Legislature(2013 - 2014)SENATE FINANCE 532

03/05/2014 05:00 PM FINANCE

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* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
Moved CSSB 129(FIN) Out of Committee
Heard & Held
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
Moved CSSB 169(FIN) Out of Committee
Scheduled But Not Heard
Michael Pawlowski Deputy Commissioner, Strategic
Finance, Dept. of Revenue
Deepa Poduval of Black and Veatch Management
Janak Mayer and Nikos Tsafos of Enalytica
SENATE BILL NO. 169                                                                                                           
     "An Act  establishing in the  Department of  Health and                                                                    
     Social  Services a  statewide immunization  program and                                                                    
     the  State Vaccine  Assessment  Commission; creating  a                                                                    
     vaccine assessment account;  requiring a fee assessment                                                                    
     from   health   care   insurers   and   other   program                                                                    
     participants  for   statewide  immunization  purchases;                                                                    
     repealing  the temporary  child and  adult immunization                                                                    
     program; and providing for an effective date."                                                                             
5:10:12 PM                                                                                                                    
Co-Chair Meyer discussed housekeeping.                                                                                          
5:11:04 PM                                                                                                                    
SENATOR CATHY  GIESSEL, stated  that SB  169 was  the second                                                                    
part of a  bill that was heard several  years prior relating                                                                    
to the state's vaccine program.  She recalled that the state                                                                    
had had a  universal vaccine program in the  past, with $4.3                                                                    
million  from the  federal government  in  annual funds.  By                                                                    
2013, Alaska  was forecasted to  have only $700,000  for the                                                                    
program.  As a  result, the  number of  vaccines offered  to                                                                    
Alaskans of all ages  had diminished significantly. The bill                                                                    
would use  state funds to re-establish  the vaccine program.                                                                    
She  stated  that the  bill  was  a  result of  the  efforts                                                                    
between Department of Health and  Social Services (DHSS) and                                                                    
insurance companies within the state.                                                                                           
5:13:08 PM                                                                                                                    
JANE CONWAY,  STAFF, SENATOR CATHY GIESSEL,  stated that the                                                                    
bill  would  setup a  state  vaccine  assessment council  to                                                                    
administer the  immunization program  under the  auspices of                                                                    
the  Department  of  Health   and  Social  Services  (DHSS).                                                                    
Members   of  the   council  would   be  appointed   by  the                                                                    
commissioner of DHSS and would  consist of the state's chief                                                                    
medical officer  or designee, the  director of  the division                                                                    
of insurance,  3 representatives from insurance  entities, 2                                                                    
healthcare providers and 1 tribal  or public healthcare plan                                                                    
person. She  stressed that the  council would  serve without                                                                    
compensation  or  reimbursement  of  expenses.  The  council                                                                    
would not  be set up  under state boards and  commission and                                                                    
staff and assistance would be  provided by DHSS. The council                                                                    
would set  forth the plan  of operation for  the calculation                                                                    
of  assessment  to  insurers;   the  purchase,  storage  and                                                                    
distribution of vaccines;  monitoring and financial tracking                                                                    
of  the  program and  review  of  financial statements  from                                                                    
insurers. She pointed  out that at least 9  other states had                                                                    
setup something similar  to what was in SB  169, elements of                                                                    
which  had been  borrowed  from each.  The department  would                                                                    
estimate the  costs needed  to purchase  vaccine universally                                                                    
based  on recommended  vaccine  schedules, vaccine  pricing,                                                                    
immunization  rates and  other  factors.  The council  would                                                                    
then assess  the insurers their  proportionate share  of the                                                                    
cost; a fee established by  the council, taking into account                                                                    
estimated  covered  lives,   vaccine  usage,  administration                                                                    
costs  and  other  variables. The  insurers  would  pay  the                                                                    
assessment to  the state and  the state would use  the funds                                                                    
to purchase  specific vaccines in  bulk; realizing  the best                                                                    
cost  savings.  The  state  would   store  the  vaccine  and                                                                    
distribute  it   to  the  healthcare  providers   that  were                                                                    
