Legislature(2011 - 2012)CAPITOL 106

04/10/2012 03:00 PM HEALTH & SOCIAL SERVICES


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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ SB 74 INS. COVERAGE: AUTISM SPECTRUM DISORDER TELECONFERENCED
Heard & Held
-- Testimony <Invitation Only> --
+ Bills Previously Heard/Scheduled TELECONFERENCED
+= SB 98 BIOMETRIC INFORMATION FOR ID TELECONFERENCED
Moved HCS CSSB 98(HSS) Out of Committee
         SB 74-INS. COVERAGE: AUTISM SPECTRUM DISORDER                                                                      
                                                                                                                                
3:02:49 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER announced that the  first order of business would be                                                               
SENATE  BILL NO.  74, "An  Act requiring  insurance coverage  for                                                               
autism   spectrum   disorders,    describing   the   method   for                                                               
establishing a  covered treatment  plan for those  disorders, and                                                               
defining  the   covered  treatment   for  those   disorders;  and                                                               
providing for an effective date."                                                                                               
                                                                                                                                
SENATOR  JOHNNY  ELLIS,  Alaska State  Legislature,  stated  that                                                               
proposed  SB   74  required  "insurance  coverage   of  medically                                                               
necessary,   evidence  based   treatments   of  autism   spectrum                                                               
disorders  (ASD)  for  individuals  under   the  age  of  21,  as                                                               
prescribed  by  a  licensed  physician   or  psychologist."    He                                                               
clarified that  these were not experimental  treatments, but were                                                               
medically necessary  treatments which included  speech, language,                                                               
physical,    and    occupational   therapies    and    behavioral                                                               
interventions  recognized  by  the   U.S.  Surgeon  General,  the                                                               
National Institute of  Child Health, and the  American Academy of                                                               
Pediatrics as effective forms of  medical treatment.  He declared                                                               
that autism  was treatable, and  that the efficacy  of behavioral                                                               
interventions  for the  treatment of  ASDs was  well established.                                                               
He stated  that intensive  behavioral therapy  had been  shown to                                                               
increase   IQ,  language   skills,   academic  performance,   and                                                               
sociality, and reduce long term  medical costs.  He reported that                                                               
nearly  half   of  those  receiving  medically   necessary  early                                                               
intervention and treatment did not  require lifelong services and                                                               
support,  while  half of  these  children  were able  to  achieve                                                               
normal functioning  after two  to three years  of treatment.   He                                                               
pointed   out   that   an   increase   to   functionality   would                                                               
significantly reduce  the fiscal impact  on the State  of Alaska.                                                               
He noted that the Governor's  Council on Disabilities and Special                                                               
Education were  strong supporters of  the proposed bill,  and had                                                               
reported that  autism insurance coverage would  save $208,500 per                                                               
child  in  avoided  special  education  costs,  with  a  lifetime                                                               
savings of  just over $1  million per  child.  He  declared that,                                                               
without treatment,  an autistic  individual would cost  the state                                                               
about $3.2  million, which included  lost productivity  and adult                                                               
care.                                                                                                                           
                                                                                                                                
3:07:09 PM                                                                                                                    
                                                                                                                                
SENATOR  ELLIS  declared  that   the  proposed  bill  would  only                                                               
slightly increase  insurance premiums.   He shared that  the cost                                                               
would be about  0.39 percent of insured premiums,  or about $1.34                                                               
per month  for each policy  holder.   He noted five  other states                                                               
which were  good indicators  of the actual  cost, as  claims data                                                               
for  two  years  of  implementation  of  this  demonstrated  that                                                               
premiums were lower than predicted,  with an average cost to each                                                               
member of 31 cents  per month at the end of the  second year.  He                                                               
pointed  to  other  insurance  mandates   that  had  passed  with                                                               
bipartisan support, which included  prostate cancer screening and                                                               
well-baby  examinations.   He  declared  that  the proposed  bill                                                               
would help children, save marriages, and keep families together.                                                                
                                                                                                                                
