    Conceptual                                                                    
Amendment 1:                                                                                                                    
                                                                                                                                
     Page 1, Line 5:                                                                                                            
                                                                                                                                
          Delete: 2022                                                                                                          
          Insert: 2026                                                                                                          
                                                                                                                                
Co-Chair Seaton OBJECTED for discussion.                                                                                        
                                                                                                                                
Representative Wilson  spoke to  her amendment.  She thought                                                                    
the board would do what was necessary.                                                                                          
                                                                                                                                
2:36:51 PM                                                                                                                    
                                                                                                                                
Representative   Kawasaki  commented   that  regarding   the                                                                    
amendment, the legislature was not  penalizing the board. He                                                                    
thought it was  a recognition that the  legislature passed a                                                                    
sunset  bill in  2009 before  the regulation  came out  that                                                                    
completely  changed the  responsibilities of  the board.  He                                                                    
did not believe  the legislature would not have  given an 8-                                                                    
year  sunset had  it known  there  were significant  changes                                                                    
coming   through  the   prescription   drug  database.   The                                                                    
committee had heard  from the chair of the  board that there                                                                    
were   several  changes   going   on   within  the   current                                                                    
administration.  The  board  spanned 3  administrations.  He                                                                    
reemphasized  that  the  committee was  not  penalizing  the                                                                    
board  but looking  closely of  the details  of the  present                                                                    
audit. He  anticipated implementing some rules  around them.                                                                    
He  though the  prescription drug  management database  were                                                                    
very important  and should be  looked at within 2  years. He                                                                    
thought   waiting   8   years  would   be   abrogating   the                                                                    
legislature's  responsibilities.  Although  the  legislature                                                                    
could look  at the board at  any time, often times  the only                                                                    
time  legislators  reviewed  them   was  when  the  saw  the                                                                    
recommendations from the chief  auditor. He would stand with                                                                    
the 4-year sunset as proposed by the legislative auditor.                                                                       
                                                                                                                                
2:39:08 PM                                                                                                                    
                                                                                                                                
Representative Wilson thought the  board was being penalized                                                                    
for legislation  passed in 2008  that the board did  not ask                                                                    
for.  She surmised  that had  the  legislation been  written                                                                    
correctly, the  right things would  have been in  place. She                                                                    
had faith in the department  that it would be monitoring the                                                                    
board. It  was a  question whether the  legislature believed                                                                    
that  the  department would  come  forward  if there  was  a                                                                    
problem. She would put her confidence in the board.                                                                             
                                                                                                                                
2:40:30 PM                                                                                                                    
                                                                                                                                
Co-Chair Seaton  did not  believe it was  a penalty  for the                                                                    
legislature to  get an audit. The  legislative auditors went                                                                    
through what was  happening in very fine  detail. He thought                                                                    
if  the legislature  had  had a  4-year  sunset, the  issues                                                                    
would not  have waited  until SB 74  was passed.  They would                                                                    
have been brought  to the attention of  the legislature much                                                                    
earlier.  Each  one of  the  departments  came forward  with                                                                    
recommendations that the legislature  had not seen. An audit                                                                    
was the way  in which the legislature  determined issues. He                                                                    
would be opposing the amendment.                                                                                                
                                                                                                                                
Representative  Guttenberg would  be opposing  the amendment                                                                    
as well. He  relayed that the boards  and commissions worked                                                                    
for  the legislature.  They happened  to function  under the                                                                    
executive department. The audits  were critical to informing                                                                    
the legislature about  what they were doing.  He thought the                                                                    
legislature,  the governor,  and  the  executive office  had                                                                    
created a  difficult situation. He  spoke of  audits showing                                                                    
difficulties.  He thought  the audit  revealed a  convoluted                                                                    
series of  legislation requirements that had  been difficult                                                                    
to  deal with.  He  did not  want to  wait  any longer  than                                                                    
necessary to  see the results  of their success.  He thought                                                                    
it  was  important  through  the audit  process  to  see  if                                                                    
something was working.  It was not a  penalization. He would                                                                    
be opposing the amendment.                                                                                                      
                                                                                                                                
2:43:42 PM                                                                                                                    
                                                                                                                                
Representative   Wilson    thought   the    discussion   was                                                                    
enlightening. She argued  that waiting for an  audit to have                                                                    
a  discussion  about  a  serious issue  did  not  work.  She                                                                    
suggested  perhaps   only  a  1-year  extension   should  be                                                                    
granted.  She was  concerned that  the board  had an  8-year                                                                    
extension.  She  relayed  that  the  2  recommendations  had                                                                    
nothing to do with the board.  She believed in the board and                                                                    
the department  and that they  would do what was  needed. If                                                                    
something could  not be  done, she  thought they  would come                                                                    
back to the legislature, even  before the 4-year sunset. The                                                                    
bill was  a sunset bill. She  would be voting yes  on the 8-                                                                    
year amendment  because of  her faith in  the board  and the                                                                    
department.                                                                                                                     
                                                                                                                                
Co-Chair Seaton MAINTAINED his OBJECTION.                                                                                       
                                                                                                                                
A roll call vote was taken on the motion.                                                                                       
                                                                                                                                
IN FAVOR: Thompson, Tilton, Wilson                                                                                              
OPPOSED: Guttenberg, Kawasaki,  Ortiz, Pruitt, Gara, Seaton,                                                                    
Foster                                                                                                                          
                                                                                                                                
Representative Grenn was absent from the vote.                                                                                  
                                                                                                                                
The MOTION to ADOPT Conceptual Amendment 1 FAILED (3/7).                                                                        
                                                                                                                                
2:46:39 PM                                                                                                                    
                                                                                                                                
Co-Chair Seaton MOVED to report HB 323 out of Committee                                                                         
with individual recommendations and the accompanying fiscal                                                                     
note.                                                                                                                           
                                                                                                                                
There being NO OBJECTION, it was so ordered.                                                                                    
                                                                                                                                
HB 323 was REPORTED out of committee with a "do pass"                                                                           
recommendation and with a previously published fiscal                                                                           
impact note: FN1(CED).                                                                                                          
                                                                                                                                
Co-Chair Foster reviewed the agenda for the following                                                                           
meeting.                                                                                                                        
                                                                                                                                

Document Name Date/Time Subjects
HB 318 Amendment #1 A.1.pdf HFIN 2/12/2018 1:30:00 PM
HB 318
HB318 Sponsor Statement 2.7.2018.pdf HFIN 2/12/2018 1:30:00 PM
HB 318
HB 318 Social-Work-Final-Report-WEB.pdf HFIN 2/12/2018 1:30:00 PM
HB 318
HB302 Sponsor Statement 1.30.18.pdf HFIN 2/12/2018 1:30:00 PM
HB 302
HB 302 Audit BPC-Final-Report-WEB.pdf HFIN 2/12/2018 1:30:00 PM
HB 302
HB 323 Audit Pharmacy-FINAL-Report-WEB.pdf HFIN 2/12/2018 1:30:00 PM
HB 323
HB323 Support Letter 2.5.18.pdf HFIN 2/12/2018 1:30:00 PM
HB 323
HB323 Sectional Analysis 2.2.18.pdf HFIN 2/12/2018 1:30:00 PM
HB 323
HB323.SponsorStatement.verD.2.2.18.pdf HFIN 2/12/2018 1:30:00 PM
HB 323