participants in  the program. Healthcare providers  would be                                                                    
able to  store the vaccine with  other prescribed medicines,                                                                    
enjoy  less   cumbersome  tracking  and   paperwork,  freely                                                                    
administering  the  vaccine  while  charging  only  for  the                                                                    
office  visit.  She  hoped that  simplifying  the  procedure                                                                    
would entice  more providers to  offer the  vaccinations and                                                                    
that the  public would be  more apt  to be immunized  due to                                                                    
the  increased access.  She  felt that  the  bill was  sound                                                                    
public  policy   that  laid  framework  for   the  statewide                                                                    
immunization program.                                                                                                           
5:16:44 PM                                                                                                                    
Senator   Olson   understood   that  there   would   be   no                                                                    
reimbursement  for expenses  in relation  to the  assessment                                                                    
Senator  Giessel replied  that it  would not  a conventional                                                                    
board  and  commission where  board  members  would get  per                                                                    
diem, lodging, or something similar;  DHSS would provide all                                                                    
of the staff support.                                                                                                           
Senator Olson  inquired if the  staff support  would include                                                                    
travel expenses.                                                                                                                
Senator Giessel replied that there  was not any anticipation                                                                    
of   travel   and   that    meetings   would   probably   be                                                                    
5:17:54 PM                                                                                                                    
DR.    ROSALYN     SINGLETON,    SELF,     ANCHORAGE    (via                                                                    
teleconference),   presented   a  PowerPoint   presentation,                                                                    
"Alaska-What have vaccines done for you?"(copy on file).                                                                        
5:18:23 PM                                                                                                                    
Dr. Singleton  addressed Slide 2, "Vaccination:  an ounce of                                                                    
prevention saves a ton of lives":                                                                                               
     · Vaccination is a Global Issue: The World Health                                                                          
        Organization estimates that vaccination saves                                                                           
        between 2 and 3 million lives every year.                                                                               
Dr. Singleton  stated that  vaccine preventable  disease was                                                                    
at an all-time  low in the United States.  She stressed that                                                                    
high-levels  of   vaccinations  were  critical   to  prevent                                                                    
diseases from  around the world  reemerging in the  U.S. and                                                                    
in Alaska. She continued with the presentation:                                                                                 
     ·  In the  US, vaccination  has  prevented 103  million                                                                    
        infections and disease rates are at historic lows -                                                                     
        However, 1.5 million vaccine-preventable deaths                                                                         
        occur each year around the world.                                                                                       
     ·  Keeping vaccination  rates  high requires  sustained                                                                    
        commitment and access to vaccines.                                                                                      
5:18:44 PM                                                                                                                    
Dr. Singleton spoke to Slide 3, "Vaccine-Preventable                                                                            
Disease Success, Alaska":                                                                                                       
     · BEFORE VACCINES:                                                                                                         
     ·  Hib  meningitis  and  sepsis  -  40-80  cases/yr  in                                                                    
     ·  Hepatitis A - Alaska-wide epidemics with up to 4,000                                                                    
     · Hepatitis B -10% of Alaska Natives in some regions.                                                                      
     ·  Measles  outbreaks   contributed   to  high   infant                                                                    
     · BECAUSE OF VACCINES:                                                                                                     
     · 0-2 cases of Hib per year!                                                                                               
     · No hepatitis A epidemics since vaccine!                                                                                  
     ·  Alaska Natives have the  lowest rate of  Hepatitis B                                                                    
        in the U.S.                                                                                                             
     · No measles cases in Alaska since 2000!                                                                                   
5:19:23 PM                                                                                                                    
Dr. Singleton addressed Slide 4, "Polio":                                                                                       
     ·  Polio attacks  the  nervous  system  and  can  cause                                                                    
