Legislature(2015 - 2016)CAPITOL 106

03/24/2016 03:00 PM HEALTH & SOCIAL SERVICES

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Audio Topic
03:03:36 PM Start
03:05:35 PM Presentation on Telehealth
04:04:12 PM HB344
04:31:24 PM HB315
05:16:36 PM HB328
07:13:45 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Presentation: TELECONFERENCED
NCSL: Telehealth
+= HB 315 ELECTRONIC VISIT VERIFICATION: MEDICAID TELECONFERENCED
Heard & Held
+= HB 334 CHILD CUSTODY;DOM. VIOLENCE;CHILD ABUSE TELECONFERENCED
<Bill Hearing Rescheduled to 3/29/16>
+= HB 328 REGULATION OF SMOKING TELECONFERENCED
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
+= HB 344 DRUG PRESCRIPTION DATABASE TELECONFERENCED
Moved CSHB 344(HSS) Out of Committee
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                         March 24, 2016                                                                                         
                           3:03 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Paul Seaton, Chair                                                                                               
Representative Liz Vazquez, Vice Chair                                                                                          
Representative Neal Foster                                                                                                      
Representative Louise Stutes                                                                                                    
Representative David Talerico                                                                                                   
Representative Geran Tarr                                                                                                       
Representative Adam Wool                                                                                                        
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
PRESENTATION ON TELEHEALTH                                                                                                      
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
HOUSE BILL NO. 344                                                                                                              
"An Act relating to the controlled substance prescription                                                                       
database; and providing for an effective date."                                                                                 
                                                                                                                                
     - MOVED CSHB 344(HSS) OUT OF COMMITTEE                                                                                     
                                                                                                                                
HOUSE BILL NO. 315                                                                                                              
"An Act relating to an electronic visit verification system for                                                                 
providers of certain medical assistance services."                                                                              
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
HOUSE BILL NO. 328                                                                                                              
"An Act prohibiting smoking in certain places; relating to                                                                      
education on the smoking prohibition; and providing for an                                                                      
effective date."                                                                                                                
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
HOUSE BILL NO. 334                                                                                                              
"An Act relating to visitation and child custody."                                                                              
                                                                                                                                
     - SCHEDULED BUT NOT HEARD                                                                                                  
                                                                                                                                
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 344                                                                                                                  
SHORT TITLE: DRUG PRESCRIPTION DATABASE                                                                                         
SPONSOR(s): REPRESENTATIVE(s) SEATON                                                                                            
                                                                                                                                
02/24/16       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/24/16       (H)       HSS                                                                                                    
03/01/16       (H)       HSS AT 3:15 PM CAPITOL 106                                                                             
03/01/16       (H)       Heard & Held                                                                                           
03/01/16       (H)       MINUTE (HSS)                                                                                           
03/08/16       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/08/16       (H)       Heard & Held                                                                                           
03/08/16       (H)       MINUTE (HSS)                                                                                           
03/10/16       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/10/16       (H)       -- Rescheduled to 3/11/16 at 8:00 a.m.                                                                 
                         --                                                                                                     
03/11/16       (H)       HSS AT 8:00 AM CAPITOL 106                                                                             
03/11/16       (H)       -- MEETING CANCELED --                                                                                 
03/15/16       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/15/16       (H)       Heard & Held                                                                                           
03/15/16       (H)       MINUTE (HSS)                                                                                           
03/17/16       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/17/16       (H)       Scheduled but Not Heard                                                                                
03/24/16       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 315                                                                                                                  
SHORT TITLE: ELECTRONIC VISIT VERIFICATION: MEDICAID                                                                            
SPONSOR(s): REPRESENTATIVE(s) VAZQUEZ                                                                                           
                                                                                                                                
02/17/16       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/17/16       (H)       HSS                                                                                                    
03/22/16       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/22/16       (H)       Heard & Held                                                                                           
03/22/16       (H)       MINUTE (HSS)                                                                                           
03/24/16       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 328                                                                                                                  
SHORT TITLE: REGULATION OF SMOKING                                                                                              
SPONSOR(s): REPRESENTATIVE(s) TALERICO                                                                                          
                                                                                                                                
02/22/16       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/22/16       (H)       HSS, JUD, FIN                                                                                          
03/22/16       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/22/16       (H)       Heard & Held                                                                                           
03/22/16       (H)       MINUTE (HSS)                                                                                           
03/24/16       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
KATE BLACKMAN                                                                                                                   
National Conference of State Legislatures                                                                                       
Denver, Colorado                                                                                                                
POSITION STATEMENT:   Introduced  the PowerPoint  presentation on                                                             
Telehealth.                                                                                                                     
                                                                                                                                
MARIO GUTIERREZ                                                                                                                 
Center for Connected Health Policy                                                                                              
Sacramento, California                                                                                                          
POSITION STATEMENT:  Presented  a PowerPoint titled "Transforming                                                             
Health Care With Connected Health."                                                                                             
                                                                                                                                
JANEY HOVENDEN, Director                                                                                                        
Division of Corporations, Business, and Professional Licensing                                                                  
Department of Commerce, Community & Economic Development                                                                        
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:   Testified  and  answered questions  during                                                             
discussion of proposed HB 344.                                                                                                  
                                                                                                                                
ANITA HALTERMAN, Staff                                                                                                          
Representative Liz Vazquez                                                                                                      
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:   Testified  and  answered questions  during                                                             
discussion  of   HB  315,  on   behalf  of  the   prime  sponsor,                                                               
Representative Vazquez.                                                                                                         
                                                                                                                                
DEB ETHERIDGE, Deputy Director                                                                                                  
Division of Senior and Disabilities Services                                                                                    
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:   Testified  and  answered questions  during                                                             
discussion of HB 315.                                                                                                           
                                                                                                                                
JOSHUA BANKS, Staff                                                                                                             
Representative Dave Talerico                                                                                                    
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:   Answered questions  on HB 328 on  behalf of                                                             
Representative Talerico, prime sponsor.                                                                                         
                                                                                                                                
CHUCK KOPP, Staff                                                                                                               
Senator Peter Micciche                                                                                                          
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:   During  the  hearing  of HB  328,  offered                                                             
testimony and answered questions on behalf of Senator Micciche.                                                                 
                                                                                                                                
HILARY MARTIN, Attorney                                                                                                         
Legislative Legal and Research Services                                                                                         
Legislative Affairs Agency                                                                                                      
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:   During  the hearing  of  HB 328,  answered                                                             
questions.                                                                                                                      
                                                                                                                                
Gary Superman, Owner                                                                                                            
Hunger Hut Bar, Motel and Liquor                                                                                                
Nikiski, Alaska                                                                                                                 
POSITION  STATEMENT:   During  the  hearing  of HB  328,  offered                                                             
opposition to the legislation.                                                                                                  
                                                                                                                                
CHRYSTAL SCHOENROCK, Owner                                                                                                      
Hunger Hut Bar, Motel and Liquor                                                                                                
Nikiski, Alaska                                                                                                                 
POSITION  STATEMENT:   During  the  hearing  of HB  328,  offered                                                             
opposition to the legislation.                                                                                                  
                                                                                                                                
DANIEL LYNCH                                                                                                                    
Soldatna, Alaska                                                                                                                
POSITION  STATEMENT:   During  the  hearing  of HB  328,  offered                                                             
opposition to the legislation.                                                                                                  
                                                                                                                                
SHEB GARFIELD                                                                                                                   
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:   During  the  hearing  of HB  325,  offered                                                             
opposition to the inclusion of vaping in the legislation.                                                                       
                                                                                                                                
GREGORY CONLEY, Attorney                                                                                                        
President, American Vaping Association                                                                                          
Medford, New Jersey                                                                                                             
POSITION  STATEMENT:   During  the  hearing  of HB  328,  offered                                                             
opposition to the inclusion of vaping in the legislation.                                                                       
                                                                                                                                
MICHAEL CERVANTES, Owner                                                                                                        
Banks Ale House                                                                                                                 
Fairbanks, Alaska                                                                                                               
POSITION  STATEMENT:   During  the  hearing  of HB  328,  offered                                                             
opposition to the legislation.                                                                                                  
                                                                                                                                
ANGELA CERNICH, Owner                                                                                                           
Artic Industries                                                                                                                
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:   During  the  hearing  of HB  328,  offered                                                             
support for the legislation.                                                                                                    
                                                                                                                                
CARMEN LUNDE, Director                                                                                                          
Kodiak CHARR                                                                                                                    
Kodiak, Alaska                                                                                                                  
POSITION  STATEMENT:   During  the  hearing  of HB  328,  offered                                                             
opposition to the legislation.                                                                                                  
                                                                                                                                
ISAAC HEWELL, Owner                                                                                                             
Cold Vapes 907                                                                                                                  
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:   During  the  hearing  of HB  328,  offered                                                             
opposition to the inclusion of vaping in the legislation.                                                                       
                                                                                                                                
ALISON HALPIN                                                                                                                   
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:   During  the  hearing  of HB  328,  offered                                                             
opposition to the inclusion of vaping in the legislation.                                                                       
                                                                                                                                
BRIAN PREBLE                                                                                                                    
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:     During  the  hearing   of  328,  offered                                                             
opposition to the inclusion of vaping in the legislation.                                                                       
                                                                                                                                
LARRY HACKENMILLER                                                                                                              
Fairbanks, Alaska                                                                                                               
POSITION  STATEMENT:   During  the  hearing  of HB  328,  offered                                                             
opposition to the legislation.                                                                                                  
                                                                                                                                
JENNIFER VARGASON                                                                                                               
Fairbanks Alaska                                                                                                                
POSITION  STATEMENT:   During  the  hearing  of HB  328,  offered                                                             
opposition to the inclusion of vaping in the legislation.                                                                       
                                                                                                                                
JESSE WALTON                                                                                                                    
Fairbanks, Alaska                                                                                                               
POSITION  STATEMENT:   During  the  hearing  of HB  328,  offered                                                             
opposition to the inclusion of vaping in the legislation.                                                                       
                                                                                                                                
TERRY CROWSON                                                                                                                   
Delta Junction, Alaska                                                                                                          
POSITION  STATEMENT:   During  the  hearing  of HB  328,  offered                                                             
support for the legislation.                                                                                                    
                                                                                                                                
CHERYL SCHOOLEY                                                                                                                 
Delta Junction, Alaska                                                                                                          
POSITION  STATEMENT:   During  the  hearing  of HB  328,  offered                                                             
support for the legislation.                                                                                                    
                                                                                                                                
WAYNE CROWSON                                                                                                                   
Delta Junction, Alaska                                                                                                          
POSITION  STATEMENT:   During  the  hearing  of HB  328,  offered                                                             
support for the legislation.                                                                                                    
                                                                                                                                
ROBIN MINARD, Director                                                                                                          
Public Affairs                                                                                                                  
Mat-Su Health Foundation                                                                                                        
Wasilla, Alaska                                                                                                                 
POSITION  STATEMENT:   During  the  hearing  of HB  328,  offered                                                             
support for the legislation.                                                                                                    
                                                                                                                                
PETE BURNS                                                                                                                      
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:   During  the  hearing  of HB  328,  offered                                                             
support for the legislation.                                                                                                    
                                                                                                                                
JOHN YORDY, M.D.                                                                                                                
Anchorage and Valley Radiation Therapy Centers                                                                                  
Wasilla, Alaska                                                                                                                 
POSITION  STATEMENT:   During  the  hearing  of HB  328,  offered                                                             
support for the legislation.                                                                                                    
                                                                                                                                
OWEN HANLEY, M.D.                                                                                                               
Fairbanks Memorial Hospital                                                                                                     
Fairbanks, Alaska                                                                                                               
POSITION  STATEMENT:   During  the  hearing  of HB  328,  offered                                                             
support for the legislation.                                                                                                    
                                                                                                                                
ERIC VARGASON                                                                                                                   
Fairbanks, Alaska                                                                                                               
POSITION  STATEMENT:   During  the  hearing  of HB  328,  offered                                                             
opposition to the inclusion of vaping in the legislation.                                                                       
                                                                                                                                
STEVEN MAPES                                                                                                                    
Kenai, Alaska                                                                                                                   
POSITION  STATEMENT:   During  the  hearing  of HB  328,  offered                                                             
opposition to the inclusion of vaping in the legislation.                                                                       
                                                                                                                                
BOB URATA, M.D.                                                                                                                 
Valley Medical Care                                                                                                             
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:   During  the  hearing  of HB  328,  offered                                                             
support for the legislation.                                                                                                    
                                                                                                                                
ANGELA CARROLL                                                                                                                  
Smoke-Free Alternative Trade Association                                                                                        
Wasilla, Alaska                                                                                                                 
POSITION  STATEMENT:   During  the  hearing  of HB  328,  offered                                                             
opposition to the inclusion of vaping in the legislation.                                                                       
                                                                                                                                
JUNE ROGERS                                                                                                                     
Fairbanks, Alaska                                                                                                               
POSITION  STATEMENT:   During  the  hearing  of HB  328,  offered                                                             
support for the legislation.                                                                                                    
                                                                                                                                
DANNY RUEREP                                                                                                                    
Fairbanks, Alaska                                                                                                               
POSITION  STATEMENT:   During  the  hearing  of HB  238,  offered                                                             
opposition to the inclusion of vaping in the legislation.                                                                       
                                                                                                                                
QUOC DONG                                                                                                                       
Akiak, Alaska                                                                                                                   
POSITION  STATEMENT:   During  the  hearing  of HB  328,  offered                                                             
opposition to the inclusion of vaping in the legislation.                                                                       
                                                                                                                                
OCTAVIA HARRIS                                                                                                                  
American Lung Association in Alaska                                                                                             
Fairbanks Alaska                                                                                                                
POSITION  STATEMENT:   During  the  hearing  of HB  328,  offered                                                             
support for the legislation.                                                                                                    
                                                                                                                                
EMILY NENON, Director                                                                                                           
Alaska Government Relations                                                                                                     
American Cancer Society Cancer Action Network                                                                                   
Anchorage, Alaska                                                                                                               
POSITION  STATEMENT:   During  the  hearing  of HB  328,  offered                                                             
support for the legislation.                                                                                                    
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:03:36 PM                                                                                                                    
                                                                                                                                
CHAIR PAUL  SEATON called  the House  Health and  Social Services                                                             
Standing   Committee    meeting   to    order   at    3:03   p.m.                                                               
Representatives  Seaton,  Vazquez,   Talerico,  and  Stutes  were                                                               
present at the call to  order.  Representatives Tarr, Foster, and                                                               
Wool arrived as the meeting was in progress.                                                                                    
                                                                                                                                
^Presentation on Telehealth                                                                                                   
                   Presentation on Telehealth                                                                               
                                                                                                                                
3:05:35 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON announced that the  first order of business would be                                                               
a  PowerPoint titled  "Transforming  Health  Care With  Connected                                                               
Health" by the  National Conference of State  Legislators and the                                                               
Center for Connected Health Policy.                                                                                             
                                                                                                                                
3:07:31 PM                                                                                                                    
                                                                                                                                
KATE  BLACKMAN,   National  Conference  of   State  Legislatures,                                                               
advised  she   is  a  policy   specialist  with   the  bipartisan                                                               
membership organization  of all state legislatures,  the National                                                               
Conference  of State  Legislatures  (NCSL).   She explained  that                                                               
NCSL advocates for  the interests of states  and territories, and                                                               
provides policy  makers with the  opportunity to  exchange ideas.                                                               
She explained that  the presentation stems from an  interest of a                                                               
team  of  key  Alaska  legislators, their  staff,  and  executive                                                               
branch  representatives who  convened  a  National Conference  of                                                               
State  Legislatures  (NCSL)  meeting  in August  to  discuss  how                                                               
health care payment and delivery  systems reform.  Telehealth has                                                               
seen increasing adoption and expansion  across the nation and the                                                               
NCSL has  been working on  these issues in  providing information                                                               
and  technical assistance  to  states.   The  NCSL also  recently                                                               
prepared a white  paper on Telehealth which is meant  to serve as                                                               
a resource to state legislatures.                                                                                               
                                                                                                                                
MS.  BLACKMAN   related  that  the  NCSL   partnered  with  Mario                                                               
Gutierrez,  Executive  Director,   Center  for  Connected  Health                                                               
Policy located in  Sacramento, California.  She  offered that Mr.                                                               
Gutierrez has  had over  30 years  of experience  in California's                                                               
non-profit health  and health philanthropy sectors,  and she then                                                               
listed his vast experience.                                                                                                     
                                                                                                                                
3:09:47 PM                                                                                                                    
                                                                                                                                
MARIO  GUTIERREZ, Center  for Connected  Health Policy,  directed                                                               
attention  to the  PowerPoint presentation,  "Transforming Health                                                               
Care  with  Connected  Health.   State  and  National  Telehealth                                                               
Trends and Issues," slide 2, and  offered a disclaimer that he is                                                               
not  a  lawyer,  the  information  is  purely  for  informational                                                               
purposes,  and the  Center  for Connected  Health  Policy is  not                                                               
funded  or supported  by  any vendor  or  commercial products  or                                                               
services as  it is  an independent  non-profit organization.   He                                                               
explained  that the  Center is  part  of a  larger public  health                                                               
institute and  its ultimate goal  is to achieve equity  in health                                                               
care,  and  quality and  affordable  care  for all,  and  further                                                               
explained that technology  is a means toward  reaching that goal.                                                               
He turned  to slides 3-4,  "Center for Connected  Health Policy,"                                                               
and said  the Telehealth Resource Center  is part of a  family of                                                               
organizations  funded through  the Office  of the  Advancement of                                                               
Telehealth under  the Office of  Rural Health Policy (ORHP).   He                                                               
turned  to slide  5, "TTAC,"  and  explained that  TTAC is  their                                                               
sister  organization   based  in   Anchorage,  and   it  provides                                                               
objective information  and support  related to telehealth  and IT                                                               
technology.                                                                                                                     
                                                                                                                                
3:12:47 PM                                                                                                                    
                                                                                                                                
MR.  GUTIERREZ, in  response  to  Representative Tarr,  explained                                                               
that the TTAC located in  Anchorage is affiliated with the Alaska                                                               
Native Tribal Health Consortium.                                                                                                
                                                                                                                                
REPRESENTATIVE  STUTES asked  the  difference between  telehealth                                                               
and telemedicine.                                                                                                               
                                                                                                                                
MR.   GUTIERREZ  answered   that  "telehealth"   is  the   common                                                               
terminology  currently used  because  it  encompasses the  entire                                                               
medical  field,  and  a  sub-set  of  that  could  be  considered                                                               
"telemedicine."                                                                                                                 
                                                                                                                                
MR. GUTIERREZ  turned to slide  6, "HRSA/OAT Grant 2012  - 2016,"                                                               
and said the detailed information,  including this discussion, is                                                               
on  their web  site together  with legal  and research  policies,                                                               
research papers,  and basic information.   He turned to  slide 7,                                                               
"Telehealth   Pioneer?"   and   explained  that   the   idea   of                                                               
communicating electronically to provide  health care services has                                                               
been  envisioned since  1925, and  operational  for 40-50  years.                                                               
Although,  the advances  in the  technology and  how it  is being                                                               
used is new.                                                                                                                    
                                                                                                                                
3:15:00 PM                                                                                                                    
                                                                                                                                
MR.  GUTIERREZ turned  to  slide 8,  "The  Value Proposition  for                                                               
Telehealth," and said  that telehealth is an  important aspect of                                                               
health care  reform and improvements  in quality of  care because                                                               
the   advances  in   telecommunication   technologies  can   help                                                               
redistribute health  care expertise when there  are shortages and                                                               
limitations, to create the greatest  value for consumers, payers,                                                               
and  health systems.    Slides 9-18,  "Value  of Telehealth."  He                                                               
explained there  are three key  values of telehealth,  "1. Timely                                                               
Access to Diagnosis & Treatment"  with primary and specialty care                                                               
services, direct to  consumer, and emergency care.   He explained                                                               
that cost  avoidance is a  benefit particularly from  the patient                                                               
side  wherein the  average  cost to  an  outpatient, waiting  two                                                               
hours, is $43  per visit, although in Alaska it  is a much higher                                                               
number.   "2.  Enhanced  Consultation/Communication," the  second                                                               
key   value  having   to  do   with  enhanced   consultation  and                                                               
communication  allowing consumers  to report  to their  physician                                                               
through  portals,  specialists  and  primary  care  providers  to                                                               
communicate,  or  for  multiple  communications  within  a  team.                                                               
Examples  of communications  are e-Consult  and the  Project Echo                                                               
Model.   The  third value  of  telehealth is  "3. Remote  Patient                                                               
Monitoring"  is related  to health  care when  chronic conditions                                                               
become  acute  and  there  is  the  ability  to  monitor  chronic                                                               
conditions, allow people to be  served in their home particularly                                                               
home-aging in place, and acute emergency situations.                                                                            
He explained that Medicare approved  Omada as a reimbursable form                                                               
of  Digital   Therapeutics  that  allows  the   intersections  of                                                               
science, technology,  and design wherein consumers  could monitor                                                               
and learn about their own health  care.  According to a number of                                                               
studies,  he advised,  remote monitoring  saves money,  time, and                                                               
improves  quality.   Illnesses  that  can  benefit   from  remote                                                               
monitoring   include,  congestive   heart  failure,   obstructive                                                               
pulmonary disease, and  stroke, and a Canadian  study showed they                                                               
could reduce hospital stays by 50  percent.  He opined there will                                                               
be  more   use  of  decentralization   of  care   through  remote                                                               
monitoring to the home, and  institutionally based outside of the                                                               
hospital with  less dependence on  acute care hospitals  which is                                                               
the most expensive.                                                                                                             
                                                                                                                                
3:21:51 PM                                                                                                                    
                                                                                                                                
MR.  GUTIERREZ  turned  to  slide   17,  and  advised  there  are                                                               
limitations  and   the  joke  on  the   slide  demonstrates  that                                                               
telehealth is  not for every form  of care.  Slide  18, "Power of                                                               
Connected-Health  Technology." He  related that  in terms  of the                                                               
value, it  is always important  to think about telehealth  in the                                                               
context  of the  three-legged  stool as  follows: the  electronic                                                               
health records  and health information exchanges  to ensure there                                                               
is intra-operability; connection so  that the HER's repository of                                                               
the  electronic   diagnostic  information  ultimately   leads  to                                                               
improvements  in health  outcomes; and  health plans  through the                                                               
health  information  exchange.   When  considering  policies,  he                                                               
opined, it is important to consider it in this larger context.                                                                  
                                                                                                                                
