Legislature(2015 - 2016)

04/09/2016 02:11 PM


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02:11:16 PM Start
02:11:58 PM SB74
02:13:07 PM Amendments
06:30:13 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
                  HOUSE FINANCE COMMITTEE                                                                                       
                       April 9, 2016                                                                                            
                         2:11 p.m.                                                                                              
                                                                                                                                
                                                                                                                                
2:11:16 PM                                                                                                                    
                                                                                                                                
CALL TO ORDER                                                                                                                 
                                                                                                                                
Co-Chair  Thompson   called  the  House   Finance  Committee                                                                    
meeting to order at 2:11 p.m.                                                                                                   
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Mark Neuman, Co-Chair                                                                                            
Representative Steve Thompson, Co-Chair                                                                                         
Representative Dan Saddler, Vice-Chair                                                                                          
Representative Bryce Edgmon                                                                                                     
Representative Les Gara                                                                                                         
Representative Lynn Gattis                                                                                                      
Representative David Guttenberg                                                                                                 
Representative Scott Kawasaki                                                                                                   
Representative Cathy Munoz                                                                                                      
Representative Lance Pruitt                                                                                                     
Representative Tammie Wilson                                                                                                    
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
None                                                                                                                            
                                                                                                                                
ALSO PRESENT                                                                                                                  
                                                                                                                                
Rex  Shattuck,  Staff,   Representative  Mark  Neuman;  Jane                                                                    
Pierson,  Staff,  Representative   Steve  Thompson;  Heather                                                                    
Shadduck,   Staff,  Senator   Pete   Kelly;  Stacie   Kraly,                                                                    
Assistant Attorney  General, Department of Law;  Jay Butler,                                                                    
Chief  Medical  Officer,  Department of  Health  and  Social                                                                    
Services;  Jon Sherwood,  Deputy Commissioner,  Medicaid and                                                                    
Health  Care   Policy,  Department  of  Health   and  Social                                                                    
Services; Representative Liz Vasquez.                                                                                           
                                                                                                                                
PRESENT VIA TELECONFERENCE                                                                                                    
                                                                                                                                
Kate   Glover,  Legislative   Legal  Services,   Legislative                                                                    
Affairs  Agency;  Erin  Narus,  State  Medicaid  Pharmacist,                                                                    
Department of  Health and Social Services;  Andrew Peterson,                                                                    
Assistant Attorney General, Office of Special Prosecution,                                                                      
Medicaid Fraud Control Unit, Department of Law.                                                                                 
                                                                                                                                
SUMMARY                                                                                                                       
                                                                                                                                
CSSB 74(FIN) am                                                                                                                 
          MEDICAID REFORM;TELEMEDICINE;DRUG DATABASE                                                                            
                                                                                                                                
          HCS  CSSB 74(FIN)  was REPORTED  out of  committee                                                                    
          with  an "amend"  recommendation and  with 13  new                                                                    
          fiscal impact notes from  the Department of Health                                                                    
          and  Social Services;  1  new  fiscal impact  note                                                                    
          from  the Department  of  Commerce, Community  and                                                                    
          Economic  Development; 1  new  fiscal impact  note                                                                    
          from the  Department of Law;  1 new  fiscal impact                                                                    
          note from  the Department of Corrections;  and one                                                                    
          previously published fiscal note: FN29 (ADM).                                                                         
                                                                                                                                