3:10:04 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE DAN SADDLER, Alaska  State Legislature, shared the                                                               
personal story  of his  autistic son,  who was  finally diagnosed                                                               
when he  was six and  one half years  of age.   After researching                                                               
autism,  he  and his  wife  had  agreed that  applied  behavioral                                                               
analysis  (ABA)  was  the  only  evidence  based,  scientifically                                                               
founded  treatment  for autism.    He  listed the  therapies  and                                                               
consultations outside Alaska, as there  were few providers in the                                                               
state.  He shared that  they had borrowed from family, refinanced                                                               
their  house, used  their insurance  to its  maximum extent,  and                                                               
spent "many  scores of thousands of  dollars out of pocket."   He                                                               
said that an  attempt at enrolling his son in  the public schools                                                               
in Anchorage had not been successful,  as his son did not receive                                                               
the necessary  intense applied behavioral analysis  services.  He                                                               
shared that  his son and  his wife  had moved to  Connecticut for                                                               
almost two years of high  quality, intense ABA services, but were                                                               
now back  in Eagle River,  where his son  was enrolled at  an ABA                                                               
school.   He  declared that  his family's  experience illustrated                                                               
the benefits of ABA,  as his son was now able  to talk, read, "do                                                               
math as well as a Saddler  can," and receive benefit from school.                                                               
He shared that,  although his family had not  broken apart, there                                                               
were  scars, which  was  a common  experience  for families  with                                                               
special  needs children.    He declared  that  the proposed  bill                                                               
would  help eliminate  the huge  upheavals in  life by  providing                                                               
good service  for children at  a young  age.  This  would improve                                                               
their prospects for  a meaningful life with  the maximum progress                                                               
in life,  save the  State of  Alaska a lot  of money  from social                                                               
services and  care, and keep  families together.  He  pointed out                                                               
that  the increased  cost of  premiums  would be  covered by  the                                                               
reductions in  educational and medical  expenses.  He  noted that                                                               
insurance pools the risks and shares  the costs of illnesses.  He                                                               
declared his  support of the  proposed bill, and although  it may                                                               
not be  the best solution, it  was a solution that  was available                                                               
today.  He  summarized that "every year there is  no action, more                                                               
children slip into darkness."                                                                                                   
                                                                                                                                
3:14:17 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER  commented that,  although the  upcoming testimonies                                                               
would   reveal  challenges   and  problems   with  the   proposed                                                               
legislation, it was not insensitive to the issue.                                                                               
                                                                                                                                
REPRESENTATIVE HERRON expressed his  agreement to the sensitivity                                                               
of the  issue, and asked  if Representative Saddler was  aware of                                                               
the autism coverage incentive program being offered in Michigan.                                                                
                                                                                                                                
REPRESENTATIVE   SADDLER   expressed    his   desire   for   more                                                               
information.                                                                                                                    
                                                                                                                                
REPRESENTATIVE HERRON, pointing out that  the proposed bill was a                                                               
health issue  and an insurance  issue, asked about  forwarding it                                                               
to the House Labor and Commerce Standing Committee.                                                                             
                                                                                                                                
REPRESENTATIVE SADDLER  stated that  the House Health  and Social                                                               
Services Standing Committee  was a good committee  to discuss the                                                               
issues  and  concerns, and  that  the  House Labor  and  Commerce                                                               
Standing Committee  would be an appropriate  committee to discuss                                                               
the fiscal ramifications of the proposed bill.                                                                                  
                                                                                                                                
3:17:00 PM                                                                                                                    
                                                                                                                                
LORRI  UNUMB, Vice  President, State  Government Affairs,  Autism                                                               
Speaks, shared that  she had an eleven year old  son with autism,                                                               
and that  she had formerly  worked as  an attorney with  the U.S.                                                               
Department  of  Justice,  and  a   Professor  of  Law  at  George                                                               
Washington  University.    She   declared  that  she  decided  to                                                               
advocate full time on behalf  of individuals with autism when she                                                               
recognized  the "inequity  in the  insurance arena."   She  noted                                                               
that she had written an  academic textbook, "Autism and the Law,"                                                               
and that  she also  taught a  law school  course on  the subject.                                                               
She  clarified   that  autism  was  a   medical  condition,  with                                                               
diagnosis  and treatment  by  a  medical doctor.    It cannot  be                                                               
cured, but  it can be  treated.  She  reported that more  than 50                                                               
percent of the time, treatment  allowed that children could enter                                                               
the  first  grade  indistinguishable   from  their  peers,  which                                                               
resulted in huge savings in special educational costs.                                                                          
                                                                                                                                
MS.  UNUMB directed  attention to  slide 3,  "ABA Therapy  Is Not                                                               
Experimental,"  and  stated  that the  most  commonly  prescribed                                                               
treatment  was applied  behavior  analysis  (ABA) therapy  which,                                                               
although it  had been  used for decades  in treatment,  was often                                                               
deemed an experimental treatment by insurance companies.                                                                        
                                                                                                                                