3:22:50 PM                                                                                                                    
                                                                                                                                
MR. GUTIERREZ  directed the committee's  attention to  the "State                                                               
Policy Analysis  & Trends" section,  slides 20-27, and  turned to                                                               
state  policy.   He  reminded  the  committee that  the  Medicaid                                                               
program is different in every  state and the Centers for Medicare                                                               
& Medicaid Services  (CMS) give the states the  ability to define                                                               
for  themselves how  it  will  deliver and  pay  for health  care                                                               
services  using Medicaid  resources with  matching dollars.   The                                                               
result, he noted,  has been a patchwork of  laws, regulations and                                                               
policies where no two states  are alike.  Subsequent to receiving                                                               
a federal  grant, the Center now  has a continuous update  on the                                                               
laws  and regulations  in every  state, which  is located  on its                                                               
website.    He  explained  that   he  defines  telehealth  policy                                                               
according to the key areas listed  on slide 24.  More commonly 43                                                               
states still use a form of  telemedicine, 28 states have moved to                                                               
using telehealth  as the  umbrella terminology,  and 2  states do                                                               
not have any definition.   The most common form of reimbursement,                                                               
because it has  been around the longest, has been  live video but                                                               
in some  ways live video  could be  the most inefficient  form of                                                               
care.                                                                                                                           
                                                                                                                                
3:25:11 PM                                                                                                                    
                                                                                                                                
MR. GUTIERREZ  noted that on  slide 25, despite all  the evidence                                                               
in the field and studies  performed, only 9 states currently will                                                               
reimburse  for "store  and  forward", and  16  states for  remote                                                               
patient monitoring.   Parity in payment is  something that Alaska                                                               
is currently considering, and there  are 27 states that have some                                                               
form of  language related to  parity, but parity is  difficult to                                                               
determine.   It  must  be  clear whether  it  is  just parity  in                                                               
services that are covered, or  whether it also includes parity in                                                               
payment.   He explained that a  majority of states have  a clause                                                               
that says  "subject to the  terms and conditions of  a contract."                                                               
Which means  that depending  upon the  payer, they  can determine                                                               
whether or not  they will pay for telehealth,  whether they don't                                                               
pay for  a particular service, or  whether it is not  included in                                                               
their policy.   It is important when  considering legislation and                                                               
policies that it be clear that if  there will be parity it has to                                                               
be without  any kind of conditional  clauses attached to it.   He                                                               
related  a  large upsurge  this  past  year in  bills  introduced                                                               
across the country  reforming telehealth laws, and  that 2016 has                                                               
shown an even  greater amount.  The majority  focus on telehealth                                                               
standards, across state licensing,  prescribing, and just changes                                                               
to telehealth laws.                                                                                                             
                                                                                                                                
3:27:22 PM                                                                                                                    
                                                                                                                                
MR.  GUTIERREZ turned  to the  "Highlights of  Individual States"                                                               
section, slides 28-37,  and offered that the State  of Nevada has                                                               
a clear and clean definition  of telehealth, it removed any prior                                                               
authorization  from the  provision of  telehealth services  which                                                               
says  that   telehealth  should  not  be   treated  as  something                                                               
different.  In 2011, California  passed a comprehensive bill that                                                               
covers much  of what he would  like to see in  legislation around                                                               
the  country, although  there are  areas  that need  improvement.                                                               
Key here, he pointed out is  that the State of California now has                                                               
language that will  reimburse for all forms of  telehealth and it                                                               
removes  the  restriction  on the  geographic  and  institutional                                                               
location of  where telehealth services  can take place.   Another                                                               
large  change was  the requirement  that  it is  only limited  to                                                               
certain professions,  mostly the  medical profession, and  it was                                                               
changed  to allow  that  any licensed  professional  can now  use                                                               
telehealth for  health care.   The  parity legislation  still has                                                               
the clause "subject to the conditions  of the policy."  The State                                                               
of  Mississippi has  one of  the  more advanced  policies in  the                                                               
country and it  recently passed a law that  requires all employee                                                               
benefit  plans to  cover all  forms of  telehealth, and  requires                                                               
reimbursement  for store  and forward.   The  State of  Minnesota                                                               
recently changed  its laws and it  now has a clean  definition of                                                               
telehealth that covers live video,  store and forward, and remote                                                               
monitoring through  its Elderly Waiver  (EV) program.   The State                                                               
of Indiana passed a law this  past week which still defines it as                                                               
telemedicine but  has clearly  defined video  conferencing, store                                                               
it forward,  and remote patient  monitoring.  The  most important                                                               
piece  of  this  legislation  is  that it  now  allows  not  just                                                               
physicians   but   physician    assistants   and   advanced-nurse                                                               
practitioners to treat patients  via telemedicine without a prior                                                               
in-person visit,  and to prescribe  without the  requirement that                                                               
the person be seen in-person, with some conditions.                                                                             
                                                                                                                                
3:30:53 PM                                                                                                                    
                                                                                                                                
MR. GUTIERREZ  asked the  committee to keep  in mind  that beyond                                                               
this  legislation,  the  administrations  in  each  state  -  the                                                               
departments of health  care and health care services  also have a                                                               
say in how  they interpret those legislations, so  he warned that                                                               
the committee be  sure that that is consistent.   Also, licensing                                                               
boards  are  now becoming  more  important  as each  professional                                                               
licensing board can now put its  own limits on what could be used                                                               
for telehealth and under what  conditions, and the courts are now                                                               
playing a big  role.  He noted that Alaska  is considering cross-                                                               
state  licensing  with the  Federation  of  State Medical  Boards                                                               
(FSMB).   He pointed out that  this does not create  a telehealth                                                               
national  license as  it simply  facilitates the  process through                                                               
the compact  that is created  for any  physician in any  state in                                                               
good standing  to apply for  a license  in another state  to take                                                               
place  much earlier.   Two  major  cases in  the courts  include:                                                               
Planned Parenthood  of the Heartland,  Inc., and Jill  Meadows v.                                                           
Iowa Board  of Medicine,  in which  the Board  of Medicine  has a                                                             
rule requiring  an in-person  examination for  the administration                                                               
of an  abortion inducing drug  and an in-person  follow-up visit.                                                               
He explained that that became a  model other states were going to                                                               
follow;  however,  it  was ruled  unconstitutional  by  the  Iowa                                                               
Supreme  Court and  so  those  laws have  now  been rolled  back.                                                               
Another  lawsuit  closely  watched  is  Teledoc,  Inc.  v.  Texas                                                             
Medical Board,  where the  medical board  is requiring  a medical                                                             
doctor  face-to-face  visit  before  a  physician  can  prescribe                                                               
medication and this case is currently moving through appeals.                                                                   
                                                                                                                                
3:32:52 PM                                                                                                                    
                                                                                                                                
MR.  GUTIERREZ  turned  to   the  "Federal  Telehealth  Policies"                                                               
section, slides  38-46, and  said that  this is  a field  that is                                                               
moving  at the  speed of  light,  but on  the federal  telehealth                                                               
policy side  it is  moving at  the speed  of Old  Man River.   He                                                               
remarked that  the Social  Security Act  defines how  Medicare is                                                               
administered,  what is  payable  and reimbursed,  and under  what                                                               
conditions,  and  was  passed  when the  first  smart  phone  was                                                               
invented by  Maxwell Smart.   Although,  he commented  there have                                                               
been  a few  incremental changes,  but by  and large  Medicare is                                                               
stuck  in  an  old  way  of thinking  in  terms  of  health  care                                                               
delivery.    Universally,  across  the  county  among  telehealth                                                               
providers  and  policy  makers,  it  is  believed  that  Medicare                                                               
policies are  sorely outdated.   (Indisc.) must  be in  a medical                                                               
home in  a strictly  defined rule  area.   Alaska and  Hawaii are                                                               
part  of a  demonstration  project for  "Store  and Forward"  and                                                               
Alaska is  using store and  forward in remote villages  for care.                                                               
It is the policy of  this federal administration, moving forward,                                                               
that all  of Medicare will be  in some form of  managed care plan                                                               
by 2018.  This provides a  lot of opportunity for telehealth, but                                                               
thus far  only 1  percent of Medicare  beneficiaries are  able to                                                               
take  advantage.    Currently,  there are  only  two  plans  that                                                               
provide for telehealth  through their plans at  the University of                                                               
Pittsburg.  House  Resolution 2 in Congress,  the Medicare Access                                                               
and  Chip Program  had some  good language  related to  advancing                                                               
telehealth  practices; however,  a  couple of  studies are  being                                                               
called for before anything can be done.                                                                                         
                                                                                                                                
3:35:15 PM                                                                                                                    
                                                                                                                                
MR. GUTIERREZ  referred to Next Generation  ACO and said it  is a                                                               
breakthrough in  telehealth and the  CMS is now funding  20 pilot                                                               
programs  across the  country  for a  two  year demonstration  in                                                               
which  it  has   lifted  all  of  the   requirements  related  to                                                               
geographic   limitations,  and   is   encouraging   the  use   of                                                               
telehealth.    He described  Congressional  Bill  S. 2484  as  an                                                               
exciting bill in that the sponsors  have been careful to craft it                                                               
so  it  meets  the  neutrality  requirements  of  the  Office  of                                                               
Management  & Budget  and Congressional  Budget  Office on  their                                                               
scoring to ensure  that all bills are budget  neutral, and opined                                                               
it may  have a chance  of passing  during the lame  duck session.                                                               
Important factors to keep in  mind around telehealth is that this                                                               
is a mode  of delivery and it  is not a different  form of health                                                               
care  so   all  laws  apply,   he  said.    This   is  important,                                                               
particularly  around liability  and  confidentiality and  privacy                                                               
through HIPAA.   Alaska still remains one of the  10 worst states                                                               
in access  to broadband  internet, clearly  as Mr.  Michael Rilly                                                               
reported   from   the  FCC,   Alaska   is   different  in   size,                                                               
transportation,  and weather  creates huge  blocks for  access to                                                               
care.  Even  though, he noted, Alaska has a  model program, there                                                               
is still a long way to go in  terms of no matter what laws are in                                                               
place, if  it doesn't have  the super highway to  deliver, Alaska                                                               
will  be inhibited  in  its  ability to  take  full advantage  of                                                               
telehealth.                                                                                                                     
                                                                                                                                
3:37:5 PM                                                                                                                     
                                                                                                                                
MR.  GUTIERREZ  turned  to the  "Technology-Enables  Health  Care                                                               
Trends in the  21st Century section, slides 47-62,  and said that                                                               
Joseph Kvedar,  M.D., wrote  The Internet  of Healthy  Things and                                                             
that he would highlight a number  of points from the book to keep                                                               
in  mind  in where  the  nation  will be  in  health  care.   The                                                               
movement from volume to value where  the results will be paid for                                                               
rather  than paying  for the  inefficient pay  for service  model                                                               
will be  the standard.   Including, he  added, the idea  that the                                                               
21st  century  is moving  from  illness  care to  keeping  people                                                               
healthy,  moving  away from  in-patient  focus  and hospital  and                                                               
physician focus to more of a  continuum of care and a model where                                                               
there are  shared risk between payers,  providers, and consumers.                                                               
The  pathway to  greatness  in health  care  delivery and  making                                                               
health care accessible  to all with quality and  efficiency is to                                                               
think  about where  the nation  will be  in the  future.   Making                                                               
incremental changes in moving forward  is helpful, but the nation                                                               
wants the kind  of policies it can grow into  and allow for these                                                               
technologies to flourish  with the proper safeguards.   Slide 50,                                                               
he advised, depicts the traditional  model of the physician being                                                               
at  the  center  of  health   care,  mostly  in-person,  facility                                                               
centric, of  which is becoming  outdated.  The health  care model                                                               
of the future is depicted on  slide 51, wherein the consumer will                                                               
be and should  be at the center of all  approaches to health care                                                               
delivery  in which  all forms  of care,  whether specialty  care,                                                               
primary  care, or  community resources  providing holistic  care,                                                               
can be interconnected between virtual  means of communication and                                                               
support.    He  described  this  as one  of  the  most  untapped,                                                               
underutilized  forms in  telehealth, but  being able  to build  a                                                               
system  allowing  this  type  of   approach  will  be  critically                                                               
important,  particularly  given  the types  of  challenges  being                                                               
faced in Alaska.                                                                                                                
                                                                                                                                
3:40:38 PM                                                                                                                    
                                                                                                                                
MR. GUTIERREZ turned  to "2. Commercialization of  Health Care: A                                                               
Fact of Life,"  is Dr. Kvedar's second point about  the future in                                                               
that commercialization  of health  care is  everywhere, including                                                               
consumer driven direct  where the consumer can be at  home with a                                                               
sick child,  call a doctor  on demand  or American Well,  and pay                                                               
with  their credit  card for  a consultation  and a  non-narcotic                                                               
prescription.    He  described   it  as  a  multi-billion  dollar                                                               
industry that  continues to grow,  and it  is tied to  the retail                                                               
market place so places such  as Walmart Care Clinic, CVS Caremark                                                               
have invested significantly.  He  pointed out that Walgreens is a                                                               
leader and it partnered with  Providence Health Care Services and                                                               
now has  25 retail clinics  in Oregon and Washington  and expects                                                               
to  expand nationally.   Interestingly,  he  noted, Walgreens  is                                                               
tying  the whole  notion  of  retail health  care  to its  retail                                                               
business  so that  within the  records  of its  members, it  will                                                               
provide  loyalty points  for improvements  in wellness  care that                                                               
can be used for retail purchases.                                                                                               
                                                                                                                                
3:42:15 PM                                                                                                                    
                                                                                                                                
MR.  GUTIERREZ  turned to  "Technology  is  Growing and  Here  to                                                               
Stay," and  related that this  is not the  future as this  is now                                                               
the   ability  for   the  consumer   to  use   their  iPhone   to                                                               
instantaneously through Bluetooth and  in real time, review their                                                               
EKG  or  send it  to  the  consumer's  cardiac physician,  or  an                                                               
organization  that   can  provide   an  instant  reading.     The                                                               
flexibility  and ability  to  use technologies  now,  as long  as                                                               
there is  access to  high speed broadband,  is at  the consumer's                                                               
fingertips.   He remarked  that the world  of clunky  cameras and                                                               
monitors  is a  thing of  the past  except in  the carts  used in                                                               
hospitals.   Currently, there are  peripherals that  can generate                                                               
information  from  long  distances  using  telehealth  with  high                                                               
quality  and  definition  when   using  wireless  devices.    For                                                               
example,  the   Berkeley  "Tricorder"  is  the   smallest  remote                                                               
monitoring on  the market today and  it is smaller than  the size                                                               
of  a quarter.    By  using Bluetooth  connectivity  it can  send                                                               
information  on a  real time  basis, in  any number  of biometric                                                               
measures, to the  consumer's health care provider.   Although, he                                                               
opined, this will be outdated in  the next year as new forms come                                                               
into  play.   Incredibly, there  is  now the  ability to  monitor                                                               
patients taking their medications with  a microchip that has been                                                               
approved by  the FDA, which  dissolves in a patient's  system and                                                               
sends  a signal  to the  physician  or health  care team  through                                                               
Bluetooth internet.   He related that this appears  to be similar                                                               
to "Nanny  Government" but consider  the hundreds of  millions of                                                               
dollars lost  in poor medication  adherence either by  not taking                                                               
the medications  or taking  the wrong medications  and this  is a                                                               
way of not only improving the  quality of care but also improving                                                               
the cost efficiency.                                                                                                            
                                                                                                                                
MR.  GUTIERREZ  advised  that  Dr. Kvedar's  last  point  is  "4.                                                               
Virtual  Care Anywhere"  and perspective  is that  the nation  is                                                               
moving  to  the  point  where  care could  be  provided  in  many                                                               
locations and,  in fact  health care delivery  is moving  in that                                                               
direction with over 75 million  virtual visits predicted by 2020.                                                               
Kaiser Permanente  has been a pioneer  in this regard and  is the                                                               
largest  national  non-profit  health  plan.   In  2013,  and  in                                                               
Northern  California  alone,  Kaiser Permanente  documented  10.5                                                               
million virtual  visits, and by  the end  of 2016 it  is expected                                                               
the number of virtual visits  will exceed the number of in-person                                                               
visits.  Over  time Kaiser Permanente expects that  75 percent of                                                               
all visits will be performed virtually.   He explained that it is                                                               
not  reducing the  number  of in-person  visits  rather that  the                                                               
patients seen  by their physicians  and specialists  are patients                                                               
that really need to be seen.   Routine follow up visits, checking                                                               
in, communication  visits, and labs  can be  performed virtually.                                                               
He stated that  his favorite organization is  Mercy Virtual based                                                               
just  outside of  St.  Louis,  and the  slide  depicts an  actual                                                               
picture  of a  hospital  without beds  in which  it  acts as  the                                                               
command center for  four states in which  they are interconnected                                                               
with clinics,  hospitals, and physicians  in other  facilities to                                                               
provide  everything from  routine  monitoring  to emergency  care                                                               
from this facility.   It expects that within the  next five years                                                               
it will have performed 3 million virtual visits, he said.                                                                       
                                                                                                                                
CHAIR  SEATON  commented  that   this  presentation  brought  the                                                               
committee along from the traditional  model of medicine.  He then                                                               
listed the individuals available for testimony or questions.                                                                    
                                                                                                                                
3:47:50 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  WOOL referred  to his  statement that  telehealth                                                               
virtual visits will  not reduce the number of  inpatient visits a                                                               
health care providers sees in  one day, together with the portion                                                               
of the  physician's day  spent with  telehealth visits  and asked                                                               
whether their days would be  spent in telehealth and face-to-face                                                               
patients.                                                                                                                       
                                                                                                                                
MR.  GUTIERREZ explained  the idea  is that  a physician  can now                                                               
increase their  reach to  the number  of patients  in a  panel by                                                               
working  through   their  health   care  team,   using  physician                                                               
extenders, to  provide care using  telehealth and the  ability to                                                               
do their routine visits using the  health care delivery team.  He                                                               
said it is  not always the physician  communicating directly with                                                               
the patient, and  what Kaiser Permanente has  been promoting, and                                                               
what  it  is proving  in  its  work,  is  that it  increases  the                                                               
efficiency, and allows its physicians  and specialists to work at                                                               
the top of  their license.  The patients actually  being seen are                                                               
patients who really  need to be seen, so it  is an enrichment and                                                               
not a replacement to care.                                                                                                      
                                                                                                                                
3:49:30 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE WOOL  surmised that  the sickest patients  most in                                                               
need  of  the highest  level  of  the  licensing would  see  that                                                               
person.    Obviously, he  noted,  the  geographical barriers  are                                                               
being  knocked down  so it  does not  matter whether  the patient                                                               
lives next door  to the clinic, the patient may  still be treated                                                               
by telehealth.   He offered his hope that the  pricing is more on                                                               
a global  scale which would  be helpful, and asked  whether there                                                               
are instances  where a patient  who wants to see  their physician                                                               
would still have  access, or would that access be  more towards a                                                               
Cadillac or higher end level coverage.                                                                                          
                                                                                                                                
MR. GUTIERREZ explained  that the ability to see  a physician, or                                                               
a  specialist in  particular  when  there is  a  shortage of  the                                                               
distribution of specialists, is one  that is causing rationing of                                                               
health care by the de facto  and long delays in getting access to                                                               
that care.   To the extent that this accelerates  the process for                                                               
a physician to  either have an e-consult with  a specialist about                                                               
a particular patient to avoid having  a long wait, or to actually                                                               
have a  consultation either  in-person or  through the  store and                                                               
forward,  telehealth  allows  it  to   be  performed  in  a  more                                                               
efficient manner.   Yes, he  said, if  a patient really  wants to                                                               
see their  physician to the  extent there is an  appointment time                                                               
involved, certainly.   He opined there truly are  times a patient                                                               
needs to  be seen  by a physician  encompassing the  touch factor                                                               
that  is always  important in  the ideal  world, but  this is  an                                                               
opportunity to expand care.                                                                                                     
                                                                                                                                
3:51:48 PM                                                                                                                    
                                                                                                                                
CHAIR  SEATON  asked for  clarification  of  the term  "physician                                                               
extenders," and  asked whether that includes  other people within                                                               
their practice with a lower level  of licensing who can take care                                                               
of the routine issues.                                                                                                          
                                                                                                                                
MR. GUTIERREZ said that was  correct, advanced practice nurseries                                                               
would include  nurse practitioners who  are trained to  take care                                                               
of most  routine forms of  medical care  and are supervised  by a                                                               
physician.   In some  states nurse  practitioners are  allowed to                                                               
practice  independently,  but  in   most  cases  they  are  being                                                               
supervised  by   a  physician  so   in  the  event  there   is  a                                                               
complication or  an issue they  can reach out to  that physician.                                                               
A  physician  assistant is  a  national  licensing with  specific                                                               
training, similar  to a  nurse practitioner  and operates  in the                                                               
same manner.                                                                                                                    
                                                                                                                                
3:52:56 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  referred to  slide regarding over  200 bills                                                               
in 42  states, with  a bullet  point of  "Telehealth Professional                                                               
Standards,"  and  another  slide that  discussed  the  interstate                                                               
compact,  and not  changing what  it means  to be  licensed as  a                                                               
doctor in  a state  or an  ANP and  surmised that  those licensed                                                               
people are being defined a scope of practice for telehealth.                                                                    
                                                                                                                                
MR. GUTIERREZ  responded not in  a scope of practice,  but within                                                               
the context of how telehealth is  used.  For example, some states                                                               
require a physical  examination before a telehealth  visit can be                                                               
provided, and some states are  repealing those types of issues to                                                               
make  it more  accessible.   Another example  would be  where the                                                               
physician can be licensed in  another state and separate from the                                                               
compact,  can  provide  care under  certain  conditions  in  that                                                               
state.                                                                                                                          
                                                                                                                                
REPRESENTATIVE  TARR described  this  as more  about delivery  of                                                               
health and  not so much about  any new type of  ethical standards                                                               
or  expectations  on   the  provider  end  of   things  as  those                                                               
opportunities are expanded.                                                                                                     
                                                                                                                                
MR. GUTIERREZ said no, that it  is important to keep in mind that                                                               
telehealth is a modality; therefore,  to the extent that whatever                                                               
licensing  requirements  there  may be  for  whatever  profession                                                               
beyond just  physicians, that all standards  apply.  It is  not a                                                               
separate  or above  that license  or requirement,  and he  hasn't                                                               
seen anything in other states.                                                                                                  
                                                                                                                                
REPRESENTATIVE TARR asked about store and forward.                                                                              
                                                                                                                                
MR. GUTIERREZ replied  that this is a form of  care that has been                                                               
used successfully  with dermatology  and ophthalmology  with high                                                               
definition digital  images.  Currently,  with smart phones  it is                                                               
even possible to  get the type of high definition  that meets the                                                               
standards.    For example,  in  ophthalmology,  the retina  of  a                                                               
diabetic patient  could be sent  to a specialist a  long distance                                                               
away and the specialist could  review that during their down time                                                               
and make a determination as to  whether or not that patient has a                                                               
likelihood of damage to the  retina that could lead to blindness.                                                               
He related  that it has  been very successful,  particularly with                                                               
Native populations.   Another example  is dermatology  wherein an                                                               
image  can be  sent  through  secure email  to  a specialist  for                                                               
review  and they  can make  a diagnosis  and determination  as to                                                               
whether or not  it is a suspicious lesion and  advise back to the                                                               
primary care physician.                                                                                                         
                                                                                                                                
3:56:57 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON  asked about the  State of Nevada slide  which read,                                                               
"Prior  authorization  provision  is specific  ...  is  expressly                                                               
prohibited,"  and asked  whether that  provision was  part of  an                                                               
overall bill, or a standalone provision,  or is it in Medicaid or                                                               
private practice, or both.                                                                                                      
                                                                                                                                
