Legislature(2007 - 2008)CAPITOL 106
01/24/2008 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB234 | |
| HB337 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 234 | TELECONFERENCED | |
| *+ | HB 337 | TELECONFERENCED | |
| + | TELECONFERENCED |
HB 337-HEALTH CARE: PLAN/COMMISSION/FACILITIES 4:09:09 PM CHAIR WILSON announced that the next order of business would be HOUSE BILL NO. 337, "An Act establishing the Alaska Health Care Commission and the Alaska health care information office; relating to health care planning and information; repealing the certificate of need program for certain health care facilities and relating to the repeal; annulling certain regulations required for implementation of the certificate of need program for certain health care facilities; and providing for an effective date." KARLEEN JACKSON, Commissioner, Department of Health & Social Services, informed the committee that the first section of HB 337 states the requirement that the Department of Health & Social Services (DHSS) will implement a statewide health plan and create the Alaska Health Care Commission. Section 2 establishes a ten-member health care commission with the purpose to develop a statewide plan to address the quality, accessibility, and availability of health care in the state. In addition, the commission will review and approve health care facility information for placement on an Internet database. Section 2 also specifies that the plan will contain strategies for encouraging personal responsibility, reducing health care costs, access to safe water and wastewater systems, the development of a sustainable health care workforce, access to quality health care, and an increase in the number of residents who are covered by insurance. REPRESENTATIVE ROSES asked the commissioner to discuss the composition of the health care commission board. He noted the lack of care providers. 4:12:10 PM COMMISSIONER JACKSON explained that commission members include representatives from different departments of the state, for example, the Department of Administration (DOA), that need to be involved in health care. There will also be a member appointed by the House and one by the Senate, and three citizen members to provide consumer representation. She observed that the committee can make changes to the membership of the commission. 4:13:29 PM REPRESENTATIVE ROSES stated his concern that boards and commissions that are capable of making policy need to be represented by stakeholders. He gave the example of the Professional Teacher Practices Commission. Representative Roses opined that medical and care giver representatives will be needed to provide essential data. 4:15:04 PM COMMISSIONER JACKSON agreed. However, she noted the difficulty of deciding who will be excluded from the provider seats. REPRESENTATIVE ROSES opined that excluding everybody is not the best way. REPRESENTATIVE GARDNER expressed her agreement with Representative Roses. She then asked Commissioner Jackson to explain the need to include a small business owner. COMMISSIONER JACKSON stated that small business owners do not often have a voice in health care negotiations. CHAIR WILSON stated her agreement; the possibility of mandatory employee insurance coverage for all businesses is an important issue for small business owners. 4:17:18 PM REPRESENTATIVE GARDNER added that many health care providers are also small business owners. REPRESENTATIVE KELLER expressed his belief that the representation of many different interest groups will create gridlock. He encouraged the formation of a small commission that will not get caught up in disputes. CHAIR WILSON asked how many members were on the health council. COMMISSIONER JACKSON answered that there were twelve voting members and two ex-officio members. REPRESENTATIVE CISSNA acknowledged that the difficult problem of health care is a topic that has not been very accessible to legislators. She stated her concern that, with the high number of state representatives on the commission, there will not be enough voices from across the state, especially when developing policy for the state. In addition, legislators are only now beginning to get analysis of the most recent health care data available. Representative Cissna encouraged the study of that data in order to develop the proper kind of health care commission. 4:21:59 PM COMMISSIONER JACKSON advised that there is a component for travel for the commission to allow for visitations all over state in order to hear from community stakeholders. She asked for clarification of Representative Cissna's other concern. REPRESENTATIVE CISSNA explained that the analysis the legislators have received is incomplete. In fact, Alaska has behavioral health treatment studies that have not been reported to the legislature. She noted that $2 billion is being spent on health care and asked for details on what amount is being spent on aspects of behavioral and physical health care. 4:24:19 PM COMMISSIONER JACKSON informed the committee that there are 70 reports posted on the health care council website. REPRESENTATIVE CISSNA clarified that she was referring to all of the divisions within health care. She expressed her intention to develop a list of issues to address at the next hearing, including, what the commission needs to look at and from whom it should hear testimony. The previous health care plan, written in the 70s and 80s, should be reviewed in order to learn from the history of the state. 4:26:24 PM COMMISSIONER JACKSON said that the second component in Section 2 establishes an Alaska health care information office that will provide, at a website, consistently updated health care facility information to consumers. She continued to explain that, to provide health care transparency, the state must provide consumers with information on the health care industry including: where to find services; what is the cost; what the other options are; and the possibility of outcomes for procedures. Florida has a website currently available to its residents. 4:29:34 PM JAY BUTLER, M. D.; Chief Medical Officer, Office of the Commissioner, Department of Health & Social Services, described his search for a prescription on the Florida website that provided information on the price of the prescription at various pharmacies in the area. The prices ranged from $11 to $41. Websites in other states allow searches for insurance carrier coverage and descriptions of services available at health centers. Dr. Butler provided descriptions of the variety of information, including prevention, that can be posted. 