3:18:57 PM                                                                                                                    
                                                                                                                                
MS. UNUMB moved  on to slide 7, "Autism Prevalence  on the Rise,"                                                               
which depicted  the exponential  increase to  the rate  of autism                                                               
over 35 years.  She declared  that statistics showed that 1 in 88                                                               
children  were  diagnosed  with autism.    She  emphasized  that,                                                               
unless  treatments  were  initiated  immediately,  the  State  of                                                               
Alaska  would be  hit "with  a huge  autism tsunami  in terms  of                                                               
special educational costs."  She  pointed out that the cost would                                                               
also  include  group  homes,  or  institutionalization,  with  an                                                               
average per  person cost of $3  million for children who  did not                                                               
receive  treatment.   She declared  that, without  private health                                                               
insurance coverage, there would not be the treatment.                                                                           
                                                                                                                                
3:20:16 PM                                                                                                                    
                                                                                                                                
MS.  UNUMB   identified  that  slide  10,   "States  with  Autism                                                               
Insurance Reform,"  listed the 29  states with  meaningful autism                                                               
insurance  legislation.   She mentioned  that  Michigan had  just                                                               
passed an autism insurance bill.   She reported that both liberal                                                               
and  conservative states  had already  passed  legislation.   She                                                               
mentioned that opponents  of this legislation had  said that this                                                               
would  be very  expensive, would  cause  companies to  go out  of                                                               
business, and  that the  cost of  insurance was  a problem.   She                                                               
acknowledged that the  cost of insurance was a  problem, but that                                                               
the cost  to add the  benefit was "incredibly minimal,"  and that                                                               
the cost  of claims data was  even lower than the  actuarial cost                                                               
predictions.  She  directed attention to page 14  of the handout,                                                               
"Insurance Coverage for Autism in  Alaska," [Included in members'                                                               
handouts] which listed the premium  costs in five of the earliest                                                               
states  to  adopt   autism  legislation.    The   first  year  of                                                               
implementation  of autism  legislation increased  the per  member                                                               
per  month insurance  cost by  an average  of 15  cents, and  the                                                               
second  year  the  average  cost  increase was  31  cents.    She                                                               
declared that most  everyone was willing to pay  an additional 31                                                               
cents each month "so that all  the children with autism could get                                                               
the  treatment  that  they  need, especially  when  it's  such  a                                                               
fiscally responsible thing for the state to do."                                                                                
                                                                                                                                
3:23:05 PM                                                                                                                    
                                                                                                                                
MS.  UNUMB furnished  slide 12,  "South  Carolina State  Employee                                                               
Plan," and  stated that  the original projection  of cost  to the                                                               
state had been  $18.9 million, revised down to  $10 million, with                                                               
an actual cost  of $856,371 in the first year,  and $2,042,392 in                                                               
the second year, which was 44 cents per member per month.                                                                       
                                                                                                                                
3:23:59 PM                                                                                                                    
                                                                                                                                
MS. UNUMB directed  attention to the handout  "Health Coverage of                                                               
Alaska Population"  [Included in members' packets]  and said that                                                               
the proposed  legislation would  affect 15  percent of  the state                                                               
population.   She pointed out  that the state could  not regulate                                                               
the 34 percent  of self-insured.  She declared  that the military                                                               
insurance in  Alaska, TRICARE,  which covered  11 percent  of the                                                               
state, had already  voluntarily adopted this same  coverage.  She                                                               
offered an analogy  for using the too few  available life jackets                                                               
to  save as  many people  as possible  from a  sinking ferry,  as                                                               
opposed to holding  on to the lifejackets because  there were not                                                               
enough to  save everyone.   She declared  that the  proposed bill                                                               
was that  lifejacket to  many families.   Directing  attention to                                                               
slide 24, "Self-Funded ERISA Plans  that cover Autism Treatments,                                                               
" she  pointed to a  list of self-insured companies,  not subject                                                               
to state law,  that had voluntarily added an  autism benefit when                                                               
the state had required the benefit.                                                                                             
                                                                                                                                
3:26:47 PM                                                                                                                    
                                                                                                                                
MS.  UNUMB   declared  that  the  argument   that  this  proposed                                                               
legislation  targeted  small  businesses was  misleading,  as  it                                                               
applied to  all businesses  that the state  could regulate.   She                                                               
urged immediate action on the  proposed legislation, as any delay                                                               
could  mean  the  difference  to  a child  for  a  life  time  of                                                               
institutionalization or a meaningful lifetime.                                                                                  
                                                                                                                                
