Legislature(2013 - 2014)HOUSE FINANCE 519

02/25/2014 01:30 PM FINANCE


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01:33:16 PM Start
01:33:30 PM SB49
02:59:30 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Bills Previously Heard/Scheduled TELECONFERENCED
+= SB 49 MEDICAID PAYMENT FOR ABORTIONS; TERMS TELECONFERENCED
Heard & Held
                  HOUSE FINANCE COMMITTEE                                                                                       
                     February 25, 2014                                                                                          
                         1:33 p.m.                                                                                              
                                                                                                                                
                                                                                                                                
1:33:16 PM                                                                                                                    
                                                                                                                                
CALL TO ORDER                                                                                                                 
                                                                                                                                
Co-Chair Stoltze called the House Finance Committee meeting                                                                     
to order at 1:33 p.m.                                                                                                           
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Alan Austerman, Co-Chair                                                                                         
Representative Bill Stoltze, Co-Chair                                                                                           
Representative Mark Neuman, Vice-Chair                                                                                          
Representative Mia Costello                                                                                                     
Representative Bryce Edgmon                                                                                                     
Representative Les Gara                                                                                                         
Representative David Guttenberg                                                                                                 
Representative Lindsey Holmes                                                                                                   
Representative Cathy Munoz                                                                                                      
Representative Steve Thompson                                                                                                   
Representative Tammie Wilson                                                                                                    
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
None                                                                                                                            
                                                                                                                                
ALSO PRESENT                                                                                                                  
                                                                                                                                
Michael   Barnhill,  Deputy   Commissioner,  Department   of                                                                    
Administration; William Streur,  Commissioner, Department of                                                                    
Health   and  Social   Services;  Stacie   Kraly,  Assistant                                                                    
Attorney of  Law, Department of  Law; Senator  John Coghill;                                                                    
Representative Gabrielle Ledoux.                                                                                                
                                                                                                                                
SUMMARY                                                                                                                       
                                                                                                                                
SSSB 49 (FIN)                                                                                                                   
          MEDICAID PAYMENT FOR ABORTIONS; TERMS                                                                                 
                                                                                                                                
          SSSB 49 (FIN) was HEARD and HELD in committee for                                                                     
          further consideration.                                                                                                
                                                                                                                                
                                                                                                                                
SPONSOR SUBSTITUTE FOR SENATE BILL NO. 49 am                                                                                  
                                                                                                                                
     "An Act relating to women's health services and                                                                            
     defining 'medically necessary abortion' for purposes                                                                       
     of making payments under the state Medicaid program."                                                                      
                                                                                                                                
1:33:30 PM                                                                                                                    
                                                                                                                                
Co-Chair  Stoltze  continued  deliberations  on  HB  49.  He                                                                    
invited  the   administration  to  testify   and  introduced                                                                    
committee members.                                                                                                              
                                                                                                                                
Representative  Wilson asked  if  the "medically  necessary"                                                                    
clause could be used for both state insurance and Medicaid.                                                                     
                                                                                                                                
MICHAEL   BARNHILL,  DEPUTY   COMMISSIONER,  DEPARTMENT   OF                                                                    
ADMINISTRATION,  replied   that  the  legislature   had  the                                                                    
ability  to clarify  a definition  applying  to the  state's                                                                    
employee health  plan. He offered  to discuss  the potential                                                                    
to amend the state's health care plan.                                                                                          
                                                                                                                                
Representative Wilson appreciated the  effort. She wished to                                                                    
clarify  the definition  of "medically  necessary" for  both                                                                    
Medicaid and the state health plan.                                                                                             
                                                                                                                                
1:37:00 PM                                                                                                                    
                                                                                                                                
Mr.  Barnhill discussed  statistics related  to the  state's                                                                    
employee  health plan,  AlaskaCare. He  listed seven  claims                                                                    
for induced  abortions in  2010, five  were denied,  one was                                                                    
approved,  reviewed   and  denied,   and  the   seventh  was                                                                    
processed incorrectly.  He stated that most  insurance plans                                                                    
required   medical  procedures   to   be  deemed   medically                                                                    
necessary.  He  wished  to  identify  a  more  concrete  and                                                                    
explicit definition  of the  term "medically  necessary." He                                                                    
added that  all claims submitted  for abortion in  2011 were                                                                    
denied.                                                                                                                         
                                                                                                                                
Mr. Barnhill  stated that insurance  plans preferred  not to                                                                    
pay for care that was  not certified as medically necessary.                                                                    
He  pointed  out  other medical  procedures  that  were  not                                                                    
deemed necessary.  The state  employee health  plan required                                                                    
analysis for  the medical necessity  of treatment.  He noted                                                                    
that the new state health  care provider, AETNA had compiled                                                                    
a  list  of  procedures   and  treatments  deemed  medically                                                                    
necessary. Elective  abortion was  not covered by  the state                                                                    
insurance  clinical policy  bulletins.  If  a procedure  was                                                                    
done for the convenience of  a patient, it was not medically                                                                    
necessary. He  believed that  the current  administration of                                                                    
the state plan was standard and appropriate.                                                                                    
                                                                                                                                
