Legislature(2019 - 2020)ADAMS ROOM 519

04/30/2019 01:30 PM FINANCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Recessed to 6:00 pm --
+ SB 36 EXTEND BOARD OF NURSING TELECONFERENCED
Heard & Held
-- Public Testimony --
+ SB 37 RENEWAL OF VACCINE ASSESSMENT PROGRAM TELECONFERENCED
Heard & Held
-- Public Testimony --
+= HB 49 CRIMES; SENTENCING;MENT. ILLNESS;EVIDENCE TELECONFERENCED
Scheduled but Not Heard
+= HB 145 PROPERTY CRIME; MOTOR VEHICLE THEFT TOOLS TELECONFERENCED
Scheduled but Not Heard
<Pending Referral>
+ Bills Previously Heard/Scheduled TELECONFERENCED
+= HB 20 SEXUAL ASSAULT EXAMINATION KITS TELECONFERENCED
Scheduled but Not Heard
                  HOUSE FINANCE COMMITTEE                                                                                       
                      April 30, 2019                                                                                            
                         1:30 p.m.                                                                                              
                                                                                                                                
1:30:34 PM                                                                                                                    
                                                                                                                                
CALL TO ORDER                                                                                                                 
                                                                                                                                
Co-Chair Wilson  called the House Finance  Committee meeting                                                                    
to order at 1:30 p.m.                                                                                                           
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Neal Foster, Co-Chair                                                                                            
Representative Tammie Wilson, Co-Chair                                                                                          
Representative Jennifer Johnston, Vice-Chair                                                                                    
Representative Dan Ortiz, Vice-Chair                                                                                            
Representative Ben Carpenter                                                                                                    
Representative Andy Josephson                                                                                                   
Representative Gary Knopp                                                                                                       
Representative Bart LeBon                                                                                                       
Representative Kelly Merrick                                                                                                    
Representative Colleen Sullivan-Leonard                                                                                         
Representative Cathy Tilton                                                                                                     
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
None                                                                                                                            
                                                                                                                                
ALSO PRESENT                                                                                                                  
                                                                                                                                
Jane Conway,  Staff, Senator  Cathy Giessel;  Sara Chambers,                                                                    
Director,   Division    of   Corporations,    Business   and                                                                    
Professional  Licensing, Department  of Commerce,  Community                                                                    
and Economic Development;  Kris Curtis, Legislative Auditor,                                                                    
Alaska  Division of  Legislative Audit;  Jill Lewis,  Deputy                                                                    
Director, Division  of Public  Health, Department  of Health                                                                    
and  Social Services;  Dr. Lily  Lou,  Alaska State  Medical                                                                    
Officer,  Department of  Health and  Social Services;  David                                                                    
Teal, Director, Legislative Finance Division.                                                                                   
                                                                                                                                
PRESENT VIA TELECONFERENCE                                                                                                    
                                                                                                                                
Chris  Logan,  Alaska   Advance  Practice  Registered  Nurse                                                                    
Association   Alliance,   Anchorage;   Lynn   Hartz,   Self,                                                                    
Anchorage;   Karen   Morton,  Alaska   Nurses   Association,                                                                    
Soldotna;  Irina  Obolentseva,  Self, Delta  Junction;  Anna                                                                    
Goncharova, Self,  Delta Junction;  John Zasada,  AK Primary                                                                    
Care Association, Anchorage; Roslayn Singleton, Self, ANC.                                                                      
                                                                                                                                
SUMMARY                                                                                                                       
                                                                                                                                
HB 20       SEXUAL ASSAULT EXAMINATION KITS                                                                                     
                                                                                                                                
            HB 20 was SCHEDULED but not HEARD.                                                                                  
                                                                                                                                
HB 49       CRIMES; SENTENCING;MENT. ILLNESS;EVIDENCE                                                                           
                                                                                                                                
            HB 49 was SCHEDULED but not HEARD.                                                                                  
                                                                                                                                
SB 36       EXTEND BOARD OF NURSING                                                                                             
                                                                                                                                
            SB 36 was HEARD and HELD in committee for                                                                           
            further consideration.                                                                                              
                                                                                                                                
SB 37       RENEWAL OF VACCINE ASSESSMENT PROGRAM                                                                               
                                                                                                                                
            SB 37 was HEARD and HELD in committee for                                                                           
            further consideration.                                                                                              
                                                                                                                                
Co-Chair Wilson reviewed the agenda for the meeting.                                                                            
                                                                                                                                
SENATE BILL NO. 36                                                                                                            
                                                                                                                                
     "An Act extending the termination date of the Board of                                                                     
     Nursing; and providing for an effective date."                                                                             
                                                                                                                                
1:31:18 PM                                                                                                                    
                                                                                                                                
JANE CONWAY,  STAFF, SENATOR  CATHY GIESSEL,  explained that                                                                    
the  sponsor could  not  be present,  as  she was  attending                                                                    
Floor  Session. She  explained that  the  bill extended  the                                                                    
Board of  Nursing for  six years.  Otherwise, the  board was                                                                    
set  to expire  on June  30, 2019.  She provided  additional                                                                    
details  of the  bill.  The board  was  established for  the                                                                    
purpose of  regulating the practice of  nursing; and covered                                                                    
advance-practice  registered   nurses,  nurse  anesthetists,                                                                    
registered nurses, licensed  practical nurses, and certified                                                                    
nurse aides (CNA).                                                                                                              
                                                                                                                                
Ms.  Conway  continued  that the  board  had  almost  20,000                                                                    
licensees,  which  she thought  was  near  to one-third  the                                                                    
workload of professional licensees.                                                                                             
Co-Chair Wilson  clarified she was  addressing SB  36 rather                                                                    
than SB 37.                                                                                                                     
                                                                                                                                
Ms.   Conway  discussed   education  requirements   for  the                                                                    
licensees,  which  spanned  from  high  school  diplomas  to                                                                    
doctoral  degrees. The  board  of  seven individuals  served                                                                    
four-year terms  and were capped  at two  consecutive terms.                                                                    
The board's mission was to  actively promote and protect the                                                                    
health  of citizens  of Alaska  through  safe and  effective                                                                    
practice of nursing as defined  by law. The 2018 audit cited                                                                    
four recommendations. She  indicated the legislative auditor                                                                    
was  present  to  provide  the  audit  findings.  The  board                                                                    
received its  revenue from licensing  and renewal  fees, and                                                                    
deficits were shown  on page 11 of the audit.  The board was                                                                    
self-sustaining and required no  general funds. The audit of                                                                    
the board  concluded that  the board  continued to  meet its                                                                    
mission and recommended its six-year sunset.                                                                                    
                                                                                                                                
1:34:33 PM                                                                                                                    
                                                                                                                                
Co-Chair  Wilson  asked  about  page 11  of  the  audit.  It                                                                    
appeared there  was a  deficit for the  board for  the first                                                                    
time. She wondered why.                                                                                                         
                                                                                                                                
Ms.  Conway  believed  there  had been  a  large  influx  of                                                                    
licensees.  There  would  be  a fee  analysis  in  May.  She                                                                    
thought the division director could provide more detail.                                                                        
                                                                                                                                
Representative  Josephson had  been told  the board  did not                                                                    
have an  executive administrator at present.  He wondered if                                                                    
the position would be filled in the near future.                                                                                
                                                                                                                                
Ms.  Conway  thought the  board  was  actively pursuing  the                                                                    
recruitment of the position.                                                                                                    
                                                                                                                                