MR. GUTIERREZ  opined that this was  in Medicaid and it  was part                                                               
of the  Medicaid regulations that initially  required that before                                                               
a service could be provided  there had to be prior authorization.                                                               
The  requirement was  in the  State of  California and  it was  a                                                               
deterrent  for physicians  to  utilize  the technologies  because                                                               
getting prior  authorization from a  state office of  Medicaid in                                                               
many cases  causes more problems  than it  is worth.   By lifting                                                               
that requirement it facilitated the process ...                                                                                 
                                                                                                                                
CHAIR  SEATON  asked  whether  that  was  a  requirement  in  the                                                               
Medicaid plan.                                                                                                                  
                                                                                                                                
MR. GUTIERREZ answered in the affirmative.                                                                                      
                                                                                                                                
CHAIR  SEATON referred  to Omada,  the digital  therapeutics, and                                                               
asked him  to explain the  slide that  reads, "A new  category of                                                               
medicine,  and then  offers each  employer and  a health  plans a                                                               
full service ... full service team at no cost."                                                                                 
                                                                                                                                
MR. GUTIERREZ  answered that the  CMS has now approved  Omada for                                                               
reimbursement under  Medicare, and  he felt  it was  important to                                                               
include in  this presentation.  He  opined that he does  not know                                                               
much about  it other  than the  fact that  it is  a sophisticated                                                               
technology that  allows a consumer  to monitor their  own chronic                                                               
condition and  be coached  through a virtual  means to  the Omada                                                               
system and control their diabetes,  obesity, hypertension and all                                                               
of the  major chronic  diseases that can  become killers  as they                                                               
become  acute.    Omada  has  been one  of  the  more  successful                                                               
companies  and  their  website  is  the  best  place  to  go  for                                                               
information.    Contrary  to  a lot  of  the  obesity  prevention                                                               
programs that  have low  compliance after  six months,  this form                                                               
has proven  to be successful with  high compliance for up  to one                                                               
year.   Omada is  seeing extensive cost  savings and,  he opined,                                                               
that  is  what Medicare  was  most  impressed  with in  terms  of                                                               
preventable conditions.                                                                                                         
                                                                                                                                
4:00:12 PM                                                                                                                    
                                                                                                                                
CHAIR  SEATON  asked whether  this  was  a CMS  determination  or                                                               
something that must be in the state plan as well.                                                                               
                                                                                                                                
MR.  GUTIERREZ  opined  that  it  was  a  CMS  determination  for                                                               
Medicare, and for Medicaid it would  have to be part of the state                                                               
plan.                                                                                                                           
                                                                                                                                
CHAIR  SEATON said  the  committee  would note  that  as it  goes                                                               
through Medicaid reform legislation.                                                                                            
                                                                                                                                
4:00:39 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR opined that  the application of telehealth in                                                               
Alaska has been entirely providing  services in more remote areas                                                               
where there wouldn't be specialists  and where services were more                                                               
limited.     She  said  she   saw  a  paradigm  shift   with  his                                                               
presentation  to   something  that  is  more   expansive  in  the                                                               
application  and  referred  to  his testimony  of  enhancing  the                                                               
system and quality.   She pointed out that she  is not yet seeing                                                               
it as  useful in  every circumstance  and she is  hung up  on the                                                               
need  for  an in-person  visit  and  the Nevada  bill  explicitly                                                               
prohibits that.  It  is hard for her, she offered,  to see how to                                                               
obtain the  strength in the  doctor/patient relationship  that is                                                               
needed  for  a  long  term positive  interaction  if  they  never                                                               
actually meet  face to face.   She asked  for his comments  as to                                                               
whether that is a patchwork of how people feel.                                                                                 
                                                                                                                                
MR.  GUTIERREZ related  that it  is important  to highlight  that                                                               
telehealth does not replace the  necessity for an in-person visit                                                               
and opined that  the State of Nevada law  specifically lifted the                                                               
requirement for a prior visit.   Certainly, telehealth has been a                                                               
valuable  resource for  isolated rural  communities and  it is  a                                                               
great opportunity to enhance care  and access.  Although, virtual                                                               
care and technology  is a powerful tool for  achieving the triple                                                               
aim of health  care, when pondering the value of  all health care                                                               
in any geographical  area consider the proposition  of giving the                                                               
most value and  the greatest efficiency of  health care resources                                                               
available.    Telehealth does  not  replace  the in-person  care,                                                               
telehealth  is an  enhancement to  the delivery  of high  quality                                                               
care and  it is  a value  tool in  that sense,  but not  one that                                                               
should ever  be seen as  replacing the necessity of  an in-person                                                               
visit, he remarked.                                                                                                             
                                                                                                                                
CHAIR  SEATON   thanked  Mr.  Gutierrez,   and  noted   that  the                                                               
presentation  expanded  the   committee's  knowledge  and  raised                                                               
issues it will want to take up in moving forward.                                                                               
                                                                                                                                
               HB 344-DRUG PRESCRIPTION DATABASE                                                                            
                                                                                                                                
4:04:12 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON announced  that the next order of  business would be                                                               
HOUSE BILL NO. 344, "An  Act relating to the controlled substance                                                               
prescription database; and providing for an effective date."                                                                    
                                                                                                                                
[Before the committee was the  proposed committee substitute (CS)                                                               
for HB  344, Version  29-LS1378\N, Bruce,  3/14/16, as  a working                                                               
document.]                                                                                                                      
                                                                                                                                
4:04:30 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 4:04 p.m. to 4:07 p.m.                                                                       
                                                                                                                                
4:07:40 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON  moved to adopt Amendment  2, labeled 29-LS1378\N.3,                                                               
which read:                                                                                                                     
                                                                                                                                
     Page 16, line 16, following "patient":                                                                                 
          Insert "more than a three-day supply of"                                                                          
                                                                                                                                
                                                                                                                                
REPRESENTATIVE TARR objected for discussion.                                                                                    
                                                                                                                                
CHAIR  SEATON   explained  that  this  amendment   would  add  an                                                               
exemption to  the mandatory  review of  the database  required in                                                               
Sec. 19, page  16, lines 14-20.  The exemption  would mean that a                                                               
practitioner or  pharmacist would  not be  required to  check the                                                               
database if  they are  dispensing a  controlled substance  with a                                                               
supply of three  days or less.  Although, they  could still check                                                               
but there would not be a requirement to check.                                                                                  
                                                                                                                                
4:08:59 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  noted that  it reads more  than a  three day                                                               
and surmised that it includes the third day.                                                                                    
                                                                                                                                
CHAIR SEATON agreed, and said three days or less.                                                                               
                                                                                                                                
4:09:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR  removed  her  objection.   There  being  no                                                               
objection, Amendment 2 was adopted.                                                                                             
                                                                                                                                
4:10:00 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON  moved to adopt Amendment  3, Version 29-LS1378\N.5,                                                               
which read:                                                                                                                     
                                                                                                                                
     Page 17, line 17, following "state":                                                                                       
          Insert "for an occupation or activity listed                                                                          
     under AS 08.01.010"                                                                                                        
                                                                                                                                
REPRESENTATIVE STUTES objected for discussion.                                                                                  
                                                                                                                                
CHAIR SEATON referred to Sec.  20, subsection (q), page 17, lines                                                               
15-17, which read:                                                                                                              
                                                                                                                                
          (q) A pharmacist or practitioner may only                                                                             
     delegate access  to the  database under  (b) or  (d) of                                                                    
     this section  to an employee  or agent who  is licensed                                                                    
     or registered in the state.                                                                                                
                                                                                                                                
CHAIR SEATON explained that the  amendment would clarify that the                                                               
person  must  be licensed  or  registered  for an  occupation  or                                                               
activity listed in AS 08.01.010.   The reason being to make clear                                                               
that they  must be  licensed or registered  with the  Division of                                                               
Corporations, Business,  and Professional Licensing and  not some                                                               
unintended  registration,  such  as the  sex  offender  registry,                                                               
thereby,  designating which  licenses  or  registration would  be                                                               
covered, he advised.                                                                                                            
                                                                                                                                
4:11:18 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  STUTES removed  her  objection.   There being  no                                                               
objection, Amendment 3 was adopted.                                                                                             
                                                                                                                                
4:11:47 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON  moved to adopt Amendment  4, Version 29-LS1378\N.6,                                                               
which read:                                                                                                                     
                                                                                                                                
     Page 18, line 15, following "TRANSITION.":                                                                                 
          Insert "(a)"                                                                                                          
                                                                                                                                
     Page 18, following line 18:                                                                                                
     Insert a new subsection to read:                                                                                           
          "(b)  On or before October 1, 2019, the                                                                               
     Department   of  Commerce,   Community,  and   Economic                                                                    
     Development  shall solicit  comments  on  the level  of                                                                    
     burden on  providers created by the  review requirement                                                                    
     in AS 17.30.200(k)(4), enacted by  sec. 19 of this Act.                                                                    
     The  department shall  summarize,  in a  report to  the                                                                    
     legislature,  the comments  received by  the department                                                                    
     and its findings based on  the comments. The department                                                                    
     shall deliver  the report to  the senate  secretary and                                                                    
     the  chief clerk  of the  house of  representatives not                                                                    
     later than October 1, 2019,  and notify the legislature                                                                    
     that  the  report  is available.  The  legislature  may                                                                    
     assess   whether  the   review  requirement   under  AS                                                                    
     17.30.200(k)(4),  enacted  by  sec.  19  of  this  Act,                                                                    
     remains necessary or if  alternative language should be                                                                    
     considered based on the report."                                                                                           
                                                                                                                                
REPRESENTATIVE TARR objected for discussion.                                                                                    
                                                                                                                                
CHAIR  SEATON  explained that  the  amendment  would add  to  the                                                               
uncodified law,  under Sec.  22 of  the HB  334.   He paraphrased                                                               
that the amendment directs the  Department of Commerce, Community                                                               
&  Economic  Development  to   solicit  comments  from  providers                                                               
regarding the level of burden  on providers created by the review                                                               
requirement  of   AS  17.30.200(k)(4)  and  to   deliver  to  the                                                               
legislature a report summarizing  the comments and the Department                                                               
of Commerce,  Community &  Economic Development's  findings based                                                               
on the  comments.  The report  would be due October  1, 2019, and                                                               
the  legislature may  assess whether  the  review requirement  is                                                               
still  necessary   or  whether  alternative  language   would  be                                                               
preferable.  Basically,   he  pointed   out,  this   directs  the                                                               
Department  of  Commerce,  Community &  Economic  Development  to                                                               
collect  comments  on the  burden  on  providers created  by  the                                                               
requirement  to   review  the  database  prior   to  prescribing,                                                               
dispensing,  or  administering,  and the  department  would  then                                                               
present  comments to  the  legislature with  the  findings.   The                                                               
legislature would then  have the option to  re-examine and review                                                               
the requirement.   It  is not  a sunset  but it  is a  review and                                                               
report.   The date of October  1, 2019 would give  the department                                                               
two years  and three  months from the  effective date  to collect                                                               
these comments and generate a report.                                                                                           
                                                                                                                                
4:13:45 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  asked who would  prepare the  report because                                                               
the  Department of  Commerce,  Community  & Economic  Development                                                               
(DCCED)  is  the stop  gap  to  move  the  database over  to  the                                                               
department  as it  does the  professional licensing,  but is  the                                                               
department well equipped  to receive comments.   For example, the                                                               
Department  of Health  and Social  Services  (DHSS) is  regularly                                                               
communicating  with its  Medicaid providers,  and suggested  that                                                               
possibly it should be DCCED and DHSS.                                                                                           
                                                                                                                                
CHAIR SEATON said  he presumed that each one  of the professional                                                               
boards would be handling those,  and called on Ms. Janey Hovenden                                                               
to respond.                                                                                                                     
                                                                                                                                
4:14:54 PM                                                                                                                    
                                                                                                                                
JANEY  HOVENDEN, Director,  Division  of Corporations,  Business,                                                               
and Professional  Licensing, Department of Commerce,  Community &                                                               
Economic Development, explained that  as she reads the amendment,                                                               
the  program coordinator  would coordinate  all information  with                                                               
all of  the different boards  and members in licensing,  which is                                                               
how a survey would be generated.   The survey would go out to all                                                               
registered  people  with  a database  and  solicit  their  input,                                                               
collect the  information and prepare  the required report  to the                                                               
legislature, she said.                                                                                                          
                                                                                                                                
4:15:42 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR asked  whether she  felt equipped  to handle                                                               
this task  and the volume  of respondents  which could be  in the                                                               
hundreds  or thousands.    She further  asked  that whether  with                                                               
existing resources the department would  be able to pull together                                                               
a report, or whether the  report would be a self-generated report                                                               
with  something  such  as  "Survey   Monkey  and  that  would  be                                                               
sufficient.                                                                                                                     
                                                                                                                                
MS. HOVENDEN  replied that even  though the department  is slowly                                                               
gathering email  addresses it isn't  quite equipped for  that and                                                               
would notify as it does  all regulation projects or anything like                                                               
that,  send snail  mail  to everyone.    The program  coordinator                                                               
being requested in this bill  would spearhead that entire project                                                               
as one of the duties of the position.                                                                                           
                                                                                                                                
REPRESENTATIVE TARR  related that sounds more  realistic in terms                                                               
of  a hefty  project and  she  did not  know what  to expect  and                                                               
sometimes given the opportunity people have a lot to say.                                                                       
                                                                                                                                
CHAIR  SEATON commented  that he  agrees that  without a  program                                                               
coordinator  if the  legislature  was just  dumping  this on  the                                                               
department, which  would not  be something  that would  be easily                                                               
handled.                                                                                                                        
                                                                                                                                
4:17:15 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  STUTES  asked  whether   this  project  could  be                                                               
performed  in  a timely  fashion.    She described  concern  that                                                               
people   cannot  receive   a  response   from  the   Division  of                                                               
Corporations, Business, and Professional Licensing, currently.                                                                  
                                                                                                                                
CHAIR  SEATON  reiterated that  there  is  a program  coordinator                                                               
hired for  this specific coordination  of the database and  it is                                                               
not  giving the  department another  job.   The description  of a                                                               
program coordinator  is located  within the  fiscal note  and the                                                               
report period  is for  two years  and three  months only.   There                                                               
will  be a  summary of  the  problems received  prepared for  the                                                               
legislature.                                                                                                                    
                                                                                                                                
REPRESENTATIVE STUTES  asked whether  the coordinator  would work                                                               
under the  Division of  Corporations, Business,  and Professional                                                               
Licensing.                                                                                                                      
                                                                                                                                
MS. HOVENDEN replied yes.                                                                                                       
                                                                                                                                
REPRESENTATIVE STUTES said that was her concern.                                                                                
                                                                                                                                
4:19:22 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VAZQUEZ   said  she  likes  the   intent  of  the                                                               
amendment  in receiving  feedback  from  providers regarding  the                                                               
burden that will be placed upon  them, but she is concerned there                                                               
will not be feedback until  three and one-half years away because                                                               
that is too long  of a period of time.  At most  it should be one                                                               
year  from now,  or something  in January,  2017.   Although, she                                                               
commented, not all of the  information will have been received to                                                               
assess  the  type  of  burden  but  there  would  be  an  initial                                                               
indication and annual  reports thereafter.  She  referred to line                                                               
11 of  Amendment 4, and pointed  out that the amendment  states a                                                               
report shall  be submitted on  "not later than October  1, 2019,"                                                               
and it is now March 24, 2016.                                                                                                   
                                                                                                                                
4:20:32 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON explained that the effective date is July 2017.                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ asked  to shorten the time  frame in order                                                               
to know the type of burden it will impose on the providers.                                                                     
                                                                                                                                
4:21:08 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON  responded that he was  trying to give at  least one                                                               
year  of  the   program  being  in  effect   to  coordinate  that                                                               
information in  an effective  manner, and this  is not  an annual                                                               
report.   He  remarked  he has  tried to  eliminate  some of  the                                                               
burden  by  allowing  the  chief  pharmacist  to  also  authorize                                                               
someone who  is licensed or  registered in the health  field, and                                                               
there  is accountability  against their  license.   The testimony                                                               
the committee received was that  the department is the busiest at                                                               
the end of  the legislature or the fiscal year  and the best time                                                               
to  prepare the  report is  October or  November so  it would  be                                                               
ready for  the legislature in  the following year.   He commented                                                               
that preparing a  report in June or July for  the legislature may                                                               
not be reviewed  until the next session, and  receiving a shorter                                                               
term report wouldn't cover an  entire year's worth of the program                                                               
and the  intention is to  calculate feedback.   In the  event the                                                               
committee  does not  wish  to have  a report,  he  said he  could                                                               
remove the report.                                                                                                              
                                                                                                                                
4:23:40 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR noted  that the  effective date  is July  1,                                                               
2017, and a full year would  be 2018, and suggested using January                                                               
1, 2019.                                                                                                                        
                                                                                                                                
CHAIR  SEATON  asked  whether the  department  could  change  the                                                               
report date.                                                                                                                    
                                                                                                                                
MS.  HOVENDEN  responded  that   the  report  will  be  presented                                                               
whenever it is requested.                                                                                                       
                                                                                                                                
4:24:50 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR moved  to adopt  Conceptual  Amendment 1  to                                                               
Amendment 4,  to change the  date on line  6 to January  1, 2019;                                                               
and on line 11 to change the date to January 1, 2019.                                                                           
                                                                                                                                
CHAIR SEATON objected.   He surmised that it  would be Conceptual                                                               
Amendment 1 to Amendment 4 to  change October 1, 2019, to January                                                               
1, 2019, on line 6 and line 11.                                                                                                 
                                                                                                                                
REPRESENTATIVE TARR agreed.                                                                                                     
                                                                                                                                
4:25:41 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE WOOL said that based  on the pharmacist's comments                                                               
that expressed  possibly foreseeable problems, he  opined that it                                                               
gives  them  a  year  to   evaluate,  and  after  that  year  the                                                               
department  has five  months to  complete a  report.   He related                                                               
that it is a good timeline.                                                                                                     
                                                                                                                                
CHAIR SEATON  removed his objection.   There being  no objection,                                                               
Conceptual Amendment 1 to Amendment 4 was adopted.                                                                              
                                                                                                                                
4:26:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR  removed her  objection  to  Amendment 4  as                                                               
amended.  There being no  objection, Amendment 4, as amended, was                                                               
adopted.                                                                                                                        
                                                                                                                                
4:27:36 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VAZQUEZ moved  to  report CSHB  344, Version  29-                                                               
LS1378\N,   as  amended,   out  of   committee  with   individual                                                               
recommendations and  the accompanying fiscal notes.   There being                                                               
no objection, CSHB  344(HSS) was reported from  the House Health,                                                               
Education and Social Services Standing Committee                                                                                
                                                                                                                                
4:28:20 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 4:28 p.m. to 4:31 p.m.                                                                       
                                                                                                                                
         HB 315-ELECTRONIC VISIT VERIFICATION: MEDICAID                                                                     
                                                                                                                                
4:31:24 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON announced  that the next order of  business would be                                                               
HOUSE  BILL NO.  315, "An  Act  relating to  an electronic  visit                                                               
verification system  for providers of certain  medical assistance                                                               
services."                                                                                                                      
                                                                                                                                
4:31:43 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ moved to adopt CSHB 315, Version 29-                                                                     
LS1287\E, Glover, 3/21/16, as the working document.                                                                             
                                                                                                                                
REPRESENTATIVE STUTES objected                                                                                                  
                                                                                                                                
4:32:18 PM                                                                                                                    
                                                                                                                                
ANITA HALTERMAN, Staff, Representative Liz Vazquez, Alaska State                                                                
Legislature, read from prepared testimony as follows:                                                                           
                                                                                                                                
     The most salient  points of this bill is  that the bill                                                                    
     protects  the most  vulnerable of  our population.   It                                                                    
     does so  by allowing an  alert to be triggered  for the                                                                    
     home and  community based provider agency  who then can                                                                    
     remediate this matter with a  beneficiary.  The goal of                                                                    
     HB 315 is to ensure  that the state only pays providers                                                                    
     for  the approved  services that  are  rendered by  the                                                                    
     appropriate home  health agency personnel  while within                                                                    
     that  recipient's  home  or other  authorized  setting.                                                                    
     Alaska's  population is  aging and  the demand  for PCA                                                                    
     and home  care services will increase.   Accordingly it                                                                    
     will continue to become  increasingly more important to                                                                    
     ensure  that the  home care  is delivered  properly and                                                                    
     that publically funded resources  are being managed and                                                                    
     spent  appropriately.   It is  anticipated that  Alaska                                                                    
     has  the potential  to realize  savings of  between $15                                                                    
     million and $35 million with this bill.                                                                                    
                                                                                                                                
CHAIR SEATON asked how the anticipated savings are to be                                                                        
realized.                                                                                                                       
                                                                                                                                
4:34:01 PM                                                                                                                    
                                                                                                                                
MS. HALTERMAN  answered that she would  like to get a  little bit                                                               
more  background on  the bill,  there's been  a lot  of questions                                                               
about  the bill  that  have been  raised by  the  public and  the                                                               
Department of Health and Social Services.   She asked that she be                                                               
allowed to read notes written for the record, as follows:                                                                       
                                                                                                                                