1:41:34 PM                                                                                                                    
                                                                                                                                
Representative  Wilson  appreciated   the  information.  She                                                                    
stated that the process used  by the state seemed sound. She                                                                    
wondered why a similar process was not used by Medicaid.                                                                        
                                                                                                                                
Co-Chair Stoltze  asked if a preapproval  period was similar                                                                    
to a waiting period.                                                                                                            
                                                                                                                                
Mr. Barnhill replied that  precertification was required for                                                                    
some  medical procedures;  abortion  was  not included.  The                                                                    
list of procedures was compiled  by AETNA with the view that                                                                    
certain  procedures  required precertification  for  various                                                                    
reasons.                                                                                                                        
                                                                                                                                
Co-Chair  Stoltze  asked  about the  approval  process  time                                                                    
required for an elective procedure.                                                                                             
                                                                                                                                
1:44:27 PM                                                                                                                    
                                                                                                                                
Mr. Barnhill  replied that approval required  longer than 24                                                                    
hours.                                                                                                                          
                                                                                                                                
Representative Wilson repeated her question.                                                                                    
                                                                                                                                
WILLIAM  STREUR,  COMMISSIONER,  DEPARTMENT  OF  HEALTH  AND                                                                    
SOCIAL SERVICES,  replied that  Medicaid was  an entitlement                                                                    
program. He  stated that the  program did  observe allowable                                                                    
medical  procedures  in a  method  similar  to that  of  the                                                                    
state's insurance.  He mentioned  the program's  practice of                                                                    
prior authorization and  retrospective review for procedures                                                                    
suspected to be elective rather than necessary.                                                                                 
                                                                                                                                
1:47:25 PM                                                                                                                    
                                                                                                                                
Representative Wilson  understood that the  regulations were                                                                    
undergoing a  change in  process. She  hoped to  imitate the                                                                    
successful   state   insurance   practice  of   paying   for                                                                    
procedures   that   were   thoughtfully   deemed   medically                                                                    
necessary.                                                                                                                      
                                                                                                                                
Commissioner  Streur stated  that the  Medicaid process  was                                                                    
similar to the  one used by the state  healthcare system. He                                                                    
explained that the  fear of a lawsuit  was present regarding                                                                    
denial of payment for pregnancy  terminations. He offered to                                                                    
review the  rigorous process offered  to state  employees by                                                                    
AETNA.                                                                                                                          
                                                                                                                                
Representative  Wilson wished  to remain  consistent in  her                                                                    
position  of  supporting  groups  receiving  insurance  from                                                                    
Medicaid and  those receiving insurance from  other sources.                                                                    
She  advocated  for  consistency among  the  approaches  and                                                                    
services offered in the state.                                                                                                  
                                                                                                                                
Co-Chair Stoltze  discussed the potential for  litigation in                                                                    
many capital  project proposals.  He opined that  a decision                                                                    
for  public policy  should not  be made  with litigation  in                                                                    
mind.                                                                                                                           
                                                                                                                                
1:51:05 PM                                                                                                                    
                                                                                                                                
Representative Wilson argued that if  one state plan was not                                                                    
challenged, then  why not incorporate  a similar  method for                                                                    
Medicaid.                                                                                                                       
                                                                                                                                
Representative Edgmon clarified  that Medicaid patients were                                                                    
in the lower  income strata. He believed  that the different                                                                    
strata should be viewed differently.                                                                                            
                                                                                                                                
1:52:52 PM                                                                                                                    
                                                                                                                                
Commissioner   Streur  noted   that   SB   49  discussed   a                                                                    
definition,  while  Mr.  Barhnill discussed  a  process.  He                                                                    
stated  that  that  a   published  definition  for  abortion                                                                    
coverage did  not exist in  the state employee  health plan.                                                                    
He agreed that comparisons of the two plans were difficult.                                                                     
                                                                                                                                
Mr.  Barnhill  agreed  that abortion  was  not  specifically                                                                    
defined in the state employee health plan book.                                                                                 
                                                                                                                                
1:54:55 PM                                                                                                                    
                                                                                                                                
Representative Costello asked about  the process regarding a                                                                    
Medicaid recipient who had an  abortion. She understood that                                                                    
the paperwork was submitted to  the Department of Health and                                                                    
Social Services following completion of the procedure.                                                                          
                                                                                                                                