1:36:37 PM                                                                                                                    
                                                                                                                                
SARA CHAMBERS, DIRECTOR,  DIVISION OF CORPORATIONS, BUSINESS                                                                    
AND   PROFESSIONAL   LICENSING,  DEPARTMENT   OF   COMMERCE,                                                                    
COMMUNITY  AND  ECONOMIC  DEVELOPMENT,  responded  that  the                                                                    
department  was   actively  recruiting  for   the  executive                                                                    
administrator position which would close the following day.                                                                     
                                                                                                                                
Representative Josephson thought  the board consisted almost                                                                    
entirely   of  new   members.  He   referenced  telemedicine                                                                    
regulations  and asked  if Ms.  Chambers  could explain  the                                                                    
turnover.                                                                                                                       
                                                                                                                                
Ms. Chambers was unsure of  the reason for the turnover. She                                                                    
assured the  committee that every  effort was being  made to                                                                    
bring new members up to speed and avoid a gap in service.                                                                       
                                                                                                                                
Co-Chair  Wilson directed  Ms.  Chambers to  respond to  her                                                                    
query about the deficit.                                                                                                        
                                                                                                                                
Ms.  Chambers informed  that she  had  submitted an  updated                                                                    
fiscal  report  to the  committee  on  the previous  Friday,                                                                    
while the  audit was  a year  old. She  detailed that  as of                                                                    
March  30, 2019,  the board  had a  $1 million  surplus. The                                                                    
funds  were  adequate  to  maintain  the  licensing  program                                                                    
activities for  a biennial licensing period.  She noted that                                                                    
page  11 of  the audit  was based  on a  time just  before a                                                                    
renewal period. She stated that it  was not unusual to see a                                                                    
flux of funds based on the schedule of renewals.                                                                                
                                                                                                                                
Co-Chair Wilson asked for the document date.                                                                                    
                                                                                                                                
Ms.  Chambers answered  that the  latest  document that  was                                                                    
provided was for  the end of the third quarter  and showed a                                                                    
$1,441,000 surplus as of March 30, 2019.                                                                                        
                                                                                                                                
1:39:17 PM                                                                                                                    
AT EASE                                                                                                                         
                                                                                                                                
1:40:06 PM                                                                                                                    
RECONVENVED                                                                                                                     
                                                                                                                                
KRIS  CURTIS,   LEGISLATIVE  AUDITOR,  ALASKA   DIVISION  OF                                                                    
LEGISLATIVE AUDIT,  reported that  the audit  concluded that                                                                    
the board  was serving the  public interest. The  audit also                                                                    
concluded  that  the  board was  not  serving  the  public's                                                                    
interest by not establishing  telehealth regulations; by not                                                                    
adequately  monitoring CNA  training  programs;  and by  not                                                                    
notifying  the   appropriate  entities  when   a  licensee's                                                                    
prescriptive  authority  had  been  suspended,  revoked,  or                                                                    
surrendered. The  audit also found  that there needed  to be                                                                    
improvements in  the investigative  process of  the Division                                                                    
of  Corporations, Business  and Professional  Licensing. The                                                                    
audit recommended extension of the board for six years.                                                                         
                                                                                                                                
Ms.  Curtis  directed  attention  to page  7  of  the  audit                                                                    
report,  which showed  licensing activity  and a  46 percent                                                                    
increase in  activity since the previous  2010 sunset audit.                                                                    
The amount  of applications reflected a  growing occupation.                                                                    
She noted that the schedule of expenditures was on page 11                                                                      
of the audit. She made note of the $337,000 deficit as of                                                                       
March 2018. She continued that the fees were adjusted.                                                                          
                                                                                                                                
Ms. Curtis referenced page 14 of the audit which contained                                                                      
the recommendations from the Division of Legislative Audit.                                                                     
She read the four recommendations:                                                                                              
                                                                                                                                
     Recommendation No. 1:                                                                                                      
                                                                                                                                
     The  board  should  adopt regulations  to  address  the                                                                    
     distance   delivery   of   nursing   services   through                                                                    
     technology.                                                                                                                
                                                                                                                                
     The  board  has  permitted  the  distance  delivery  of                                                                    
     nursing  services via  technology (telehealth)  without                                                                    
     formal statutory  or regulatory  guidance. In FY  15, a                                                                    
     licensee approached  the board  and asked  for guidance                                                                    
     on  providing telehealth  services  which prompted  the                                                                    
     board  to  issue  an   advisory  opinion.  The  board's                                                                    
     advisory  opinion   defined  telehealth   and  provided                                                                    
     limited  guidance   on  the  scope  of   practice.  The                                                                    
     guidance  was  inadequate  to  promote,  preserve,  and                                                                    
     protect  the  public's  health,  safety,  and  welfare.                                                                    
     Although the  board discussed the need  for regulations                                                                    
     to  guide the  distance delivery  of nursing  services,                                                                    
     the board could not agree on regulatory language.                                                                          
                                                                                                                                
     Per   AS  08.68.100(a)(1),   the   board  shall   adopt                                                                    
     regulations  pertaining to  the  scope  of practice  of                                                                    
     nursing in  Alaska. Providing insufficient  guidance to                                                                    
     licensees  increases  the  risk  that  nurses  may  not                                                                    
     maintain acceptable  standards of  practice or  may not                                                                    
     adequately protect patients' confidentiality.                                                                              
                                                                                                                                
     We  recommend the  board adopt  regulations to  address                                                                    
     the  distance  delivery  of  nursing  services  through                                                                    
     technology.  Additionally,  the   board  should  ensure                                                                    
     statutes appropriately  allow for the  establishment of                                                                    
     telehealth regulations.                                                                                                    
                                                                                                                                
     Recommendation No. 2:                                                                                                      
                                                                                                                                
     The board  should take steps to  ensure the appropriate                                                                    
     entities  are notified  when a  licensee's prescriptive                                                                    
     authority is suspended, revoked, or surrendered.                                                                           
                                                                                                                                
     The  audit  identified  eight   APRNs  that  had  their                                                                    
     prescriptive    authority   suspended,    revoked,   or                                                                    
     surrendered  between  July  1, 2014,  and  January  31,                                                                    
     2018. In all cases, the  board did not notify the Board                                                                    
     of  Pharmacy  or  the Drug  Enforcement  Administration                                                                    
     (DEA)  about the  licensing action.  The entities  were                                                                    
     not  notified   because  there  were  no   statutes  or                                                                    
     regulations in place that require notification.                                                                            
                                                                                                                                
     The  board  is  established  under  AS  08.68  for  the                                                                    
     purpose of  controlling and regulating the  practice of                                                                    
     nursing, including:                                                                                                        
                                                                                                                                
     APRNs,  nurse  anesthetists, registered  nurses,  LPNs,                                                                    
     and  CNAs.  The  board's   mission  statement  is:  "to                                                                    
     actively  promote   and  protect  the  health   of  the                                                                    
     citizens  of  Alaska  through the  safe  and  effective                                                                    
     practice  of  nursing  as  defined   by  law."  Per  AS                                                                    
     17.30.200,  the Board  of Pharmacy  is responsible  for                                                                    
     administering  the  controlled  substance  prescription                                                                    
     database.  The  database  is  reviewed  by  pharmacists                                                                    
     prior   to  dispensing   controlled  substances,   with                                                                    
     certain  exceptions. Failure  to  notify  the Board  of                                                                    
     Pharmacy when prescriptive  authority has been revoked,                                                                    
     suspended,  or  surrendered  increases  the  risk  that                                                                    
     controlled substances may be abused or diverted.                                                                           
                                                                                                                                
     Per  federal law,  the DEA  may rescind  or revoke  the                                                                    
     federal  authority to  prescribe controlled  substances                                                                    
     if an  existing DEA registrant  loses his or  her state                                                                    
     privileges. Failure  to notify  the DEA that  an APRN's                                                                    
     prescriptive authority has  been suspended, revoked, or                                                                    
     surrendered  may  result  in improper  or  unauthorized                                                                    
     prescriptions.                                                                                                             
                                                                                                                                