     House  Bill 315  is the  electronic visit  verification                                                                    
     Medicaid bill.   A 2012, the  Government Accountability                                                                    
     Office (GAO)  report has indicated  that 40  percent of                                                                    
     all  national   fraud  convictions  initiated   by  the                                                                    
     Medicaid  Fraud Control  Units (MFCUs)  are related  to                                                                    
     services that  are rendered in  the home  and community                                                                    
     based  settings.    According   to  the  institutes  of                                                                    
     Medicaid  ...  medicine  fraud ...  medical  fraud  and                                                                    
     abuse in  health care costs  $75 billion  annually, and                                                                    
     the cost  to unattended  patients can  be immeasurable.                                                                    
     It  has  been reported  that  the  adoption of  use  of                                                                    
     technology is  not only about  compliance, it  is about                                                                    
     survival.  Even FedEx deliveries  of a $4 item requires                                                                    
     an  electronic signature  proving  the  delivery.   Why                                                                    
     shouldn't  something as  valuable  as  patient care  be                                                                    
     electronically  documented and  verified?   Perspective                                                                    
     approaches to  combatting fraud, waste, and  abuse, are                                                                    
     far  more  effective  than  reactive  or  retrospective                                                                    
     approaches such  as audits  and imposing  new mandates.                                                                    
     To give  a little bit  of history, the State  of Alaska                                                                    
     has  previously   considered  using   electronic  visit                                                                    
     electronic verification systems.   On July 28, 2014, it                                                                    
     was reported by  the Anchorage or the ...  the ADN that                                                                    
     the  state  was  considering  a pilot  for  EVV.    The                                                                    
     Assistant Attorney  General at that time  reported that                                                                    
     Medicaid   fraud   was   costing  Alaska   Medicaid   a                                                                    
     conservative  estimate of  $45 million  per year.   EVV                                                                    
     systems  are  easy  to  use,  they  don't  require  any                                                                    
     installation  of software  or  hardware.   They  ensure                                                                    
     that  beneficiaries  receive   the  services  that  are                                                                    
     authorized for  the support that has  been approved and                                                                    
     for which the state is being  billed.  A person who can                                                                    
     use EVV, typically can use  the telephone.  EVV is used                                                                    
     for  compliance  and  for  quality  assurance  purposes                                                                    
     throughout  the nation.   Beneficiaries  are identified                                                                    
     by either a  landline or a GPS  location and caregivers                                                                    
     are identified by a unique  identifier, and a biometric                                                                    
     match that allows  the system to verify  that the calls                                                                    
     were   made  from   the   proper   caregiver  for   the                                                                    
     beneficiary.  EVV systems  authenticate the presence of                                                                    
     service providers,  they may  rely on  telephony, which                                                                    
     is the  most commonly used  form of EVV,  GPS tracking,                                                                    
     biometrics,  computers   for  the   provider  agencies,                                                                    
     mobile tablets,  tokens, or other applications  - those                                                                    
     names  of  devices  vary  by  vendor,  and  then  smart                                                                    
     phones.   An  individual  without  landline or  systems                                                                    
     used to authenticate services can  be provided a device                                                                    
     by a  vendor, kind of like  a pager.  This  generates a                                                                    
     client ID  with a ...  that provides a  digital readout                                                                    
     that can be given to the  caregiver who can call in and                                                                    
     then enter that  code into a system  about that client.                                                                    
     Our  research indicates  that  it  appears the  average                                                                    
     cost  of  ...  of that  verification  is  approximately                                                                    
     $0.15  per visit.   Biometrics  are critical  component                                                                    
     for  successful   EVV  implementation.     They  ensure                                                                    
     further  reduction  of  fraud,   waste,  and  abuse  by                                                                    
     identifying  that  caregiver's   identify.    Statewide                                                                    
     independent  approaches  involve vendor  solutions  and                                                                    
     are considered funded mandates.   These are cloud-based                                                                    
     platforms  that allow  for  remote patient  monitoring.                                                                    
     The states  that have  chosen the  statewide approaches                                                                    
     have done  so because  they want to  maintain oversight                                                                    
     over their EVV systems.   Statewide vendor solutions do                                                                    
     the following:  it allows the  state to  access federal                                                                    
     assistance  matching percentages  of up  to 90  percent                                                                    
     for frontend  system development; they gain  75 percent                                                                    
     for recurring  costs when the systems  are plugged into                                                                    
     the claims system; it removes  fraud liability from the                                                                    
     consumer  directed home  care  provider  agency and  it                                                                    
     places  it directly  on the  consumer  directed PCA  or                                                                    
     caregiver under  her consumer  directed clients.   This                                                                    
     morning  I  confirmed  with the  department  that  only                                                                    
     approximately  1.5 percent  of the  clients are  served                                                                    
     under  an  agency  based model,  so  this  would  limit                                                                    
     liability   from   any   of   our   consumer   directed                                                                    
     beneficiaries and their agencies.                                                                                          
                                                                                                                                
4:39:13 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON asked for more explanation.                                                                                        
                                                                                                                                
MS. HALTERMAN explained  there are two different  models, such as                                                               
an agency  based model  that typically  requires that  the agency                                                               
staff the  beneficiary's care  in that  home, and  sends someone,                                                               
typically a  CNA, to the home  to provide that care.   The agency                                                               
has some  direct responsibility over  directing the care  when it                                                               
is an  agency based caregiver.   When  it is a  consumer directed                                                               
PCA  model, the  consumer directly  hires, supervises,  and fires                                                               
their  caregivers,  they  provide  the  training,  and  they  are                                                               
responsible  for the  oversight  of their  care.   These  systems                                                               
place that responsibility  more directly on the  consumer and its                                                               
caregivers, rather than the agency, she said.                                                                                   
                                                                                                                                
4:40:16 PM                                                                                                                    
                                                                                                                                
MS. HALTERMAN continued reading her written testimony as                                                                        
follows:                                                                                                                        
                                                                                                                                
     Statewide vendor  solutions can also be  set to trigger                                                                    
     an  alert so  that they  can  be sent  to the  provider                                                                    
     agency in  order for that  agency to investigate  a gap                                                                    
     in  care.   These can  be  set to  set an  alert to  an                                                                    
     administrator within the state  agency, but only if the                                                                    
     state chooses that option.   EVV systems can monitor to                                                                    
     ensure visits  are happening  as expected  and/or alert                                                                    
     that provider agency  when a gap in  care is occurring.                                                                    
     The  reports  and these  alerts  are  optional for  the                                                                    
     Department  of Health  and Social  Services.   Provider                                                                    
     agencies  maintain  all  control  over  scheduling  and                                                                    
     resolving any gaps in care  with that direct caregiver.                                                                    
     Generally, vendors provide training  and the use of the                                                                    
     EVV  systems  to   administrative  staff  within  those                                                                    
     agencies,  who  then  provide training  to  the  direct                                                                    
     caregiver.   EVV  systems statewide  allow for  con ...                                                                    
     configuration  of  new  software  so  EVV  systems  can                                                                    
     incorporate programs  specific business rules  for each                                                                    
     of  our  agencies.     They  ensure  for  comprehensive                                                                    
     training  to   be  consistently  provided,   which  may                                                                    
     include providing a training  kit, visual aids, videos,                                                                    
     or documentation  on best practices.   EVV  systems can                                                                    
     generate   reports  that   alert   agencies  when   the                                                                    
     caregiver  fails  to  show  up.   EVV  systems  can  be                                                                    
     integrated, again  with the existing  provider systems,                                                                    
     to minimize the impact on those provider agencies.                                                                         
                                                                                                                                
     A  standards based  approach,  which  we've heard  some                                                                    
     folks  testify and  some ...  we've  seen some  written                                                                    
     testimony in support of.  Um,  I want to kind of define                                                                    
     the standards based approach.   It is an approach where                                                                    
     the  department sets  the minimum  set of  requirements                                                                    
     that  the provider  must meet  with the  use of  an EVV                                                                    
     system.  The  provider then needs to  ensure that those                                                                    
     requirements ... um, occur with  the solution that they                                                                    
     provide ...  or they procure  on their own.   Standards                                                                    
     based approaches  are unfunded  mandates.   States have                                                                    
     chosen those options  but those that have  done so have                                                                    
     experienced   that  they   have   little  control   and                                                                    
     oversight over their data.   The standards approach may                                                                    
     lead  to increased  reimbursement due  to the  cost and                                                                    
     complications  of  implementing  new systems  for  each                                                                    
     provider.   For  instance, the  State of  Washington we                                                                    
     have learned  has increased reimbursement  to providers                                                                    
     due  to   the  implementation  of  a   standards  based                                                                    
     recordkeeping system  or timekeeping system.   It's not                                                                    
     technically a  fully ... fully functioning  EVV system.                                                                    
     It   has  no   oversight   or   management  of   claims                                                                    
     integration.                                                                                                               
                                                                                                                                
4:43:15 PM                                                                                                                    
                                                                                                                                
MS. HALTERMAN continued reading her written testimony as                                                                        
follows:                                                                                                                        
                                                                                                                                
     Standards based EVV systems do  not necessarily lead to                                                                    
     the  savings  that  are  found   in  the  vendor  based                                                                    
     solutions because the  provider still maintains control                                                                    
     and check the validity of all  of the data that is sent                                                                    
     to  the state.   There  is no  data sent  to the  state                                                                    
     independently  and; therefore,  no independence  of any                                                                    
     EVV  data.   Standards based  solutions may  become too                                                                    
     costly for  some of  our smaller  providers.   They may                                                                    
     become  far too  complicated for  smaller providers  to                                                                    
     implement.   Even our PCA Association  has pointed this                                                                    
     fact  out.    Our  fear  is  that  if  we  implement  a                                                                    
     standards based  solution this could cause  some of our                                                                    
     small  providers in  Alaska to  close  their doors  and                                                                    
     impede competition  due to an  unfunded mandate  of the                                                                    
     development  of  new  systems.    Standards  based  EVV                                                                    
     systems can  significantly slow  implementation because                                                                    
     if the state allows  for integration of standards based                                                                    
     EVV solutions  into existing business practices  it may                                                                    
     take  a  lot  longer  to  finish  full  implementation.                                                                    
     Standards based  EVV approaches can be  challenging for                                                                    
     some of our providers, it  can be complicated for those                                                                    
     providers.   They may delay the  full implementation or                                                                    
     cause non-compliance  for provider agencies  that can't                                                                    
     fully  implement.     They   may  reduce   the  savings                                                                    
     generated,  again  due to  the  lack  of oversight  and                                                                    
     control.   This is still essentially  a (indisc.) model                                                                    
     with  no upfront  fraud  prevention.   Standards  based                                                                    
     solutions place  the burden of verifying  or certifying                                                                    
     systems within  the State of  Alaska on  the department                                                                    
     in order  to assure that strong  technical controls are                                                                    
     placed  and maintained.   Requiring  the state  to make                                                                    
     exceptions  to address  the needs  of  remote or  small                                                                    
     providers as  has been suggested  by some, may  force a                                                                    
     vendor solution in  part to be considered  along with a                                                                    
     standards  based   solution  because   otherwise  small                                                                    
     providers may be forced to close their doors.                                                                              
                                                                                                                                
4:45:34 PM                                                                                                                    
                                                                                                                                
MS. HALTERMAN continued reading her written testimony as                                                                        
follows:                                                                                                                        
                                                                                                                                
     So, I want to talk a  little bit about what EVV systems                                                                    
     do.  EVV systems can  do the following: they can reduce                                                                    
     inappropriate  billing  for  home health  and  personal                                                                    
     care    attendant    services;   they    can    improve                                                                    
     efficiencies; reduce  paid work  for both  the agencies                                                                    
     and the  State of Alaska's  Medicaid Agency.   They can                                                                    
     improve quality  by ensuring services are  provided for                                                                    
     the  most  vulnerable of  our  populations.   They  may                                                                    
     assist agencies  and providers  in helping  to identify                                                                    
     unmet  needs  or  missed   or  late  appointments  when                                                                    
     caregivers don't  show.  They  may improve  the ability                                                                    
     to make  adjustments to care  quickly by  triggering an                                                                    
     alert to an agency who  then knows the caregiver didn't                                                                    
     show up,  they can  initiate a backup  plan.   They can                                                                    
     improve policy decisions and  improve strategies due to                                                                    
     the ...  having access to  the encounter data  that the                                                                    
     state  has  never had  before.    It can  improve  data                                                                    
     collection,  evaluation,  and  also provide  a  unified                                                                    
     view of each  home and community based  and PCA service                                                                    
     that  will allow  care to  be examined  across multiple                                                                    
     agencies and  possibly multiple  provider types.   This                                                                    
     will  improve   the  quality  of  services   for  those                                                                    
     beneficiaries.     EVV  systems   can  afford   a  more                                                                    
     effective    invoice,    billing,    scheduling,    and                                                                    
     documentation of the service  delivery process and they                                                                    
     can  lead  to  enhanced  administrative  processes  for                                                                    
     those    agencies.       EVV   systems    capture   and                                                                    
     electronically submit  claims data with  accurate dates                                                                    
     from visits  that are verified  which allows  the state                                                                    
     to   validate  that   the  data   is  coming   from  an                                                                    
     independent source.  EVV systems  can ease reporting by                                                                    
     providing  a  central   location  that  identifies  the                                                                    
     support   and  services   that   those  providers   are                                                                    
     rendering.  EVV systems  can generate exception reports                                                                    
     that can  be run  ad hoc  ... um,  and they  can reduce                                                                    
     adult  protective  service  issues  and  the  need  for                                                                    
     investigations.   These reports may help  DHSS identify                                                                    
     concerns earlier than  they have been able to  do so in                                                                    
     the  past.    So,  the  benefits  of  EVV  include  the                                                                    
     potential  to eliminate  the padding  of timesheets  by                                                                    
     caregivers, it  allows for a  flag to  the supervisors,                                                                    
     the agencies  ... um,  to alert  to suspected  abuse or                                                                    
     neglect.  It  can reduce errors, it can  save money for                                                                    
     agencies and for the State  of Alaska.  If plugged into                                                                    
     the  claims   system  it  can  speed   up  payments  if                                                                    
     implemented  with that  claims system.   It  can ensure                                                                    
     compliance with state and federal  regulations.  It can                                                                    
     improve  quality  assurance  and  streamline  processes                                                                    
     including payroll for  many of our agencies.   They can                                                                    
     improve  efficiencies and  effectiveness.   And, lastly                                                                    
     save money on audits because  the proof of care will be                                                                    
     automated.                                                                                                                 
                                                                                                                                
     I  have  in  our  research, Rep.  Vazquez  and  I  have                                                                    
     discovered...                                                                                                              
                                                                                                                                
4:49:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VAZQUEZ  interjected  that she  wanted  to  place                                                               
certain  relative  experiences  on  the record  and  offered  her                                                               
extensive  Medicaid  fraud background.    She  related that  many                                                               
states  have  been  using  electronic  visit  verification  (EVV)                                                               
systems for years, if not decades.   As a prosecutor she attended                                                               
numerous  national conferences  on  Medicaid fraud  and has  seen                                                               
demonstrations on  how these systems  work.  Currently,  there is                                                               
evidence that  these systems  can save  states money  by reducing                                                               
fraud, waste, and abuse, and add  to the quality of care that the                                                               
most vulnerable  of Alaska's population  needs.   Recent research                                                               
indicates that Congress  has gotten onto this idea,  and in 2015,                                                               
Representative  Steven Guthrie  introduced HR  2446, which  would                                                               
require  these   types  of  systems  for   every  state  offering                                                               
Medicaid, which is now all  50 states, and stipulates that states                                                               
that do  not implement the system  will be subject a  decrease of                                                               
Federal Medical Assistance Percentage  (FMAP), the federal share.                                                               
The most  recent action on this  bill was November 4,  2015, when                                                               
the bill was forwarded to the  subcommittee on Health to the full                                                               
Energy  and  Commerce  Committee.    In 2015,  on  the  House  of                                                               
Representatives  side   of  Congress,  Senator   Charles  "Chuck"                                                               
Grassley  introduced  SB  2416,  which  also  would  require  EVV                                                               
systems  in  Medicaid  and  in   addition  Medicare.    The  bill                                                               
stipulates that states  that do not implement will  be subject to                                                               
a decreased  federal share in  Medicaid, or FMAP.   She explained                                                               
that it's always  difficult, as a prosecutor who  also dealt with                                                               
civil cases,  to chase  after Medicaid  providers after  the fact                                                               
because it  very difficult once  the horse  has left the  barn to                                                               
recover money.  In 2015, there was  a PCA agency owner and it was                                                               
alleged  that $1.2  million were  billed  inappropriately to  the                                                               
Medicaid  program.   Restitution  was  ordered  by the  judge  at                                                               
judgement  but   recovering  $1.2   million  posed   a  difficult                                                               
challenge  for the  state.   This bill  in essence  would try  to                                                               
catch  the fraud,  waste,  and abuse,  upfront  before the  horse                                                               
leaves  the barn  and it  also adds  to the  quality of  care for                                                               
individuals, she explained.                                                                                                     
                                                                                                                                
4:53:32 PM                                                                                                                    
                                                                                                                                
MS. HALTERMAN  added that their  research identified a  number of                                                               
vendors that  provide this  service.  Sandata  is the  vendor the                                                               
sponsor's office  has been  working with  to crunch  numbers that                                                               
used  some data  from Kaiser  Family Foundation  from 2012.   She                                                               
pointed out that Sandata would  like to analyze more current data                                                               
and the  department has been  speaking with this vendor  and they                                                               
had a meeting  to share insights about these  systems, and answer                                                               
questions.   There are a number  of vendors such as,  First Data,                                                               
Vilify Health,  Access, Technology Solutions, and  Care Watch are                                                               
all EVV  vendors.  She explained  that it has been  made clear to                                                               
Sandata  that no  guarantee were  offered to  Sandata in  the RFP                                                               
process.   She said  that unfortunately, of  the 130  fraud cases                                                               
that have  been investigated by  Alaska's Medicaid  Fraud Control                                                               
Unit, 120  of them are  directly related to the  populations that                                                               
would be targeted with this bill.                                                                                               
                                                                                                                                
MS.  HALTERMAN  referred  to Sandata's  Brian  Lawson's  previous                                                               
testimony and  said he is  willing to make himself  available for                                                               
anyone  with  further  questions   to  explain  the  benefits  of                                                               
analyzing real  data and the  return on investment found  from an                                                               
effective  implementation of  an EVV  system.   Although, Sandata                                                               
was not their  only research tool, it helped  develop the pricing                                                               
and return  on investment forecast  is collected from  the Kaiser                                                               
Family Foundation,  its 2012 data.   It  has been noted  that the                                                               
enrollment in populations in the  Medicaid expenditures are down,                                                               
but  only  PCA  data  was presented.    Ms.  Halterman  continued                                                               
reading her written testimony as follows:                                                                                       
                                                                                                                                
     While the  return on investment  that was  generated by                                                                    
     Sandata includes not just  PCA, it identifies potential                                                                    
     savings for home  and community based waiver.   Now, in                                                                    
     the  targets that  they presented  on  that return  and                                                                    
     investment  because it  was not  using actual  Medicaid                                                                    
     data.   They would  need to have  access to  true data,                                                                    
     real  data, from  the  department, enrollments  numbers                                                                    
     and spending outcomes in order  to present a more valid                                                                    
     forecast of  what these savings  could be.  So  now the                                                                    
     current  data  does  show that  the  beneficiaries  and                                                                    
     spending are  down slightly for these  populations that                                                                    
     would be  targeted with  this bill.   It is  clear that                                                                    
     the  proper  implementation  of  an  EVV  system  would                                                                    
     provide a  significant return on  investment regardless                                                                    
     of  what the  numbers are,  regardless of  how much  is                                                                    
     spent.   The 5 percent  return on investment  was based                                                                    
     on  the PCA  and  home and  community based  population                                                                    
     savings  that use  an EVV  system.   And  the total  of                                                                    
     those expenditures was  approximately $305 million, the                                                                    
     numbers  again used  for the  analysis was  sample data                                                                    
     and   it  used   fail  information   that  the   vendor                                                                    
     identified from  a source that  was valid but  wasn't a                                                                    
     reliable  ...   necessarily  a  100   percent  reliable                                                                    
     source.  If  the department is willing  to provide more                                                                    
     reliable  data,  the  vendor   is  willing  to  analyze                                                                    
     current real  data to come  up with a  realistic return                                                                    
     on investment.   It should be noted  that while Sandata                                                                    
     did  present  a  return  on   investment  that  used  5                                                                    
     percent, 8  percent, and  12 percent  returns, Medicaid                                                                    
     Fraud  Control  unit  has alerted  us  that  those  are                                                                    
     conservative  estimates  because  they  have  presented                                                                    
     that fraud has  conservatively reached approximately 20                                                                    
     percent with those populations.   So sadly, in light of                                                                    
     the  testimony last  year in  Senate Finance  and House                                                                    
     Finance it  is clear that  Alaska has a  fraud problem.                                                                    
     Several documents...                                                                                                       
                                                                                                                                
4:59:54 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON  interrupted  and  pointed  out  that  the                                                               
committee  actually wanted  a summary  of changes.   Before  each                                                               
member  is  HB 315,  with  a  proposal  to  take up  a  committee                                                               
substitute which is  different, he said.  The  committee wanted a                                                               
summary of those  changes which he opined that  one requires that                                                               
a  standards based  model  be used,  and Version  E  is that  the                                                               
department  shall  contract  with  the  vendor  to  implement  an                                                               
electronic visit  verification (EVV)  system.   Also, he  said it                                                               
required real time  reporting, to the extent feasible.   He asked                                                               
whether  the committee  has questions  on considering  the vendor                                                               
model versus the standard based model in the original bill.                                                                     
                                                                                                                                
5:01:25 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR advised she does not have Version E.                                                                        
                                                                                                                                
The committee took an at-ease from 5:01 p.m. to 5:05 p.m.                                                                       
                                                                                                                                
5:05:23 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  WOOL  noted that  the  committee  heard from  the                                                               
vendors during the  last committee meeting and  asked whether the                                                               
committee has heard from the department.                                                                                        
                                                                                                                                
5:06:29 PM                                                                                                                    
                                                                                                                                
DEB   ETHERIDGE,  Deputy   Director,  Division   of  Senior   and                                                               
Disabilities Services, Department of  Health and Social Services,                                                               
said she is available.                                                                                                          
                                                                                                                                
REPRESENTATIVE SEATON asked Ms.  Etheridge to discuss fiscal note                                                               
wherein  it lists  $224,000 each  year for  the next  five years;                                                               
however, in  the analysis, he  paraphrased the  following: "Three                                                               
states passed  legislation to  implement an  EVV program  and two                                                               
are fully implemented but that  they reported there was high cost                                                               
of  however  reported  initial cost  for  implementation  of  $13                                                               
million."  He remarked that he  is trying to relate that although                                                               
they have a larger population, but  it reads that "a timeline for                                                               
implementation be  24 months."   He pointed out that  this fiscal                                                               
note relates to Version A.                                                                                                      
                                                                                                                                
5:07:47 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ offered a  correction that the fiscal note                                                               
before the committee, OMB Component  Number 2663, states that the                                                               
total cost is $224,200, and it  would be 50 percent federal match                                                               
so the general fund match would be $112,100.                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON offered that it  is a recurring cost and he                                                               
is trying  to determine  how that  corresponds to  the narrative,                                                               
and he  paraphrased the following,  "that said in  several places                                                               
that the impacts were substantial.                                                                                              
                                                                                                                                
5:08:55 PM                                                                                                                    
                                                                                                                                
MS.  ETHERIDGE   responded  that  the  fiscal   note  before  the                                                               
committee is a  fiscal note to the  administrative component, and                                                               
it captures  the department's personnel costs  for implementation                                                               
and  ongoing compliance  and oversight  of  the electronic  visit                                                               
verification (EVV) system.  The  fiscal note was developed on the                                                               
original version and not on Version  E.  The other estimated cost                                                               
that the department struggled to  develop would have impacted the                                                               
Senior  and Disability  Services Medicaid  component and  at this                                                               
time  there  is not  an  indeterminate  Medicaid component  note.                                                               
However,  the  division   did  note  in  the   narrative  on  its                                                               
administrative  fiscal  note  that there  would  be  expenditures                                                               
impacting its Medicaid budget, and  it gave some logic about what                                                               
the division  anticipates or why  it had  difficulty anticipating                                                               
the cost associated with how it would impact Medicaid.                                                                          
                                                                                                                                
REPRESENTATIVE  SEATON  surmised  that  was looking  at  one  GGU                                                               
Health Program Manager  II positions in Anchorage, and  it is the                                                               
main portion of the fiscal note.                                                                                                
                                                                                                                                
MS.  ETHERIDGE  agreed  that  it  is  the  main  portion  of  the                                                               
administrative fiscal note.                                                                                                     
                                                                                                                                