        muscle weakness, paralysis or death.                                                                                    
     ·  In 1952 there  were 21,000 polio  cases in the  US -                                                                    
        the last US polio case was in 1979.                                                                                     
     ·  Thanks to  polio vaccination,  polio cases  are down                                                                    
        99%; however, polio has recently reemerged in areas                                                                     
        that had been polio-free for years.                                                                                     
     · Polio is just one plane flight away                                                                                      
5:19:39 PM                                                                                                                    
Dr. Singleton discussed Slide 5, "Diphtheria":                                                                                  
     ·  In 1925 a  diphtheria epidemic threatened  Nome. The                                                                    
        nearest serum was in Anchorage.                                                                                         
     ·  A relay of dog teams rushed  the vaccine from Nenana                                                                    
        to Nome.                                                                                                                
     ·  The serum arrived  in time  to prevent  the epidemic                                                                    
        and save hundreds of lives.                                                                                             
     ·  Today diphtheria is a disease of the past because of                                                                    
     ·  However, a  US citizen  who had  refused Td  vaccine                                                                    
        died from diphtheria after visiting Haiti.                                                                              
5:19:51 PM                                                                                                                    
Dr. Singleton addressed Slide 6, "Hib Disease":                                                                                 
     ·  Haemophilus   influenzae   type   b   (Hib)   causes                                                                    
        meningitis, pneumonia, cellulitis, epiglottitis  and                                                                    
        sepsis in infants & children.                                                                                           
     · Alaska Native Hib disease before Vaccine                                                                                 
     ·  5-10 times  higher  rate of  disease  than other  US                                                                    
     · Younger peak age (4-6 months)                                                                                            
     · Since Hib Vaccine: Hib disease has decreased >95%                                                                        
5:20:30 PM                                                                                                                    
Dr. Singleton addressed Slide 7, "Hepatitis A and B in                                                                          
     · In 1970s-80 Alaska Natives had the highest rate of                                                                       
        hepatitis B infection and liver cancer  any non-                                                                        
        immigrant group in US                                                                                                   
     · Alaska also had the highest rates of hepatitis A                                                                         
        infections in US in most years up to 1995.                                                                              
     · Universal vaccination and School requirements have                                                                       
        eliminated spread of hepatitis A and B in Alaska                                                                        
          o Alaska Native people have the lowest hepatitis                                                                      
             B infection rate of any US ethnicity:                                                                              
          o Alaska has one of the lowest rates of hepatitis                                                                     
             A infection of any state.                                                                                          
5:20:59 PM                                                                                                                    
Dr. Singleton spoke to Slide 8, "Measles":                                                                                      
     · Measles causes a rash, fever, pneumonia and                                                                              
        diarrhea, and can leave children blind, deaf or                                                                         
        brain damaged.                                                                                                          
     · Measles deaths have decreased globally by 74%, but                                                                       
        measles still kills 450 people each day.                                                                                
     · Although measles is imported into the United States                                                                      
        every week, Alaska has had no measles since 2000 -                                                                      
        thanks to our 2 dose MMR school requirement                                                                             
Dr. Singleton  related that she  supported the  bill because                                                                    
she  understood that  providers  had to  front  the cost  of                                                                    
vaccines  and keep  separate stocks  of  private and  public                                                                    
vaccines. She  noted that some  providers were  finding that                                                                    
the  cost  and   administrative  headaches  associated  with                                                                    
vaccinations were  prohibitive. She  believed that  the bill                                                                    
would streamline the process  and provide a self-sustaining,                                                                    
cost saving model that would  improve access to vaccines for                                                                    
all Alaskans.                                                                                                                   
5:22:12 PM                                                                                                                    