     We  recommend  the  board  take  steps  to  ensure  the                                                                    
     appropriate  entities are  notified  when a  licensee's                                                                    
     prescriptive  authority   is  suspended,   revoked,  or                                                                    
     surrendered.                                                                                                               
                                                                                                                                
1:43:29 PM                                                                                                                    
                                                                                                                                
Ms. Curtis continued discussing the audit:                                                                                      
                                                                                                                                
     Recommendation No. 3:                                                                                                      
                                                                                                                                
     The  DCBPL  chief   investigator  should  ensure  nurse                                                                    
     investigations are adequately  documented and performed                                                                    
     timely.                                                                                                                    
                                                                                                                                
     The audit identified 13  investigations with periods of                                                                    
     unjustified  inactivity  and two  investigations  which                                                                    
     were inadequately documented. Specifically:                                                                                
                                                                                                                                
     Thirteen cases in  a random sample of  2810 had periods                                                                    
     of unjustified  inactivity ranging from 61  days to 3.6                                                                    
     years.  Furthermore, 10  of the  13 cases  had multiple                                                                    
     periods  of  inactivity.  The  periods  of  unjustified                                                                    
     inactivity were mainly due  to changes in investigative                                                                    
     staff assigned to the case and competing priorities.                                                                       
                                                                                                                                
     The long-term  care ombudsman identified  two licensees                                                                    
     for  investigation  that  were  potentially  practicing                                                                    
     outside a  LPN's scope of practice.  Auditors could not                                                                    
     evaluate   the  investigations   due  to   a  lack   of                                                                    
     documentation  in the  DCBPL case  fi les.  One of  the                                                                    
     licensees continued  to practice during the  four years                                                                    
     that the  investigation was open, potentially  posing a                                                                    
     risk to  public safety.  The DCBPL investigator  fi les                                                                    
     note  that  the two  cases  were  put in  storage  from                                                                    
     October 2012 until April 2014  due to an office remodel                                                                    
     and did not progress during that time.                                                                                     
                                                                                                                                
     Per  AS  08.01.050(a)(19),  DCBPL  is  responsible  for                                                                    
     investigating  and  monitoring  occupational  licensing                                                                    
     activity. Investigations  and complaints that  sit idle                                                                    
     for extended periods may pose a risk to public safety.                                                                     
                                                                                                                                
     We recommend the DCBPL  chief investigator ensure nurse                                                                    
     investigations are adequately  documented and performed                                                                    
     timely.                                                                                                                    
                                                                                                                                
     Recommendation No. 4:                                                                                                      
                                                                                                                                
     The  board  chair  should  take  steps  to  ensure  the                                                                    
     required  CNA  on-site  training  program  reviews  and                                                                    
     self-evaluations  are  conducted prior  to  reapproving                                                                    
     the programs.                                                                                                              
                                                                                                                                
     The audit found the  required self-evaluations were not                                                                    
     received and  on.notdefsite reviews were not conducted prior                                                             
     to board  re.notdefapproval of CNA training programs. During                                                             
     the  audit,  the process  to  approve  five of  22  CNA                                                                    
     training programs was reviewed.  Auditors found on site                                                                    
     reviews  were  not  conducted  for  four  of  the  five                                                                    
     programs    as   required    prior   to    re-approval.                                                                    
     Additionally,  self-evaluations were  not obtained  and                                                                    
     reviewed.  The board's  failure  to adequately  monitor                                                                    
     programs  may lead  to  undetected deficiencies,  which                                                                    
     could result in inadequately trained CNAs.                                                                                 
                                                                                                                                
     According   to  board   staff,   on-site  reviews   and                                                                    
     monitoring of self-evaluation  forms were not completed                                                                    
     timely  because the  contractor hired  to complete  the                                                                    
     reviews  was terminated  in FY  14, and  procurement to                                                                    
     hire  another  contractor  was  not  successful.  DCBPL                                                                    
     received  approval  for  a nurse  consultant  position,                                                                    
     which was  filled in October  2015; however,  the nurse                                                                    
     consultant  did  not  begin  performing  reviews  until                                                                    
     spring  2016.  Programs  were  approved  by  the  board                                                                    
     without  on-site visits  or self-evaluations  due to  a                                                                    
     lack of  resources to complete  the reviews and  a need                                                                    
     for the programs  to continue to be  available to train                                                                    
     CNAs.                                                                                                                      
                                                                                                                                
     Regulation  12  AAC  44.857(a)  and  (c)  requires  CNA                                                                    
     training  programs be  board-approved  every two  years                                                                    
     with  an on-site  review.  Self-evaluations  are to  be                                                                    
     completed during a  year in which an  on-site review is                                                                    
     not scheduled.                                                                                                             
                                                                                                                                
     We recommend the  board chair take steps  to ensure the                                                                    
     required  CNA  training  program  on-site  reviews  and                                                                    
     self-evaluations  are  conducted prior  to  reapproving                                                                    
     the programs.                                                                                                              
                                                                                                                                
1:46:22 PM                                                                                                                    
                                                                                                                                
Ms.  Curtis pointed  out that  the  department response  was                                                                    
found  on page  27  of  the audit.  The  department did  not                                                                    
comment on recommendations  1 and 4, which  were directed to                                                                    
the board. The department  agreed with recommendations 2 and                                                                    
3. Administrative procedures had  been implemented to notify                                                                    
the Board of  Pharmacy and the Drug  Enforcement Agency when                                                                    
licensing  action was  taken.  Additionally, procedures  had                                                                    
been  improved  to  help  improve   the  timeliness  of  the                                                                    
investigative process.  She added that the  board's response                                                                    
was found of page 29 of  the audit. The board did agree with                                                                    
all  four recommendations  and  planned  to take  corrective                                                                    
action.                                                                                                                         
                                                                                                                                
                                                                                                                                
Representative  Josephson   asked  about   the  telemedicine                                                                    
recommendation. He was  told that the board  had submitted a                                                                    
regulation  packet the  previous  fall and  wondered if  the                                                                    
auditor had seen it.                                                                                                            
                                                                                                                                
Ms. Curtis  informed that  the audit  was dated  April 2018.                                                                    
The board's response to the  audit indicated that it planned                                                                    
to take corrective action in November 2018.                                                                                     
                                                                                                                                
Ms. Chambers  reviewed the fiscal  note from  the Department                                                                    
of  Commerce,  Community  and Economic  Development  (DCCED)                                                                    
that reflected  the cost  of extending  the board.  The bill                                                                    
did  not  change the  licensing  program.  If the  bill  was                                                                    
unsuccessful  and  the  board  sunset,  there  would  be  no                                                                    
change. If  there was an  extension of the board;  DCCED had                                                                    
proposed $28,400  to cover travel  for the board to  meet as                                                                    
required,  to advertise  public  meetings,  and for  various                                                                    
training and conference fees.                                                                                                   
                                                                                                                                
Co-Chair  Wilson highlighted  that page  3 showed  the board                                                                    
costs and licensing fees.                                                                                                       
                                                                                                                                
Representative    Knopp    asked    Ms.    Chambers    about                                                                    
recommendation 4  regarding CNAs. He referred  to a previous                                                                    
conversation.                                                                                                                   
                                                                                                                                