REPRESENTATIVE  SEATON  asked whether  Ms.  Etheridge  had had  a                                                               
chance to look at the vendor portion and generate a fiscal note.                                                                
                                                                                                                                
MS. ETHERIDGE stated  that she had an opportunity  today to learn                                                               
more about the intention of  the implementation of the EVV system                                                               
and she  has a better  understanding of what the  obligations may                                                               
be and she is preparing a fiscal note.                                                                                          
                                                                                                                                
REPRESENTATIVE SEATON added  that he just wanted  to clarify that                                                               
because there  is a single fiscal  note there, but that's  if the                                                               
department would do it and not  through the vendor model which is                                                               
Version E.                                                                                                                      
                                                                                                                                
5:11:38 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  offered that  due to  the recent  changes to                                                               
the PCA program, and also  the major Medicaid reform package that                                                               
is moving  through the legislature,  her concern is that  this is                                                               
potentially too many things at once.                                                                                            
                                                                                                                                
MS. ETHERIDGE related that the  department does, and the Division                                                               
of Senior and Disability Services  has a number of initiatives in                                                               
which  it  is  working  on  currently  through  Medicaid  reform,                                                               
through  its  CMS compliance  necessary  for  the home  community                                                               
based services.   Which includes  the initiatives  the department                                                               
has  taken  to  streamline  and  have  more  oversight  over  its                                                               
personal care program.  She noted  that is part of the reason the                                                               
department  would  require  additional staff  to  implement  this                                                               
program, and the  department anticipates it will  take 24 months,                                                               
at least.                                                                                                                       
                                                                                                                                
REPRESENTATIVE TARR  surmised that the changes  that affected the                                                               
amount of  time each recipient  is receiving, in part  to address                                                               
the issue of  potential fraud or misuse of the  time.  She opined                                                               
that in this particular instance,  some of the potential problems                                                               
may have been addressed through that process.                                                                                   
                                                                                                                                
MS. ETHERIDGE  answered that the  division has made  some changes                                                               
to account for time for task,  and it allocates time and then the                                                               
recipient  receives  a  time  that is  authorized  weekly.    The                                                               
division  feels   like  it  has   oversight  and  a   more  clear                                                               
understanding of  the services it has  been authorizing; however,                                                               
it understands the  benefits of an EVV system as  it has explored                                                               
implementing that  system.  There  are some examples  of rounding                                                               
that may  happen that  it may  capture if it  was to  be directly                                                               
tied into  the division's enterprise  system so that  claims were                                                               
tied into the system so there  could be some efficiencies in that                                                               
way.   She advised that it  is difficult for the  division to say                                                               
what percent  of fraud would  be realized  at this time,  but she                                                               
has talked to other states and is trying to get a handle on it.                                                                 
                                                                                                                                
5:14:24 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  reminded the committee that  the motion to                                                               
adopt Version E, a vendor system, is still on the table.                                                                        
                                                                                                                                
5:14:33 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE STUTES  removed her  objection to adopt  CSHB 315,                                                               
Version 29-LS1287\E,  Glover, 3/21/16,  as the  working document.                                                               
There being no objection, Version E was before the committee.                                                                   
                                                                                                                                
CHAIR SEATON  asked Ms. Etheridge  to round out some  numbers for                                                               
Version E.                                                                                                                      
                                                                                                                                
MS. ETHERIDGE agreed.                                                                                                           
                                                                                                                                
[HB 315 was held over.]                                                                                                         
                                                                                                                                
                  HB 328-REGULATION OF SMOKING                                                                              
                                                                                                                                
5:16:36 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON announced that  the final order of business                                                               
would  be HOUSE  BILL NO.  328,  "An Act  prohibiting smoking  in                                                               
certain   places;   relating   to  education   on   the   smoking                                                               
prohibition; and providing for an effective date."                                                                              
                                                                                                                                
5:17:26 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TALERICO moved  to adopt  the proposed  committee                                                               
substitute  (CS)   for  HB  328,  Version   29-LS1502\W,  Martin,                                                               
3/18/16, as the working document.                                                                                               
                                                                                                                                
REPRESENTATIVE SEATON objected for discussion.                                                                                  
                                                                                                                                
5:18:20 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TALERICO  noted that current Alaska  law prohibits                                                               
smoking  in  many  areas  of   the  state,  including  healthcare                                                               
facilities,  schools, childcare  facilities,  and public  meeting                                                               
rooms  in government  buildings.    He offered  that  one of  his                                                               
biggest  concerns is  the state  level  of Medicaid  expenditures                                                               
attributed to  smoking is about $67  Million per year.   There is                                                               
no  doubt, he  said, that  a fair  portion of  this is  certainly                                                               
driven by  Alaska's current fiscal situation,  but this committee                                                               
has routinely  discussed healthcare  and preventative  measure to                                                               
improve Alaska's situation statewide.                                                                                           
                                                                                                                                
CHAIR SEATON  asked for  a quick  explanation of  the significant                                                               
changes between  the original bill  and the  committee substitute                                                               
being considered.                                                                                                               
                                                                                                                                
5:19:59 PM                                                                                                                    
                                                                                                                                
JOSHUA BANKS,  Staff, Representative Dave Talerico,  Alaska State                                                               
Legislature, advised  that Version  W was  drafted to  mirror the                                                               
changes made to SB 1.   [He presented a slideshow titled "HB 328,                                                               
The 'Take it Outside' Act," slides 1-6.]                                                                                        
                                                                                                                                
5:20:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  removed his  objection to adopt  Version W                                                               
as  the committee's  working document.   There  being no  further                                                               
objection, Version W was before the committee.                                                                                  
                                                                                                                                
5:20:48 PM                                                                                                                    
                                                                                                                                
MR. BANKS continued  his presentation and advised that  HB 328 is                                                               
all  about  saving lives  and  dollars,  helping Alaskans  to  be                                                               
healthier,  and to  spend  less  on healthcare.    The bill  will                                                               
provide a smoke-free work environment  for Alaska's workforce, it                                                               
will create a  standard for smoking that  is effective statewide,                                                               
and it will  put all businesses and  workplaces throughout Alaska                                                               
on a level  playing field.  Currently,  approximately one-half of                                                               
Alaska's population is covered by  smoke-free workplace laws, yet                                                               
a 2015 Dittman Research survey  shows that 88 percent of Alaskans                                                               
support a  statewide smoke-free  law.   The sponsor's  office has                                                               
conclusive  evidence regarding  Anchorage's smoke-free  ordinance                                                               
that smoke-free  laws do not  have adverse  economic consequences                                                               
for restaurants and bars subject to  the laws.  The bill does not                                                               
ban smoking or the use of  e-cigarettes and Section 1 of the bill                                                               
depicts  the   areas  where  smoking   is  prohibited   under  AS                                                               
13.85.301.                                                                                                                      
                                                                                                                                
5:22:27 PM                                                                                                                    
                                                                                                                                
MR.  BANKS explained  that  Section 1,  AS  18.35.301(a) and  (b)                                                               
provides  a  statewide  smoking prohibition  in  enclosed  public                                                               
spaces, public transportation vehicles  and facilities, places of                                                               
employment, government  buildings, buildings or  residences where                                                               
a  business  is located  for  paid  childcare, paid  adult  care,                                                               
healthcare  facilities,  Pioneer   Homes,  Veteran's  Homes,  and                                                               
vehicles that  are places of employment  with certain exceptions.                                                               
Also included  under AS 18.35.301(c)  are school  grounds, public                                                               
parks,  outdoor arena  seating,  smoke-free  campuses, and  areas                                                               
within  certain distances  from entrances,  windows, and  air in-                                                               
take vents of buildings where smoking is prohibited.                                                                            
                                                                                                                                
MR. BANKS continued that under  Sections 2-4, 6-7, the Department                                                               
of   Environmental   Conservation    (DEC)   commissioner   adopt                                                               
regulations for filing,  processing, and investigating violations                                                               
of this bill, including the  filing of complaints and issuance of                                                               
citations.   AS  18.35.321  requires  the DEC  to  work with  the                                                               
Department  of  Health  and Social  Services  to  implement  this                                                               
smoking  prohibition and  provide educational  programs to  those                                                               
affected   by   this  bill.      The   DEC  can   also   delegate                                                               
responsibilities  to another  agency, such  as the  Department of                                                               
Health  and Social  Services  under AS  18.35.316(b).   The  bill                                                               
requires that  a person  in charge  of a  place where  smoking is                                                               
prohibited display  signs under AS  18.35.306, and the  signs can                                                               
be  provided by  the  Department  of Environmental  Conservation.                                                               
The  Division  of  Public Health's  Tobacco  and  Prevention  and                                                               
Control  Program   will  be  responsible  for   providing  public                                                               
education materials, he said.                                                                                                   
                                                                                                                                
5:24:21 PM                                                                                                                    
                                                                                                                                
CHUCK  KOPP,   Staff,  Senator   Peter  Micciche,   Alaska  State                                                               
Legislature,  [referred to  slides  7-12], and  advised that  the                                                               
Surgeon General's  report is the  31st report in 50  years issued                                                               
to document  the dangers of  involuntary exposure  to second-hand                                                               
smoke.    More  recent  data suggests  that  this  public  health                                                               
concern  is described  as a  "quite urgent  matter" that  must be                                                               
addressed.   Since the period  of time the Surgeon  General began                                                               
reporting on  this issue,  over the last  50 years,  the nation's                                                               
premature  deaths  caused by  smoke  and  exposure to  secondhand                                                               
smoke is up  to approximately 21 million Americans.   With regard                                                               
to DUI fatalities  where people die violently  and quickly, there                                                               
are  10,000  in  one  year,   yet  the  nation  has  over  41,000                                                               
secondhand  smoke fatalities  in one  year.   The national  blood                                                               
alcohol content  (BAC) was 0.15  percent, then it was  changed to                                                               
0.10 percent, and  currently the BAC is 0.08  percent or greater.                                                               
He  noted that  drinking  and driving  a  vehicle and  secondhand                                                               
smoke  both involve  the reckless  use of  a dangerous  substance                                                               
that  kills  people.    He  advised  that  approximately  440,000                                                               
smokers die in the United States each year.                                                                                     
                                                                                                                                
5:26:25 PM                                                                                                                    
                                                                                                                                
MR. KOPP  noted that  stroke is the  most recent  causally linked                                                               
disease to secondhand  smoke exposure by the  Centers for Disease                                                               
Control  and Prevention  (CDC).   It  is known  that exposure  to                                                               
secondhand  smoke  within 30  minutes  has  a "nearly  immediate"                                                               
impact  on the  cardiovascular  system,  damaging blood  vessels,                                                               
making blood  more likely  to clot, and  increasing the  risk for                                                               
heart attack  and stroke.   The Surgeon General's Report  is that                                                               
there is  no safe level  of secondhand  smoke exposure and  it is                                                               
casually linked  to 20 percent  to 30 percent increased  risk for                                                               
stroke.   The  national cost  is $5.6  billion per  year in  lost                                                               
productivity due to  exposure to secondhand smoke,  and in Alaska                                                               
60 deaths each  year and more than $1 million  each year directly                                                               
related  to lost  productivity.   He related  that $1  million is                                                               
probably a  conservative number,  which is not  counting Medicaid                                                               
costs which  Representative Talerico covered earlier.   He stated                                                               
that  evidence is  sufficient to  infer this  causal relationship                                                               
and the implementation  of a smoke-free policy  leads directly to                                                               
reduction  in  coronary events  among  people  age 65  years  and                                                               
older.   There  are several  large municipalities  in the  United                                                               
States that have  gone smoke-free, such as  Colorado and Arizona,                                                               
that  had  upwards of  40  percent  and  45 percent  decrease  in                                                               
coronary and  stroke incidents over  one year after  going smoke-                                                               
free.   The only variable  they could contribute to  the decrease                                                               
was  going  smoke-free.   Mr.  Kopp  pointed  out that  the  bill                                                               
sponsor looks  at this  bill as  a question  of rights  of people                                                               
that choose  to smoke  versus the  need to  breathe, and  a clean                                                               
indoor policy  does not  prohibit smoking  it only  requires that                                                               
those who choose to smoke do  so in manner that does not threaten                                                               
or harm others.                                                                                                                 
                                                                                                                                
5:28:25 PM                                                                                                                    
                                                                                                                                
MR. BANKS  turned to  slides 13-20 of  the slideshow  and pointed                                                               
out that  a good portion of  the opposition to this  bill is that                                                               
e-cigarettes  are  included within  the  bill  as smoking.    The                                                               
sponsor believes there is good rationale for grouping e-                                                                        
cigarettes  with  traditional  cigarettes even  though  they  are                                                               
different   from  traditional   cigarettes.     E-cigarettes  are                                                               
generally battery  operated and  use an  atomizer to  heat liquid                                                               
from a cartridge until it  becomes a chemical-filled aerosol, and                                                               
can  contain   nicotine,  ultrafine  metal   particles,  volatile                                                               
organic compounds, and other carcinogenic  toxins.  The use of e-                                                               
cigarettes  by high  school students  has increased  dramatically                                                               
from 1.5 percent  in 2011, to 13.4 percent in  2014.  He remarked                                                               
that slide  14 depicts the trend  in contrast to the  decrease in                                                               
use of the traditional cigarettes  by high school students.  This                                                               
trend, as well as advertising  by e-cigarette companies have many                                                               
people  worried,  including  the  CDC  which  believes  that  the                                                               
increased  marketing  and  use by  youth  of  e-cigarettes  could                                                               
reverse the  progress in  preventing tobacco use  by youth.   The                                                               
CDC noted that some of the  same marketing strategies used by the                                                               
tobacco  industry are  being  used  to encourage  the  use of  e-                                                               
cigarettes by today's  youth.  Under AS 11.76.109,  it is illegal                                                               
to sell or give products  containing nicotine to anyone under the                                                               
age of 19, and e-cigarette retailers  do not need a sales license                                                               
endorsement,  so there  is no  program of  compliance checks  for                                                               
these sales, he pointed out.                                                                                                    
                                                                                                                                
5:30:19 PM                                                                                                                    
                                                                                                                                
MR.  BANKS,  turned  to  side 17,  and  advised  that  separating                                                               
smokers   from   non-smokers,   air  cleaning   technology,   and                                                               
ventilation  systems  cannot  effectively  and  reliably  protect                                                               
public health.  Smoke-free workplace  laws have been seen to help                                                               
reduce tobacco use  among smokers, and former  Surgeon General C.                                                               
Everett Koop,  who served under  President Ronald  Reagan, stated                                                               
the following:                                                                                                                  
                                                                                                                                
         The right of smokers to smoke ends where their                                                                         
     behavior affects the health and well-being of others;                                                                      
       furthermore, it is the smoker's responsibility to                                                                        
     ensure that they do not expose non-smokers.                                                                                
                                                                                                                                
MR. BANKS  continued that as previously  mentioned, approximately                                                               
one-half of Alaska's population  is protected by local ordinances                                                               
from  secondhand smoke  at  work,  including: Anchorage,  Juneau,                                                               
Bethel,  Dillingham,   Unalaska,  and  Palmer.     The  remaining                                                               
boroughs  with large  populations do  not have  the legal  health                                                               
powers to  enact smoke-free laws,  and this does not  include the                                                               
unorganized boroughs  of Alaska.  Overall,  Alaskans support laws                                                               
such as  HB 328, and  88 percent  of Alaskans overall  agree that                                                               
all Alaskan workers should be  protected from secondhand smoke in                                                               
the  workplace.    This  includes the  majority  of  smokers  who                                                               
support smoke-free workplace  laws, and by regions  in Alaska the                                                               
support of  this law ranges  from 75 percent  to 88 percent.   He                                                               
related  that  the  legislation is  good  for  Alaskan's  health,                                                               
businesses, and good  for Alaska overall.  He said  that a number                                                               
of research sources  used to create the slideshow  are slides 20-                                                               
21.                                                                                                                             
                                                                                                                                
5:32:14 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON referred to  Section 1, AS 18.35.301(b)(7),                                                               
page 2, lines 13-14, which read:                                                                                                
                                                                                                                                
           (7) in a building or residence that is the                                                                           
       site of a business at which the care of adults is                                                                        
     provided on a fee-for-fee basis;                                                                                           
                                                                                                                                
CHAIR SEATON asked whether that  includes PCAs that are receiving                                                               
personal care  health services in  their own home.   He explained                                                               
that  they've  been  trying  through   Medicaid  to  get  out  of                                                               
institutional care by providing services at home.                                                                               
                                                                                                                                
MR. KOPP  responded that it  does not,  this was an  amendment in                                                               
the  Senate side  to specifically  make  it so  that a  residence                                                               
being  occupied   by  a  homeowner   who  is   provided  personal                                                               
assistance care  is not required  to stop smoking.   He explained                                                               
that it is only when a residence  is used as a business, which is                                                               
why  specific  language  was  included,  that it  is  site  of  a                                                               
business in which  the care of adults is provided.   Unless it is                                                               
an  adult care  business,  a  homeowner can  smoke  "if they  are                                                               
receiving care from a personal care assistant," he explained.                                                                   
                                                                                                                                
5:33:58 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON  referred to Section 1,  AS 18.35.301(d)(1)(D), page                                                               
3, lines 13-14, which read:                                                                                                     
                                                                                                                                
            (D) that is a freestanding building not                                                                             
     attached to another business or to a residence;                                                                            
                                                                                                                                
CHAIR SEATON  asked the relationship  to subparagraph  (D) versus                                                               
"it doesn't share  a ventilation system with another  part of the                                                               
building."    He  asked  whether  that  is  the  purpose  of  the                                                               
freestanding  building, that  it  is not  attached  to any  other                                                               
building or business.                                                                                                           
                                                                                                                                
5:34:39 PM                                                                                                                    
                                                                                                                                
MR. KOPP replied  that primarily its purpose is  to prevent fumes                                                               
and particulates from  being shared and a  free standing building                                                               
accomplishes that.  Representative Seaton  is correct in that the                                                               
primary concern is that it  is not impacting other businesses, he                                                               
replied.                                                                                                                        
                                                                                                                                
REPRESENTATIVE WOOL  referred to the free  standing building, and                                                               
used  the  example of  downtown  Juneau  where it  is  buildings,                                                               
buildings,  buildings  touching,   although  there  are  separate                                                               
walls, it depends  upon the actual structures.   He asked whether                                                               
those are free  standing because there is not an  air gap between                                                               
them or are they continuous buildings.                                                                                          
                                                                                                                                
MR.  KOPP opined  that  from an  engineering  standpoint most  of                                                               
those  building  would  probably   be  considered  free  standing                                                               
because they do not appear  to be structurally dependent upon one                                                               
another.                                                                                                                        
                                                                                                                                
5:35:50 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE WOOL  opined that  if one  of those  buildings was                                                               
torn  down  the  others  would  still  be  standing,  hence  free                                                               
standing.                                                                                                                       
                                                                                                                                
MR. KOPP responded yes, that is a good way to define it.                                                                        
                                                                                                                                
REPRESENTATIVE WOOL  said he was uncertain  whether the buildings                                                               
touched walls at the Rockwell, in downtown Juneau.                                                                              
                                                                                                                                
REPRESENTATIVE SEATON noted that his  normal definition of a free                                                               
standing building is buildings that  are not in contact with each                                                               
other.  He opined that the definition needs to be clarified.                                                                    
                                                                                                                                
MR. KOPP agreed.                                                                                                                
                                                                                                                                
REPRESENTATIVE STUTES  noted that  there is  a zero  fiscal note,                                                               
yet DEC  is required to provide  signs to hundreds of  places, is                                                               
required to enforce  the statute, and is required  to educate the                                                               
public.  She asked how that is possible with no money.                                                                          
                                                                                                                                
5:37:17 PM                                                                                                                    
                                                                                                                                
MR. KOPP offered  that under the law, DEC is  already required to                                                               
do this and  this bill is amending current law.   The DEC already                                                               
has  regulatory  oversight  of the  prohibition  of  smoking  and                                                               
already works with  the Department of Health  and Social Services                                                               
with signage.   The sponsor  drafted the  bill so that  the signs                                                               
required are  part of  its current inventory,  and many  of these                                                               
places  are  already  posted  "smoke-free"  workplaces  involving                                                               
state facilities  and buildings.  He  advised that it is  part of                                                               
the  Department of  Environmental Conservation's  ongoing expense                                                               
that it  is already engaged with.   Current law was  just amended                                                               
but it currently has this regulatory oversight, he related.                                                                     
                                                                                                                                
REPRESENTATIVE STUTES  surmised that approximately 50  percent of                                                               
the  municipalities, villages,  and cities  in Alaska  are smoke-                                                               
free.                                                                                                                           
                                                                                                                                
MR. KOPP agreed and related that  most of the buildings that have                                                               
the infrastructure and population base are already covered.                                                                     
                                                                                                                                
REPRESENTATIVE  STUTES said  she  does not  believe  there is  no                                                               
fiscal note  that should be  attached to this because  it doesn't                                                               
make sense.                                                                                                                     
                                                                                                                                
CHAIR  SEATON  advised  that  the department  will  be  asked  to                                                               
justify its fiscal note.                                                                                                        
                                                                                                                                
5:39:20 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR referred to  Section 1, AS 18.35.301(c), page                                                               
2, line 18, which read:                                                                                                         
                                                                                                                                
          (c) Smoking is prohibited outdoors                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  advised that  these are  in new  sections of                                                               
the bill and referred to paragraph (c)(1), which read:                                                                          
                                                                                                                                
             (1) at an area located at a public or                                                                              
      private school or a state or municipal park that is                                                                       
     primarily designated as a place for children to play;                                                                      
                                                                                                                                
REPRESENTATIVE  TARR opined  that she  thinks of  Alaska's public                                                               
lands as being available for anyone  to enjoy whether an adult or                                                               
a child.  For example, currently  someone could be at a municipal                                                               
park and  smoke a  cigarette and this  bill would  prohibit that.                                                               
She asked  who is  going to say  whether the park  has to  have a                                                               
certain  number of  picnic tables  that a  certain percentage  of                                                               
adults would also frequent.                                                                                                     
                                                                                                                                
MR. KOPP  responded that the  key qualifier for that  language is                                                               
that it  is a park  that is primarily  designated as a  place for                                                               
children to play.  Municipal  parks are not primarily playgrounds                                                               
as some are campgrounds, and the  emphasis here is those that are                                                               
primarily designated as a place for children to play.                                                                           
                                                                                                                                
5:41:13 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  referred to page  2, line 21,  (c)(2), which                                                               
read:                                                                                                                           
                                                                                                                                
          (2) in a seating area for an outdoor arena,                                                                           
     stadium, or amphitheater;                                                                                                  
                                                                                                                                
REPRESENTATIVE TARR noted there are  places that have gone smoke-                                                               
free and  have physically built  something to be a  smoking area.                                                               
Although,  if this  were an  outdoor facility  where there  was a                                                               
designated smoking  area it  appears that  the language  is broad                                                               
enough that  that would also be  prohibited.  She asked  that the                                                               
restrictiveness of that language be explained.                                                                                  
                                                                                                                                