Commissioner  Streur  concurred.  He noted  that  recipients                                                                    
were sometimes  flown to  Anchorage without  knowing whether                                                                    
the  appointment was  for family  planning counseling  or an                                                                    
abortion.  If  an  abortion   was  performed,  the  provider                                                                    
submitted a form  stating that the pregnancy  was either the                                                                    
result of  rape or incest  or medically necessary.  He noted                                                                    
that  all  of  the  forms  for the  last  three  years  were                                                                    
identified   as   "medically   necessary."   In   2012,   he                                                                    
implemented strict  use of the  Medicaid form. In  2013, the                                                                    
current  form  was  drafted and  included  approximately  20                                                                    
examples  of  potential  medical necessity.  He  added  that                                                                    
Alaska had the highest rate  of domestic violence and sexual                                                                    
assault in the nation.                                                                                                          
                                                                                                                                
1:57:52 PM                                                                                                                    
                                                                                                                                
Representative Costello  asked if the bill  would change the                                                                    
course of  events. She wondered  if women on  Medicaid would                                                                    
wait for  approval to move  forward with a  planned abortion                                                                    
if the legislation were to pass.                                                                                                
                                                                                                                                
Commissioner  Streur  stated  that  the  statute  would  not                                                                    
change  the  process  significantly. He  believed  that  the                                                                    
stricter  rules  and  parameters would  be  established  for                                                                    
abortions paid for by Medicaid under the statute.                                                                               
                                                                                                                                
Representative Costello  asked if Medicaid  recipients would                                                                    
undergo the  abortion procedure prior  to the  submission of                                                                    
the insurance  paperwork. She asked  the price of  a medical                                                                    
abortion procedure.                                                                                                             
                                                                                                                                
1:59:21 PM                                                                                                                    
                                                                                                                                
Commissioner Streur  believed that there was  no requirement                                                                    
for   a  waiting   period  prior   to  the   procedure;  the                                                                    
legislation  did define  which abortions  would be  eligible                                                                    
for  payment. The  cost of  the procedure  was approximately                                                                    
$600.                                                                                                                           
                                                                                                                                
Representative  Gara  asked how  long  Mr.  Barnhill was  an                                                                    
assistant Attorney General.                                                                                                     
                                                                                                                                
Mr. Barnhill replied 12 years.                                                                                                  
                                                                                                                                
Representative Gara  asked if  the greatest  opportunity for                                                                    
lawsuit was during a violation  of a Supreme Court order. He                                                                    
stated that a Supreme  Court order defined abortions allowed                                                                    
under state law.  The state signed a consent  decree in 2011                                                                    
to define medically necessary.                                                                                                  
                                                                                                                                
Mr.  Barnhill replied  that people  can sue  any time  about                                                                    
anything.  A  complaint in the United States  could be heard                                                                    
before a court of law in any state in the country.                                                                              
                                                                                                                                
Representative  Gara  asked  if  it  was  very  likely  that                                                                    
violating a Supreme Court order would result in litigation.                                                                     
                                                                                                                                
Mr. Barnhill refused to testify  about whether an action was                                                                    
very likely to result in litigation.                                                                                            
                                                                                                                                
Representative  Gara argued  that a  definition for  medical                                                                    
necessity  already existed  in state  law. He  asked if  the                                                                    
definition in SB  49 was different from  that established in                                                                    
the  Supreme Court  opinion and  the settlement  between the                                                                    
state and the parties.                                                                                                          
                                                                                                                                
STACIE KRALY, ASSISTANT ATTORNEY  OF LAW, DEPARTMENT OF LAW,                                                                    
requested further information about the consent decree.                                                                         
                                                                                                                                
2:04:17 PM                                                                                                                    
                                                                                                                                
Representative Gara replied that  the consent decree defined                                                                    
medically  necessary shall  be certified  by a  physician to                                                                    
ameliorate a  condition harmful to  the woman's  physical or                                                                    
psychological health.                                                                                                           
                                                                                                                                
Co-Chair  Stoltze asked  for the  consent decree  in writing                                                                    
for members and sponsors to refer to.                                                                                           
                                                                                                                                
Representative  Gara  responded   that  the  consent  decree                                                                    
included language related to harm  to a woman's physical and                                                                    
psychological health, while the  definition in SB 49 omitted                                                                    
the words "psychological health."                                                                                               
                                                                                                                                
Ms. Kraly  replied that the  Supreme Court did  articulate a                                                                    
list  of conditions  with a  reference to  bipolar disorder.                                                                    
The  list was  not  identified as  a  definition of  medical                                                                    
necessity.  She   wished  to  see  the   consent  decree  to                                                                    
determine whether it related to  the 2001 Planned Parenthood                                                                    
decision.                                                                                                                       
                                                                                                                                
2:06:13 PM                                                                                                                    
                                                                                                                                
Representative Gara asked for  an estimate for the potential                                                                    
litigation cost.                                                                                                                
                                                                                                                                
Commissioner  Streur  replied  that   he  did  not  have  an                                                                    
estimate of the cost of a potential litigation.                                                                                 
                                                                                                                                
Representative Gara  wished to  review facts related  to the                                                                    
women's health program.                                                                                                         
                                                                                                                                