Ms. Chambers reported that the  board had addressed all four                                                                    
of  the audit  recommendations and  regulations were  moving                                                                    
forward.   The  CNA   program   was   moving  forward   with                                                                    
evaluations  as   prescribed  by  law.  She   discussed  the                                                                    
importance  of licensing  in a  timely manner.  She reported                                                                    
that  the division  was fully  staffed.  The department  was                                                                    
always  looking  to  do   more  streamlining  of  processes,                                                                    
particularly with regard to  military spouses and healthcare                                                                    
facilities that needed to get people on staff quickly.                                                                          
                                                                                                                                
1:50:23 PM                                                                                                                    
                                                                                                                                
Representative Knopp referred to  the military spouse issue.                                                                    
He asked  how long it  took for  CNA licensees to  receive a                                                                    
license once they have applied.                                                                                                 
                                                                                                                                
Ms.  Chambers  stated that  once  a  licensee submitted  the                                                                    
legally required elements,  the department usually processed                                                                    
the application in two weeks.                                                                                                   
                                                                                                                                
1:51:15 PM                                                                                                                    
                                                                                                                                
Co-Chair Wilson OPENED Public Testimony.                                                                                        
                                                                                                                                
CHRIS  LOGAN,  ALASKA   ADVANCE  PRACTICE  REGISTERED  NURSE                                                                    
ASSOCIATION ALLIANCE, ANCHORAGE  (via teleconference), spoke                                                                    
in  support  of  SB  36.   She  relayed  that  the  alliance                                                                    
supported  the bill.  She discussed  the  importance of  the                                                                    
Board of Nursing. She urged the committee to pass the bill.                                                                     
                                                                                                                                
1:52:28 PM                                                                                                                    
                                                                                                                                
LYNN HARTZ,  SELF, ANCHORAGE (via teleconference),  spoke in                                                                    
favor of  advancing SB  36. She  thanked the  committee. She                                                                    
thought  the Board  of Nursing  was an  essential government                                                                    
tool  in promoting  the  health and  welfare  of the  Alaska                                                                    
public. She  expressed that through licensure,  oversight of                                                                    
education  and discipline,  the  board and  its staff  exert                                                                    
vital and unique  functions on the states  behalf and should                                                                    
be allowed to continue their important work.                                                                                    
                                                                                                                                
1:53:20 PM                                                                                                                    
                                                                                                                                
KAREN  MORTON,  ALASKA  NURSES  ASSOCIATION,  SOLDOTNA  (via                                                                    
teleconference), strongly  supported SB 36. She  read from a                                                                    
prepared  statement. She  discussed the  work of  the Alaska                                                                    
Nurses  Association.  She  thought  the board  worked  in  a                                                                    
transparent  fashion and  ensured that  regulations utilizes                                                                    
best practices.                                                                                                                 
                                                                                                                                
1:54:50 PM                                                                                                                    
                                                                                                                                
Co-Chair Wilson CLOSED Public Testimony.                                                                                        
                                                                                                                                
Co-Chair Wilson indicated amendments  were due on Wednesday,                                                                    
May 1, 2019 by 5:00 P.M.                                                                                                        
                                                                                                                                
SB  36  was   HEARD  and  HELD  in   committee  for  further                                                                    
consideration.                                                                                                                  
                                                                                                                                
CS FOR SENATE BILL NO. 37(FIN)                                                                                                
                                                                                                                                
     "An Act relating to the statewide immunization                                                                             
     program; and providing for an effective date."                                                                             
                                                                                                                                
1:55:14 PM                                                                                                                    
                                                                                                                                
JANE CONWAY, STAFF, SENATOR CATHY GIESSEL, reviewed the                                                                         
legislation. She read from the sponsor statement:                                                                               
                                                                                                                                
     CS  for Senate  Bill 37(FIN)reauthorizes  the statewide                                                                    
     immunization program  in the  Department of  Health and                                                                    
     Social Services, which is  scheduled for repeal January                                                                    
     1, 2021.  Established in 2014, via  Senate Bill169, the                                                                    
     program   monitors,  purchases   and  distributes   all                                                                    
     childhood  vaccines   and  select  adult   vaccines  to                                                                    
     providers, making access to  vaccines universal for all                                                                    
     Alaskans.  By  2018,  the  program  covered  more  than                                                                    
     333,000 Alaskans, 45% of the  total population. Next to                                                                    
     clean drinking water and  good nutrition, vaccines have                                                                    
     saved  more   lives  than   any  other   public  health                                                                    
     intervention.                                                                                                              
                                                                                                                                
     The statewide  immunization program is fully  funded by                                                                    
     the   state   Vaccine    Assessment   Account   through                                                                    
     assessments  (upfront  fees)   from  health  plans  and                                                                    
     insurers  and other  fees.  There  are no  undesignated                                                                    
     general  funds  needed  for  this  program.  The  state                                                                    
     leverages  its buying  power  to  purchase vaccines  in                                                                    
     bulk using  the fees collected from  healthcare payers.                                                                    
     The  state distributes  that vaccine  to providers  who                                                                    
     then  administer them  at no  charge, improving  health                                                                    
     and wellbeing  while lowering overall vaccine  costs by                                                                    
     20 -30%.                                                                                                                   
                                                                                                                                
     CSSB37(FIN) creates  the vaccine assessment fund  as an                                                                    
     account  in  the  general  fund   and  will  allow  the                                                                    
     Commissioner  of the  Department of  Health and  Social                                                                    
     Services  to  administer  the program  and  react  more                                                                    
     nimbly  in  the  event  of an  outbreak  without  first                                                                    
     seeking  legislative  approval.  Alaska's  immunization                                                                    
     program is  an example  of a  successful public-private                                                                    
     partnership  that ensures  Alaskans a  healthier future                                                                    
     at  the lowest  possible cost.  The department  reduces                                                                    
     vaccine  -preventable  diseases,   and  providers  have                                                                    
     improved health outcomes for  their patients and easier                                                                    
     vaccine  stock management.  The  insurers  pay less  to                                                                    
     vaccinate individuals;  we all  save more money  in the                                                                    
     long run  due to decreased medical  costs from vaccine-                                                                    
     preventable diseases.                                                                                                      
                                                                                                                                
Ms. Conway  detailed that the state  could purchase vaccines                                                                    
in bulk,  the providers  could administer more  vaccines and                                                                    
have greater access  with no waste. She relayed  a number of                                                                    
benefits to the program.  Waste was eliminated, and patients                                                                    
paid less for  their vaccines. She concluded  her portion of                                                                    
the presentation. She conveyed  the names of those available                                                                    
for questions.                                                                                                                  
                                                                                                                                
Co-Chair Wilson invited Ms. Lewis to the table.                                                                                 
                                                                                                                                
2:00:39 PM                                                                                                                    
                                                                                                                                
JILL  LEWIS, DEPUTY  DIRECTOR,  DIVISION  OF PUBLIC  HEALTH,                                                                    
DEPARTMENT OF  HEALTH AND SOCIAL SERVICES,  relayed that the                                                                    
chief Medical Officer would begin testimony.                                                                                    
                                                                                                                                
LILY  LOU,  ALASKA  STATE  MEDICAL  OFFICER,  DEPARTMENT  OF                                                                    
HEALTH AND  SOCIAL SERVICES, introduced herself  and relayed                                                                    
she  had  served  on  the Council  for  the  Alaska  Vaccine                                                                    
Assessment Program (AVAP) and  was President of the American                                                                    
Academy of Pediatrics Alaska Chapter.  She noted there was a                                                                    
letter (copy  on file) authored  in her capacity  as chapter                                                                    
president. She  discussed the  vaccine program,  noting that                                                                    
the  program  made access  to  vaccines  universal, and  did                                                                    
include  uninsured adults.  Alaska was  the only  state that                                                                    
provided the coverage for uninsured adults.                                                                                     
                                                                                                                                