5:42:06 PM                                                                                                                    
                                                                                                                                
HILARY   MARTIN,  Attorney,   Legislative   Legal  and   Research                                                               
Services, Legislative  Affairs Agency, Alaska  State Legislature,                                                               
responded that the  park issue on paragraph (1) reads  that it is                                                               
primarily designated  as a place  for children to  play, although                                                               
it is  slightly unclear there  would have  to be a  decision made                                                               
that it is primarily a place  for children to play.  She referred                                                               
to  the park  strip in  downtown Anchorage  where there  are ball                                                               
fields  and other  things, and  then there  is a  playground area                                                               
and, she  opined, that  is what  the bill is  getting at.   Signs                                                               
would  also  have to  be  posted  with  the  idea that  a  person                                                               
wouldn't be walking and suddenly  walk into an area where smoking                                                               
is prohibited and didn't realize, she offered.                                                                                  
                                                                                                                                
REPRESENTATIVE TARR pointed out that  she has difficult with that                                                               
because in  the neighborhoods she represents  she frequently sees                                                               
people at the  parks smoking, but they are doing  it there rather                                                               
than being at  home where the children are.   She described it as                                                               
trying to  make a good decision  to not smoke around  children by                                                               
going to a  different nearby location that has a  picnic table or                                                               
a swing.  Although, she said,  that would put them in a situation                                                               
of  being in  violation of  the  law.   She expressed  discomfort                                                               
because it  appears that  enforcement could  be difficult  and it                                                               
may  be left  to  interpretation  as to  what  is  legal in  that                                                               
particular area, and unfairly get someone in trouble.                                                                           
                                                                                                                                
MR. KOPP  suggested deleting "primarily" and  the provision would                                                               
read "designated  as a place" so  there is no question,  and a no                                                               
smoking sign must be posted close to the playground.                                                                            
                                                                                                                                
5:44:45 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  WOOL  pointed out  that  there  are many  outdoor                                                               
recreational  areas that  have  a smaller  area  within it  where                                                               
children play,  and within that same  body of land people  may be                                                               
walking  their dogs,  and adults  hangout and  play Frisbee  with                                                               
other adults.   He offered that  he can see mission  creep as far                                                               
the "Take it  Outside" issue wherein a person can't  just take it                                                               
outside in  that they have to  take it outside to  a certain area                                                               
outside.   He referred  to Section  1, AS  18.35.301(c)(4)(A) and                                                               
(B), page 2 lines 25-29, which read:                                                                                            
                                                                                                                                
             (A) 10 feet of an entrance to a bar or                                                                             
     restaurant that serves alcoholic beverages;                                                                                
                    (B) 20 feet of an entrance, open                                                                            
     window,  or heating  or ventilation  system air  intake                                                                    
     vent at  an enclosed area  at a place where  smoking is                                                                    
     prohibited under this section; or                                                                                          
                                                                                                                                
5:45:43 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  WOOL  remarked that  a  person  walking down  the                                                               
sidewalk in  downtown Juneau  smoking would have  to walk  in the                                                               
middle of the street to not violate (c)(4)(A) and (B).                                                                          
                                                                                                                                
MR. KOPP  clarified that the  intention with not being  within 10                                                               
feet  of a  bar or  restaurant is  that those  tend to  be higher                                                               
volume businesses,  people step  outside and  don't have  to step                                                               
out  as far.   They  do not  have to  walk in  the middle  of the                                                               
street  and can  walk up  or  down the  sidewalk.   He turned  to                                                               
(c)(4)(B)  and said  20  feet  of an  entrance  would also  cover                                                               
health care  facilities and other  places because it reads  "at a                                                               
place  where smoking  is prohibited  under this  section."   This                                                               
entire  section  covers  a  number   of  places  that  Mr.  Banks                                                               
highlighted that fall  under this provision.   Rather than trying                                                               
to  break down  an individual  distance it  was standardized,  he                                                               
explained.                                                                                                                      
                                                                                                                                
REPRESENTATIVE WOOL surmised that  prohibited other places may be                                                               
a hardware store,  jeweler, or sandwich shop and would  all be at                                                               
a  20  foot buffer  so  it  may be  difficult  to  walk down  the                                                               
sidewalk, and  he noted that  may be  the intent.   He reiterated                                                               
that  he is  referring to  a dense  urban area  such as  downtown                                                               
Juneau or Anchorage.                                                                                                            
                                                                                                                                
MR.  KOPP advised  that the  idea to  keep the  smoke outside  is                                                               
primarily what the sponsors are  getting at.  Representative Wool                                                               
is correct, that the distance may be something to be discussed.                                                                 
                                                                                                                                
REPRESENTATIVE  TARR  referred  to the  questions  regarding  the                                                               
fiscal note and  said that she noticed on page  4, beginning line                                                               
17 with the notice of  prohibition and said smoking prohibited by                                                               
law and the burning cigarette but,  she pointed out, if this will                                                               
be  expanded  to  e-cigarettes  and  vaping she  did  not  see  a                                                               
definition  in  the  bill  for what  would  be  considered  those                                                               
products.  She noted that  these technologies are changing so she                                                               
was unsure  whether that is  a necessity.   She referred  back to                                                               
the "Notice of prohibition," and opined  it would need to be more                                                               
explicit  because  there   is  a  lot  of   confusion  about  the                                                               
international no  smoking people are thinking  like a traditional                                                               
tobacco cigarette.   She  said she was  unsure whether  she would                                                               
automatically   think   that   e-cigarettes   and   vaping   were                                                               
prohibited, and the language should  be more explicit and in that                                                               
sense maybe  the existing inventory of  signage wouldn't actually                                                               
be as useable, or maybe could have a sticker put on it.                                                                         
                                                                                                                                
5:49:25 PM                                                                                                                    
                                                                                                                                
MR. KOPP  referred to the  definition of smoking, Section  12, AS                                                               
18.35.399(11), page 9, lines 28-30, which read:                                                                                 
                                                                                                                                
               (11) "smoking" means using an e-cigarette or                                                                     
     other  oral  smoking   device  or  inhaling,  exhaling,                                                                    
     burning,  or  carrying  a   lighted  or  heated  cigar,                                                                    
     cigarette, pipe,  or tobacco or plant  product intended                                                                    
     for inhalation.                                                                                                            
                                                                                                                                
MR.  KOPP explained  that the  sponsors  tried to  cover as  many                                                               
things as  possible under  that definition  so the  smoking signs                                                               
would work.   Also,  the public  information campaign  has rolled                                                               
out  with  the  smoke-free  law which  is  significant,  and  the                                                               
Department   of  Health   and  Social   Services  does   that  in                                                               
cooperation  with the  Department of  Environmental Conservation,                                                               
which is  identified in  a later  section and  they work  hand in                                                               
glove.   Currently, that is one  of the duties of  the Department                                                               
of Health  and Social Services  under AS  44.29.020(a)(14), which                                                               
read:                                                                                                                           
                                                                                                                                
               (14) a comprehensive smoking education,                                                                          
     tobacco  use prevention,  and tobacco  control program;                                                                    
     to the  maximum extent  possible, the  department shall                                                                    
     administer  the program  required under  this paragraph                                                                    
     by grant or contract with  one or more organizations in                                                                    
     the state; the department's program must include                                                                           
                                                                                                                                
                    (A) a community-based tobacco use                                                                           
     prevention  and  cessation   component  addressing  the                                                                    
     needs  of  youth  and  adults   that  includes  use  of                                                                    
     cessation aids such  as a nicotine patch  or a nicotine                                                                    
     gum tobacco substitute;                                                                                                    
                                                                                                                                
                    (B) youth-based efforts that involve                                                                        
     youth  in  the  design and  implementation  of  tobacco                                                                    
     control efforts;                                                                                                           
                                                                                                                                
                    (C)    anti-tobacco    counter-marketing                                                                    
     targeting both youth and  adult populations designed to                                                                    
     communicate messages  to help prevent  youth initiation                                                                    
     of tobacco use, promote  cessation among tobacco users,                                                                    
     and  educate the  public about  the  lethal effects  of                                                                    
     exposure to secondhand smoke;                                                                                              
                                                                                                                                
                    (D) tobacco use surveys of youth and                                                                        
     adult  populations   concerning  knowledge,  awareness,                                                                    
     attitude, and use of tobacco products; and                                                                                 
                                                                                                                                
                    (E) an enforcement component;                                                                               
                                                                                                                                
                                                                                                                                
5:50:36 PM                                                                                                                    
                                                                                                                                
MR. KOPP agreed  about the public education,  and Alaska Airlines                                                               
as an example in that it  advises no smoking and that includes e-                                                               
cigarettes.                                                                                                                     
                                                                                                                                
REPRESENTATIVE SEATON referred to  Section 1, AS 18.35.301(f)(2),                                                               
Page 4, lines 5-6, which read:                                                                                                  
                                                                                                                                
           (2) on a marine vessel when the vessel is                                                                            
     engaged in commercial fishing or sport charter fishing                                                                     
     or is otherwise used as a place of employment.                                                                             
                                                                                                                                
CHAIR SEATON noted it is an  exemption; however, he asked why the                                                               
language  solely discusses  ocean vessels  because sport  fishing                                                               
takes place in  guiding on free water systems.   He asked whether                                                               
the terminology "marine vessel" specifically  is in there to mean                                                               
only at sea.                                                                                                                    
                                                                                                                                
MR. KOPP  referred to line  6, and  noted that it  includes sport                                                               
charter fishing.  He said that  charter means a vessel which is a                                                               
place  of employment;  therefore,  sport fishing  boats are  also                                                               
exempted for  the same purpose  that a commercial  fishing vessel                                                               
is.  The state territorial waters  only go out three miles so for                                                               
a  near shore  fisherman it  means  working on  open decks  where                                                               
there is  outdoor, fresh  air exposure.   The skipper  or captain                                                               
can regulate  how far  from the  air intake  or vent  a fisherman                                                               
must stand when smoking.  He  described this as angels dancing on                                                               
the head of  a pin - some  of the judgment calls,  but the people                                                               
in the work boat industry  brought to the sponsors attention that                                                               
they are outdoors all of the time.                                                                                              
                                                                                                                                
5:50:40 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON remarked that the  language will have to be                                                               
looked at  because it starts on  a marine vessel, and  the others                                                               
are modifying  what is being done  but it is on  a marine vessel.                                                               
It does  not say that it  is on a sport  charter fishing vessels,                                                               
but rather a  marine vessel when engaged either  in commercial or                                                               
sport fishing.  In the event  a fisherman is halibut fishing this                                                               
would apply, but if the fisherman  was on the Kenai River fishing                                                               
for King Salmon they are not on a marine vessel.                                                                                
                                                                                                                                
MR. KOPP  noted that if the  fisherman is out with  friends sport                                                               
fishing,  they can  smoke.   He referred  to page  4, lines  1-6,                                                               
which read:                                                                                                                     
                                                                                                                                
        (f) Notwithstanding (b) of this section, unless                                                                         
     the owner or operator prohibits it, smoking is allowed                                                                     
           (2) on a marine vessel when the vessel is                                                                            
     engaged in commercial fishing or sport charter fishing                                                                     
     or is otherwise used as a place of employment.                                                                             
                                                                                                                                
MR.  KOPP  explained  that  it  is  being  used  as  a  place  of                                                               
employment at  that time, but  if a  fisherman is out  having fun                                                               
fishing it wouldn't apply.                                                                                                      
                                                                                                                                
REPRESENTATIVE SEATON  related that the language  would be looked                                                               
at further.                                                                                                                     
                                                                                                                                
5:54:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  referred to  Section 1,  AS 18.35.301(a)(3),                                                               
page 1, lines6-7, and lines 11-12, which read:                                                                                  
                                                                                                                                
        (a) Smoking is prohibited in an enclosed area in                                                                        
     a public place, including an enclosed area                                                                                 
          (3) at a public transit depot, bus shelter,                                                                           
        airport terminal, or other public transportation                                                                        
     facility;                                                                                                                  
                                                                                                                                
REPRESENTATIVE TARR  opined that currently when  going through an                                                               
airport  terminal there  is an  enclosed designated  smoking area                                                               
and asked whether the provision makes those areas illegal.                                                                      
                                                                                                                                
5:54:39 PM                                                                                                                    
                                                                                                                                
MR. KOPP opined that currently  there are not any airports, other                                                               
than  international  terminals which  do  because  people are  in                                                               
transit and are  not under FTSA regulation.  They  may be allowed                                                               
to leave the  airport while in transit and they  do have a smoke-                                                               
free room.  This legislation  covers that as an exemption wherein                                                               
they  can have  the smoke  rooms in  those airports  where people                                                               
cannot leave the airport to step outside.                                                                                       
                                                                                                                                
5:55:11 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE STUTES  offered concern about the  enforcement and                                                               
described it as passive enforcement  such that "they are going to                                                               
give you a  1-800 number and if somebody's in  violation you just                                                               
pick up the  phone and call 1-800  and say, hey this  place is in                                                               
violation," and that  concerns her.  To 86 someone,  they will be                                                               
on  the   horn  in  a   pair  of  seconds  telling   someone  the                                                               
establishment is in violation.   It further reads that "citations                                                               
could be  made by  the Department of  Health and  Social Services                                                               
designated staff or another agency,"  which is unclear.  This can                                                               
be addressed at a later time  but, she expressed, it is a concern                                                               
as it is the enforcement.                                                                                                       
                                                                                                                                
MR. KOPP  advised that  when Anchorage  went smoke-free  in 2007,                                                               
within  five years  of enforcement  it only  had three  citations                                                               
because there was almost 100  percent voluntary compliance.  This                                                               
is not  a heavy handed thing  and it is complaint  driven and not                                                               
pro-active.   In fact, for a  peace officer to be  involved these                                                               
offenses  must  occur  in  their  presence  and  not  called  in.                                                               
Traditionally,  he offered,  it  has been  passively carried  out                                                               
because  people  want this  and  they  voluntarily comply.    Joe                                                               
Darnel, with the Tobacco Prevention  Program can speak to how the                                                               
program  works  as they  have  been  doing  this  and it  is  low                                                               
maintenance on them  to gain compliance.  He  explained that they                                                               
have a program  of warnings, educating business  owners, and that                                                               
Anchorage  is  over  300,000  people  and  have  only  had  three                                                               
citations in five years.                                                                                                        
                                                                                                                                
REPRESENTATIVE STUTES  commented that areas Mr.  Kopp referred to                                                               
have  voluntarily  gone  smoke-free,  this  is  not  a  voluntary                                                               
program as the  legislation is taking one-half of  the state that                                                               
is non-smoking  and, she  said, it  has been  on the  ballots and                                                               
they've voted it down.                                                                                                          
                                                                                                                                
5:57:40 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  WOOL read,  "in  a seating  area  for an  outdoor                                                               
arena,  stadium, or  amphitheater" means  a seating  area in  the                                                               
prior three areas.                                                                                                              
                                                                                                                                
MR. KOPP responded where the public can come and be seated.                                                                     
                                                                                                                                
REPRESENTATIVE  WOOL  continued   that  an  outdoor  amphitheater                                                               
grassy hill is fine, although if it is a seating area ...                                                                       
                                                                                                                                
MR. KOPP advised  it is a designated seating area  for the public                                                               
to come in and sit for an event.                                                                                                
                                                                                                                                
REPRESENTATIVE  SEATON opened  public testimony  and advised  all                                                               
testifiers to limit their testimonies to two minutes.                                                                           
                                                                                                                                
5:58:55 PM                                                                                                                    
                                                                                                                                
GARY SUPERMAN,  Owner, Hunger Hut  Bar, Motel and  Liquor advised                                                               
that he sits  on the state board  of CHARR, and said  that all of                                                               
Mr.  Kopps' citations  and figures  are alarming  and provocative                                                               
for everyone to chew on.   Unfortunately, he stated, they've been                                                               
promulgated out  of a 1992 EPA  study that was thrown  out by the                                                               
United States District Court in  1995 as being pure junk science.                                                               
Advocacy  groups assert  that these  bans  help shape  individual                                                               
preferences  against  smoking,  and in  fact  these  re-education                                                               
efforts  have  drastic reshaped  attitudes  of  smokers and  non-                                                               
smokers alike.  He related that  Alaska is acclimated to the fact                                                               
that public  buildings and private building  are now non-smoking,                                                               
what   is  unacceptable   is   the   advocacy  groups'   absolute                                                               
unwillingness  to allow  a few  remaining  venues to  accommodate                                                               
Alaskans own preferences.   At this juncture in  time, the rights                                                               
of non-smokers  and non-patrons of  bars supersede the  rights of                                                               
his  smoking  patrons  and  himself  as a  business  owner.    He                                                               
expressed that there is no net  benefit to anyone, this is simply                                                               
a taking, no one is compelled  to enter his establishment, and he                                                               
respects  adults  choosing  to  make their  own  decisions.    He                                                               
referred  to postings  and articles  he has  seen describing  the                                                               
upcoming Senate  vote on SB  1, and  described it as  little more                                                               
than a  proclamation of disgust  from his  view point.   It looks                                                               
like  the former  mayor of  Soldatna and  current mayor  of Kenai                                                               
will  soon be  triumphant once  and for  all in  their relentless                                                               
crusade to save  society.  Their zeal seeks to  impose one of the                                                               
ultimate nanny  state devices down  the throat of those  who only                                                               
wish to  be left  alone in  the last refuges  left in  the state.                                                               
There is no smoking  in public buildings and HB 328  and SB 1 are                                                               
de facto  already as the only  places left that allow  a few bars                                                               
whose numbers dwindle annually, and he  and his wife own one.  He                                                               
related  that  the  battle  has  smacked  of  elitism  and  basic                                                               
contempt for the unwashed working  classes who still partake.  He                                                               
advised that he  will not comply and "you will  have to bring the                                                               
strong arm of the  state down on me.  I  will not be re-educated.                                                               
I  loathe   their  politically  correct  agendas   and  dangerous                                                               
genuflections to special interests  groups whose only interest is                                                               
control over those of us who  still have a notion of what freedom                                                               
is."                                                                                                                            
                                                                                                                                
6:01:58 PM                                                                                                                    
                                                                                                                                
CHRYSTAL  SCHOENROCK, Owner,  Hunger Hut  Bar, Motel  and Liquor,                                                               
said she is the secretary for  Kenai Peninsula CHARR and a member                                                               
of the Alaska State CHARR.  She  put forth that she would like to                                                               
know why  smokers can't  have the same  rights as  non-smokers as                                                               
there  should  be an  area  that  does  not prohibit  smoking  so                                                               
smokers do not  have to go outside 20-30 feet  from a building at                                                               
-10  to  -30  below.    Her patrons  want  smoking,  all  of  her                                                               
employees  smoke, and  her patrons  help  her to  pay the  bills,                                                               
licenses, permits,  stock, and  taxes.  She  referred to  the low                                                               
rate of oil  prices and that people are being  laid off, and said                                                               
she cannot wait  five years to increase the amount  of patrons in                                                               
her bar.   When the small businesses are forced  to close, Alaska                                                               
does  not  receive  their  taxes.    She  agreed  to  post  signs                                                               
indicating that  smoking is  permitted, and  if a  patron doesn't                                                               
want to  enter because  they are a  non-smoker, "then  don't come                                                               
in.   So be it."   As it stands,  the smokers have no  rights and                                                               
this  is not  fair and  just, and  "as far  as I'm  concerned, my                                                               
patrons, and I  have people coming in my bar  that doesn't smoke,                                                               
nor do they drink.   But, I feel that my patrons  have a right to                                                               
have what  they need and I  feel that as a  business owner paying                                                               
all  my everything,  that I  should have  the right  to say  what                                                               
going goes  on in my  establishment and  not have to  worry about                                                               
what's going on in my parking lot or in a little building."                                                                     
                                                                                                                                
6:04:20 PM                                                                                                                    
                                                                                                                                
DANIEL  LYNCH said  he  is representing  himself  and freedom  in                                                               
Alaska.  He related  that it makes his heart sing  to see so many                                                               
economic free  market Republicans  on the committee  knowing that                                                               
they are not  believers of the nanny state government  and he has                                                               
confidence  they  will   do  the  right  thing   and  leave  this                                                               
legislation  in committee.    America was  built  on tobacco  and                                                               
freedom.  There  are two "watering holes" in  Soldotna across the                                                               
street from one another, and  one establishment has chosen not to                                                               
allow  smoking, and  the  owner of  the  other establishment  has                                                               
chosen to allow  smoking.  The BFW, Elks,  and veterans currently                                                               
decide through their membership how  to run their rules and their                                                               
buildings.  He  described that the numbers  related to secondhand                                                               
smoke are  speculative at  best, and that  he works  on equipment                                                               
that causes  his mustache to  wring with  oil yet he  wouldn't be                                                               
allowed  to smoke.   In  the event  he succumbs  to lung  issues,                                                               
people would say  that he was a  smoker and it had  nothing to do                                                               
with the  diesel running  out of  his mustache.   The  fallacy of                                                               
being a workplace safety issue  is a simple strawman, and driving                                                               
to  the   LIO  office  he  passed   six  fast-food  drive-through                                                               
restaurants  and a  dozen drive-through  coffee  shacks all  with                                                               
employees hanging out the window  sucking in carbon monoxide from                                                               
every vehicle, engine and tailpipe.   It is known that smoking is                                                               
not  a  good habit  and  in  his 45  years  of  doing so  he  has                                                               
contributed $10s of  thousands of dollars to  the federal, state,                                                               
borough, and  city tax  collectors, and he  said he  presumes the                                                               
legislature will  increase alcohol  and tobacco taxes  again this                                                               
year.  He asked that if  the revenue from tobacco stopped, how it                                                               
would be replaced, by taking away the freedom of smokers.                                                                       
                                                                                                                                
6:07:22 PM                                                                                                                    
                                                                                                                                
SHEB  GARFIELD advised  he is  an ex-smoker  and is  now an  avid                                                               
vaporer.  He  asked that the vaping provision  in the legislation                                                               
be completely removed  in that vaping is in this  bill because it                                                               
looks  like smoking.   The  bill includes  vaporizers due  to the                                                               
fear of secondhand vapor being  as dangerous as secondhand smoke,                                                               
and  it  pre-emptively   bans  its  use  in   public  places  and                                                               
businesses  even though  a short  time  on google  will show  the                                                               
opposite.   He  then  read various  studies  and health  expert's                                                               
reports that he would submit to the committee.                                                                                  
                                                                                                                                
6:10:14 PM                                                                                                                    
                                                                                                                                
CHAIR   SEATON   asked  Mr.   Garfield   to   send  the   studies                                                               
electronically to the committee.                                                                                                
                                                                                                                                