Co-Chair  Stoltze  replied  that  the  issue  was  discussed                                                                    
earlier.                                                                                                                        
                                                                                                                                
Representative Gara  wished to  gain an  understanding about                                                                    
the elimination  of the women's  health program from  the CS                                                                    
earlier in the day.                                                                                                             
                                                                                                                                
Co-Chair Stoltze allowed the discussion.                                                                                        
                                                                                                                                
Representative  Gara   asked  the  commissioner   about  the                                                                    
differences between  coverage of  family planning  under the                                                                    
women's  health   program,  which   was  deleted   from  the                                                                    
legislation. He asked if the  women's health program covered                                                                    
women  without  children,  while  Medicaid  extended  family                                                                    
planning services to women with children.                                                                                       
                                                                                                                                
2:08:15 PM                                                                                                                    
                                                                                                                                
Commissioner   Streur  concurred;   the  two   options  were                                                                    
different. The "people" were not eligible for Medicaid.                                                                         
                                                                                                                                
Representative Gara  asked if Medicaid did  not cover family                                                                    
planning  coverage  for women  with  children  at a  certain                                                                    
income level.                                                                                                                   
                                                                                                                                
Commissioner  Streur  replied   that  childless  adults  not                                                                    
eligible for Medicaid coverage under  100 percent of poverty                                                                    
level were few. Most adults  with children had some level of                                                                    
coverage within  Medicaid and would  be eligible  for family                                                                    
services.                                                                                                                       
                                                                                                                                
Representative  Gara asked  about a  pregnant woman  without                                                                    
children.                                                                                                                       
                                                                                                                                
Commissioner  Streur  replied  that   once  a  woman  became                                                                    
pregnant, she was eligible for  an array of Medicaid service                                                                    
upon application.                                                                                                               
                                                                                                                                
Co-Chair  Stoltze requested  that committee  members request                                                                    
answers instead of validation.                                                                                                  
                                                                                                                                
Representative Gara  asked if  the family  planning services                                                                    
were  the  same  ones  available under  the  women's  health                                                                    
program.                                                                                                                        
                                                                                                                                
Commissioner Streur believed so.                                                                                                
                                                                                                                                
Representative  Gara  asked  about   the  income  limit  for                                                                    
participation in the program for family planning services.                                                                      
                                                                                                                                
Commissioner Streur  stated 100  percent of  federal poverty                                                                    
level was the requirement  for Medicaid; the family planning                                                                    
amendment removed in the morning  meeting was 175 percent. A                                                                    
pregnant  woman  who qualified  for  Denali  Kid Care  (DKC)                                                                    
would be eligible up to 175 percent of poverty level.                                                                           
                                                                                                                                
2:11:14 PM                                                                                                                    
                                                                                                                                
Representative Gara asked which  pregnant women would not be                                                                    
covered by DKC.                                                                                                                 
                                                                                                                                
Commissioner Streur  replied that most pregnant  women at or                                                                    
below 175 percent of poverty  level would be covered by DKC.                                                                    
He noted that the women must apply for DKC.                                                                                     
                                                                                                                                
Representative Gara asked which women would not be covered.                                                                     
                                                                                                                                
Commissioner Streur  stated that exceptions existed,  but he                                                                    
believed that  most women in  the mentioned  parameters were                                                                    
covered.                                                                                                                        
                                                                                                                                
Representative  Gara asked  if  all  pregnant women  seeking                                                                    
family  planning services  were  covered  under the  women's                                                                    
health program.                                                                                                                 
                                                                                                                                
Commissioner Streur concurred.                                                                                                  
                                                                                                                                
Representative    Gara   understood    that   DKC    covered                                                                    
approximately  65 percent  of federal  funding. He  asked if                                                                    
the  family  planning  services  under  the  women's  health                                                                    
program would be covered at 90 percent of federal funding.                                                                      
                                                                                                                                
Commissioner Streur replied yes.                                                                                                
                                                                                                                                
2:12:42 PM                                                                                                                    
                                                                                                                                
Representative Holmes  asked about the  regulations proposed                                                                    
that  were similar  to the  legislation. She  wondered about                                                                    
the  different elements.  She requested  further explanation                                                                    
about the differences.                                                                                                          
                                                                                                                                
Commissioner  Streur commented  on  the differences  between                                                                    
the regulations and the bill.  He assumed that the requested                                                                    
difference   was  related   to   the  psychiatric   disorder                                                                    
component. He stated that the  decision to include the issue                                                                    
was  difficult, but  he  wished to  include  a portion  that                                                                    
would survive challenge for the  continued movement toward a                                                                    
meaningful   program.  The   language  was   related  to   a                                                                    
psychiatric disorder that placed  a woman in imminent danger                                                                    
of medical  impairment of major bodily  function if abortion                                                                    
is not performed.                                                                                                               
                                                                                                                                