3:27:41 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE HERRON  asked if  the Michigan  autism legislation                                                               
model fit with this legislation.                                                                                                
                                                                                                                                
MS. UNUMB,  in response,  explained that  Michigan had  created a                                                               
state autism  fund which reimbursed  the insurance  companies for                                                               
any additional costs from the coverage.                                                                                         
                                                                                                                                
REPRESENTATIVE  HERRON  asked  what   was  the  response  by  the                                                               
insurance companies.                                                                                                            
                                                                                                                                
MS. UNUMB replied that the insurance companies were thrilled.                                                                   
                                                                                                                                
3:29:14 PM                                                                                                                    
                                                                                                                                
CHAIR  KELLER  expressed  his agreement  that  the  fund  concept                                                               
seemed so  logical.   He asked about  any ramifications  from the                                                               
federal Patient Protection  and Affordable Care Act  (PPACA).  He                                                               
offered his belief that insurance  mandates would be paid by each                                                               
state, without any federal match.                                                                                               
                                                                                                                                
3:29:51 PM                                                                                                                    
                                                                                                                                
MS.  UNUMB directed  attention to  slide 30,  "Impact of  Federal                                                               
Health  Care Reform,"  and  clarified that  PPACA  stated that  a                                                               
state would  be "on the  hook" for  any benefits which  the state                                                               
required  unless  those benefits  were  included  in the  federal                                                               
essential benefits package.                                                                                                     
                                                                                                                                
MS. UNUMB  indicated slide 31,  "federal Health Care  Reform: The                                                               
Essential  Benefits  Package  (pre-amendment)  which  listed  the                                                               
essential benefits  in PPACA, as  it was going  through Congress.                                                               
When Autism  Speaks reviewed the  list, it was unclear  if autism                                                               
benefits were  included, so language  had been  added, "including                                                               
behavioral health  treatments," to ensure that  autism treatments                                                               
were covered.   She moved  on to  slide 33, "Federal  Health Care                                                               
Reform:  The  Essential  Benefits Package  (as  enacted),"  which                                                               
included behavioral  health treatment, as well  as rehabilitative                                                               
and habilitative  services.  She  emphasized that proposed  SB 74                                                               
would  be  included  in  the  federal  PPACA  essential  benefits                                                               
package, and should  not include any obligation for  the state to                                                               
defray excess costs.                                                                                                            
                                                                                                                                
3:31:57 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER  offered his  belief that, as  the outcome  of PPACA                                                               
was an  unknown, it was "an  unsettled segment."  He  opined that                                                               
ABA should  be included in  special education funding,  and asked                                                               
if other states had done anything toward this line of funding.                                                                  
                                                                                                                                
3:32:51 PM                                                                                                                    
                                                                                                                                
MS.   UNUMB  explained   that   the   federal  Individuals   with                                                               
Disabilities  Education  Act  (IDEA)  required  that  all  public                                                               
schools  accommodate children  with disabilities,  which included                                                               
autism.   She pointed out that  it did not require  treatment for                                                               
the  underlying  disability.   She  informed  the committee  that                                                               
prior to IDEA,  schools could "shut their doors  to children with                                                               
disabilities," and  that the  intent of  the legislation  was for                                                               
schools  to  accommodate  the disability,  but  not  provide  the                                                               
treatment.  She declared that,  if a family had health insurance,                                                               
it was the responsibility of  the insurance company to contribute                                                               
to the treatment cost.  She  said that although some schools used                                                               
the principles of ABA in  education, that lower threshold did not                                                               
meet the medical necessity threshold.                                                                                           
                                                                                                                                
3:35:00 PM                                                                                                                    
                                                                                                                                
MS. UNUMB,  in response to  Chair Keller, said that  the revision                                                               
to  the Diagnostic  and Statistical  Manual (DSM)  was due  to be                                                               
released in  the near  future.   She offered  her belief  that it                                                               
would  include  a re-shaping  of  the  autism spectrum;  although                                                               
there was no intent to narrow  the diagnosis, there was a concern                                                               
that this would be the effect.                                                                                                  
                                                                                                                                
3:35:30 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER  clarified that the  DSM was under  consideration by                                                               
the American Psychiatric Association, and  was due for release in                                                               
May  2013.   He  offered his  belief  that "we  could  do a  more                                                               
intelligent bill just a little bit later."                                                                                      
                                                                                                                                
MS.  UNUMB replied  that many  states  have had  to grapple  with                                                               
this,  but that  the definitions  for the  diagnoses would  still                                                               
affect the same category of children.                                                                                           
                                                                                                                                
