Legislature(2013 - 2014)CAPITOL 106

03/14/2014 08:00 AM House HEALTH & SOCIAL SERVICES


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
-- Recessed from 3/13/14 --
+= HB 134 MEDICAID PAYMENT FOR MEDISET PRESCRIPTION TELECONFERENCED
Moved CSHB 134(HSS) Out of Committee
+= HB 250 MEDICAL MALPRACTICE ACTIONS TELECONFERENCED
Moved CSHB 250(HSS) Out of Committee
*+ HCR 18 BABY-FRIENDLY HOSPITAL INITIATIVE TELECONFERENCED
Moved Out of Committee
*+ HCR 19 SUPPORTING EFFORTS OF RECOVER ALASKA TELECONFERENCED
Moved CSHCR 19(HSS) Out of Committee
+ Bills Previously Heard/Scheduled TELECONFERENCED
+= HB 214 MENTAL HEALTH PATIENT RIGHTS & GRIEVANCES TELECONFERENCED
Moved CSHB 214(HSS) Out of Committee
          HCR 19-SUPPORTING EFFORTS OF RECOVER ALASKA                                                                       
                                                                                                                                
8:57:03 AM                                                                                                                    
                                                                                                                                
CHAIR HIGGINS  announced that the  final order of  business would                                                               
be HOUSE CONCURRENT RESOLUTION NO.  19, Supporting Recover Alaska                                                               
in  its  efforts  to  reduce the  effects  of  excessive  alcohol                                                               
consumption.                                                                                                                    
                                                                                                                                
8:57:18 AM                                                                                                                    
                                                                                                                                
REPRESENTATIVE BOB HERRON,  Alaska State Legislature, paraphrased                                                               
from the sponsor statement, which read:                                                                                         
                                                                                                                                
     Alaska is "The Great Land"-and we know our great land                                                                      
     takes first place on a number of lists.  Year after                                                                        
     year, Alaska tops national state-by-state rankings for                                                                     
     domestic violence, sexual assault, certain serious                                                                         
     illness, and suicide rates.  More than just shocking                                                                       
     numbers on paper, these "firsts" are loaded with real-                                                                     
     life stories of hardship and pain.  A major factor in                                                                      
     the struggle?  Excessive alcohol consumption.                                                                              
                                                                                                                                
     Recover Alaska is a public-private partnership                                                                             
     initiative formed by a dynamic group of concerned                                                                          
     Alaska business, government, and independent leaders.                                                                      
     Together, members share expertise in the criminal                                                                          
     justice and health care systems, community                                                                                 
     development, and other fields touching on the causes                                                                       
     and consequences of excessive alcohol consumption.                                                                         
                                                                                                                                
     Working with diverse stakeholders, Recover Alaska                                                                          
     pursues a variety of strategies to effect long-term                                                                        
     change.  Strategies include (but are by no means                                                                           
     limited to):                                                                                                               
                                                                                                                                
          Implementation of a comprehensive statewide                                                                           
     communication and advocacy plan to educate the public                                                                      
     about the negative impacts of excessive alcohol                                                                            
     consumption on individuals, families, communities, and                                                                     
     the state as a whole;                                                                                                      
          Development of a one-stop-shop for Alaskans to                                                                        
     access accurate information, as well as prevention and                                                                     
     treatment referral services; and                                                                                           
          A sincere review of laws governing the sale and                                                                       
     distribution of alcohol in the state.                                                                                      
                                                                                                                                
     Recover Alaska is not anti-alcohol, anti-self                                                                              
     determination, or anti-business.  Rather, in the                                                                           
     course of seeking to reduce the occurrence and the                                                                         
     aftermath of excessive consumption, Recover Alaska                                                                         
     supports healthier communities and brighter futures                                                                        
     for all Alaskans.                                                                                                          
                                                                                                                                
9:02:08 AM                                                                                                                    
                                                                                                                                
CHAIR HIGGINS asked how this resolution would be distributed.                                                                   
                                                                                                                                