Representative Holmes noted  earlier questions regarding the                                                                    
omission of mental health in the bill language.                                                                                 
                                                                                                                                
Co-Chair  Stoltze stated  that Senator  Coghill would  share                                                                    
information  received  by  the Alaska  Mental  Health  Trust                                                                    
during recent discussions.                                                                                                      
                                                                                                                                
Representative  Holmes wished  to  provide the  commissioner                                                                    
the opportunity to address the issue.                                                                                           
                                                                                                                                
Co-Chair Stoltze believed that  the commissioner was present                                                                    
during the mentioned conversations.                                                                                             
                                                                                                                                
Representative   Holmes  requested   additional  information                                                                    
related to a nonviable fetus and abortion.                                                                                      
                                                                                                                                
Co-Chair Stoltze relayed  that a fetus could  be referred to                                                                    
as a baby.                                                                                                                      
                                                                                                                                
Representative Holmes  understood. She wished  to understand                                                                    
the  coverage available  for  women  encountering this  very                                                                    
difficult and rare situation.                                                                                                   
                                                                                                                                
2:16:32 PM                                                                                                                    
                                                                                                                                
Commissioner Streur  replied that that he  believed that the                                                                    
procedure  was covered  in  the unlikely  event  of a  woman                                                                    
carrying a nonviable fetus.                                                                                                     
                                                                                                                                
Representative  Holmes requested  further confirmation  from                                                                    
the department.                                                                                                                 
                                                                                                                                
Representative  Munoz asked  about abortions  that were  not                                                                    
funded   for  reasons   that  were   not  deemed   medically                                                                    
necessary.                                                                                                                      
                                                                                                                                
Commissioner  Streur  expressed   confidence  that  abortion                                                                    
procedures were  delivered, but not  paid for  by insurance.                                                                    
He had no knowledge of  the denial of abortion payments from                                                                    
Medicaid during the last calendar year.                                                                                         
                                                                                                                                
Representative   Munoz  asked   if   all  medically   funded                                                                    
abortions were  approved by  Medicaid regardless  of medical                                                                    
necessity.                                                                                                                      
                                                                                                                                
Commissioner  Streur  disagreed.  He stated  that  the  form                                                                    
required   for  reimbursement   required  certification   of                                                                    
medical   necessity   by   the  physician   performing   the                                                                    
procedure.                                                                                                                      
                                                                                                                                
Representative Munoz asked if  the commissioner was aware of                                                                    
any procedures rejected for Medicaid reimbursement.                                                                             
                                                                                                                                
Commissioner  Streur replied  that a  request filed  without                                                                    
the  certification  was  denied, however,  requests  without                                                                    
certification were not received in the last year.                                                                               
                                                                                                                                
2:19:14 PM                                                                                                                    
                                                                                                                                
Representative Edgmon discussed  data related to pregnancies                                                                    
in  Alaska.   He  read  from  literature   provided  by  the                                                                    
Guttmacher  Institute  that   approximately  50  percent  of                                                                    
pregnancies were unwanted  at a huge cost  absorbed by state                                                                    
agencies.  The  majorities   of  unwanted  pregnancies  were                                                                    
unintended  and could  have been  prevented with  additional                                                                    
family planning services.                                                                                                       
                                                                                                                                
Commissioner Streur was familiar  with the source. He stated                                                                    
that  he read  the article  and noted  that the  assumptions                                                                    
made  by   the  large   research  institute  could   not  be                                                                    
corroborated or denied.                                                                                                         
                                                                                                                                
2:22:10 PM                                                                                                                    
                                                                                                                                
Representative  Edgmon  wondered  if  more  family  planning                                                                    
services could  reduce the  number of  unwanted pregnancies.                                                                    
He  wondered if  increased  family  planning services  might                                                                    
save the state money.                                                                                                           
                                                                                                                                
Co-Chair  Stoltze  asked  about  the  parameters  of  family                                                                    
planning.                                                                                                                       
                                                                                                                                
2:23:13 PM                                                                                                                    
                                                                                                                                
SENATOR JOHN  COGHILL stated  that the  Guttmacher Institute                                                                    
was  credible and  pro-abortion.  He was  unsure of  related                                                                    
statistics in Alaska. He found  it difficult to believe that                                                                    
50  percent of  pregnancies  in Alaska  were unintended  and                                                                    
unwanted. He  noted that the  discussion of  family planning                                                                    
begged the  question "are our  families deeply  involved the                                                                    
way they should  be." He wondered if  Planned Parenthood was                                                                    
the  optimal  location  for family  planning  resources,  as                                                                    
their main  goal was family  planning for  contraception and                                                                    
abortion,  which  he  considered   a  method  of  population                                                                    
control rather than family planning.                                                                                            
                                                                                                                                