Co-Chair Meyer  announced that the committee  would continue                                                                    
with  the  public  testimony   before  introducing  the  new                                                                    
committee substitute for the bill.                                                                                              
5:22:37 PM                                                                                                                    
PHYLLIS   ARTHUR,   BIOTECHNOLOGY   INDUSTRY   ORGANIZATION,                                                                    
WASHINGTON D.C. (via teleconference), read from a prepared                                                                      
document (copy on file):                                                                                                        
     Mr. Chairman and Committee members,  my name is Phyllis                                                                    
     Arthur  and  I  represent  the  Biotechnology  Industry                                                                    
     Organization (BIO)  and I  am here  to speak  on Senate                                                                    
     Bill 169.                                                                                                                  
     BIO opposes Senate Bill (S.B.)  169. While we recognize                                                                    
     and  share   the  State's   goals  of   increasing  the                                                                    
     administrative  ease  of   vaccine  administration  and                                                                    
     achieving  high  vaccination   rates,  we  believe  the                                                                    
     proposed   program  would   result  in   an  additional                                                                    
     administrative burden for  the State, create redundancy                                                                    
     relative  to the  Affordable Care  Act  (ACA) and  have                                                                    
     very   little  impact   on  immunization   rates  among                                                                    
     America's   vaccine   manufacturers  strongly   support                                                                    
     efforts by states to  increase immunization rates among                                                                    
     people  of  all  ages.   We  work  closely  with  state                                                                    
     governments,  insurers and  other vaccine  stakeholders                                                                    
     to develop  and implement solutions that  are proven to                                                                    
     increase  access to  immunizations through  sustainable                                                                    
     public-private partnerships.                                                                                               
     I would like to discuss three key issues:                                                                                  
          1.   UP  programs  have  not  actually  helped  to                                                                    
          increase immunization rates;                                                                                          
          2.   The  implementation of  this program  may not                                                                    
          actually   solve  the   current  issues   of  many                                                                    
          providers; and                                                                                                        
          3.   Providing   private    insurers   access   to                                                                    
          federally   discounted    vaccine   intended   for                                                                    
          disadvantaged   children  runs   counter  to   the                                                                    
          original intent of the VFC  program and provides a                                                                    
          pass  through  to  insurers   at  the  expense  of                                                                    
          vaccine companies.                                                                                                    
     The UP  program created by  S.B. 169, will  most likely                                                                    
     not lead to higher immunization rates.                                                                                     
          o    For 30  years, Alaska had a  full UP program.                                                                    
          Higher  immunization  rates along  with  increased                                                                    
          access  to  vaccines  have  long  been  touted  as                                                                    
         benefits of universal purchase programs.                                                                               
          o    However,  according  to  2012 data  from  the                                                                    
          CDC, only  3 UP states  were ranked among  the top                                                                    
          10  states nationally  for childhood  immunization                                                                    
          rates  while another  3 UP  states were  ranked in                                                                    
          the bottom 10.[1]                                                                                                     
          o    From 2000  to 2009  Alaska ranked at  or well                                                                    
          below  the U.S.  average for  all standard  series                                                                    
          o    In 2012,  the year for which  the most recent                                                                    
          CDC data  is available, the  estimated vaccination                                                                    
          coverage rate among children  aged 19-35 months in                                                                    
          Alaska  was 59.5%,  the lowest  in the  nation for                                                                    
          the standard series. . [2]                                                                                            
     The Affordable Care Act (ACA) has addressed many of                                                                        
     the financial barriers to immunization affecting                                                                           
     patients by requiring private insurers to cover ACIP-                                                                      