REPRESENTATIVE  HERRON explained  that the  goal of  the proposed                                                               
resolution was  for recognition by  the Alaska  State Legislature                                                               
that there was excessive alcohol  consumption in Alaska, and that                                                               
the legislature  would strive, in conjunction  with Department of                                                               
Health and Social Services (DHSS), to address the problem.                                                                      
                                                                                                                                
9:03:32 AM                                                                                                                    
                                                                                                                                
CHAIR HIGGINS asked if this proposed resolution would go to the                                                                 
governor, as it was important for the governor to understand                                                                    
this request for help with this problem.                                                                                        
                                                                                                                                
REPRESENTATIVE HERRON  expressed his  agreement, and  deferred to                                                               
Commissioner Streur.                                                                                                            
                                                                                                                                
REPRESENTATIVE NAGEAK expressed  his agreement that it  was a big                                                               
problem  and  that it  was  necessary  to continue  working  with                                                               
organizations to encourage young people.                                                                                        
                                                                                                                                
REPRESENTATIVE  HERRON said  that the  resolution recognized  the                                                               
people  working  with  Recover  Alaska that  want  a  change  for                                                               
excessive consumption.                                                                                                          
                                                                                                                                
REPRESENTATIVE   TARR   expressed   her  appreciation   for   the                                                               
resolution.                                                                                                                     
                                                                                                                                
9:08:09 AM                                                                                                                    
                                                                                                                                
[A short video was presented]                                                                                                   
                                                                                                                                
9:11:29 AM                                                                                                                    
                                                                                                                                
DIANE KAPLAN,  President and CEO, Rasmuson  Foundation, commented                                                               
on   a  letter   previously  received   from  Governor   Parnell,                                                               
explaining his  veto that  half of  the alcohol  tax be  used for                                                               
alcohol programs.   He had  stated that he would  reconsider this                                                               
decision if he  was persuaded that there  were impactful programs                                                               
in  place,  and  he  had   urged  that  Recover  Alaska  look  at                                                               
innovative ways to address the  issue.  She relayed that Rasmuson                                                               
Foundation  had  convened a  broad  based,  high level  group  of                                                               
policy makers  about four years  earlier to discuss the  issue of                                                               
excessive  alcohol use.   She  listed some  of the  programs with                                                               
alcohol related problems that  Rasmuson Foundation had supported,                                                               
and  she pointed  out the  necessity for  Rasmuson Foundation  to                                                               
work toward the core of the problem.   She shared that this was a                                                               
joint initiative including  participation by Rasmuson Foundation,                                                               
the Alaska  Mental Health Trust  Authority, Department  of Health                                                               
and Social  Services, and the  Mat-Su Health Foundation,  as well                                                               
as members  of the  judiciary, health  providers, and  other non-                                                               
profits.                                                                                                                        
                                                                                                                                
9:13:28 AM                                                                                                                    
                                                                                                                                
ELIZABETH RIPLEY,  Executive Director, Mat-Su  Health Foundation,                                                               
reported that  surveys completed during the  last year throughout                                                               
Alaska  had revealed  that alcohol  and substance  abuse was  the                                                               
"top issue  listed by Alaskans  as detrimental to  their health."                                                               
She acknowledged that its impact  had drained resources and that,                                                               
although  many  organizations  were  addressing  the  issue,  the                                                               
effect had  plateaued and many providers,  funders, families, and                                                               
individuals were frustrated.   She emphasized that,  as this hurt                                                               
the schools,  the communities,  the employers,  and the  State of                                                               
Alaska, it affected all Alaskans.   She declared that it was such                                                               
a complex issue  that many organizations stayed away  for fear of                                                               
not making  any impact.   She remarked that  discussion regarding                                                               
the economic impacts of alcohol  often focused on the hospitality                                                               
industry, although alcohol  was not an ordinary  commodity and it                                                               
had "a terrible social cost"  which needed to be acknowledged and                                                               
addressed.   She stated  that the monetary  impact to  the Alaska                                                               
economy was  almost $1.2  billion annually.   She  explained that                                                               
the  group would  focus  on  the systems  and  the leadership  to                                                               
better align  efforts and  partners.  She  noted that  the Mat-Su                                                               
community  had also  ranked alcohol  and substance  abuse as  the                                                               
number one  issue, and  that the  top five  health issues  in the                                                               
community were all  related to behavioral health.   She said that                                                               
the  board  of directors  of  the  Mat-Su Health  Foundation  had                                                               
selected  behavioral health  and  child trauma  as  the areas  to                                                               
focus  its  funding.   She  said  that  $5 million  was  annually                                                               
allocated to  raise the health  status of people in  the Borough.                                                               
She  pointed  out that  alignment  throughout  Alaska by  Recover                                                               
Alaska  to the  behavioral  health investment  efforts for  time,                                                               
expertise, and  money would  "really make a  bigger dent  in this                                                               
issue."                                                                                                                         
                                                                                                                                