Senator  Coghill  stated  that Planned  Parenthood  was  the                                                                    
aggressive  litigant  in  every   abortion  case  in  Alaska                                                                    
proposing  that  abortion  be   performed  with  the  lowest                                                                    
possible threshold to entrants.  He understood that the goal                                                                    
of  Planned  Parenthood  was to  protect  women's  right  to                                                                    
choose. He agreed  that women deserved the  right to choose,                                                                    
but  that  right  was  not  a  financial  responsibility  of                                                                    
government. He opined that the  cost of an elective abortion                                                                    
was  the  responsibility  of  the  woman.  The  state  would                                                                    
provide  funds  for   preventative  services  and  education                                                                    
related to pregnancy. He  agreed that unintended pregnancies                                                                    
should be prevented by wise choices                                                                                             
                                                                                                                                
2:26:41 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE GABRIELLE  LEDOUX, explained that  the bill's                                                                    
attempt  was to  define  the term  "medically necessary"  as                                                                    
related  to  an  abortion  procedure.   She  argued  that  a                                                                    
discussion  about family  planning  was better  suited to  a                                                                    
budget discussion  for the Department  of Health  and Social                                                                    
Services.  She  stated  that the  proposed  legislation  was                                                                    
simple and  ought not to  be decorated with  family planning                                                                    
amendments.                                                                                                                     
                                                                                                                                
Representative Edgmon  pointed out the  economic perspective                                                                    
of  his argument.  He  wondered if  state  savings could  be                                                                    
realized  with  a  reduction  of  unwanted  pregnancies.  He                                                                    
believed that  a correlation  existed between  state savings                                                                    
and family planning.                                                                                                            
                                                                                                                                
Commissioner Streur  spoke to family planning  aspect of the                                                                    
bill.  He noted  that  his response  to Representative  Gara                                                                    
related  to family  planning was  relevant  to Medicaid  and                                                                    
DKC. He  stated that  family planning services  were offered                                                                    
in most  public health centers.  The services covered  at 90                                                                    
percent/10 percent  were available  to any  woman presenting                                                                    
for  diagnosis of  general  reproductive health  conditions,                                                                    
diagnosis  of sexually  transmitted diseases  and infections                                                                    
and for  contraception. All  other family  planning services                                                                    
were  covered  at 50  percent.  He  stated that  the  public                                                                    
health center  staff distributed  contraception and  had for                                                                    
many years at a cost of $800 per participant.                                                                                   
                                                                                                                                
2:30:30 PM                                                                                                                    
                                                                                                                                
Representative   Guttenberg   asked  if   the   commissioner                                                                    
participated  in  the creation  of  the  list of  acceptable                                                                    
reasons for an abortion.                                                                                                        
                                                                                                                                
Commissioner Streur responded in the negative.                                                                                  
                                                                                                                                
Representative  Guttenberg   asked  if  there   was  another                                                                    
medical   procedure  that   required  a   similar  list   of                                                                    
prerequisites.                                                                                                                  
                                                                                                                                
Commissioner  Streur answered  that most  medical procedures                                                                    
were  approved  with  prior authorization  or  retrospective                                                                    
review  utilizing  specific  criteria.  He  noted  that  the                                                                    
manner of publishing the requirements  was different for the                                                                    
abortion procedure.                                                                                                             
                                                                                                                                
Representative  Guttenberg asked  if  another procedure  was                                                                    
described or delineated similarly in statute.                                                                                   
                                                                                                                                
Commissioner Streur replied that  there was limited scope in                                                                    
regulation,   but  he   could  not   speak  to   statutorily                                                                    
requirements.                                                                                                                   
                                                                                                                                
Senator Coghill  surmised that since  Row vs Wade  there had                                                                    
not been another similarly litigated  health topic. He noted                                                                    
that the  definition of medically necessary  emanated from a                                                                    
consent decree through a Supreme  Court Case. He pointed out                                                                    
language protecting  the doctor's  opinion. The goal  was to                                                                    
protect the life of the mother to the extent possible.                                                                          
                                                                                                                                
2:32:54 PM                                                                                                                    
                                                                                                                                
Representative Guttenberg asked about Tay-Sachs disease.                                                                        
                                                                                                                                
Senator Coghill did not know about Tay-Sachs disease.                                                                           
                                                                                                                                
Representative Guttenberg read from  a dictionary, that Tay-                                                                    
Sachs  disease  was a  "hereditary  disorder  caused by  the                                                                    
absence of  an enzyme  needed to  break down  fatty material                                                                    
leading to death in childhood."  He wondered why the disease                                                                    
was  not   included  in  the  list   of  approved  medically                                                                    
necessary reasons for compensated abortion.                                                                                     
                                                                                                                                
Representative Ledoux  replied that the item  related to the                                                                    
death of a  child and not the mother. The  list of medically                                                                    
necessary diseases  included those  related to the  death of                                                                    
the mother, not the death of the child.                                                                                         
                                                                                                                                
Representative Guttenberg asked how  that was different from                                                                    
sickle cell.                                                                                                                    
                                                                                                                                