Ms. Lou  continued her  remarks. She  discussed the  cost of                                                                    
the program.  She discussed the discount  in vaccine pricing                                                                    
and the  bulk purchasing  benefits. The program  was created                                                                    
in  January 15  and  should  sunset in  2021.  In 2008,  the                                                                    
program had  covered 50 percent of  Alaskans. The department                                                                    
had seen a significant  improvement in vaccination rate. She                                                                    
discussed  national recognition  for  the state's  increased                                                                    
vaccination rates.                                                                                                              
                                                                                                                                
2:03:46 PM                                                                                                                    
                                                                                                                                
Ms.  Lou directed  attention to  a slide  in member  packets                                                                    
[She pointed to the AVAP Handout  - SB 37 Renewal of Vaccine                                                                    
Assessment Program]  (copy on file). She  referenced a mumps                                                                    
outbreak  the  previous  year.  The  bill  reauthorized  the                                                                    
program,  removed the  phase-in  language,  and removed  the                                                                    
sunset  language.  She  emphasized  that the  bill  did  not                                                                    
change   or  impact   any   regulations  regarding   vaccine                                                                    
exemptions.  She discussed  the advantages  of the  program.                                                                    
She  discussed  the advantage  of  a  unified and  effective                                                                    
inventory system.                                                                                                               
                                                                                                                                
Mr. Lou  shared an estimate  that for every dollar  spent on                                                                    
vaccine  programs,  it  saved  $10  in  medical  costs.  She                                                                    
asserted  that the  program had  proven itself.  She thanked                                                                    
members for the opportunity to speak.                                                                                           
                                                                                                                                
2:07:11 PM                                                                                                                    
                                                                                                                                
Vice-Chair Ortiz spoke  to the issue of  what the department                                                                    
oversaw. He  had gleaned  that the  bill would  help improve                                                                    
access to vaccinations. He  mentioned diminished services in                                                                    
public  health  clinics  and rural  areas.  He  wondered  if                                                                    
public health  clinics were the best  access to vaccinations                                                                    
and  he wondered  about  access if  a  public health  clinic                                                                    
closed.                                                                                                                         
                                                                                                                                
Dr. Lou responded that the  department was aware that public                                                                    
health clinics provided an  important service. She clarified                                                                    
that  the program  provided vaccines  to  any provider  that                                                                    
administered vaccinations.                                                                                                      
                                                                                                                                
Vice-Chair  Ortiz  asked  if the  department  had  seen  any                                                                    
increase in outbreaks  of disease that could  be affected by                                                                    
not having access to vaccines.                                                                                                  
                                                                                                                                
Dr. Lou  appreciated the challenges  when a  health facility                                                                    
closed.                                                                                                                         
                                                                                                                                
Representative       Sullivan-Leonard      asked       about                                                                    
reauthorizations  for the  program.  She  wondered if  other                                                                    
diseases were coming to the forefront such as measles.                                                                          
                                                                                                                                
Dr.  Lou responded  that measles  was  the primary  national                                                                    
issue, although  it had not  been seen in Alaska  yet. There                                                                    
was  a   recent  outbreak  of   measles  in  the   State  of                                                                    
Washington.  There   were  no   current  vaccine-preventable                                                                    
outbreaks  in Alaska.  There were  other  outbreaks such  as                                                                    
tuberculosis.                                                                                                                   
                                                                                                                                
2:10:47 PM                                                                                                                    
                                                                                                                                
Ms.  Lewis introduced  the PowerPoint  presentation: "SB  37                                                                    
Renewal of  Vaccine Assessment Program" (copy  on file). She                                                                    
began with slide 2, "SB 37":                                                                                                    
                                                                                                                                
     ?Reauthorizes the  statewide Alaska  Vaccine Assessment                                                                    
     Program  in   the  Department  of  Health   and  Social                                                                    
     Services, scheduled for sunset January 1, 2021.                                                                            
                                                                                                                                
     ?Eliminates a  temporary phase-in period that  ended in                                                                    
     2017.                                                                                                                      
                                                                                                                                
     ?Uses  the state  Vaccine Assessment  Account to  fully                                                                    
     fund the program.                                                                                                          
          o No unrestricted general funds are involved.                                                                         
                                                                                                                                
Ms. Lewis turned to slide 3, "What is the Alaska Vaccine                                                                        
Assessment Program?":                                                                                                           
                                                                                                                                
     Established   in  2014,   AVAP   is   a  public-private                                                                    
     partnership  making access  to  vaccines universal  for                                                                    
     all Alaskans at no cost to the state.                                                                                      
                                                                                                                                
     ?Provides all childhood and  certain adult vaccines for                                                                    
     privately insured children and some adults.                                                                                
                                                                                                                                
     ?Covers  vaccine  costs through  assessments  collected                                                                    
     from    private    health   insurers,    third    party                                                                    
     administrators, and other program participants.                                                                            
                                                                                                                                
     ?Purchases  vaccines at  discounted  rates  off a  bulk                                                                    
     contract.                                                                                                                  
                                                                                                                                
     ?Distributes vaccine  directly to  healthcare providers                                                                    
     at  no  charge who  administer  the  vaccines to  their                                                                    
     patients.                                                                                                                  
                                                                                                                                
Ms. Lewis detailed that providers could still bill for an                                                                       
office visit or to administer the vaccines.                                                                                     
                                                                                                                                
Ms. Lewis continued to slide 4: "What is the Alaska Vaccine                                                                     
Assessment Program.":                                                                                                           
     ?  Through   AVAP,  Alaska  continues   to  demonstrate                                                                    
     leadership   in  creating   innovative  solutions   for                                                                    
     difficult public health issues.                                                                                            
                                                                                                                                
     ? Alaska is one of only  11 states that has a universal                                                                    
     childhood  vaccine program  and  one of  only 3  states                                                                    
     that offers adult vaccines.                                                                                                
                                                                                                                                
     ? Alaska is the only state that offers healthcare                                                                          
     providers the option of purchasing state-supplied                                                                          
     vaccine to serve uninsured adults.                                                                                         
                                                                                                                                
2:14:10 PM                                                                                                                    
                                                                                                                                
Ms. Lewis reviewed  the flow chart on slide 5.  She began at                                                                    
the top of the slide  with Alaska Vaccine Assessment Council                                                                    
which  set the  annual assessment  rate based  on historical                                                                    
information. To  the right showed  the payers who  paid into                                                                    
the  assessment quarterly  based on  their reported  covered                                                                    
lives. The  Division of Public Health  purchased the vaccine                                                                    
off  a  discounted bulk  contract.  The  Division of  Public                                                                    
Health then distributed the vaccine  at no cost to providers                                                                    
or through  the Vaccine Depot. Providers  vaccinated covered                                                                    
patients, only  billing payers for office  visits. Providers                                                                    
then  reported  administered  vaccines to  the  Division  of                                                                    
Public Health,  and then  provided data  to the  council for                                                                    
rate  setting.  She  remarked  on  the  streamlined  process                                                                    
provided by the program.                                                                                                        
                                                                                                                                
2:17:40 PM                                                                                                                    
                                                                                                                                
Vice-Chair Johnston understood that  the program had gone on                                                                    
for almost 5  years. She asked if the department  had a good                                                                    
idea  of  the amount  of  vaccines  that were  needed  after                                                                    
collecting data over time.                                                                                                      
                                                                                                                                
Ms. Lewis  thought Vice-Chair Johnston was  asking about the                                                                    
department's  ability to  forecast  the  number of  vaccines                                                                    
needed. She thought the council  was good at forecasting and                                                                    
had been operating a central  vaccine depot for more than 30                                                                    
years. Previously  the depot was federally  funded until the                                                                    
funds were  lost when the  former United States  Senator Ted                                                                    
Stevens left  office. She asserted  that the  department was                                                                    
very accurate with  its data, and actively  worked to manage                                                                    
waste.                                                                                                                          
                                                                                                                                