9:17:37 AM                                                                                                                    
                                                                                                                                
JEFF JESSEE, Chief Executive Officer,  Alaska Mental Health Trust                                                               
Authority,  Department of  Revenue, expressed  his agreement  for                                                               
the alignment  of efforts across  a variety of partners,  as this                                                               
was critical for advancement of  solutions to these problems.  He                                                               
declared that this  was the best opportunity he had  seen, in his                                                               
34 years working  in this field, to actually  make some progress.                                                               
He  pointed  out that  Rasmuson  Foundation  was leading  Recover                                                               
Alaska, the  Alaska Mental Health Trust  Authority had identified                                                               
alcohol  and substance  abuse as  one  its new  focus areas,  and                                                               
Senator Pete Kelly  had coordinated a group with the  goal to end                                                               
fetal alcohol spectrum disorder (FASD)  in Alaska.  He noted that                                                               
the Mat-Su Health  Foundation was also leading a  local effort to                                                               
deal with  this issue, and  other wellness coalitions  and tribal                                                               
partners had dedicated their efforts  to change some social norms                                                               
and reduce the negative impacts of excessive consumption.                                                                       
                                                                                                                                
9:19:30 AM                                                                                                                    
                                                                                                                                
MS. KAPLAN  reported that  none of the  partners were  willing to                                                               
simply  meet and  "contribute to  a  report that's  gonna sit  on                                                               
someone's  shelf for  the next  20 years."   She  emphasized that                                                               
there  was   a  lot  of   drinking  in  Alaska,  with   very  few                                                               
consequences, so  it was  necessary to  change the  social norms.                                                               
She pointed to  the tobacco cessation program in  the early 1990s                                                               
as an  example.   She shared that  change in  alcohol consumption                                                               
had  already started,  noting that  not there  were not  too many                                                               
three  martini  lunches anymore.    She  stated that  people  now                                                               
routinely used seat belts, which  was another major social change                                                               
in  the community.   She  expressed her  belief that  this change                                                               
could also  be accomplished  with excessive  alcohol consumption.                                                               
She  pointed out  that it  was  very uncommon  to see  noticeably                                                               
pregnant women drinking  in public, as this  behavior was subject                                                               
to social  pressure.  She  stressed the necessity to  have public                                                               
and private  partners working together,  which was the  basis for                                                               
Recover Alaska.   This would be a long term  project, noting that                                                               
the tobacco cessation  effort had taken 20 years,  with the first                                                               
impacts  noticed  after  3  years,  and  acknowledging  that  the                                                               
alcohol  program would  also take  this  long.   She stated  that                                                               
private  entities  made  good  partners,   as  they  had  patient                                                               
capital.   She reported  that Rasmuson  Foundation had  taken the                                                               
lead for  the organization  of the Recover  Alaska efforts.   She                                                               
said that Rasmuson was actively involved  in a review of Title 4,                                                               
the  state alcohol  rules,  and  this review  was  chaired by  an                                                               
officer   of  the   Cabaret,  Hotel,   Restaurant,  &   Retailers                                                               
Association (CHARR).   She reported that these  60 active members                                                               
were looking  at every aspect  of the  alcohol laws, with  a goal                                                               
for  proposed  legislation  by  2015  to  reduce  the  amount  of                                                               
excessive drinking in  Alaska.  She stated that there  would be a                                                               
social norms  campaign focused on  youth, sharing that  kids like                                                               
to be normal and commenting that  cool kids don't drink, so other                                                               
kids will want to  be like them.  She noted  that most kids think                                                               
every  other kid  was drinking.   She  discussed partnerships  to                                                               
review  adverse childhood  experiences, including  neglect caused                                                               
by alcohol.   The outcomes in  later life of this neglect were an                                                               
increased  prevalence  of  obesity,  suicide,  and  other  health                                                               
conditions,  and happiness  would be  impacted.   She stated  the                                                               
need  of a  resource  in Alaska  for people  who  need help,  and                                                               
declared  that Rasmuson  would pilot  a one-stop-shop  for guided                                                               
help to find the available resources.                                                                                           
                                                                                                                                