Senator Coghill  relayed that the sickle  cell anemia listed                                                                    
was a concern to the mother.                                                                                                    
                                                                                                                                
Representative  Holmes MOVED  friendly AMENDMENT  related to                                                                    
Senator  Coghill's  testimony.  She corrected  that  he  had                                                                    
meant  the  responsibility of  the  woman  and man  when  he                                                                    
discussed payment for an elective abortion.                                                                                     
                                                                                                                                
Senator Coghill appreciated the correction.                                                                                     
                                                                                                                                
2:35:35 PM                                                                                                                    
                                                                                                                                
Representative Wilson  asked about  the process  between the                                                                    
patient, her doctor and the state.                                                                                              
                                                                                                                                
Commissioner  Streur replied  that the  procedure was  first                                                                    
performed. The  provider then submitted a  form attesting to                                                                    
the medical  necessity of the  procedure. Without  the form,                                                                    
the physician would not be paid for the procedure.                                                                              
                                                                                                                                
Representative Wilson expressed  confusion about the process                                                                    
and how the bill would change it.                                                                                               
                                                                                                                                
Commissioner  Streur  replied   that  the  determination  of                                                                    
medical necessity could be conducted  at any time. He stated                                                                    
that the medical review of a chart could occur at any time.                                                                     
                                                                                                                                
2:38:10 PM                                                                                                                    
                                                                                                                                
Representative  Wilson opined  that the  bill addressed  the                                                                    
medical necessity of one procedure  alone. She wondered if a                                                                    
doctor would deny  services to a woman if  the procedure was                                                                    
not deemed medically necessary.                                                                                                 
                                                                                                                                
Commissioner Streur  replied that the doctor  would make the                                                                    
decision to either perform the  procedure or submit the form                                                                    
certifying  medical  necessity  or receive  other  means  of                                                                    
payment.  The  choice would  be  left  to  the woman  to  go                                                                    
forward with the procedure or to remain pregnant.                                                                               
                                                                                                                                
Representative  Wilson   posed  a  scenario  in   which  the                                                                    
abortion  procedure requested  was not  medically necessary.                                                                    
She  asked about  additional means  of payment  for abortion                                                                    
services. She  wondered what would  happen to the  woman who                                                                    
chose to  have an  abortion despite  the doctor's  denial of                                                                    
medical necessity.                                                                                                              
                                                                                                                                
2:40:42 PM                                                                                                                    
                                                                                                                                
Commissioner  Streur  replied  that  other  funding  sources                                                                    
existed to help women in need.  He could not speak about the                                                                    
safety  of procedures  offered at  discount rates;  he could                                                                    
only speak to Medicaid.                                                                                                         
                                                                                                                                
Representative Wilson  commented that  the Alaska  Bureau of                                                                    
Vital  Statistics  provided  a   form  related  to  abortion                                                                    
procedures. She  wondered about the "other"  category listed                                                                    
on the form in which 766 abortions were documented in 2012.                                                                     
                                                                                                                                
2:42:40 PM                                                                                                                    
                                                                                                                                
Commissioner Streur  offered to  visit the Alaska  Bureau of                                                                    
Vital  Statistics  to  obtain   and  provide  the  requested                                                                    
information.                                                                                                                    
                                                                                                                                
Representative  Gara  stressed  the  goal  of  limiting  the                                                                    
number  of  unwanted  pregnancies and  abortions.  He  asked                                                                    
about  the  difference  in  coverage  between  DKC  and  the                                                                    
women's  health  program.  He understood  that  DKC  allowed                                                                    
coverage during pregnancy  up to 175 percent  of the poverty                                                                    
level  with  the option  for  family  planning services.  He                                                                    
expressed interest in the  family planning options available                                                                    
for  women  who  were  not  pregnant  and  wished  to  avoid                                                                    
pregnancy. He  noted that  an adult  woman was  not eligible                                                                    
for DKC unless she was pregnant.                                                                                                
                                                                                                                                
Commissioner Streur agreed.                                                                                                     
                                                                                                                                
Representative Gara  pointed out  that a  non-pregnant adult                                                                    
without  children  was  not  eligible  for  family  planning                                                                    
services under DKC.                                                                                                             
                                                                                                                                
Commissioner Streur concurred.                                                                                                  
                                                                                                                                
Representative  Gara asked  if  the  women's health  program                                                                    
allowed  a non-pregnant  childless  woman contraceptive  and                                                                    
other family planning services.                                                                                                 
                                                                                                                                
2:45:44 PM                                                                                                                    
AT EASE                                                                                                                         
                                                                                                                                
2:46:03 PM                                                                                                                    
RECONVENED                                                                                                                      
                                                                                                                                
Commissioner Streur  replied that  a non-pregnant  woman who                                                                    
was not receiving Medicaid could  receive services through a                                                                    
public health center.                                                                                                           
                                                                                                                                