3:36:46 PM                                                                                                                    
                                                                                                                                
TONJA UPDIKE, Board Member, Governor's  Council on Disabilities &                                                               
Special Education,  offered a personal story  her autistic child.                                                               
She  declared that  the early  intervention  program, the  speech                                                               
therapist, and the occupational  therapist had made great strides                                                               
with  his development,  but that,  although  he was  now able  to                                                               
speak,  he was  still not  able to  spontaneously converse.   She                                                               
shared that  the insurance  benefits from  her husband's  job did                                                               
not cover a lot of her  son's therapies.  She emphasized that the                                                               
early age  services for  her son  made a  huge difference  in his                                                               
development.  She declared that  the situation was very stressful                                                               
for a  family, and that it  was necessary to remember  the impact                                                               
on the  family and the  children.  She  shared her dream  for her                                                               
son to be an independent member of the community.                                                                               
                                                                                                                                
3:40:19 PM                                                                                                                    
                                                                                                                                
MILLIE   RYAN,   Executive   Director,  Governor's   Council   on                                                               
Disabilities  &  Special  Education,   stated  that  the  Council                                                               
strongly  supported SB  74.   She reported  that the  Council had                                                               
developed  a   five  year  autism  plan   "focused  on  universal                                                               
screening,  expanded  diagnostic capacity,  enhanced  information                                                               
and  referral resources,  work force  development, and  funding."                                                               
She summarized  that the Council considered  that parents, health                                                               
insurance, education, and the state  all had roles to ensure that                                                               
children  with autism  received  necessary services  in a  timely                                                               
manner.   She declared that  proposed SB  74 would make  a major,                                                               
positive difference.                                                                                                            
                                                                                                                                
3:41:44 PM                                                                                                                    
                                                                                                                                
BREEANN DAVIS  shared a  personal story of  her son  with autism,                                                               
the burden this placed on  her family, neighborhood, schools, and                                                               
community,  and the  difficulties of  constant supervision.   She                                                               
declared that although ABA therapy  was considered a proven, best                                                               
practice  therapy, it  was out  of  their financial  reach.   She                                                               
stated that  her insurance  would pay  for medications  and other                                                               
therapies, but  would not  pay for  ABA.   She declared  that ABA                                                               
offered  her son  the best  chance for  a full  life.   She urged                                                               
passage  of the  proposed  bill.   She pointed  out  that, for  a                                                               
family struggling to  get through each hour,  the postponement of                                                               
legislation until the next year "feels like a death sentence."                                                                  
                                                                                                                                
3:45:09 PM                                                                                                                    
                                                                                                                                
CHRISTINE   POTTER,   President,   Alaska   Nurse   Practitioners                                                               
Association,  reported that  the association  was discussing  the                                                               
introduction   of  an   amendment   to   include  advance   nurse                                                               
practitioners as providers.                                                                                                     
                                                                                                                                
3:45:58 PM                                                                                                                    
                                                                                                                                
AL TAMAGNI,  National Federation of Independent  Business (NFIB),                                                               
asked why  small businesses, which  represented 14-17  percent of                                                               
the insured  in Alaska, were  being singled  out to pay  for this                                                               
program.  He  offered his belief that large  corporations did not                                                               
have to pay for this, as  they were self-insured.  He suggested a                                                               
need to  review what was  fair and  equitable, and that  the best                                                               
possible solution would be to  set up the program under Medicaid,                                                               
as the cost would be equally spread.                                                                                            
                                                                                                                                
3:49:24 PM                                                                                                                    
                                                                                                                                
CHAIR  KELLER asked  if  NFIB  would accept  for  all the  autism                                                               
coverage to  be in a "blind  pool" with the cost  of the coverage                                                               
shared among everyone.                                                                                                          
                                                                                                                                
MR.  TAMAGNI replied  that  NFIB would  assist  in drafting  this                                                               
legislation.                                                                                                                    
                                                                                                                                
CHAIR KELLER  said that the state  could then put money  into the                                                               
fund.                                                                                                                           
                                                                                                                                
3:50:41 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  asked if  NFIB would support  the proposed                                                               
bill if  the State of Alaska  also included this benefit  for its                                                               
employees.                                                                                                                      
                                                                                                                                
MR.  TAMAGNI  replied  that  NFIB would  be  more  interested  in                                                               
"taking a  look at it to  where all entities participate  in that                                                               
pool."  He suggested that the  money be deposited into a separate                                                               
pool or trust entity for Medicaid.                                                                                              
                                                                                                                                