CHAIR HIGGINS asked about the United Way 211 system.                                                                            
                                                                                                                                
MS. KAPLAN replied that this  system offered no better resources,                                                               
as no one kept a list  of the available programs, available beds,                                                               
assessments, in-patient  care, and  what insurance  was accepted.                                                               
She reported  that Rasmuson Foundation  would pilot  this program                                                               
in two communities.                                                                                                             
                                                                                                                                
9:25:54 AM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  REINBOLD  commented on  the  wide  spread use  of                                                               
alcohol on college  campuses, and asked how the  program would be                                                               
implemented.                                                                                                                    
                                                                                                                                
9:26:54 AM                                                                                                                    
                                                                                                                                
MS. KAPLAN  replied that  they were  currently working  to define                                                               
the impact messaging,  and she offered an example  of the tobacco                                                               
alliance  messages  to  teenagers.   She  said  that  the  Mat-Su                                                               
partnership was working with professional  media companies to try                                                               
out  different  messages  on  focus groups  of  teenagers.    She                                                               
emphasized that kids would be defining the messages.                                                                            
                                                                                                                                
9:28:00 AM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  REINBOLD  suggested  reaching out  to  the  youth                                                               
leaders.                                                                                                                        
                                                                                                                                
9:28:23 AM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KELLER  stated that he  had "very little  faith in                                                               
legislation  making  the  level  of   changes  by  itself."    He                                                               
expressed  his  support  for the  partnership  described  by  Mr.                                                               
Jessee, as there  were "some really tough questions  that have to                                                               
be brought forward," and he offered FASD as an example.                                                                         
                                                                                                                                
9:29:39 AM                                                                                                                    
                                                                                                                                
MR.  JESSEE,  referencing  the aforementioned  legislation,  said                                                               
that the Alcohol  Beverage Control (ABC) Board  was reviewing the                                                               
Title IV  alcohol beverage control statutory  framework, which he                                                               
declared  to be  a  "hodge-podge  of additions  over  time."   He                                                               
stated that enforcement  was inconsistent, and the  ABC board had                                                               
convened a number  of committees to review  topics which included                                                               
local options, underage drinking, and  licensing.  He shared that                                                               
he was the  chair of the licensing committee, that  70 percent of                                                               
his committee members were from  the [alcohol] industry, and that                                                               
the  goal was  to find  common areas  of agreement  for a  public                                                               
health   oriented   approach   to  alcohol   regulation   without                                                               
negatively  impacting  the  legitimate business  interests.    He                                                               
spoke about  the committee  review of  underage drinking  and the                                                               
subsequent  criminal records  for offenders.   He  explained that                                                               
the  onerous   consequences  discouraged  police   officers  from                                                               
writing citations.  He suggested  lowering the criminality of the                                                               
offense  to  be  more  consistent   with  law  enforcement.    He                                                               
suggested that  legislation for a  follow-up to  the registration                                                               
of kegs found  at underage drinking parties could be  part of the                                                               
solution.                                                                                                                       
                                                                                                                                
CHAIR  HIGGINS offered  his belief  that a  problem which  groups                                                               
fall into was to think  "their mousetrap is better than everybody                                                               
else's  mousetrap."     He  declared  that  there   was  not  any                                                               
coordination  among the  many good  groups.   He opined  that any                                                               
group receiving  state funding  or grants  should be  required to                                                               
have a conference  for coordination of efforts.   He suggested to                                                               
team up with United Way 211 to  make that site "the best it could                                                               
possibly be, 'cause they're already doin'  it."  He stated a need                                                               
for coordinated efforts.                                                                                                        
                                                                                                                                