Representative Tilton referenced the  flow chart on slide 5.                                                                    
She  asked  if the  "payers"  referenced  on the  chart  was                                                                    
referencing insurance companies.                                                                                                
                                                                                                                                
Ms. Lewis responded  that the health plans  and the insurers                                                                    
were required to  pay the assessment. In order  to cover the                                                                    
uninsured  adult population,  the program  allowed providers                                                                    
to  opt into  the  program.  If the  providers  had a  large                                                                    
community to serve,  such as a community  health clinic, the                                                                    
providers  could get  the same  price  break by  voluntarily                                                                    
participating. Without  participation, providers  would have                                                                    
to  pay the  retail  cost and  would not  be  able to  avail                                                                    
themselves of the 20 to 30 percent discount.                                                                                    
                                                                                                                                
Representative Tilton asked  how providers could participate                                                                    
in the program.                                                                                                                 
                                                                                                                                
Ms. Lewis responded  that providers had to  agree to certain                                                                    
conditions in order to  participate and provided information                                                                    
about how many  patients were in the caseload.  The cost was                                                                    
the same rate that health plans paid per member per month.                                                                      
                                                                                                                                
Co-Chair  Wilson asked  if the  program required  parents to                                                                    
immunize their children.                                                                                                        
                                                                                                                                
Ms.  Lewis stated  that in  Alaska there  was the  option to                                                                    
decline  vaccination due  to medical  or religious  reasons,                                                                    
and  the bill  did not  affect the  option. She  returned to                                                                    
speaking to the flow chart on slide 5.                                                                                          
                                                                                                                                
2:22:55 PM                                                                                                                    
                                                                                                                                
Ms. Lewis explained slide 6:  "Vaccine Cost," which showed a                                                                    
bar graph depicting  the cost to vaccinate  a person through                                                                    
18  years of  age for  the AVAP  program versus  the private                                                                    
sector.  The  overall  vaccine   costs  were  lowered  20-30                                                                    
percent  by  the program  and  showed  a savings  of  almost                                                                    
$1,000 per child.                                                                                                               
                                                                                                                                
Ms. Lewis reported on slide 7: "Vaccine Coverage":                                                                              
                                                                                                                                
     2018                                                                                                                       
     ? 366,000 Alaskans covered                                                                                                 
          ? 50% of the population                                                                                               
     ? 86,000 children                                                                                                          
          ? 44% of all children                                                                                                 
     ? 280,000 adults                                                                                                           
          ? 52% of all adults                                                                                                   
                                                                                                                                
     Vaccination Coverage Awards                                                                                                
     ?Most improved among adolescents for HPV                                                                                   
    ?Most improved among adults aged 65+ for pneumonia                                                                          
                                                                                                                                
Ms. Lewis  noted that Alaska  was improving  its vaccination                                                                    
rates, which were lower than the rest of the country.                                                                           
                                                                                                                                
Ms. Lewis discussed slide 8: "Successes":                                                                                       
                                                                                                                                
     Win-Win-Win-Win                                                                                                            
     ?  The  Division  of   Public  Health  reduces  vaccine                                                                    
     preventable diseases.                                                                                                      
     ?   Providers  have   improved   health  outcomes   for                                                                    
     vaccinated   individuals  and   easier  vaccine   stock                                                                    
     management.                                                                                                                
     ? The health insurance industry pays less to vaccinate                                                                     
     individuals.                                                                                                               
     ? All Alaskans  save more money in the long  run due to                                                                    
     fewer medical costs from vaccine-preventable diseases.                                                                     
                                                                                                                                
Ms. Lewis reviewed the benefits of the program on slide 9:                                                                      
"Return on Health":                                                                                                             
                                                                                                                                
     Lowers direct and long-term healthcare costs and yields                                                                    
     numerous public health benefits:                                                                                           
                                                                                                                                
     ? Ensures that every child  and some adults who enter a                                                                    
     participating doctor's  office or hospital  can receive                                                                    
     recommended vaccines at no cost.                                                                                           
                                                                                                                                
     ?  More  healthcare  providers  can  offer  vaccination                                                                    
     services                                                                                                                   
                                                                                                                                
          ? less up-front costs to finance out of their own                                                                     
          pockets for vaccines, and                                                                                             
                                                                                                                                
          ? reduces staff burdens required to separate                                                                          
          private and public vaccine stock.                                                                                     
                                                                                                                                
     ? Allows the State to manage the supply of vaccines,                                                                       
          ? ensuring that the state can quickly supply                                                                          
          vaccines to vulnerable patient groups during                                                                          
          emergencies or vaccine shortages, and                                                                                 
                                                                                                                                
          ? reducing waste through centralized inventory                                                                        
          management.                                                                                                           
                                                                                                                                
Ms. Lewis discussed the challenges of stocking vaccine                                                                          
supply before the centralized program.                                                                                          
                                                                                                                                
2:26:45 PM                                                                                                                    
                                                                                                                                
Ms.  Lewis discussed  slide 10:  "For  every $1  spent on  a                                                                    
vaccine in  the US?". She  noted that the MMR  vaccine saved                                                                    
$26 for every dollar spent.                                                                                                     
                                                                                                                                
Vice-Chair Johnston  asked if the  flu vaccines  and shingle                                                                    
vaccines were covered.                                                                                                          
                                                                                                                                
Ms. Lewis responded that the state covered both vaccines.                                                                       
                                                                                                                                
Vice-Chair Johnston asked if the  newer shingles vaccine was                                                                    
covered.                                                                                                                        
                                                                                                                                
Ms.  Lewis responded  that the  newer  shingles vaccine  was                                                                    
covered.  She discussed  the  restructuring  of the  Vaccine                                                                    
Assessment Account.  The new vaccine was  more expensive and                                                                    
estimated to cost $1 million  more per year. The new vaccine                                                                    
also applied  to a  broader age  group and  thereby required                                                                    
more vaccines.  Under the fund  transfer, the  program would                                                                    
be limited  to the  appropriation amount  in a  single year.                                                                    
She noted with  the fund capitalization the  program was not                                                                    
as  limited  and  could  spend  assessments  that  had  been                                                                    
collected.                                                                                                                      
                                                                                                                                
Co-Chair Wilson  asked if  shingles vaccines  were available                                                                    
for retired state employees.                                                                                                    
                                                                                                                                
Ms. Lewis  believed that the  state did provide  the vaccine                                                                    
but was  considered in terms  of covered lives.  She thought                                                                    
the vaccine coverage for retirees was limited.                                                                                  
                                                                                                                                
Representative Merrick  noted Ms.  Lewis had  mentioned that                                                                    
unused vaccines  were returned. She  wondered how  ensure to                                                                    
vaccines had been properly cared for while in other hands.                                                                      
                                                                                                                                
Ms.  Lewis  indicated  that the  quality  control  was  well                                                                    
managed for  vaccines. The depot  spent a great deal  of its                                                                    
time on  quality assurance including site  visits, mandatory                                                                    
temperature checks, and reports.                                                                                                
                                                                                                                                
2:30:26 PM                                                                                                                    
                                                                                                                                
Representative LeBon referenced slide  7 and asked about the                                                                    
44 percent  of children covered.  He wondered if  the number                                                                    
indicated the number of children vaccinated.                                                                                    
                                                                                                                                