     recommended  vaccines  for  children,  adolescents  and                                                                    
     adults   with   no   out-of-pocket   expense   and   no                                                                    
     deductible.     While  there  are  still   some  issues                                                                    
     affecting providers, UP programs  may not help to solve                                                                    
     these problems.                                                                                                            
          o    The ability of the  state to assess all types                                                                    
          of  insurance plans  in the  state is  unclear and                                                                    
          may not  be allowed under  federal law.   This may                                                                    
          result  in  a   multi-tiered  immunization  system                                                                    
          where  providers  still  must access  the  private                                                                    
          sector for some patients  or specific vaccines but                                                                    
          with smaller volumes.                                                                                                 
          o    In addition providers  will still be required                                                                    
          to screen patients  for eligibility, stock private                                                                    
          sector  doses   for  children  and   adults  whose                                                                    
          insurance plan  is not paying into  the assessment                                                                    
          pool, submit  for reimbursement  and track  use of                                                                    
          these doses.  Moreover, providers will  still need                                                                    
          to bill for the administration of vaccines.                                                                           
          o    Lastly UP programs  often burden state health                                                                    
          departments  with  the  additional  administrative                                                                    
          costs  of  managing  the vaccine  supply  for  the                                                                    
          entire  state, such  as  warehousing and  shipping                                                                    
          doses  to  multiple  sites.    Accountability  for                                                                    
          ordering, storing,  tracking and  shipping vaccine                                                                    
          ultimately  rests with  the  Alaska Department  of                                                                    
          Heath  during a  time when  public sector  funding                                                                    
          for infrastructure is being cut.                                                                                      
     Lastly  this type  of UP  program, tax  assessments and                                                                    
     insurance  pools, create  a pass  through of  a federal                                                                    
     discount intended for vulnerable populations.                                                                              
          o    Parents and employers  pay premiums for their                                                                    
          immunization  coverage,  so  the vaccine  cost  is                                                                    
          already paid for,  as is the visit and  all of the                                                                    
          other medical care.                                                                                                   
          o    Vaccine costs  are not a high  or significant                                                                    
          cost  for  insurers  as  a  portion  of  insurance                                                                    
          premiums.   In fact a  2009 HHS study  showed that                                                                    
          vaccine coverage accounts for  only 0.8% of family                                                                    
          o    Health  plans  reap  the  benefits  of  fully                                                                    
          immunized   populations   through  reductions   in                                                                    
          health  expenditures for  hospitalizations, office                                                                    
          visits, testing, and treatment.                                                                                       
     America's   vaccine   manufacturers  are   continuously                                                                    
     investing  in  both  existing   and  new  vaccines  for                                                                    
     children,  adolescents  and  adults.     This  is  only                                                                    
     possible when  there is a sustained,  viable market for                                                                    
     these vital public health products.                                                                                        
     BIO  believes that  a private  sector  solution can  be                                                                    
     found   that  solves   the   issues   of  all   vaccine                                                                    
     stakeholders  -   patients,  providers,   insurers  and                                                                    
     vaccine  manufacturers.   We have  worked closely  with                                                                    
     states to develop public- private  solutions to many of                                                                    
     these  same  problems.  For example,  in  Colorado  BIO                                                                    
     works with  a large  coalition of  vaccine stakeholders                                                                    
     to develop  a set of  recommendations for the  state on                                                                    
     ways to  increase immunization access  and rates.   The                                                                    
     group   is   evaluating  unique   contracting   options                                                                    
     specifically  targeted  to  small volume  providers  in                                                                    
     rural and underserved  areas, researching organizations                                                                    