REPRESENTATIVE  REINBOLD suggested  that youth  community service                                                               
should be an aspect of sentencing for underage drinking.                                                                        
                                                                                                                                
MS. KAPLAN, in response to Chair  Higgins, said that the plan for                                                               
the one-stop-shop was  for the United Way 211 to  be the entryway                                                               
into services.   This would be supported by a  person acting as a                                                               
guide  to actual  services, as  currently there  was just  a list                                                               
without any  support or follow  up help.   She noted  that United                                                               
Way was also a key member of Recover Alaska.                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR  asked  if   this  effort  was  regional  or                                                               
statewide, and how it would identify  those who need help to best                                                               
meet their needs.                                                                                                               
                                                                                                                                
MR. JESSEE  acknowledged that  the group  was stealing  this idea                                                               
from the Tobacco quit line.   He declared that the important part                                                               
of the  one-stop-shop was for  someone to help decide  what would                                                               
be  the most  effective treatment  program, and  then check  back                                                               
with the individual  for any follow up support.  He declared that                                                               
this  was a  fundamental difference  from the  211 referral.   He                                                               
opined   that  more   information   for   improvement  would   be                                                               
forthcoming as the system and the services were being utilized.                                                                 
                                                                                                                                
9:37:43 AM                                                                                                                    
                                                                                                                                
MS. KAPLAN  directed attention to  the partnership  strategy with                                                               
media to  raise public  awareness.  She  mentioned the  series on                                                               
FASD  in  the  Anchorage  Daily News  (ADN),  and  reported  that                                                               
Rasmuson Foundation  was funding  a full  time reporter  and part                                                               
time  photographer at  ADN for  18  months to  report on  alcohol                                                               
issues.  Referring to the FASD  series in ADN, she stated that 50                                                               
percent of pregnancies in Alaska  were unplanned.  She noted that                                                               
most women  were not thinking  about ceasing  alcohol consumption                                                               
until pregnancy was  a reality, and not just a  possibility.  She                                                               
stated  that the  cost of  an FASD  child to  the family,  to the                                                               
state, and to the child itself, was enormous.                                                                                   
                                                                                                                                
9:39:42 AM                                                                                                                    
                                                                                                                                
CHAIR HIGGINS  requested project  directors:   "please do  not be                                                               
politically correct."  He suggested telling the truth.                                                                          
                                                                                                                                
REPRESENTATIVE KELLER said that he  was excited about the program                                                               
and  the quality  of the  organizations aligning  to address  the                                                               
problem.  He pointed to  the "depth of the political ramification                                                               
and the visceral  reactions that are tied to this  issue that you                                                               
have to deal with."                                                                                                             
                                                                                                                                
REPRESENTATIVE  REINBOLD mentioned  that both  Mark Hamilton  and                                                               
Senator (Pete) Kelly were passionately  working on eradication of                                                               
FASD.  She referred to  a recently formed Medicaid taskforce. She                                                               
offered  her belief  that this  was an  important opportunity  to                                                               
address  the issue  and reduce  the DHSS  budget.   She suggested                                                               
that  the Friday  night church  programs,  Recovery Alaska,  were                                                               
amazing and impressive.                                                                                                         
                                                                                                                                
MS. RIPLEY,  in response to  Representative Reinbold,  listed the                                                               
medical sector, the education sector,  and the business sector as                                                               
all identifying  alcohol and  substance abuse  as the  number one                                                               
issue.                                                                                                                          
                                                                                                                                
REPRESENTATIVE  TARR,  pointing  to the  earlier  discussion  for                                                               
social norms  surrounding alcohol abuse, suggested  that there be                                                               
more empathy and less judgment toward alcohol abuse.                                                                            
                                                                                                                                
REPRESENTATIVE NAGEAK  stated that  it was our  job to  share the                                                               
messaging with those who were struggling.                                                                                       
                                                                                                                                