3:52:29 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON  asked to  clarify  whether  all the  NFIB                                                               
members  qualified for  Medicaid,  or if  NFIB  only supported  a                                                               
universal  health   care  system   that  included   Medicaid  for                                                               
everyone.                                                                                                                       
                                                                                                                                
MR.  TAMAGNI replied  that  universal  contributions to  Medicaid                                                               
coverage for autism would be an idea.                                                                                           
                                                                                                                                
REPRESENTATIVE  SEATON, in  response to  Chair Keller,  explained                                                               
that he was attempting to clarify  the NFIB proposal.  He offered                                                               
his belief that not all  NFIB members would qualify for Medicaid.                                                               
He  questioned  whether Mr.  Tamagni  was  proposing a  universal                                                               
health care  system, which he  deemed to  be a much  larger issue                                                               
than was proposed in the current legislation.                                                                                   
                                                                                                                                
3:53:50 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE KERTTULA asked to  clarify that insurance coverage                                                               
for  autism was  only for  those that  you insured,  and did  not                                                               
include everyone with autism.                                                                                                   
                                                                                                                                
MR. TAMAGNI expressed his agreement.                                                                                            
                                                                                                                                
3:54:26 PM                                                                                                                    
                                                                                                                                
ALLY BAKER, sharing  that there was autism in  her family, stated                                                               
her support  for proposed SB 74.   She reported that  her son had                                                               
been diagnosed with  autism, and she had only  recently been able                                                               
to  obtain health  insurance  to include  her  son, and  received                                                               
approval for  Medicaid benefits for  him, as well.   She declared                                                               
that the diagnosis  process was extremely difficult.   She stated                                                               
that her son  had appeared to be normal until  he was enrolled in                                                               
pre-school, and then  he was not able to function  in that social                                                               
setting.  She explained that  he had high functioning autism, but                                                               
that  he  lacked social  skills  and  empathy, with  a  different                                                               
comprehension of social  situations.  She shared  of her struggle                                                               
and  challenges  to  find  autism   services,  even  with  double                                                               
insurance coverage.  She reported that  he was now enrolled in an                                                               
integrated pre-school,  and he was  being taught how  to interact                                                               
socially.   She  directed attention  to the  Centers for  Disease                                                               
Control  and Prevention  (CDC) estimate  that  1 in  54 boys  had                                                               
autism.   She stated that  "it would cost  people the price  of a                                                               
gumball a month to insure that  these services that can, that are                                                               
proven  to teach  our  kids the  skills that  they  need to  have                                                               
productive  and  good  quality  lives."     She  asked  that  the                                                               
supporters  in  the  audience  for   proposed  SB  74  stand  up.                                                               
[Approximately 35 people stood up]                                                                                              
                                                                                                                                
3:59:19 PM                                                                                                                    
                                                                                                                                
KATIE  KING said  that she  was very  appreciative of  her family                                                               
support, that her mom, in Seattle, was her biggest supporter.                                                                   
                                                                                                                                
3:59:58 PM                                                                                                                    
                                                                                                                                
LINDA HALL,  Director, Anchorage  Office, Division  of Insurance,                                                               
Department  of   Commerce,  Community  &   Economic  Development,                                                               
referred  to  the  pie  chart   of  "Health  Coverage  of  Alaska                                                               
Population" [Included  in members'  packets].  She  declared that                                                               
any  insurance mandate  only applied  to  the 15  percent of  the                                                               
insured  programs which  were state  regulated, although  many of                                                               
the  self-insured programs  would  offer  the mandated  benefits.                                                               
She noted  that Alaska had  15 insurance mandates, which  did not                                                               
apply to Medicare, Medicaid, military,  or Indian Health Service.                                                               
She reported that, generally, any  ERISA (Employee Retirement and                                                               
Income Security Act  of 1974) self-insured plan  was not included                                                               
under the authority of the State.   She expressed her concern for                                                               
any unrealistic expectations.                                                                                                   
                                                                                                                                
MS. HALL  agreed that  many entities which  were not  required to                                                               
offer a mandate  often did so after it was  adopted.  In response                                                               
to  Chair  Keller,  she  said that  nothing  would  prevent  pool                                                               
coverage by insurance carriers.                                                                                                 
                                                                                                                                
4:04:12 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KERTTULA asked  if the  proposed autism  coverage                                                               
mandate  would be  handled in  the same  manner as  the other  15                                                               
mandates.                                                                                                                       
                                                                                                                                