     that  can  help  providers with  billing  of  insurance                                                                    
     plans  and developing  better educational  programs for                                                                    
     provider offices and staff.   We are working on similar                                                                    
     programs in California and New Mexico.                                                                                     
     Thank you again for this opportunity to share our                                                                          
     issues.  I will be glad to answer any questions.                                                                           
5:30:00 PM                                                                                                                    
DR.  WARD HURLBURT,  CHIEF  MEDICAL  OFFICER, DEPARTMENT  OF                                                                    
HEALTH AND  SOCIAL SERVICES, spoke  in support of  the bill.                                                                    
He agreed the partnerships  that medical profession had with                                                                    
the  pharmaceutical  industry  had   been  one  of  the  key                                                                    
breakthroughs  in  supplying  vaccinations. He  shared  that                                                                    
Small Pox was seen in humans  around 10,000 B.C. and that in                                                                    
the earliest  days of America;  about 500,000  Europeans per                                                                    
year were  dying of Small pox.  He related that even  in the                                                                    
19th century  500 million people  per year  contracted Small                                                                    
Pox,  1  million died.  He  explained  that in  1796  Edward                                                                    
Jenner, an  English physician, observed that  milkmaids were                                                                    
not contracting Small Pox because  the Cow Pox on the udders                                                                    
was protective. In 1979 the  World Health Organization (WHO)                                                                    
stated that Small  Pox had been eradicated from  the face of                                                                    
the  earth; the  only  people who  were currently  immunized                                                                    
were  research scientists.  He said  that Polio  eradication                                                                    
was  on  the  horizon,  which was  endemic  in  Afghanistan,                                                                    
Pakistan  and  Nigeria. He  reiterated  that  that the  bill                                                                    
would create  a public/private partnership, modeled  on what                                                                    
other  states had  done. He  stated that  New Hampshire  had                                                                    
participated in a similar program  for one year and had seen                                                                    
a 20  percent increase  in their immunization  rates, second                                                                    
only to Hawaii.  He noted that Alaska was cited  in 2012 for                                                                    
having the  worst infant  immunizations rates;  however, the                                                                    
data  had  been incorrect  and  CDC  had made  an  erroneous                                                                    
presumption. He  said that Alaska  was now number  38, which                                                                    
was a significant improvement from  the past. He stated that                                                                    
the bill  had support from the  Alaska Pediatric Association                                                                    
and a  number of other groups.  He stated that the  money to                                                                    
buy the  vaccine would be  recovered through a  surcharge on                                                                    
the  payers.  He  relayed  that  the  department  wanted  to                                                                    
eventually  include  adults,  but  that  children  were  the                                                                    
5:36:52 PM                                                                                                                    
Dr.  Hurlburt stated  that the  program  could be  run as  a                                                                    
public/private partnership  without accessing  state general                                                                    
funds and that less than 1.5  percent of the funds would pay                                                                    
for the storage  fees for procurement through  the depot. He                                                                    
believed that  the bill would  reduce costs for  the public,                                                                    
while also benefiting  pharmaceutical companies. The program                                                                    
would not be mandatory.                                                                                                         
5:38:02 PM                                                                                                                    
Senator Olson inquired  how many of the  vaccines covered by                                                                    
the  bill  were  required  for  children  to  attend  public                                                                    
Dr.  Hurlburt  replied that  all  of  the required  vaccines                                                                    
would be covered under the legislation.                                                                                         
5:39:11 PM                                                                                                                    
Senator Olson inquired how high  the hepatitis A vaccine was                                                                    
on the priority list.                                                                                                           
Dr. Hurlburt replied  that it was one of  the most effective                                                                    
vaccines and would be a high priority.                                                                                          
5:39:36 PM                                                                                                                    
Senator Olson shared that, in  his experience, children with                                                                    
