Legislature(2005 - 2006)BUTROVICH 205

04/26/2006 01:30 PM HEALTH, EDUCATION & SOCIAL SERVICES


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01:34:33 PM Start
01:37:27 PM SCR28
01:39:35 PM SB281
02:06:21 PM Overview: Obesity Prevention – American Heart Association
02:52:16 PM HB258
03:01:11 PM HB393
03:28:01 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= SCR 28 TECHNOLOGY FOR DISTANCE EDUCATION TELECONFERENCED
Heard & Held
+= SB 281 SCHOOL DIST. ENROLLMENT SHARING/CORRESPON TELECONFERENCED
Heard & Held
+ OVERVIEW: American Heart Association - TELECONFERENCED
Obesity Prevention
+ HB 258 SEXUAL ASSAULT BY PERSON WITH HIV/AIDS TELECONFERENCED
Moved CSHB 258(JUD) Out of Committee
+ HB 393 INSURANCE FOR COLORECTAL CANCER SCREENING TELECONFERENCED
Heard & Held
+ Bills Previously Heard/Scheduled TELECONFERENCED
    CSHB 393(HES)-INSURANCE FOR COLORECTAL CANCER SCREENING                                                                 
                                                                                                                                
CHAIR DYSON announced CSHB 393(HES) to be up for consideration.                                                                 
                                                                                                                                
HEATH  HILYARD, Staff  to Representative  Anderson,  said that  a                                                               
blank committee  substitute (CS)  for the  bill was  submitted to                                                               
the committee.   He remarked  that he  would like to  explain the                                                               
changes within the CS.                                                                                                          
                                                                                                                                
CHAIR DYSON  moved to adopt  SCS CSHB  393(HES), version L  of as                                                               
the committee's  working document.   He objected for  the purpose                                                               
of discussion.                                                                                                                  
                                                                                                                                
MR.  HILYARD said  that the  only substantial  difference between                                                               
version L  and the  previous version  could be  found on  page 2,                                                               
beginning on line 21.   The change clarifies that notification is                                                               
the responsibility  of the employer,  not the  insurance company,                                                               
unless the  policy is being  purchased directly by  an individual                                                               
from  the  company,  in  which  case  the  standard  notification                                                               
process is in place.                                                                                                            
                                                                                                                                
He said  that colorectal  cancer is the  second leading  cause of                                                               
cancer  deaths in  Alaska  and Alaska  Natives  have the  highest                                                               
rates of  colorectal cancer in  the country.   He added  that the                                                               
survival rate for colorectal cancer  when caught at the localized                                                               
stage through  routine screening  is over 90  percent but,  if it                                                               
progresses to  advanced stages, the  survival rate is  only about                                                               
10 percent.                                                                                                                     
                                                                                                                                
MR.  HILYARD   said  that  colonoscopies  are   over  90  percent                                                               
effective at  detecting colon cancer and  can remove precancerous                                                               
polyps.    Screening  is  cost  effective  and  national  studies                                                               
confirm that the cost of  these screenings is minimal when spread                                                               
across the insured population.                                                                                                  
                                                                                                                                
SENATOR OLSON  asked what is  the incidence of  complications for                                                               
colonoscopies.                                                                                                                  
                                                                                                                                
MR. HILYARD replied that he could not answer that question.                                                                     
                                                                                                                                
SENATOR  ELTON asked  whether  this bill  allows  the insurer  to                                                               
choose a particular screening method.                                                                                           
                                                                                                                                
3:01:11 PM                                                                                                                    
                                                                                                                                
MR.  HILYARD   replied  that  language   in  the   original  bill                                                               
specifying the  four available  methods for  colorectal screening                                                               
was  removed  in  the CS.    He  added  that  page 2  of  the  CS                                                               
references  the  use of  the  test  recommended in  the  American                                                               
Cancer  Society (ACS)  guidelines for  colorectal screening.   He                                                               
remarked  that many  of the  major insurance  providers recognize                                                               
this test as the gold standard for the procedure.                                                                               
                                                                                                                                
SENATOR ELTON  asked if he  is correct in his  understanding that                                                               
passage of  the bill would  require insurance companies  to cover                                                               
any one of the four procedures.                                                                                                 
                                                                                                                                
MR. HILYARD replied yes.                                                                                                        
                                                                                                                                
CHAIR  DYSON asked  Ms. Millhorn  whether the  administration has                                                               
taken a position on the bill.                                                                                                   
                                                                                                                                