Dr. Lou  reported that the  44 percent denoted  the children                                                                    
covered  by  the  AVAP, which  was  different  than  vaccine                                                                    
rates. She noted  that 100 percent of  Alaskan children were                                                                    
covered.                                                                                                                        
                                                                                                                                
Representative  LeBon  asked  about the  record  of  vaccine                                                                    
participation in the state.                                                                                                     
                                                                                                                                
Dr.  Lou responded  that vaccination  rates were  tracked by                                                                    
vaccine at  the point  of vaccine administration.  The state                                                                    
did  not  have the  best  vaccination  rates. She  mentioned                                                                    
"herd  immunity" and  thought  the state  was  close to  the                                                                    
cusp. She  mentioned that the  percentage required  for herd                                                                    
immunity of the community was different for each disease.                                                                       
                                                                                                                                
Representative LeBon  asked Dr. Lou about  measles in Alaska                                                                    
and if she had concerns.                                                                                                        
                                                                                                                                
Dr.  Lou replied  that as  a pediatrician  she had  concerns                                                                    
about the trend,  and thought the state had a  93 percent to                                                                    
94 percent  vaccination rate for the  disease. She expressed                                                                    
concerns   that  there   were   communities  where   vaccine                                                                    
hesitancy  was   at  much  higher   rates  and   a  vaccine-                                                                    
preventable disease could  take hold and spread  to the rest                                                                    
of the state.                                                                                                                   
                                                                                                                                
Co-Chair  Wilson  asked  if the  program  sunset  was  being                                                                    
removed. She  wondered if the  legislation allowed  for fees                                                                    
to be adjusted.                                                                                                                 
                                                                                                                                
Ms. Lewis  responded that the  AVAP Council had  the ability                                                                    
to adjust the rate if needed.                                                                                                   
                                                                                                                                
2:34:05 PM                                                                                                                    
                                                                                                                                
Vice-Chair Johnston understood that  the bill would not have                                                                    
a  sunset date.  She  asked  if the  program  had ever  been                                                                    
audited.                                                                                                                        
                                                                                                                                
Ms. Lewis  indicated that the  program was  audited annually                                                                    
by an independent auditor.                                                                                                      
                                                                                                                                
Representative  Josephson referenced  cuts to  public health                                                                    
nursing. He wondered  if the cuts had  affected provision of                                                                    
vaccines.                                                                                                                       
                                                                                                                                
Dr. Lou  responded that Representative  Josephson's question                                                                    
was a separate question from  the bill. However, she thought                                                                    
cutting  public   health  care  resources  did   impact  the                                                                    
provision of vaccines.                                                                                                          
                                                                                                                                
2:35:40 PM                                                                                                                    
                                                                                                                                
Co-Chair Wilson OPENED Public Testimony.                                                                                        
                                                                                                                                
KAREN  MORTON,  ALASKA  NURSES  ASSOCIATION,  SOLDOTNA  (via                                                                    
teleconference), spoke  in favor  of the bill.  She reviewed                                                                    
the many  benefits of the  program and urged support  of the                                                                    
bill.                                                                                                                           
                                                                                                                                
2:36:43 PM                                                                                                                    
                                                                                                                                
IRINA    OBOLENTSEVA,    SELF,     DELTA    JUNCTION    (via                                                                    
teleconference), read  a doctor's  opinion about  autism and                                                                    
vaccinations.  She relayed  that  certain vaccinations  were                                                                    
unsafe products that she felt  the state should not pay for.                                                                    
She argued that  one-shot-fits-all was not a  smart thing to                                                                    
do.                                                                                                                             
                                                                                                                                
2:39:49 PM                                                                                                                    
                                                                                                                                
ANNA GONCHAROVA, SELF,  DELTA JUNCTION (via teleconference),                                                                    
spoke  in  opposition to  the  bill.  She spoke  of  chronic                                                                    
symptoms  related to  vaccinations. She  listed a  number of                                                                    
repercussions  resulting  from  vaccinations.  She  did  not                                                                    
support SB 37 and urged members to vote against the bill.                                                                       
                                                                                                                                
2:42:05 PM                                                                                                                    
                                                                                                                                
JOHN  ZASADA, AK  PRIMARY CARE  ASSOCIATION, ANCHORAGE  (via                                                                    
teleconference),  reported  his members  strongly  supported                                                                    
the bill.  He discussed  health center participation  in the                                                                    
program.  The   program  allowed  non-profit   practices  to                                                                    
purchase and  administer vaccines, and also  allowed them to                                                                    
provide services  for infectious  diseases. He  continued to                                                                    
discuss the benefit  of the vaccination program  no matter a                                                                    
person's ability to pay.                                                                                                        
                                                                                                                                
2:44:50 PM                                                                                                                    
                                                                                                                                
ROSLAYN SINGLETON, SELF,  ANC (via teleconference), strongly                                                                    
supported SB  37. She  discussed a  time when  vaccines were                                                                    
not  available in  rural locations.  As a  pediatrician, she                                                                    
had seen  children die of preventable  diseases. She recited                                                                    
some rates  of debilitating infection. She  talked about the                                                                    
importance of vaccinating for measles.  She urged support of                                                                    
the bill.                                                                                                                       
                                                                                                                                
2:46:46 PM                                                                                                                    
                                                                                                                                
Co-Chair Wilson CLOSED Public Testimony.                                                                                        
                                                                                                                                
2:47:07 PM                                                                                                                    
                                                                                                                                
DAVID  TEAL, DIRECTOR,  LEGISLATIVE FINANCE  DIVISION, noted                                                                    
that  the  department had  testified  that  the program  had                                                                    
reduced  the   cost  and   increased  the   availability  of                                                                    
vaccines, and  the bill  would re-establish  AVAP as  a fund                                                                    
capitalization rather  than as a  fund transfer. He  used an                                                                    
example to show the advantages  of a fund capitalization. He                                                                    
referenced  the Regional  Education  Attendance Area  (REAA)                                                                    
School Fund,  which was used  to build and  maintain schools                                                                    
in the REAAs.  The fund was established as  a fund transfer,                                                                    
into  which the  legislature had  appropriated approximately                                                                    
$40   million  per   year.  Additionally,   the  legislature                                                                    
appropriated money to individual school capital projects.                                                                       
                                                                                                                                
Mr.   Teal   continued   with  his   example   of   a   fund                                                                    
capitalization. Three years  previously the attorney general                                                                    
had indicated  that the  REAA fund  transfer was  being done                                                                    
incorrectly,  and money  should have  been put  in the  fund                                                                    
without  the  state  choosing projects.  The  Department  of                                                                    
Education  and  Early  Development should  have  ranked  the                                                                    
school  construction projects,  and  the  funding should  be                                                                    
used  in  the  prioritized  order.  It used  to  be  a  fund                                                                    
transfer  where  money was  appropriated  to  the fund  then                                                                    
appropriated  from the  fund to  the capital  project. After                                                                    
the attorney  general's ruling the  fund was converted  to a                                                                    
fund  capitalization; after  which monies  were appropriated                                                                    
to   the   fund   and  it   flowed   out   without   further                                                                    
appropriations.  The  same  thing   would  happen  with  the                                                                    
vaccination program.                                                                                                            
                                                                                                                                
Mr. Teal  explained that the  fiscal notes would  change the                                                                    
language  in  both the  House  and  Senate versions  of  the                                                                    
operating  budget  bill.  There  were 3  fiscal  notes.  The                                                                    
fiscal  note with  OMB component  number 296  was no  longer                                                                    
needed due to  the change he described. The  second note OMB                                                                    
component 3083 was  also no longer needed.  The third fiscal                                                                    
note was  a new  fiscal note and  was a  fund capitalization                                                                    
that would add language to  the bill that deposited money to                                                                    
the fund. The deposit would  be an appropriation the program                                                                    
could  immediately spend  to purchase  vaccines. The  fiscal                                                                    
notes were a net zero.                                                                                                          
                                                                                                                                