6:10:29 PM                                                                                                                    
                                                                                                                                
GREGORY CONLEY,  Attorney, said  he has  been a  leading advocate                                                               
for vapor products,  e-cigarettes, and that he used  them to quit                                                               
smoking approximately  five years ago.   He explained  that vapor                                                               
products  are  not  tobacco  products,   as  it  is  anti-tobacco                                                               
technology products.   Vapors  are smoke-free,  tobacco-free, and                                                               
often nicotine-free  and are increasingly  being recognized  as a                                                               
smart way  to get smokers  to transition away from  dangerous and                                                               
densely  combustible cigarettes.    Contrary  to claims  previous                                                               
made in this committee, there  is no evidence that these products                                                               
pose  risks to  bystanders, but  there is  evidence of  long harm                                                               
reversal or quality of life  improvement in smokers who have made                                                               
the switch  including smokers with  COPD and asthma.   He advised                                                               
that in previous  testimony he discussed a  review published last                                                               
year  by  Tuttle  Publishing  advising   that  one  of  its  main                                                               
conclusions is  that vaping should  not be treated  like smoking,                                                               
and it  was endorsed by a  dozen of the largest  (indisc.) groups                                                               
in the United Kingdom, including  Cancer Research United Kingdom,                                                               
the  Royal  College  of  Physicians,  and  the  United  Kingdom's                                                               
largest  anti-smoking  organizations.   He  surmised  that  these                                                               
groups  support  smoking  bans  but  government  mandated  vaping                                                               
restrictions go  too far.   These  restrictions could  have grave                                                               
unintended  consequences, such  as  sending a  deadly message  to                                                               
smokers that  vaping is no  less hazardous than  inhaling burning                                                               
smoke.  In 2014, among adult  smokers that quit in the last year,                                                               
22  percent were  using  vapor products  and  these products  are                                                               
helping smokers quit.  These  products also have the potential to                                                               
save Medicaid and Medicare costs  because a study by State Budget                                                               
Solutions suggested  a multi-billion  savings if smokers  need to                                                               
switch.   He urged the  committee to amend the  bill's definition                                                               
of smoking to  only include products that  actually create smoke.                                                               
He added that this is also  true for the vapor product retailers,                                                               
they need to be  exempt from this bill even if  they share a wall                                                               
to another business.   Both Chicago and New York  City, two anti-                                                               
tobacco  cities  that  have banned  smoking  and  retail  tobacco                                                               
stores, created  exemptions that  allow vaporing in  vape stores.                                                               
He  asked  that  if  the  bill  must  move  forward  to  consider                                                               
exempting  bars, private  workplaces and  other places  where the                                                               
public is invited and only adults congregate.                                                                                   
                                                                                                                                
CHAIR  SEATON  advised that  he  was  welcome to  submit  written                                                               
comments to the committee as well.                                                                                              
                                                                                                                                
6:13:19 PM                                                                                                                    
                                                                                                                                
MICHAEL CERVANTES,  Owner, Banks  Ale House, said  he is  a board                                                               
member  for  Alaska CHARR,  and  that  as  an  owner of  a  local                                                               
business it is his choice to  be smoke-free or not, and this bill                                                               
takes that privilege away from  local entrepreneurs in the state.                                                               
He  referred to  testimonies regarding  secondhand smoke  and its                                                               
impact on  individuals and he  agrees that secondhand smoke  is a                                                               
choice  for  an  individual  to  make  when  entering  a  smoking                                                               
establishment.   Most  areas throughout  the  state, whether  the                                                               
establishment is posted non-smoking  or smoking allowed the signs                                                               
are  posted at  the entrance  of most  bars or  restaurants.   He                                                               
expressed  that  he disagrees  with  the  testimony that  when  a                                                               
smoking  establishment  goes  non-smoking  they  do  not  feel  a                                                               
financial impact because  friends and other owners  who have gone                                                               
smoke-free  and  (indisc.)  claim  businesses  grow  because  the                                                               
customers  have left  their establishment  to go  into a  smoking                                                               
establishment.   Not  every  owner has  the  opportunity to  wait                                                               
multiple years  to gain back  or re-establish that  customer base                                                               
that they lost  to another restaurant or bar.   He asked that the                                                               
committee oppose  HB 328  as it does  offend and  restrict owners                                                               
and others from smoking being available to their community.                                                                     
                                                                                                                                
6:16:19 PM                                                                                                                    
                                                                                                                                
ANGELA CERNICH,  Owner, Artic Industries,  said she is  an Alaska                                                               
born Athabascan woman who along  with her husband own and operate                                                               
Artic  Industries.   There  is  no irony  in  the  fact that  her                                                               
business  focuses  on (indisc.)  in  the  workplace.   Secondhand                                                               
smoke is  a personal concern for  her because as a  child she was                                                               
raised in a  smoke filled environment complements  of her parents                                                               
who  were  proverbial chain  smokers.    This caused  a  profound                                                               
effect  on  her personal  health  in  that  she has  many  issues                                                               
related to her severe allergies with  smoke.  After moving out of                                                               
her  home, many  of the  severe  issues subsided;  however, as  a                                                               
young  adult  she  always  felt the  asthmatic  and  lung  issues                                                               
related  to the  damage done  to  her lungs.   Last  year at  the                                                               
hospital with lungs that were  collapsing, she was diagnosed with                                                               
Chronic Obstructive  Pulmonary Disease (COPD) and  she personally                                                               
never smoked  a day  in her  life, but is  now facing  a lifelong                                                               
disease that  will shorten her life,  a disease she has  to fight                                                               
with all of its symptoms.    Even a common cold becomes a lengthy                                                               
disease  that  causes  her  to have  coughing  bouts  that  cause                                                               
migraine-like headaches  and, yet she  is not the one  who caused                                                               
this.   She  expressed  that when  she hears  'no  one should  be                                                               
allowed to  take away  their right to  smoke', she  responds that                                                               
she does  have a right  to be in  a smoke-free environment.   She                                                               
related that  some areas in  Alaska are  small with few  jobs and                                                               
while taking  care of  her father who  suffered from  cancer, the                                                               
only job  she could find was  at the Inlet (indisc.),  which is a                                                               
restaurant/bar that allowed smoking.   Within one week she was so                                                               
sick  she had  to quit  her job  and because  no other  jobs were                                                               
available she was forced to leave  and did not have the chance to                                                               
spend that time  with her dying father.  She  related that if her                                                               
father were alive  today, without a doubt he would  look a person                                                               
in the eye and tell them to take smoking outside.                                                                               
                                                                                                                                
6:19:23 PM                                                                                                                    
                                                                                                                                
CARMEN  LUNDE,  Director, Kodiak  CHARR,  said  the Kodiak  CHARR                                                               
opposes  the  bill because  it  believes  strongly that  business                                                               
owners  have  the  right  to   make  their  own  choices  without                                                               
government on any federal, state,  local level mandating laws for                                                               
a small  business owner  to go against  their wishes.   Punishing                                                               
smokers  for their  own good  is repulsive  to basic  freedoms of                                                               
choice and  she does not feel  government has any role  in making                                                               
these choices  for its citizens.   Kodiak has  positively handled                                                               
the  smoking the  issue and  has used  the common  sense approach                                                               
that  works.   There  are  16  non-smoking establishments  and  6                                                               
smoking establishments giving every adult  a free choice to enjoy                                                               
their drinks  in both type establishments,  and this demonstrates                                                               
free  choice at  its  best.   Alaskans live  in  a country  where                                                               
personal  choice   is  one  of   its  most   cherished  freedoms.                                                               
Personally,  she said,  every day  one  or more  of our  personal                                                               
choices are  being taken away from  us.  She asked  the committee                                                               
to not take  another freedom away as people should  not be forced                                                               
to  stand outside  to  smoke  a cigarette  in  cold and  freezing                                                               
temperatures.     She  advised  that  two   of  Kodiak's  busiest                                                               
establishments  went  non-smoking  last  year  and  within  three                                                               
months had  to re-instate  smoking due to  their heavy  losses of                                                               
income,  and she  wonders how  many businesses  can weather  that                                                               
loss in  being forced  to close  their doors.   Please  leave the                                                               
choice of  smoking or non-smoking  to the  men and women  who own                                                               
these establishments  as they have the  right to do what  is best                                                               
for their individual establishments, she said.                                                                                  
                                                                                                                                
6:21:32 PM                                                                                                                    
                                                                                                                                
ISAAC HEWELL,  Owner, Cold Vapes  907, said he  is vice-president                                                               
of  Clear  The  Air  Alaska  which is  the  state's  local  trade                                                               
association and  consumer advocacy for  the vaping industry.   He                                                               
advised is  a former smoker  who saved  his life by  switching to                                                               
electronic  cigarettes  and  feels tremendously  healthier  as  a                                                               
result.    The  use  of e-cigarettes  benefits  the  environment,                                                               
health, and  costs to consumers,  and it is premature  to suggest                                                               
that  vaping  is  unhealthy  just   by  certain  national  health                                                               
advocacy's suggestions.   He  related that he  is unaware  of any                                                               
national  double-blind  multi-year  academic  studies  but  noted                                                               
various  studies in  the  United Kingdom.    Most recent  studies                                                               
completed by  the (indisc.) and  funded by  the FDA and  NIH have                                                               
found that  electronic cigarettes  are not  a gateway  to tobacco                                                               
use, and  that 75  percent of minors  get cigarettes  from social                                                               
sources.   The exit  for current  tobacco users  is to  switch to                                                               
safe alternatives,  and other states have  recognized that vaping                                                               
is not smoking, such as Idaho, Nevada, and New York, he said.                                                                   
                                                                                                                                
6:24:31 PM                                                                                                                    
                                                                                                                                
ALISON  HALPIN offered  that the  bill violates  individual human                                                               
rights and  includes vaporizers as  smoking.  Vaping  and smoking                                                               
are two entirely different things  as stated in People v. Thomas,                                                             
in  that  an  electronic  cigarette  does  not  contain  or  burn                                                               
tobacco.   The  court noted,  instead the  use of  such a  device                                                               
which is commonly  referred to as vaping,  involve the inhalation                                                               
of  vaporized (indisc.)  cigarette  liquid  consisting of  water,                                                               
nicotine,   (indisc.),   and  vegetable   glycerin   occasionally                                                               
(indisc.).    She related  that  this  state  has a  tobacco  use                                                               
problem and as  a former smoker who tried  multiple DHSS approved                                                               
(indisc.) devices  to try  to quit tobacco  and failed  with each                                                               
product, she  found vaping  and has been  tobacco free  for three                                                               
years.  Vaping has been proven  by public health in England to be                                                               
95 percent  safer than  with combustible  cigarettes.   Alaska is                                                               
fighting against  the tobacco problem,  not the  nicotine problem                                                               
in  that is  an  organic chemical  created  by plants  naturally.                                                               
Nicotine  is  found  in  many   vegetables,  such  as  eggplants,                                                               
potatoes, tomatoes, kale, and many  other green leafy vegetables.                                                               
Nicotine is  the only trait  similar to tobacco products  and she                                                               
urged the committee to remove vaping from this bill.                                                                            
                                                                                                                                
6:26:16 PM                                                                                                                    
                                                                                                                                
BRIAN  PREBLE  said  he  agrees  with  everything  the  last  two                                                               
witnesses testified  to in that  vaping is  not smoking.   He has                                                               
four children and does not allow  them around his vaping, they do                                                               
not enter  places that allows  vaping which  is his choice  as an                                                               
adult  and an  American.   He  does choose  to vape  in his  work                                                               
vehicle and  outdoors and,  he opined  that responsible  users of                                                               
vapor products often try  to keep it out of the  line of those it                                                               
could  affect because  they  know what  cigarettes  have done  to                                                               
people.  He  asked the committee to oppose this  bill or at least                                                               
rewrite it to focus more  on actual smoking and secondhand smoke,                                                               
and until more  is known about vaping it should  not be lumped in                                                               
with the issue of secondhand smoke.                                                                                             
                                                                                                                                
6:27:52 PM                                                                                                                    
                                                                                                                                
LARRY HACKENMILLER said that the  mere presence of smoke inside a                                                               
building where the public is  allowed does not legally constitute                                                               
a  public  health hazard,  or  where  people  are employed.    In                                                               
federal  law  in  the  Clean  Air  Act,  indoor  air  quality  is                                                               
controlled by OSHA and under  this act all air contaminants known                                                               
today  are listed  in the  air  contaminant standards  of 29  CRF                                                               
1910.1000.  It  lists the concentration of  the contaminant being                                                               
inhaled  and  the  time  of  exposure to  come  up  with  a  risk                                                               
assessment,  and they  all have  "permissible exposure  levels or                                                               
limits" to determine  the public health risk  associated with the                                                               
chemical.    As  for  secondhand  smoke  in  the  air,  OSHA  the                                                               
authority  of  indoor air  quality,  has  stated outright  "field                                                               
studies  on environmental  tobacco  smoking  indicate that  under                                                               
normal conditions the  components in second ...  in tobacco smoke                                                               
are diluted below existing permissible  exposure levels (PELs) as                                                               
referenced in  the Air Contaminant  Standard.  Further,  it would                                                               
be very  rare to find a  workplace with so much  smoking that any                                                               
PEL would be  exceeded."  He said it is  difficult to justify the                                                               
need for  HB 328,  to protect  the public  health when  no public                                                               
protections  are needed  under existing  federal standards.   The                                                               
data relating to death and  major health issues attributed to the                                                               
presence of secondhand smoke in  the workplace does not cite OSHA                                                               
as  a reference  in their  quoted science  references.   He asked                                                               
whether the  committee found  that odd that  the people  with the                                                               
authority  and  control  of  indoor  air  quality  has  not  been                                                               
referenced in all  of these scientific studies about  the woes of                                                               
secondhand smoke, 60  people dying a year of  something that OSHA                                                               
indicates  a person  can't  get  enough of  in  a  building.   He                                                               
suggested asking  the references  of what OSHA  has to  say about                                                               
their  research and  to  ask the  experts to  testify.   This  is                                                               
indoor air,  what about outdoor  air, what was  the concentration                                                               
of  the  contaminants  causing  death  and  major  health  issues                                                               
outside  the baseball  stadium.   Currently,  AS 18.35  regulates                                                               
smoking  in  certain  areas and  states  "the  statute  considers                                                               
smoking in  any form a nuisance  and a public health  hazard and;                                                               
therefore,  prohibits   smoking  in  public  places   and  indoor                                                               
places."  This is in conflict  with the Clean Air Act, he pointed                                                               
out,  which  identified  public health  hazard  through  the  air                                                               
contaminant standards  in practice today.   The key word  here is                                                               
hazard and  the starting point for  each of these issues  is that                                                               
the  indoor air  quality  does not  legally recognize  secondhand                                                               
smoke as  a public hazard.   He asked  that someone show  him the                                                               
science  about outdoor  air  and testify  about  the patterns  of                                                               
secondhand smoke and  what the permissible exposure  limit is for                                                               
outside  air quality  on secondhand  smoke.   He referred  to the                                                               
fiscal  note problem  and said  if the  bill is  passed that  the                                                               
state will have to  send a trooper out to the  villages to give a                                                               
$50 citation so there will be a fiscal note.                                                                                    
                                                                                                                                
6:31:33 PM                                                                                                                    
                                                                                                                                
JENNIFER VARGASON  said vaping saved  her life from the  ball and                                                               
chain of tobacco  use, she and her family are  healthier, and she                                                               
does not understand  how smoking tobacco and vaping  is the same.                                                               
Vapor products do  not contain tobacco so there  is no combustion                                                               
and  research has  shown that  vaping does  not have  the harmful                                                               
effects of smoking, and there  are no carcinogens for bystanders.                                                               
The  ingredients  in  a  liquid are  in  everyday  food  products                                                               
consumed, and  it has  been shown that  nicotine is  not harmful.                                                               
She  referred to  an article  that  stated that  there have  been                                                               
instances  where   nicotine  has  been  known   to  help  certain                                                               
conditions,   such   as  Alzheimer's,   depression,   Parkinson's                                                               
disease, and  more.  She  is an ex-smoker who,  initially, rolled                                                               
her eyes  at vaping  but then  gave it a  try and  since December                                                               
2013  has  been  completely  without  tobacco.    She  asked  the                                                               
committee to please reconsider HB 328.                                                                                          
                                                                                                                                
6:34:25 PM                                                                                                                    
                                                                                                                                
JESSE WALTON asked that all  references to vaping be removed from                                                               
the bill.   She has  been vaping since  2013 when she  received a                                                               
Christmas gift  from a nurse  practitioner, which allowed  her to                                                               
quit smoking.  She feels healthier,  has more energy, and is able                                                               
to  get the  snow  machine unstuck.   She  listed  the amount  of                                                               
milligrams she  started on  and is  now down  to, and  listed the                                                               
various remedies  she previously tried, yet  always found herself                                                               
with  a  cigarette in  her  hand.    [Difficult to  decipher  Ms.                                                               
Walton's  testimony  due to  audio.]  There  are many  people  in                                                               
Fairbanks  trying  to  quit  smoking  for  themselves  and  their                                                               
families, and there are reputable  vape shops around Alaska where                                                               
people are welcome to learn about the industry, she said.                                                                       
                                                                                                                                
6:36:18 PM                                                                                                                    
                                                                                                                                
TERRY CROWSON  said that the  committee is aware  that secondhand                                                               
smoke is  bad and how  bad [background noises masked  the audio].                                                               
She related that  when a local vote to prohibit  smoking is held,                                                               
those who vote  against public smoking and lose the  vote, lose a                                                               
lot more than  face because the public loses  the opportunity for                                                               
clean air.   Although, the public has the choice  to not go where                                                               
smoking  is   allowed,  the  public  loses   the  opportunity  to                                                               
socialize, do business, or whatever  is offered.  This bill would                                                               
protect not only  folks who need a  job bad enough to  take a job                                                               
in a  smoking situation, but  also everyone who does  business in                                                               
these places.  The legislature  has an opportunity to promote and                                                               
enable a  healthier Alaskan environment.   Please take  action to                                                               
make  this  positive  difference  for healthy  living  for  those                                                               
Alaskans who can't  count on a clean deep breath,  she asked.  In                                                               
small communities  there often  is only one  choice of  a similar                                                               
place to  do business and  when that business allows  smoke there                                                               
is  no choice  for  those  who want  to  avoid secondhand  smoke.                                                               
After listening  to prior testimony,  she suggested  removing the                                                               
vaping  provisions   and  move   on  to  protect   Alaskans  from                                                               
secondhand smoke.                                                                                                               
                                                                                                                                
6:38:41 PM                                                                                                                    
                                                                                                                                
CHERYL SCHOOLEY  said that people  who have made  the responsible                                                               
choice  to  not   smoke  are  victims  of   secondhand  smoke  in                                                               
establishments  where smoking  is  still legally  allowed.   This                                                               
backward mindset sends a message  from the legislature that it is                                                               
okay  to light  up, and  puff up,  secondhand smoke.   This  bill                                                               
promotes a  healthier Alaska  which will  lower health  costs and                                                               
help budget  challenges, without this  bill it appears  the state                                                               
is  choosing to  promote  the  negative effects.    Alaska has  a                                                               
pristine image  to be proud of,  and is a market  for the tourism                                                               
industry, let's be a class act, she remarked.                                                                                   
                                                                                                                                
6:39:38 PM                                                                                                                    
                                                                                                                                
WAYNE CROWSON said he has  listened to smokers testify today, and                                                               
listened to  them having trouble  breathing and coughing  as they                                                               
spoke, which  was him 20 years  ago.  His lungs  are much clearer                                                               
now since he's  quit smoking and he would like  to keep them that                                                               
way, he  commented.  Please  move this  bill to the  governor for                                                               
signing  this  session as  the  governor  wrote "Alaskans  Health                                                               
First," he said.                                                                                                                
                                                                                                                                
6:40:26 PM                                                                                                                    
                                                                                                                                
ROBIN   MINARD,   Director,   Public   Affairs,   Mat-Su   Health                                                               
Foundation,  said she  strongly supports  HB 328.   While  making                                                               
great  headway in  the Mat-Su  and Alaska,  she pointed  out that                                                               
Alaska continued  to have some  of the highest tobacco  use rates                                                               
in  the  nation.     Tobacco  use  rates  bump   up  its  chronic                                                               
respiratory disease rates, such  as bronchitis, asthma, and COPD.                                                               
Tobacco use costs Alaska $579  million annually in direct medical                                                               
costs and lost  productivity due to tobacco related  deaths.  She                                                               
stressed that enacting  this law in Alaska  to require smoke-free                                                               
public places  will help  reduce these costs  and will  also help                                                               
reduce  Medicaid costs,  something that  the legislators  and the                                                               
Foundation  care deeply  about.   Much  has been  said about  the                                                               
effects of  secondhand smoke  and e-vaping,  and she  stated that                                                               
Alaska needs  robust clean indoor  air statutes that  includes e-                                                               
cigarettes  because adolescents  perceive  e-cigarettes as  safer                                                               
than traditional cigarettes.  In  addressing the myths that these                                                               
products  are  safer or  that  they  are  a cessation  tool,  she                                                               
advised they  are the  opposite.  These  products are  a grooming                                                               
tool, grooming  kids to accept,  like, and become  dependent upon                                                               
smoking  and nicotine.    A 2015,  National  Institute of  Health                                                               
report showed  that ninth-graders  using these  e-cigarettes were                                                               
over three times  more likely to begin  using traditional tobacco                                                               
products than those who didn't.   She asked the committee to keep                                                               
in mind that e-cigarettes have not  been approved by the FDA as a                                                               
smoking cessation aide.   As discussed earlier,  only one-half of                                                               
Alaskans  are protected  by smoke-free  workplace  laws and  many                                                               
jurisdictions,  such as  Mat-Su, do  not have  the health  powers                                                               
necessary to pass  an areawide smoke-free ban.   This legislation                                                               
is  the  next   step  in  further  reducing   smoking  rates  and                                                               
secondhand  smoke exposure  in Alaska,  it  is the  next step  in                                                               
raising  the health  status of  all Alaskans,  the Mat-Su  Health                                                               
Foundation supports  the bill, and  she asked that  the committee                                                               
expedite its passage.                                                                                                           
                                                                                                                                
6:42:40 PM                                                                                                                    
                                                                                                                                
PETE BURNS  said he is  testifying for himself and  Humpy's Great                                                               
Alaskan Ale House.  He offered testimony as follows:                                                                            
                                                                                                                                
      I know this sounds bad that sometimes go against the                                                                      
      grain and CHARR has always been a great advocate for                                                                      
     various industry stuff,  but for this one I  have to go                                                                    
     against them.                                                                                                              
                                                                                                                                
     My story  is, my father was  born in 1936.   He started                                                                    
     smoking  in  1951, in  1994  he  passed.   He  gave  up                                                                    
     smoking.  1998  he had his first heart attack.   He was                                                                    
     wheelchair bound  from then  for the  next part  of his                                                                    
     life.   2002 I  had a  pain in  my hip,  I went  to the                                                                    
     doctors here in Anchorage, they  sent me to the Seattle                                                                    
     Cancer Care Alliance  in Seattle.  One thing  is that I                                                                    
     had  never smoked,  I had  never been  around it  in my                                                                    
     life.  I spent three  and one-half months in the Cancer                                                                    
     Care Alliance,  over a  year am  able to  walk.   And I                                                                    
     vividly  remember  my  dad   sitting  in  a  wheelchair                                                                    
     sobbing thinking he  had caused cancer in  me.  Whether                                                                    
     he  did or  didn't it  did not  matter when  you are  a                                                                    
     child your  father is your  idol.  I went  in remission                                                                    
     at that time,  within one year and one-half.   2009 May                                                                    
     15th, my  father got  sick with what  he thought  was a                                                                    
     chest  cold,   he  was  admitted   to  a   hospital  in                                                                    
     Knoxville,  Tennessee.   July  29th, 45  days later  he                                                                    
     passed  away and  in those  45  days he  went from  185                                                                    
     pounds to 85 pounds.   He developed emphysema and COPD.                                                                    
     He hid it  from our family, he didn't want  us to know.                                                                    
     Our  family  incurred over  $300,000  in  debt for  his                                                                    
     hospital  stays.   It is  a debt  that we  gladly would                                                                    
     have paid  any day just to  have one more day  with our                                                                    
     father.                                                                                                                    
                                                                                                                                