MS. HALL  replied that  some were  mandatory offers,  which meant                                                               
that although  it had to be  offered by an insurance  company, it                                                               
was not included in all coverage.                                                                                               
                                                                                                                                
REPRESENTATIVE  KERTTULA asked  how  many  insurance pools  there                                                               
were in the state.                                                                                                              
                                                                                                                                
MS.  HALL  explained  that  ACHIA  (Alaska  Comprehensive  Health                                                               
Insurance  Association),  the  high  risk  pool,  was  funded  by                                                               
assessments on  insurers.   She detailed that  50 percent  of the                                                               
contribution was  deductible by the insurance  companies from the                                                               
premium tax, so, in effect the state was paying.                                                                                
                                                                                                                                
REPRESENTATIVE KERTTULA,  noting that this  was the only  pool in                                                               
Alaska, offered  her belief  that it seemed  unlikely for  a pool                                                               
idea  to  be  worked  out  during  the  short  remainder  of  the                                                               
legislative session.   She suggested  starting with  the mandate,                                                               
and then reviewing the need for a pool at a later date.                                                                         
                                                                                                                                
MS. HALL expressed her agreement that anything was possible.                                                                    
                                                                                                                                
4:06:29 PM                                                                                                                    
                                                                                                                                
SHEELA TALLMAN, Premera Blue Cross  Blue Shield, expressed policy                                                               
concerns for  the proposed legislation  previously outlined  in a                                                               
letter dated April  6, 2012 [Included in members'  packets].  She                                                               
stated a  concern for  the challenges of  autism, and  declared a                                                               
need  to balance  the  interests of  the  families with  autistic                                                               
members and the  other insured members that Premera  served.  She                                                               
declared that autistic diagnosis  received the same comprehensive                                                               
medical  coverage provided  to all  the  members, which  included                                                               
mental  health services,  and rehabilitation  services: physical,                                                               
occupational, and speech  therapy.  She pointed  out that federal                                                               
health care  reform allowed that  children diagnosed  with autism                                                               
were guaranteed  access to private medical  insurance without any                                                               
pre-existing  condition exclusions.    She pointed  out that  the                                                               
proposed legislation did  not extend to State  of Alaska employee                                                               
health   insurance,  the   Indian   Health  Services,   Medicare,                                                               
Medicaid, self-insured  groups, or  the federal  employee benefit                                                               
plan.  She  declared that the proposed bill  imposed an expensive                                                               
mandate only on  private insurance coverage, about  15 percent of                                                               
Alaska residents.   She declared  that the self-funded  plans had                                                               
the option to  include this benefit.  She  reminded the committee                                                               
that the  subsidized cost for any  new mandate passed by  a state                                                               
had to be paid  by the state unless it was included  as a part of                                                               
essential health  benefits, as determined  by the  federal health                                                               
care reform.  She noted that it  was still unclear as to what was                                                               
included  in  essential  health benefits  and  behavioral  health                                                               
services.   She  reported that  almost 47,000  Alaskans would  be                                                               
subsidized by the federal government  when the insurance exchange                                                               
was  implemented  in 2019,  and  the  State  of Alaska  would  be                                                               
financially responsible  for covering the autism  costs for these                                                               
individuals,  in  addition  to  any cost  increase  for  Medicaid                                                               
expansion.                                                                                                                      
                                                                                                                                
4:10:41 PM                                                                                                                    
                                                                                                                                
MS.  TALLMAN pointed  out that  Washington State  and Oregon  had                                                               
considered similar  autism mandates, and that  neither had passed                                                               
the mandate,  primarily due to  the estimated cost impact  to the                                                               
state employee plan.  She  agreed that earlier identification for                                                               
autism would  lead to better  outcomes, although it  would impact                                                               
medical  service   utilization  and  cost.     She  declared  the                                                               
necessity to evaluate  both the short and long term  costs of the                                                               
proposed bill.                                                                                                                  
                                                                                                                                
4:12:10 PM                                                                                                                    
                                                                                                                                
MS. TALLMAN, in response to  Representative Herron, said that she                                                               
had read a little bit about  the Michigan incentive plan and that                                                               
it was a valid concept to be  reviewed.  She agreed that the idea                                                               
should  be  explored  for  better  understanding,  offering  that                                                               
Premera would work on any future legislation.                                                                                   
                                                                                                                                