4:32:28 PM REPRESENTATIVE ROSES asked whether the prescription quotes compared brand names with generic equivalents. DR. BUTLER responded that he was not sure; however, specific information like this can be designed into the website. REPRESENTATIVE FAIRCLOUGH asked whether there are multiple definitions of medical codes. She also asked how a consumer could compare the costs for different types of fractures. DR. BUTLER explained that the goal of the information website is to focus on the greatest majority of health care costs. It would be impossible to try to capture the costs of all procedures. REPRESENTATIVE FAIRCLOUGH asked how expensive it will be for the state to develop a criteria process, to define the most common drugs and treatments, so that consumers can make an informed choice. To protect the physician, accuracy must also be maintained when quoting rates, and she asked how other states provide a continuous update of information. DR. BUTLER stated that the most common procedures are determined by a review of claims data. COMMISSIONER JACKSON reminded the committee that the fiscal note provides for employees to create the web based technical components of the website, and two health planners who will begin developing the website using best practices procedures. Alaska is at the beginning of the process and the health care commission will be providing many of the details. REPRESENTATIVE FAIRCLOUGH asked how much Florida spent to establish its website. She noted that the "software world" can be very expensive. REPRESENTATIVE GARDNER suggested that the state could buy the software from an existing site. COMMISSIONER JACKSON said that the DHSS would provide answers to both of these questions at a later date. She continued to explain that a committee substitute (CS) would be introduced next week with more detailed information on this section. REPRESENTATIVE ROSES expressed his support of reporting information on the Internet. However, he stated his concern about the potential harm of inaccurate reporting, absent a strict protocol for the provision of services. He gave an example of costs that only seemed comparable, and cautioned about creating an opportunity for improper, unethical, or illegal behavior. 4:40:08 PM COMMISSIONER JACKSON agreed and assured the committee that the site would be under the authority of the chief medical officer. DR. BUTLER added that an aspect of the disclosure of reporting is that quality data, like cost data, can be difficult to determine. There are certain benchmarks; for example, one of the states reports in-hospital complication rates and mortality rates, along with costs. REPRESENTATIVE FAIRCLOUGH recalled that the committee discussed self medication, over-dosing, and drug seeking. She asked whether the state can prevent abuse of the system. 4:42:51 PM DR. BUTLER said that he was not sure how reporting price data would alter drug seeking behavior. REPRESENTATIVE FAIRCLOUGH pointed out that medical providers have testified that advertising a pharmaceutical product encourages patients to advocate for its use. CHAIR WILSON expressed her understanding that this bill will put on-line the cost of health care for an individual who wants to know how much a procedure will cost, and thus will help people help themselves. 4:45:06 PM DR. BUTLER demonstrated how to use the Florida website, using an illustrative patient and medication. REPRESENTATIVE FAIRCLOUGH asked whether there is recourse for a consumer if the information is not accurate. DR. BUTLER said that he did not know and advised that a consumer should call the provider and confirm prices. He acknowledged that the accuracy of the information is critical. REPRESENTATIVE ROSES related a personal anecdote and re-stated his caution about the state's website providing "advertising" for products. 4:50:25 PM REPRESENTATIVE KELLER stressed the importance of the individual's responsibility in his or her health care, particularly in the price that is paid for drugs. He commended the DHSS for its work. CHAIR WILSON asked whether the information website was a recommendation of the health care council. REPRESENTATIVE GARDNER said yes. COMMISSIONER JACKSON agreed and noted that the Florida website was endorsed by the Florida attorney general. 4:51:39 PM DR. BUTLER continued to demonstrate the comparison of drug prices on the Florida website. 4:52:48 PM COMMISSIONER JACKSON said that the proposed bill will require health care facilities, home and community based waiver services, and personal care attendants, to provide the DHSS with information related to their costs, types of insurance, location, and facilities. DR. BUTLER added that web site data that is customized and interactive can make a difference in the prevention of disease. He related the success of a Kentucky wellness website that improved the health of state employees. 4:54:36 PM COMMISSIONER JACKSON informed the committee that part 3 of the bill, with the exception of Section 5 that establishes administrative support for the health care commission, addresses the repeal of the Certificate of Need program. She recalled that the CON program was put in place to increase access to care and to keep the cost of facility care down; however, better tools to serve these purposes are now available. Commissioner Jackson noted that there are nine active lawsuits that the state must defend concerning denied CON applications. She referred to the CS that proposes to repeal the CON by a two year process. REPRESENTATIVE ROSES reminded the committee that past testimony regarding the CON was heard last session and the parties were encouraged to work on a compromise. He expressed his understanding that the offered compromise has not been incorporated into the bill. COMMISSIONER JACKSON expressed her appreciation of the work that was done by the negotiated rule-making task force. There were recommendations made, although the recommendations were not unanimous. Some of the recommendations suggested the addition of staff for enforcement and data collection. She encouraged the committee to read the report that was issued by the task force. 5:00:11 PM CHAIR WILSON pointed out that the report is very detailed and will be reviewed at a later hearing. REPRESENTATIVE GARDNER asked how the health care commission and health information website is related to the repeal of the CON. If they are related, she suggested that the repeal should be delayed until after the commission and website are underway. 5:02:09 PM COMMISSIONER JACKSON explained that part of the issue is that the work done so far, by the CON task force, would not remove current or future lawsuits. She opined that the health care commission and the website will begin to serve the purposes of the CON; furthermore, the current lawsuits would become moot under the proposed bill. REPRESENTATIVE GARDNER expressed her doubt as to how listing costs and consumer information will affect the cost to hospitals of providing necessary services. REPRESENTATIVE FAIRCLOUGH asked for the purpose of proposing three bills in one, as opposed to three separate components. She suggested that the committee could delete the controversial issue in order to move forward with other components. She further asked about the liability of an open market and deregulation. REPRESENTATIVE CISSNA asked whether there has been a comprehensive market study done on the communities that may be affected by the legislation. 5:05:25 PM COMMISSIONER JACKSON said that she was not aware of one. [HB 337 was held over.]
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