     I am selfish.   I miss my father.   I wish someone back                                                                    
     in  the 1950s  and 1960s  had done  this to  my father.                                                                    
     Taken that  away from  them.  It's  not about  me, it's                                                                    
     not  about you,  it's  about the  families, their  kids                                                                    
     that don't  have a choice in  this to grow up  like me.                                                                    
     I'm a 44 year old man  and mention my father puts me on                                                                    
     the  ground.   I cannot  see him  again, I  cannot even                                                                    
     begin, I cannot learn from him  again.  All I can do is                                                                    
     know that he knows that I  am fighting a good fight for                                                                    
     him.  I beg you pass this, end it now.  Thank you.                                                                         
                                                                                                                                
6:45:43 PM                                                                                                                    
                                                                                                                                
JOHN  YORDY,   M.D.,  Anchorage  and  Valley   Radiation  Therapy                                                               
Centers, said  he is testifying  in support  of this bill  and on                                                               
behalf of the Anchorage and  Valley Radiation Therapy Centers and                                                               
himself,  he  lives  and  works in  Wasilla,  and  treats  cancer                                                               
patients with radiation therapy.   He related that his concern is                                                               
with  the  health  risks  of secondhand  smoke  and  the  disease                                                               
causing properties  of being  exposed to smoke.   He  referred to                                                               
the  testimonies regarding  businesses  and individuals  opposing                                                               
smoke-free  work environments  and explain  that from  the health                                                               
care perspective  in treating  cancer patients  on a  daily basis                                                               
and watching the effects of what  cancer does, as well as knowing                                                               
the exposure  to smoke  has directly caused  some of  the cancers                                                               
that  he is  treating makes  him compelled  and passionate  about                                                               
trying to eradicate  smoking from the workplace.   There are many                                                               
reasons why  people may  feel compelled  to expose  themselves to                                                               
secondhand smoke  despite a desire  to the  contrary.  It  may be                                                               
the only job  or the best job  they can get and,  he pointed out,                                                               
many people live in  an area where it may be  difficult to find a                                                               
good  job so  they  feel  compelled to  put  themselves into  the                                                               
[smoked-filled] situation  so they can  put food on the  table or                                                               
buy medicine  for their  children.   There are  other professions                                                               
dependent upon  protecting themselves in a  public situation such                                                               
as  musicians,   who  may  feel   compelled  to  perform   in  an                                                               
environment that  is smoke-filled.   He related that  his concern                                                               
is for  these people who may  not be smokers themselves,  but are                                                               
being forced  to partake  in work situations  that cause  them to                                                               
breathe in smoke that can be  harmful to their health.  For these                                                               
reasons, he said he strongly  supports this legislation and asked                                                               
that the committee consider passage  so all Alaskans can work and                                                               
live in smoke-free workplace environments.                                                                                      
                                                                                                                                
6:48:15 PM                                                                                                                    
                                                                                                                                
OWEN  HANLEY, M.D.,  Fairbanks Memorial  Hospital, said  he is  a                                                               
pulmonary lung  doctor and he strongly  supports the legislation.                                                               
He  pointed  out  that  patients   in  Fairbanks  want  the  same                                                               
protection  that  citizens  in  Juneau and  Anchorage  have,  and                                                               
disagrees with  the remark that  one-half of the state  wanted it                                                               
and the other half  didn't want it and voted it  out.  He related                                                               
that Fairbanks hasn't had an  opportunity because our borough has                                                               
no health powers.   [Audio difficulties.] My  patients would love                                                               
to have  a smoke-free environment  (indisc.) in Fairbanks.   Some                                                               
patients are  living in housing and  on oxygen but the  people in                                                               
the  hallways and  next  door are  smoking  and have  ventilation                                                               
systems (indisc.).   Most Alaskans  would like to enjoy  the same                                                               
opportunities of  smoke-free clean  air that legislators  have in                                                               
their buildings,  he said.   (Indisc.) testimony that  since OSHA                                                               
doesn't  find   secondhand  smoke  exceeds  a   particular  toxic                                                               
standard that it is therefore safe.   The science of the evidence                                                               
is  overwhelming  that  secondhand   smoke  is  lethal,  and  the                                                               
evidence  is  overwhelming  that limiting  secondhand  smoke  has                                                               
dramatic reduction  in heart attacks  and strokes.   E-cigarettes                                                               
must be banned,  while it may be true that  some e-cigarettes are                                                               
safe,  there  are  enumerable  things  that can  be  put  in  the                                                               
containers such  as, nicotine, marijuana, or  an unlimited amount                                                               
of chemicals,  an e-cigarette  is just a  delivery device  and it                                                               
would  be  impossible to  legislate  or  enforce  what is  in  an                                                               
individual vaping  device.   He stated  that there  is no  way to                                                               
ensure  that  an  e-cigarette  contains  a  safe  substance,  and                                                               
whether the  person next  to them is  producing a  harmful toxin.                                                               
The legislation  is not asking people  to quit using it,  just to                                                               
take it outside, he pointed out.                                                                                                
                                                                                                                                
6:51:00 PM                                                                                                                    
                                                                                                                                
ERIC VARGASON referred  to the prior testimonies  and opined that                                                               
everyone  wants the  same thing,  although, he  does not  believe                                                               
including vaping and  e-cigarettes language is most  prudent.  He                                                               
said he  opposes this  bill due  to the  inclusion of  the vaping                                                               
language  because by  not allowing  sampling  "e-juices" in  vape                                                               
shops the bill is basically pushing  more people to smoke, at the                                                               
end of  the day.   He advised  the committee that  everyone wants                                                               
clean  air and  to  consider the  relevant  studies testified  to                                                               
today,  otherwise, it  as  not only  jumping the  gun  but it  is                                                               
irresponsible and  overreaching.  He  said that when he  is alone                                                               
in his  house vaping and his  children are with their  mother, he                                                               
is still left to these standards.   Not only is that not fair, he                                                               
advised but the government is telling  him what he can and cannot                                                               
do in his own  house provided he is not hurting  anyone else.  He                                                               
said he  has chosen to  not vape  around anyone else,  vaping has                                                               
made him  healthy, and speaking  as a  former smoker he  does not                                                               
need a study to tell him how he feels right now.                                                                                
                                                                                                                                
6:53:21 PM                                                                                                                    
                                                                                                                                
STEVEN MAPES said  he is speaking in opposition to  HB 328 and is                                                               
speaking for  all of the adults  on the Kenai Peninsula  who have                                                               
made  the choice  to  vape rather  than smoke.    He referred  to                                                               
various studies and noted that  one study indicated the threshold                                                               
limit values  of vapors produced by  e-cigarettes were magnitudes                                                               
below OSHA  limits.   Adults choosing to  vape rather  than smoke                                                               
looked  to  unbiased  independent   studies  to  help  them  make                                                               
informed decisions.   He  stated that  vaping has  saved previous                                                               
smokers  thousands of  dollar because  they "ain't  paintin their                                                               
lungs  with  tar  and  fillin  their  blood  stream  with  carbon                                                               
monoxide" and  it has had  a tremendous positive impact  on their                                                               
lives, including his.  This  bill would effectively regulate this                                                               
healthier  alternative out  of existence,  and it  will harm  the                                                               
health and wellbeing  of the citizens of Alaska.   The standalone                                                               
language for vape  shops and secondhand vape goes  against all of                                                               
the science and  research available today.  He  related that both                                                               
of his parents died  of lung cancer and it was  ugly, and he made                                                               
the choice  to quit  smoking and  finally found  vaping.   He has                                                               
been  vaping for  four years  and  can breathe  and exercise  and                                                               
feels about 1,000 times better.  On  a side note, he said he sees                                                               
adults writing  testimonies for their  children to read  at these                                                               
teleconferences, and he  watches this happening at  the Kenai LIO                                                               
every  time he  goes down  there,  and these  actions taint  this                                                               
process.                                                                                                                        
                                                                                                                                
6:55:41 PM                                                                                                                    
                                                                                                                                
BOB URATA, MD,  Valley Medical Care, said he was  born and raised                                                               
in Wrangell,  and has  practiced medicine  in Juneau  since 1984.                                                               
He has  been a volunteer  for the American Heart  Association for                                                               
16  years and  is testifying  today as  a representative  for the                                                               
American  Heart  Association  and  himself.    He  expressed  his                                                               
support for this  bill and the inclusion  of e-cigarettes because                                                               
every 34  seconds an American  dies of  a heart attack,  every 40                                                               
seconds  an   American  dies   of  a   stroke;  and   cancer  and                                                               
cardiovascular disease are  the number one and two  causes of the                                                               
deaths of Alaskans.  Secondhand smoke  is one of the main causes,                                                               
he stressed and  it kills over 50,000 Americans each  year, it is                                                               
expensive  as the  CDC reports  secondhand smoke  exposure causes                                                               
the  United  States  to  spend   $5.6  billion  a  year  in  lost                                                               
productivity, tobacco expenditures in  the United States are $133                                                               
billion in  direct medical  care for adults,  and this  state may                                                               
save $5  million in Medicaid  medical expenses  if not more.   An                                                               
example of a  success of the Clean Air Act  is Pueblo, Colorado -                                                               
1.5 years  before and after  passage of its  smoke-free ordinance                                                               
it saw a 20 percent rise  in bar and restaurant sales tax revenue                                                               
and  a 27  percent  decrease  in heart  attacks.    He opined  e-                                                               
cigarettes should be included due  to the serious questions about                                                               
their  safety because  the FDA  found  toxins that  are known  to                                                               
cause problems to  health, and also nicotine in the  products.  A                                                               
medical saying is "First do no  harm" and he believes that vaping                                                               
must  remain in  the  bill.   Imagine  the  many  lives saved  if                                                               
cigarettes had been  properly studied before being  placed on the                                                               
market and  Alaskans must  make sure  that e-cigarettes  are safe                                                               
before  exposing everyone  to  them.   In  closing, the  positive                                                               
impacts  will benefit  many in  the short  and long  term and  on                                                               
behalf of  the American Heart  Association and many  Alaskans, he                                                               
urged the committee to support this bill.                                                                                       
                                                                                                                                
6:58:27 PM                                                                                                                    
                                                                                                                                
ANGELA  CARROLL, Smoke-Free  Alternative Trade  Association, said                                                               
she represents  the Smoke-Free Alternative Trade  Association and                                                               
noted  that  more  states  are  looking  at  electronic  delivery                                                               
systems to add  a solution to the tobacco problem.   These states                                                               
are  reviewing the  science behind  this new  technology that  is                                                               
saving lives  and could ultimately  save billions in  health care                                                               
costs including lost  work time, per a  scientific study released                                                               
by the  State Budget Solutions in  March 2015.  She  read various                                                               
studies  and peer  reviewed studies  and advised  that they  have                                                               
been submitted as documents of  opposition.  She remarked that as                                                               
representatives  of Alaska  the committee  has an  opportunity to                                                               
show its  constituents the members  care about their  health, and                                                               
are  in  favor  of  Alaskans utilizing  a  safer  alternative  to                                                               
combustible cigarettes  by supporting vape shops.   Alaskans make                                                               
the choice  to enter  a vape  shop to test  flavors and  find the                                                               
device to  help them  to maintain that  vapor alternative.   This                                                               
bill would  force current vape  owners to relocate  (indisc.) for                                                               
vape products  and this one  provision will force most  vape shop                                                               
owners  out of  business in  Alaska, eliminating  the opportunity                                                               
for  adult Alaskans  who currently  smoke  from discovering  this                                                               
alternative  to combustible  cigarettes.   For these  reasons the                                                               
members of  the Smoke-Free Alternative Trade  Association (SFATA)                                                               
are asking that the vape language  be removed from this bill, and                                                               
in   the  alternative   SFATA  is   asking  for   the  standalone                                                               
requirement  to be  removed so  they can  continue to  operate in                                                               
their  current   location.    No   shop  currently   meets  these                                                               
requirements and it would be  cost prohibitive for these "mom and                                                               
pop" establishments  to (indisc.) standalone structures.   If the                                                               
bill passes as written the  SFATA members would close up existing                                                               
shops and  this alternative combustible cigarette  would be lost.                                                               
She asked  that the legislation  be re-written before  passing it                                                               
out of committee.                                                                                                               
                                                                                                                                
7:01:47 PM                                                                                                                    
                                                                                                                                
JUNE ROGERS said  she is testifying as a concerned  member of the                                                               
community and  as a business owner.   She said she  has long been                                                               
in favor  of a smoke-free  environment because 15 years  ago when                                                               
she  and her  husband began  their business,  a coffee  house and                                                               
recording  studio, they  determined  that the  business would  be                                                               
smoke-free.  A  significant factor in her strong  support of this                                                               
bill  is that  her mother  was diagnosed  with emphysema  and had                                                               
never smoked, although, she did  work in smoke filled restaurants                                                               
for most of  her life.  Ms. Rogers advised  she has never smoked,                                                               
but in earlier  times of her performance work she  spent too many                                                               
hours in smoke  filled rooms, breathing more  deeply than perhaps                                                               
anyone  else in  the room  as she  sang for  their entertainment.                                                               
While  she does  not have  the severe  condition that  her mother                                                               
has, she does  have issues of allergic  and problematic breathing                                                               
responses to  smoke filled  rooms.  She  referred to  the comment                                                               
that  people make  the choice  to work  in such  conditions, true                                                               
enough and; therefore, made the  decision to create her own smoke                                                               
free workplace where her band  performs every Friday and Saturday                                                               
evening.   However,  she  pointed  out this  is  not a  realistic                                                               
option for most musicians,  particularly young hopeful musicians,                                                               
and stressed  that they should  not have  to put their  health in                                                               
jeopardy in  order to  work.   In speaking  with club  owners who                                                               
have converted  to smoke  free venues she  is not  surprised when                                                               
they  advise that  their revenue  increased substantially.   Only                                                               
recently did  she investigate the properties  of e-cigarettes but                                                               
based  upon  what  she  has   learned,  she  firmly  agrees  that                                                               
including them as  an item that does not deserve  acceptance in a                                                               
smoke-free  venue.   As Alaskan  leaders, legislators  are called                                                               
upon to decide  on a broad spectrum of issues  that relate to the                                                               
wellbeing of  Alaska's communities, she asked  that the committee                                                               
give its upmost  consideration to this bill as it  will provide a                                                               
more productive and healthy workplace,  and not surprisingly will                                                               
also benefit in less healthcare costs for Alaska.                                                                               
                                                                                                                                
7:04:00 PM                                                                                                                    
                                                                                                                                
DANNY RUEREP  said his opposition to  HB 328 is based  solely [on                                                               
vaping] because he  does not want to see the  vape shops in local                                                               
communities  removed because  it  will destroy  the vaping  local                                                               
economies.   He described this as  a step in the  wrong direction                                                               
because he had been a smoker for  20 years until he found a local                                                               
vape shop  and sampled  every liquid he  desired, and  advised he                                                               
has now  been two years  free of cigarettes.   He related  to the                                                               
committee that  in taking the  vaping provisions out of  the bill                                                               
there will be less opposition.                                                                                                  
                                                                                                                                
7:055 PM                                                                                                                      
                                                                                                                                
QUOC DONG said  that he had smoked for 10  years, vaped for three                                                               
years, quit vaping,  and has gone from 18  milligrams of nicotine                                                               
to  zero.   He  opined that  it  is  a good  tool  for people  to                                                               
transition their lives from tobacco  smoking.  While in school he                                                               
was taught that if he made a  mistake with something he had to do                                                               
it  in  the  correct  manner  twice  before  he  could  learn  it                                                               
correctly, and felt that is the same  for any habit.  In order to                                                               
quit  smoking, he  opined,  a couple  of years  might  be a  more                                                               
reasonable expectation of people  and that eventually most people                                                               
vaping  will  quit  vaping  in  addition to  not  smoking.    The                                                               
environment in  which vaping has  been created is not  similar to                                                               
smoking as  it is built on  innovations.  In an  economy that has                                                               
led to many  devices and different types of e-liquids  in a short                                                               
period of time, if bills such as  HB 328 continue to be passed in                                                               
the  United  States, different  innovations  will  arise and  the                                                               
legislature will be  dealing with a whole other  thing that could                                                               
be far worse  than vaping.  In order to  pre-empt that, he opined                                                               
the committee  should reconsider the language  and reconsider how                                                               
vaping  is  used   before  actually  passing  laws.     With  the                                                               
introduction  of marijuana  to  Alaska, he  opined  that the  two                                                               
industries  side-by-side  and a  negative  view  on vaping  could                                                               
potentially create  a hazardous  environment for  nicotine users.                                                               
He  advised that  some  vape shops  in  Anchorage sell  marijuana                                                               
tools  which, unsurprisingly,  are smokeless  devices that  don't                                                               
produce vapor.  Speaking as a  person who formerly vaped, he said                                                               
he has  quite a bit  of vaping paraphernalia which  also includes                                                               
100 milligrams  per milliliter nicotine.   He related that  if he                                                               
were to drink  the entire bottle he would die  so some people may                                                               
have the wrong impression about what vaping is.                                                                                 
                                                                                                                                
7:08:56 PM                                                                                                                    
                                                                                                                                
OCTAVIA  HARRIS, American  Lung Association  in Alaska,  said the                                                               
American Lung Association  in Alaska supports HB 328  as there is                                                               
no  safe level  of secondhand  smoke  or aerosol  exposure.   She                                                               
pointed out  that there  is statewide support  for this  bill and                                                               
approximately  1,000   businesses  and  organizations   from  all                                                               
corners of the  state have signed resolutions in  support of this                                                               
measure,  and  an  updated  version  will  be  submitted  to  the                                                               
committee.  She asked that  committee support the legislation and                                                               
pass it out of committee.                                                                                                       
                                                                                                                                
7:10:11 PM                                                                                                                    
                                                                                                                                
EMILY  NENON,  Director,  Alaska Government  Relations,  American                                                               
Cancer  Society Cancer  Action Network,  noted that  a number  of                                                               
volunteers contacted  her after  Tuesday's hearing  regarding not                                                               
getting  a chance  to testify  and she  suggested that  the folks                                                               
send  in  their written  comments.    She  pointed out  that  the                                                               
legislation is modeled after a  number of the existing ordinances                                                               
in  the  state including  Anchorage.    The language  around  the                                                               
children's play  area is  discussing playground  equipment, which                                                               
is identical  to the language  already in place in  Anchorage and                                                               
existing ordinances around the state.   No smoking on a toddler's                                                               
swing is  how it  has been interpreted  over time,  she remarked,                                                               
and  the bill  is focused  on inside  workplaces.   Regarding the                                                               
questions around the education program,  the Department of Health                                                               
and Social  Services has an  existing tobacco  prevention program                                                               
with grantees around the  state performing educational (programs)                                                               
regarding  secondhand  smoke  and  other  tobacco  issues.    She                                                               
pointed out  that those folks  performing the education  work now                                                               
will be transitioning  some of their work  to implementation, and                                                               
education  around  this  bill  is  already  in  place  and  being                                                               
performed  which is  one of  the reasons  there is  no additional                                                               
cost.     Many  discussions  have   come  up   around  electronic                                                               
cigarettes as cessation  products which, she related,  is not the                                                               
argument at  hand in  this bill because  it is  simply discussing                                                               
exposure to secondhand aerosol.                                                                                                 
                                                                                                                                
REPRESENTATIVE  SEATON,  after  ascertaining  no  one  wished  to                                                               
testify, closed public testimony.                                                                                               
                                                                                                                                
7:13:06 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON advised  he will  take  the bill  up at  a                                                               
future  hearing,  questions were  submitted  to  the sponsor  who                                                               
indicated he  will return  the answers to  the committee,  and it                                                               
would be  best that  all amendments  are prepared  by Legislature                                                               
Legal and Research Services.                                                                                                    
                                                                                                                                
[HB 328 was held over.]                                                                                                         
                                                                                                                                
7:13:45 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Health  and  Social  Services   Standing  Committee  meeting  was                                                               
adjourned at 7:13 p.m.                                                                                                          

Document Name Date/Time Subjects
HB 344 proposed amendment_Seaton N.6.pdf HHSS 3/24/2016 3:00:00 PM
HB 344
HB 344 Proposed amendment Seaton N 5.pdf HHSS 3/24/2016 3:00:00 PM
HB 344
HB 344 Proposed amendemnt- SEaton N 3.pdf HHSS 3/24/2016 3:00:00 PM
HB 344
HB328 Testimony_Kenai LIO_8 support_032216.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB328_Testimony_Kenai LIO_Opposition_032216.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB328 support_Mat-Su Health_March 22 2016.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB 344 testimony_AMA_ proposed changes letter 3-10-16_UPDATED.pdf HHSS 3/24/2016 3:00:00 PM
HB 344
HB 344 Testimony_Kristi Rice.pdf HHSS 3/24/2016 3:00:00 PM
HB 344
HB 344 testimony Tanana Chiefs.pdf HHSS 3/24/2016 3:00:00 PM
HB 344
HB 344 Testimony Joshua Sonkiss.pdf HHSS 3/24/2016 3:00:00 PM
HB 344
HB315 proposed amendment E.1.pdf HHSS 3/24/2016 3:00:00 PM
HB 315
NCSL Telehealth presentation_March 24 2016.pdf HHSS 3/24/2016 3:00:00 PM
Telehealth
HB344 Letter to Rep Seaton_Holt.pdf HHSS 3/24/2016 3:00:00 PM
HB 344
HB 328 - Supporting Document - Powerpoint Presentation.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB 315 Fiscal Note -DHSS-SDSA-3.18.16-UPDATED.pdf HHSS 3/24/2016 3:00:00 PM
HB 315
HB328 Fiscal Note-DOT-NRHA-3.19.16.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB328 Fiscal Note DOT-SRHA-3.19.16.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB328 Fiscal Note-DOT-IASO-3.19.16.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB328 Fiscal Note - DOT-SEF-3.19.16.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB328 Fiscal Note -DOT-CRHA-3.19.06.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB328 Fiscal Note-DOT-MVO-3.19.16.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB 328 amendment Wool.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB315 proposed CS_ver W.pdf HHSS 3/24/2016 3:00:00 PM
HB 315
HB 328 Opposition emails March 23.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB 328 Opposition- 3.24 testimony_11 letters.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB 328 Support_March 24 testimony_14 letters.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB 328 Opposition-ALL testimony-39 individuals_3.21-3.26.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB 328 Suppport-ALL testimony_74 individuals_3.21-3.26.pdf HHSS 3/24/2016 3:00:00 PM
HB 328
HB 328 Support 8 emails_March 23.pdf HHSS 3/24/2016 3:00:00 PM
HB 328