Hepatitis A  did not exhibit  any symptoms,  unlike infected                                                                    
adults.  He   queried  if   vaccinating  children   was  the                                                                    
priority,  why  would  the   Hepatitis  A  vaccination  take                                                                    
precedence over other vaccinations.                                                                                             
Dr. Hurlburt replied  that it would be  prioritized based on                                                                    
cost  effectiveness.   Hepatitis  A  could  spread   by  the                                                                    
ingestion  of contaminated  water and  that put  children at                                                                    
high risk, particularly in rural areas.                                                                                         
5:40:53 PM                                                                                                                    
PATRICIA   SENNER,   NURSE  PRACTITIONER,   ALASKA   NURSE'S                                                                    
ASSOCIATION,  ANCHORAGE  (via  teleconference),  voiced  the                                                                    
Alaska  Nurse's   Association's  support  of  SB   168.  She                                                                    
attested  to the  difficulty of  providing immunizations  to                                                                    
those  at most  risk.  She said  that she  had  to keep  two                                                                    
separate  sets of  vaccines  in her  clinic:  one for  those                                                                    
eligible for  vaccines through state  programs, and  one for                                                                    
those  who  were  ineligible.   She  opined  that  providing                                                                    
vaccinations to the public was  challenging. She stated that                                                                    
the cost difference between the  price of vaccinations under                                                                    
the legislation  and the  current cost to  her as  a private                                                                    
provider  was tremendous.  She  concluded  that the  program                                                                    
would be an immense help to private providers.                                                                                  
5:43:16 PM                                                                                                                    
Co-Chair Meyer CLOSED public testimony.                                                                                         
5:43:30 PM                                                                                                                    
Vice-Chair Fairclough MOVED to  ADOPT the proposed committee                                                                    
substitute  for  SB  169, WORK  DRAFT  28-LS1219\I  (Mischel                                                                    
3/5/14) as a working document.  There being NO OBJECTION, it                                                                    
was so ordered.                                                                                                                 
5:43:55 PM                                                                                                                    
AT EASE                                                                                                                         
5:44:38 PM                                                                                                                    
5:44:45 PM                                                                                                                    
CHRISTINE MARASIGAN,  STAFF, SENATOR  KEVIN MEYER,  spoke to                                                                    
the  changes in  the new  committee substitute.  She related                                                                    
that  the only  change could  be  found on  Page 5,  section                                                                    
18.09.230. She  said that the  language had been  changed in                                                                    
order to reflect more flexibility  in accounting by allowing                                                                    
the state  to capitalize a  fund for the  vaccine assessment                                                                    
fund. The  changes in the  bill addressed concerns  with the                                                                    
previous fiscal note attached to the bill.                                                                                      
5:46:53 PM                                                                                                                    
DAVID  TEAL, DIRECTOR,  LEGISLATIVE FINANCE  DIVISION, spoke                                                                    
to the  fiscal notes attached  to the bill. He  related that                                                                    
the fiscal  notes were  complicated because  the bill  was a                                                                    
fund capitalization,  which caused  money to move  around in                                                                    
ways  that were  not typical  for  a fiscal  note; this  was                                                                    
caused by the language that  Ms. Marasigan had mentioned. He                                                                    
explained that  there could not  be a mixture  of duplicated                                                                    
and unduplicated  funds going out  with a single  fund code.                                                                    
He referenced the fiscal note labeled "fund caps".                                                                              
Co-Chair Meyer noted  that the note had a date  of 3/5/14 at                                                                    
the bottom.                                                                                                                     
5:48:38 PM                                                                                                                    
Mr. Teal that the words "fund  cap" could be found under the                                                                    
department affected on the note.                                                                                                
5:49:05 PM                                                                                                                    
AT EASE                                                                                                                         
5:49:37 PM                                                                                                                    
5:49:44 PM                                                                                                                    