REPRESENTATIVE  PRUITT acknowledged  that this  was a  monumental                                                               
task  and he  suggested that  adults had  to be  targeted in  the                                                               
message, as well  as kids.  He declared that  the public norm had                                                               
to also be  viewed, and he offered an  anecdote regarding alcohol                                                               
consumption  at public  functions.   He  asked  that the  program                                                               
message be  expanded beyond  kids, declaring that  we all  had to                                                               
keep ourselves,  our colleagues,  and our friends  from excessive                                                               
alcohol consumption.                                                                                                            
                                                                                                                                
MR. JESSEE offered several anecdotes  regarding the atmosphere of                                                               
social norms that needed to change.                                                                                             
                                                                                                                                
CHAIR HIGGINS shared an anecdote.                                                                                               
                                                                                                                                
9:49:37 AM                                                                                                                    
                                                                                                                                
WILLIAM  STREUR,   Commissioner,  Office  of   the  Commissioner,                                                               
Department of Health and Social  Services (DHSS), stated "this is                                                               
a good thing.   What we're doing with this  is something that is,                                                               
I think,  going to get  us off of dead  center."  He  shared that                                                               
there had  been these same challenges  for 40 years, and  that it                                                               
was financially evident that this  could not continue in the same                                                               
way.   He  pointed to  the negative  effects of  alcohol and  the                                                               
amount of money spent on  alcohol problems among the divisions in                                                               
Department of  Health and  Social Services.   He declared  that a                                                               
common  theme  among  many  departments in  the  state  were  the                                                               
results from mis-use of alcohol and  drugs.  He declared the need                                                               
for  a partnership  with "our  tribes,  with our  municipalities,                                                               
with our villages, and with  our private partners."  He expressed                                                               
his support for the Recover Alaska group.                                                                                       
                                                                                                                                
9:52:35 AM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HERRON  offered two  insights he had  gained after                                                               
this presentation, one  insight was that this was  not a project,                                                               
as it  had no end  date, and the second  insight was that  all 60                                                               
legislators had to be involved  and supportive.  He expressed his                                                               
appreciation for  Senator Kelly "carrying that  banner" for FASD;                                                               
however, FASD  and not drinking  when you were pregnant  had been                                                               
in the  statutes for  25 years.   He  declared that  the proposed                                                               
resolution not  only recognized Recover  Alaska, but  it declared                                                               
the need for help from everyone.                                                                                                
                                                                                                                                
9:54:48 AM                                                                                                                    
                                                                                                                                
CHAIR  HIGGINS opined  that there  would  be substantial  savings                                                               
through Recover Alaska, if its  efforts could be coordinated with                                                               
other groups.   He declared that  it was a necessity  for all the                                                               
stakeholders  to  communicate.    He emphasized  that  jobs  were                                                               
necessary as it gave value to people's lives.                                                                                   
                                                                                                                                
9:56:05 AM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KELLER  suggested that the final  paragraph of the                                                               
sponsor  statement  be  phrased  more positively  to  state  that                                                               
Recover Alaska was willing to take on issues.                                                                                   
                                                                                                                                
CHAIR HIGGINS  asked about an  earlier reference for a  change to                                                               
the wording order in the title of the resolution.                                                                               
                                                                                                                                
REPRESENTATIVE HERRON  explained his request for  a minor, though                                                               
significant,  change  in the  title  to  now read:    "Supporting                                                               
Recover  Alaska  in  its  efforts  to  reduce  excessive  alcohol                                                               
consumption and the effects."                                                                                                   
                                                                                                                                
9:58:04 AM                                                                                                                    
                                                                                                                                
REPRESENTATIVE PRUITT  suggested a  conceptual amendment  for the                                                               
title  to read:   "Supporting  Recover Alaska  in its  efforts to                                                               
reduce excessive alcohol consumption and its effects."                                                                          
                                                                                                                                
There being no objection, Conceptual Amendment 1 was adopted.                                                                   
                                                                                                                                
9:58:36 AM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KELLER  moved  to  report  HCR  19,  Version  28-                                                               
LS1475\A,   as  amended,   out  of   committee  with   individual                                                               
recommendations and  the accompanying  zero fiscal notes.   There                                                               
being no  objection, CSHCR  19(HSS) was  reported from  the House                                                               
Health and Social Services Standing Committee.                                                                                  

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