Representative  Gara asked  specifically  about the  women's                                                                    
health program.                                                                                                                 
                                                                                                                                
Commissioner Streur stated that  an expansion of the program                                                                    
was  necessary  for the  inclusion  of  women who  were  not                                                                    
eligible  for Medicaid;  the expansion  would be  similar to                                                                    
that discussed for Medicaid.                                                                                                    
                                                                                                                                
Representative Gara  asked if Alaska applied  to the federal                                                                    
government  for the  amount  eligible  through the  American                                                                    
Affordable  Care  Act,  would  a  non-pregnant  adult  woman                                                                    
receive  contraceptive  services  under the  women's  health                                                                    
program, but not under DKC.                                                                                                     
                                                                                                                                
2:48:58 PM                                                                                                                    
                                                                                                                                
Representative  Gara asked  again  if the  state applied  to                                                                    
obtain  the  women's  health  coverage  program  up  to  175                                                                    
percent  of  the poverty  level  as  was allowed  under  the                                                                    
American Affordable Care Act  would family planning services                                                                    
including  contraception be  covered for  non-pregnant women                                                                    
in the state.                                                                                                                   
                                                                                                                                
Commissioner Streur replied yes.                                                                                                
                                                                                                                                
Representative Gara  asked if the option  available under an                                                                    
expansion  of the  women's  health  program to  non-pregnant                                                                    
adult women were unavailable in the state through DKC.                                                                          
                                                                                                                                
Commissioner Streur agreed.                                                                                                     
                                                                                                                                
2:50:47 PM                                                                                                                    
                                                                                                                                
Representative  Munoz asked  about  Medicaid  and the  90/10                                                                    
split  available  for  three   categories  of  service.  She                                                                    
wondered  if  the population  would  be  eligible for  other                                                                    
services at the 50/50 split.                                                                                                    
                                                                                                                                
Commissioner Streur responded that  the three categories for                                                                    
the   90/10  split   included  the   diagnosis  of   general                                                                    
reproductive  health conditions,  the diagnosis  of sexually                                                                    
transmitted  infections  and  contraception. He  noted  that                                                                    
family planning  related services  such as the  treatment of                                                                    
the  diagnosed  conditions  were  eligible  for  the  normal                                                                    
federal participation rate of 50 percent.                                                                                       
                                                                                                                                
Representative Munoz asked if  the legislation's fiscal note                                                                    
included the 50/50 cost to the state.                                                                                           
                                                                                                                                
Commissioner  Streur stated  that he  was unsure,  but would                                                                    
provide the answer to the committee.                                                                                            
                                                                                                                                
2:52:40 PM                                                                                                                    
                                                                                                                                
Senator Coghill appreciated the time  spent on the issue. He                                                                    
appreciated  the   issue's  complexity.  He   explained  the                                                                    
state's agreement  with the federal  government to  care for                                                                    
people under  certain economic conditions.  He noted  that a                                                                    
process was defined regarding  medical necessity. The narrow                                                                    
legislation   was  highly   litigated   and  required   fine                                                                    
attention to  the definition of medical  necessity. He added                                                                    
that peripheral  issues of philosophy and  practice added to                                                                    
the complexity.  The goal  of the sponsor  was to  allow for                                                                    
state funded  abortions that benefited  the health  and life                                                                    
of the mother.                                                                                                                  
                                                                                                                                
Representative  Ledoux  thanked  the committee.  She  opined                                                                    
that the discussion  assumed that care provided  in a public                                                                    
health  clinic  was  substandard.   She  stressed  that  the                                                                    
clinics provided  family planning  services and  she herself                                                                    
had  taken  advantage of  services  from  the Kodiak  public                                                                    
health clinic.                                                                                                                  
                                                                                                                                
Co-Chair Stoltze  stated that  he did not  want to  rush the                                                                    
committee through the process.  He opined that proper public                                                                    
process  would require  additional debate  and consideration                                                                    
of the legislation. He noted  the submission of an amendment                                                                    
that would be discussed in a future meeting.                                                                                    
                                                                                                                                
2:57:06 PM                                                                                                                    
                                                                                                                                
Co-Chair  Stoltze   believed  that   the  fiscal   note  was                                                                    
accurately expressed.                                                                                                           
                                                                                                                                
Co-Chair Stoltze discussed the next day's schedule.                                                                             
                                                                                                                                
SSSB 49  (FIN) was HEARD  and HELD in committee  for further                                                                    
consideration.                                                                                                                  
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
2:59:30 PM                                                                                                                    
                                                                                                                                
The meeting was adjourned at 2:59 p.m.                                                                                          
                                                                                                                                
                                                                                                                                

Document Name Date/Time Subjects
SB 49 Testimony HFIN.pdf HFIN 2/25/2014 1:30:00 PM
SB 49
SB 49 Amendment #1 Gara-Guttenberg.pdf HFIN 2/25/2014 1:30:00 PM
SB 49