2:51:42 PM                                                                                                                    
                                                                                                                                
Mr.    Teal   further    discussed    the   fiscal    notes.                                                                    
He  discussed  increased  flexibility for  using  funds  for                                                                    
immediate  needs.  He  suggested  that  with  an  open-ended                                                                    
appropriation  from  the  insurers (and  perhaps  providers)                                                                    
into the fund, then AVAP  could increase the assessments and                                                                    
money in the fund, which  could be spent with no legislative                                                                    
action. The  change would eliminate  double counting  with a                                                                    
single appropriation to  the fund. The change  made the fund                                                                    
no  longer  subject   to  the  annual  sweep   into  to  the                                                                    
Constitutional Budget  Reserve. He discussed  the conditions                                                                    
under which  funds were swept.  He thought the  fiscal notes                                                                    
seemed more  complicated than a simple  bill should warrant,                                                                    
but assured  that the notes  resulted in  a net zero  to the                                                                    
state.                                                                                                                          
                                                                                                                                
2:54:38 PM                                                                                                                    
                                                                                                                                
Representative LeBon  asked if the program  went through all                                                                    
its  money every  year,  or if  there was  a  fund that  was                                                                    
building up.                                                                                                                    
                                                                                                                                
Mr. Teal informed that the  program set its assessment fees.                                                                    
In years of high outflow,  AVAP didn't lose the money. There                                                                    
was  no advantage  to building  a big  fund balance,  so the                                                                    
program  should  tailor the  assessments  to  the amount  of                                                                    
money expected to be needed.                                                                                                    
                                                                                                                                
Representative Tilton had a question  for the bill sponsor's                                                                    
staff.  She  had heard  in  public  testimony about  adverse                                                                    
reactions  to  vaccinations. She  wondered  if  there was  a                                                                    
reporting mechanism for adverse reactions.                                                                                      
                                                                                                                                
Dr. Lou responded that there  was a very stringent reporting                                                                    
system  for  adverse  reactions  to  vaccinations  that  was                                                                    
maintained  by  the  Center  for  Disease  Control  and  was                                                                    
accessible to anyone any time.                                                                                                  
                                                                                                                                
Co-Chair Wilson  informed members  that amendments  were due                                                                    
by 5:00 P.M. on Wednesday, May 1, 2019.                                                                                         
                                                                                                                                
[Recessed  to  the Call  of  the  Chair. The  meeting  never                                                                    
reconvened.]                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
2:57:17 PM                                                                                                                    
                                                                                                                                
The meeting was adjourned at 2:57 p.m.                                                                                          
                                                                                                                                
                                                                                                                                

Document Name Date/Time Subjects
SB36 Letter of Support APRN 3-4-19.pdf HFIN 4/30/2019 1:30:00 PM
SB 36
SB36 Letter of Support AK Nurses Assn 2-27-19.pdf HFIN 4/30/2019 1:30:00 PM
SB 36
SB36 Letter of Support BON 2-14-19.pdf HFIN 4/30/2019 1:30:00 PM
SB 36
SB36 Letter of Support Booher 3-26-19.pdf HFIN 4/30/2019 1:30:00 PM
SB 36
SB36 Letter of Support Carver 3-31-19.pdf HFIN 4/30/2019 1:30:00 PM
SB 36
SB36 Letter of Support DeLapp 3-23-19.pdf HFIN 4/30/2019 1:30:00 PM
SB 36
SB36 Letter of Support Farnstrom 2-26-19.pdf HFIN 4/30/2019 1:30:00 PM
SB 36
SB36 Letter of Support Hartz 4-8-19.pdf HFIN 4/30/2019 1:30:00 PM
SB 36
SB36 Letter of Support Michels 2-28-19.pdf HFIN 4/30/2019 1:30:00 PM
SB 36
SB36 Letter of Support Phillips 2-28-19.pdf HFIN 4/30/2019 1:30:00 PM
SB 36
SB36 Sponsor Statement 1-28-19.pdf HFIN 4/30/2019 1:30:00 PM
SB 36
SB36 Supporting Document BON Audit April 2017.pdf HFIN 4/30/2019 1:30:00 PM
SB 36
SB36 Supporting Document BON Audit Summary 08-20113-18.pdf HFIN 4/30/2019 1:30:00 PM
SB 36
SB36 Supporting Document BON Fact Sheer 3-29-19.pdf HFIN 4/30/2019 1:30:00 PM
SB 36
SB36 Supporting Document BON Roster 4-24-19.pdf HFIN 4/30/2019 1:30:00 PM
SB 36
SB36 Supporting Document DCCED CBPL Responses to SFIN 3-11-19.pdf HFIN 4/30/2019 1:30:00 PM
SB 36
SB36 Letter of Support AK Nurses Foundation 2-27-19.pdf HFIN 4/30/2019 1:30:00 PM
SB 36
SB 37 Supporting Document Explanation of Changes to SB 37(SFIN).pdf HFIN 4/30/2019 1:30:00 PM
SB 37
CSSB37(FIN) Sponsor Statement.pdf HFIN 4/30/2019 1:30:00 PM
SB 37
CSSB37(FIN) Sectional Analysis vsn S 3-30-19.pdf HFIN 4/30/2019 1:30:00 PM
SB 37
SB37 Supporting Document PPt AVAP DPH 2-5-19.pdf HFIN 4/30/2019 1:30:00 PM
SB 37
SB37 Supporting Document Alaska Public Health Advisory 1-29-19.pdf HFIN 4/30/2019 1:30:00 PM
SB 37
SB37 Supporting Document AVAP Annual Report 2018.pdf HFIN 4/30/2019 1:30:00 PM
SB 37
SB37 Supporting Document AVAP Cumulative Cost Savings.pdf HFIN 4/30/2019 1:30:00 PM
SB 37
SB37 Supporting Document AVAP historical timeline.pdf HFIN 4/30/2019 1:30:00 PM
SB 37
SB37 Supporting Document AVAP main points 4-5-19.pdf HFIN 4/30/2019 1:30:00 PM
SB 37
SB37 Supporting Document Who Pays AVAP.pdf HFIN 4/30/2019 1:30:00 PM
SB 37
SB37 Supporting Document AVAP Payers.pdf HFIN 4/30/2019 1:30:00 PM
SB 37
SB37 Supporting Document AVAP Providers.pdf HFIN 4/30/2019 1:30:00 PM
SB 37
SB37 Supporting Document AVAP Status Update 2017.pdf HFIN 4/30/2019 1:30:00 PM
SB 37
SB37 Supporting Document DHSS Vaccine Formulary 2019.pdf HFIN 4/30/2019 1:30:00 PM
SB 37
SB37 Supporting Document Measles Info CDC.pdf HFIN 4/30/2019 1:30:00 PM
SB 37
SB37 Supporting Document Measles Info DHSS.pdf HFIN 4/30/2019 1:30:00 PM
SB 37
SB37 Supporting Document Q's Posed to Public Health SFIN.pdf HFIN 4/30/2019 1:30:00 PM
SB 37
SB37 Supporting Document Status Update 2018.pdf HFIN 4/30/2019 1:30:00 PM
SB 37
SB37 Supporting Document Vaccination Rate Trends 2013-17.pdf HFIN 4/30/2019 1:30:00 PM
SB 37
SB 37 Supporting Document Opposition.pdf HFIN 4/30/2019 1:30:00 PM
SB 37
SB37 Opposition letter Obolentseva (003).pdf HFIN 4/30/2019 1:30:00 PM
SB 37