MELANIE MILLHORN, Director, Division  of Retirement and Benefits,                                                               
replied that her division has not  taken a policy position on the                                                               
bill.                                                                                                                           
                                                                                                                                
CHAIR  DYSON  asked whether  this  legislation  would affect  the                                                               
state's retirement system.                                                                                                      
                                                                                                                                
MS. MILLHORN  replied that  her division  has concluded  that the                                                               
bill  would have  no impact  on  the state's  active and  retiree                                                               
plans because those plans are not regulated under AS.21.42.                                                                     
                                                                                                                                
3:04:25 PM                                                                                                                    
                                                                                                                                
CHAIR  DYSON asked  whether the  state has  adopted the  mandates                                                               
that it has placed on the insurance industry.                                                                                   
                                                                                                                                
MS.  MILLHORN   remarked  that  only  the   Commissioner  of  the                                                               
Department of  Administration has  the authority to  make changes                                                               
to  the state's  active and  retiree plans.   She  said that  the                                                               
State has  voluntarily adopted some  of the mandated  coverage it                                                               
has  imposed  such  as  mammograms,   pap  smears,  and  prostate                                                               
specific antigen testing.                                                                                                       
                                                                                                                                
CHAIR DYSON asked whether  the administration considered amending                                                               
section 39, as well as 42.                                                                                                      
                                                                                                                                
MR. HILYARD replied that they had not made that consideration.                                                                  
                                                                                                                                
SENATOR  ELTON asked  whether the  commissioner  could exclude  a                                                               
benefit from a plan once it had been adopted.                                                                                   
                                                                                                                                
MS. MILLHORN replied  that might be considered  a diminishment of                                                               
benefits. The Alaska Supreme Court  ruled that the advantages and                                                               
disadvantages of changes  to the retiree health  plan must offset                                                               
one  another.   She added  that colorectal  screening is  covered                                                               
under the State's  active plan so long as a  provider requests it                                                               
and it occurs  within 30 days of the employee's  annual exam, but                                                               
that  preventative colorectal  screening is  not available  under                                                               
the retiree plan except for retirees with a related diagnosis.                                                                  
                                                                                                                                
3:08:25 PM                                                                                                                    
                                                                                                                                
SENATOR  ELTON   asked  whether   the  bill   requires  insurance                                                               
companies to pay the entire cost of colorectal cancer screening.                                                                
                                                                                                                                
MR. HILYARD replied  that on page 2, beginning on  lines 1 and 2,                                                               
the  bill states  that  the standard  policy  provisions and  the                                                               
deductible  and copayment  provisions shall  stay in  place.   He                                                               
added that the  sponsor had not considered  a specific percentage                                                               
structure for additional costs.                                                                                                 
                                                                                                                                
SENATOR  ELTON remarked  that his  provider  recommended that  he                                                               
have   his  procedure   performed  in   Seattle  because   it  is                                                               
significantly cheaper  there than  in Juneau.   He  asked whether                                                               
the bill takes prevailing costs into account.                                                                                   
                                                                                                                                
MR. HILLARD replied that is not addressed in the bill.                                                                          
                                                                                                                                
CHAIR  DYSON  remarked  that his  wife's  procedure  cost  nearly                                                               
$5,000,  which  was  outrageous.    He  asked  whether  there  is                                                               
anything the  legislature could do  to address  excessive billing                                                               
from providers.                                                                                                                 
                                                                                                                                
3:12:08 PM                                                                                                                    
                                                                                                                                
MS. MILLHORN  replied that  that the  state could  advertise cost                                                               
differences in their news breaks.   She added that there are ways                                                               
that the  third party administrator could  negotiate some charges                                                               
through  network savings  and similar  measures on  an individual                                                               
basis.                                                                                                                          
                                                                                                                                
3:13:15 PM                                                                                                                    
                                                                                                                                
CHAIR DYSON  remarked that  someone ought  to review  the medical                                                               
invoices  of State  employees to  ensure that  all of  the billed                                                               
expenses are legitimate.                                                                                                        
                                                                                                                                
MS. MILLHORN replied  that the division looks into  some of those                                                               
areas, and added  that the state is adopting  another third party                                                               
administrator  from which  it expects  to  receive some  benefits                                                               
that will  save the state money.   She said that  the division is                                                               
considering  making changes  to its  plan configuration  to cover                                                               
air  travel  to places  that  offer  procedures at  significantly                                                               
lower rates.                                                                                                                    
                                                                                                                                
3:15:46 PM                                                                                                                    
                                                                                                                                
CHAIR DYSON asked whether any  representatives from the insurance                                                               
industry were scheduled to testify on this bill.                                                                                
                                                                                                                                