4:13:41 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KERTTULA  pointed  to  an  apparent  disagreement                                                               
between  Ms.  Tallman and  Ms.  Unumb  about the  possible  state                                                               
requirements from the federal law.                                                                                              
                                                                                                                                
MS. TALLMAN  expressed her agreement  that the federal  law could                                                               
change.                                                                                                                         
                                                                                                                                
REPRESENTATIVE  KERTTULA  asked  about   the  difference  in  the                                                               
reported cost of "per member per  month" from Ms. Tallman and Ms.                                                               
Unumb.                                                                                                                          
                                                                                                                                
MS.  TALLMAN  said  that  the Premera  analysis  focused  on  its                                                               
specific  membership and  its current  plans and  premiums.   She                                                               
said  that some  of  the  other actuarial  analyses  looked at  a                                                               
broader market.                                                                                                                 
                                                                                                                                
REPRESENTATIVE  KERTTULA  asked  what the  Premera  analysis  had                                                               
determined to be a "per member per month" cost.                                                                                 
                                                                                                                                
MS.  TALLMAN  replied  that  she   did  not  have  that  specific                                                               
information, but  that analysis  had estimated it  to be  about 3                                                               
percent,  specifically   on  the   individual  and   small  group                                                               
purchasers.                                                                                                                     
                                                                                                                                
4:15:13 PM                                                                                                                    
                                                                                                                                
CHAIR KELLER stated that the bill would be held over.                                                                           
                                                                                                                                

Document Name Date/Time Subjects
SB74 Vers. A 27-LS0443-A- 3.6.2012.pdf HHSS 4/10/2012 3:00:00 PM
SB 74
SB74 Sponsor Statement.pdf HHSS 4/10/2012 3:00:00 PM
SB 74
SB74 Alaska Fiscal Note-DCCED 2.22.12.pdf HHSS 4/10/2012 3:00:00 PM
SB 74
SB74 Sectional Analysis.pdf HHSS 4/10/2012 3:00:00 PM
SB 74
SB74 Opposition-Letter-Premera 4.12.11.pdf HHSS 4/10/2012 3:00:00 PM
SB 74
SB74 Opposition Document-Letter-NFIB 1.31.11.pdf HHSS 4/10/2012 3:00:00 PM
SB 74
SB74 Opposition Document-Letter NIFB-4.2.12.pdf HHSS 4/10/2012 3:00:00 PM
SB 74
SB74 Opposition Document- Letter-Premera- Rep Wes Keller- 4.6.12.pdf HHSS 4/10/2012 3:00:00 PM
SB 74
SB74 Autism Coverage in Alaska 2012.xlsx HHSS 4/10/2012 3:00:00 PM
SB 74
SB74 Supprot Document-Autism Intervention Research Findings.pdf HHSS 4/10/2012 3:00:00 PM
SB 74
SB74 NCSL - Autism Insurance Legislation.pdf HHSS 4/10/2012 3:00:00 PM
SB 74
SB74 US Dept Letter-ehb-faq-508 (2) Autism.pdf HHSS 4/10/2012 3:00:00 PM
SB74 Support Document- Letter-Gov's Council -Member.pdf HHSS 4/10/2012 3:00:00 PM
SB 74
SB74 Suppport Document Learn the Signs.pdf HHSS 4/10/2012 3:00:00 PM
SB 74
SB74 Support Letter-Stone Soup Group 3.7.11.pdf HHSS 4/10/2012 3:00:00 PM
SB 74
SB74 Support Document-Trust Letter2.7.2011.pdf HHSS 4/10/2012 3:00:00 PM
SB 74
SB74-Support Document-Letter-AWL 2010.pdf HHSS 4/10/2012 3:00:00 PM
SB 74
SB74 Washington State-Autism- fiscal note.pdf HHSS 4/10/2012 3:00:00 PM
SB 74
SB74 US Dept Letter-ehb-faq-508 (2) Autism.pdf HHSS 4/10/2012 3:00:00 PM
SB74 Supprot Document- Letter-Gov's Council -Member.pdf HHSS 4/10/2012 3:00:00 PM
SB 74
SB74 Suppport Document Lear the Signs.pdf HHSS 4/10/2012 3:00:00 PM
SB 74
SB74 Autism Coverage in Alaska 2012.xlsx HHSS 4/10/2012 3:00:00 PM
SB 74
SB 98 Biometrics will be heard in House Health and Social Services Committee.pdf HHSS 4/10/2012 3:00:00 PM
SB 98
SB 98 Version L 4-10-2012.pdf HHSS 4/10/2012 3:00:00 PM
SB 98