Mr.  Teal noted  that the  top of  the note  reflected $31.5                                                                    
million in  expenditures. He  said that  the $.5  million in                                                                    
general funds going  in to the account, with  $27 million of                                                                    
the  vaccine  assessment  program receipts  going  into  the                                                                    
account   as   well;   both   would   appear   as   language                                                                    
appropriations because it was  a fund capitalization and was                                                                    
contingent on  passage. He stressed that  both general funds                                                                    
and  the program  receipts would  be  appropriated into  the                                                                    
5:50:36 PM                                                                                                                    
Mr.  Teal  discussed the  other  draft  fiscal note  labeled                                                                    
"epidemiology."  He  noted  that  the $4.5  million  in  the                                                                    
operating  expenditures portion  of the  note was  currently                                                                    
included in  the governor's FY15  requested budget.  He said                                                                    
that the  money would come  from the agency and  go directly                                                                    
into  the  account,  mirroring   the  number  found  on  the                                                                    
previously  discussed fiscal  note. He  noted the  use of  a                                                                    
temporary code, which reflected  $31.5 million, and would be                                                                    
replaced with  the vaccine assessment account  when the bill                                                                    
passed. He  furthered that  the money  in the  account would                                                                    
not lapse;  a specific  amount could  be appropriated  in an                                                                    
appropriation  bill, or  an  estimated  amount, which  would                                                                    
allow the  department the flexibility  to spend  all program                                                                    
receipts should they have higher receipts than anticipated.                                                                     
5:52:58 PM                                                                                                                    
Co-Chair Meyer pointed out to  the committee that the backup                                                                    
reflected a net zero fiscal note.                                                                                               
Mr. Teal replied in the affirmative.                                                                                            
Co-Chair Meyer wondered if there  was a less complicated way                                                                    
to set up the fund.                                                                                                             
Mr. Teal understood  that the general fund  money going into                                                                    
the  general   fund  was  seed  money;   vaccines  would  be                                                                    
purchased  and  then  provider would  use  the  vaccine  and                                                                    
replace those funds,  and the cycle would  continue as such.                                                                    
How many times the money would circulate was unknown.                                                                           
5:55:40 PM                                                                                                                    
AT EASE                                                                                                                         
5:55:58 PM                                                                                                                    
5:56:08 PM                                                                                                                    
Co-Chair  Kelly  MOVED  to  REPORT   CSSB  169(FIN)  out  of                                                                    
committee   with   individual    recommendations   and   the                                                                    
accompanying fiscal notes. There  being NO OBJECTION, it was                                                                    
so ordered.                                                                                                                     
5:56:16 PM                                                                                                                    
CSSB  169(FIN) was  REPORTED  out of  committee  with a  "do                                                                    
pass"  recommendation   and  with  a   previously  published                                                                    
indeterminate fiscal note:  FN5(ADM), a previously published                                                                    
zero fiscal  note: FN4(CED), a  new fiscal impact  note from                                                                    
Department  of  Health and  Social  Services,  a new  fiscal                                                                    
impact note  from Department of Health  and Social Services,                                                                    
and  with an  indeterminate  fiscal not  from Department  of                                                                    
Health and Social Services.                                                                                                     

Document Name Date/Time Subjects
SB 129 Sponsor Statement.pdf SFIN 3/5/2014 5:00:00 PM
SB 129
SB 129 Supp Doc-DCCED BCREA Audit 2013.pdf SFIN 3/5/2014 5:00:00 PM
SB 129
SB191-DOR-TRS-02-28-14.pdf SFIN 3/5/2014 5:00:00 PM
SB 191
sectional analysis sb 191 updated march 3.pdf SFIN 3/5/2014 5:00:00 PM
SB 191
sponsor statement sb 191 updated march 3.pdf SFIN 3/5/2014 5:00:00 PM
SB 191
SB 161 ACOA support.pdf SFIN 3/5/2014 5:00:00 PM
SB 161
SB 161 AFN Support.pdf SFIN 3/5/2014 5:00:00 PM
SB 161
SB 161 BBNC support.pdf SFIN 3/5/2014 5:00:00 PM
SB 161
CS SB 129(FIN) work draft version P.pdf SFIN 3/5/2014 5:00:00 PM
SB 129
CS SB 161(FIN) work draft version N.pdf SFIN 3/5/2014 5:00:00 PM
SB 161
CS SB 169(FIN) work draft version I.pdf SFIN 3/5/2014 5:00:00 PM
SB 169
SB191 Amendment 1 - Senate Finance Committee.pdf SFIN 3/5/2014 5:00:00 PM
SB 191
CS SB 129 New Sponsor Statement.pdf SFIN 3/5/2014 5:00:00 PM
SB 129
CS SB129 New Sectional Analysis.pdf SFIN 3/5/2014 5:00:00 PM
SB 129
SB 129 APR Summary of Changes 2-17-13a.pdf SFIN 3/5/2014 5:00:00 PM
SB 129
SB161CS(FIN)-DHSS-SMEO-03-05-14.pdf SFIN 3/5/2014 5:00:00 PM
SB 161