MR. HILYARD replied no.                                                                                                         
                                                                                                                                
CHAIR DYSON asked whether any  representatives from the insurance                                                               
industry had testified on the bill in previous hearings.                                                                        
                                                                                                                                
MR. HILYARD  replied that representatives from  the industry were                                                               
present  at several  of the  House committee  meetings where  the                                                               
bill was discussed.   He said Mr. Reed Stoops  of AETNA testified                                                               
that  his organization  had  concerns about  a  section that  has                                                               
since been changed in the CS.   He said that other than that they                                                               
did not have any opposition to  the bill.  He remarked that AETNA                                                               
and  Blue Cross  already provide  coverage for  the screening  in                                                               
their standard policies.                                                                                                        
                                                                                                                                
3:17:02 PM                                                                                                                    
                                                                                                                                
CHAIR  DYSON  remarked that  he  hates  putting mandates  on  the                                                               
private sector,  and that if  spending the  money on the  test is                                                               
going  to  provide  better  health  outcomes  for  patient-client                                                               
policyholders, and save  the insurance company money  in the long                                                               
term, all responsible insurance companies should be doing it.                                                                   
                                                                                                                                
He related  a conversation he had  with insurance representatives                                                               
five  or  six  years  ago  when dealing  with  this  issue.  They                                                               
admitted that the  screening is good for them  and their clients,                                                               
but wanted  to be sure that  everyone would be required  to cover                                                               
it so that they would not be at a cost disadvantage.                                                                            
                                                                                                                                
MR.  HILYARD said  that a  number of  members in  the other  body                                                               
expressed the same philosophical  approach.  The sponsor's office                                                               
has worked with members of  the insurance industry to satisfy any                                                               
concerns with minimal impact, yet  benefit the public health.  He                                                               
restated  that  while he  has  not  received comment  from  small                                                               
private  insurers, the  two major  providers in  this state  have                                                               
expressed their satisfaction with the bill.                                                                                     
                                                                                                                                
3:19:15 PM                                                                                                                    
                                                                                                                                
CHAIR DYSON  asked whether Linda  Hall, Director of  the Division                                                               
of Insurance (DOI), has commented on this bill.                                                                                 
                                                                                                                                
MR. HILYARD  replied that  DOI believes this  bill would  have no                                                               
fiscal impact.  He said that  she did not offer a policy position                                                               
on the bill.                                                                                                                    
                                                                                                                                
SENATOR ELTON referenced a statement  from Blue Cross/Blue Shield                                                               
of Alaska  that it currently  covers colorectal screening  on all                                                               
of  its plans.  He asked  whether  this benefit  would extend  to                                                               
retirees  without  the  Commissioner's acceptance  of  colorectal                                                               
coverage,  if the  state  adopts Blue  Cross/Blue  Shield as  its                                                               
third party administrator.                                                                                                      
                                                                                                                                
MR.  HILYARD replied  that active  members are  currently covered                                                               
for this screening, but retirees are not.                                                                                       
                                                                                                                                
SENATOR ELTON  said he understood  that active state  members are                                                               
only  covered if  a physician  asks  for the  screening but  this                                                               
legislation would  provide that they would  be covered regardless                                                               
of whether or not a physician requests the procedure.                                                                           
                                                                                                                                
MR. HILYARD replied that is correct.                                                                                            
                                                                                                                                
3:22:23 PM                                                                                                                    
                                                                                                                                
MOLLY McCAMMON, Juneau resident, testified  in support of HB 393,                                                               
saying that she is living proof that screening saves lives.                                                                     
                                                                                                                                
                                                                                                                                
DARYL McCLENDON,  MD, testified in  support of  HB 393.   He said                                                               
that  coverage  for  colorectal   screening  is  financially  and                                                               
medically prudent  since the lifetime  risk of  colorectal cancer                                                               
is high, one in twenty, and the incidence of survival is much                                                                   
higher when it is caught in the early stages of its development.                                                                
                                                                                                                                
CHAIR DYSON said that the cost of the screening seems to be                                                                     
inordinately expensive in Anchorage and asked whether quality                                                                   
testing is available in other locations.                                                                                        
                                                                                                                                
DR. McCLENDON replied that he did not know how the costs in                                                                     
Anchorage compare to costs in other areas.                                                                                      
                                                                                                                                
CHAIR DYSON thanked the witness for his work in Alaska and                                                                      
announced that the bill would be held in committee.                                                                             
                                                                                                                                

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