CS FOR SENATE BILL NO. 74(FIN) am                                                                                             
                                                                                                                                
     "An   Act  relating   to   diagnosis,  treatment,   and                                                                    
     prescription  of drugs  without a  physical examination                                                                    
     by a  physician; relating to  the delivery  of services                                                                    
     by  a  licensed  professional counselor,  marriage  and                                                                    
     family    therapist,     psychologist,    psychological                                                                    
     associate, and  social worker by audio,  video, or data                                                                    
     communications;  relating to  the duties  of the  State                                                                    
     Medical  Board;  relating  to limitations  of  actions;                                                                    
     establishing the Alaska  Medical Assistance False Claim                                                                    
     and  Reporting  Act;  relating  to  medical  assistance                                                                    
     programs administered  by the Department of  Health and                                                                    
     Social Services;  relating to the  controlled substance                                                                    
     prescription database;  relating to  the duties  of the                                                                    
     Board  of  Pharmacy;  relating to  the  duties  of  the                                                                    
     Department   of  Commerce,   Community,  and   Economic                                                                    
     Development;   relating  to   accounting  for   program                                                                    
     receipts; relating  to public record status  of records                                                                    
     related to  the Alaska  Medical Assistance  False Claim                                                                    
     and   Reporting   Act;  establishing   a   telemedicine                                                                    
     business registry; relating  to competitive bidding for                                                                    
     medical assistance  products and services;  relating to                                                                    
     verification  of  eligibility   for  public  assistance                                                                    
     programs administered  by the Department of  Health and                                                                    
     Social  Services; relating  to annual  audits of  state                                                                    
     medical  assistance  providers; relating  to  reporting                                                                    
     overpayments    of    medical   assistance    payments;                                                                    
     establishing  authority to  assess civil  penalties for                                                                    
     violations of medical  assistance program requirements;                                                                    
     relating  to seizure  and  forfeiture  of property  for                                                                    
     medical  assistance fraud;  relating to  the duties  of                                                                    
     the   Department  of   Health   and  Social   Services;                                                                    
     establishing    medical     assistance    demonstration                                                                    
     projects;  relating  to   Alaska  Pioneers'  Homes  and                                                                    
     Alaska Veterans'  Homes; relating to the  duties of the                                                                    
     Department  of Administration;  relating to  the Alaska                                                                    
     Mental Health Trust  Authority; relating to feasibility                                                                    
     studies for the provision  of specified state services;                                                                    
     amending Rules  4, 5, 7,  12, 24,  26, 27, 41,  77, 79,                                                                    
     82, and 89,  Alaska Rules of Civil  Procedure, and Rule                                                                    
     37, Alaska  Rules of Criminal Procedure;  and providing                                                                    
     for an effective date."                                                                                                    
                                                                                                                                
2:11:58 PM                                                                                                                    
                                                                                                                                
Co-Chair Thompson  discussed that  the committee  would hear                                                                    
amendments on SB 74.                                                                                                            
                                                                                                                                
^AMENDMENTS                                                                                                                   
                                                                                                                                
2:13:07 PM                                                                                                                    
                                                                                                                                
Co-Chair Neuman  MOVED to  ADOPT Amendment  1, 29-LS0692\T.1                                                                    
(Glover,  4/7/16) (copy  on file).  [Note: due  to amendment                                                                    
length it has not been included  in the minutes. See copy on                                                                    
file.]                                                                                                                          
                                                                                                                                
Co-Chair Thompson OBJECTED for discussion.                                                                                      
                                                                                                                                
Co-Chair  Neuman explained  that the  amendment addressed  a                                                                    
major  concern   by  adding  a   sunset  provision   to  the                                                                    
Prescription Drug Monitoring  Database (PDMP). He elaborated                                                                    
that he  had received a couple  of letters on the  issue. He                                                                    
detailed that the amendment would  sunset the PDMP provision                                                                    
in three years; the topic  would come before the legislature                                                                    
at that time to determine  whether it had worked as intended                                                                    
or  if  there were  areas  of  concern. He  elaborated  that                                                                    
because  the  bill  would allow  additional  individuals  to                                                                    
access the PDMP (including  non-licensed individuals) he was                                                                    
concerned  that information  may be  leaked. He  stated that                                                                    
information had been found that  social security numbers and                                                                    
other  personal   information  had  been  leaked   from  the                                                                    
database in other states.                                                                                                       
                                                                                                                                
Co-Chair  Neuman  relayed  that  individuals  had  expressed                                                                    
surprise  when he  had asked  his constituents  whether they                                                                    
were aware  the state and  federal government kept  track of                                                                    
the  prescription  drugs  people  took  in  a  database.  He                                                                    
believed  the  provision  increased government  in  people's                                                                    
lives;  he   was  opposed  to   the  database   adding  more                                                                    
government  into  people's  private lives.  He  referred  to                                                                    
testimony from physicians about  the time the database took.                                                                    
He shared  that he had spent  the past few years  talking to                                                                    
many doctors about the issue.  He understood the PDMP was an                                                                    
important tool  for doctors. He  stated that in  three years                                                                    
the legislature  could look at  portions that  were expanded                                                                    
to allow access to others.  He stressed that the legislators                                                                    
were the voice of the  people. He believed it was respectful                                                                    
to take  a look to  determine whether there had  been issues                                                                    
during the first three years.  He hoped it would require the                                                                    
department  [the  Department   of  Commerce,  Community  and                                                                    
Economic Development (DCCED)] or  medical board to determine                                                                    
if there were  issues over the three-year  period. He opined                                                                    
the  database  was  very intrusive  into  people's  personal                                                                    
lives.                                                                                                                          
                                                                                                                                
2:17:20 PM                                                                                                                    
                                                                                                                                
Co-Chair Thompson  noted that there  would be an  expense to                                                                    
put  the bill's  PDMP  provision in  place.  He wondered  if                                                                    
there  would  be  another  expense  in  the  future  if  the                                                                    
provision  sunset  and  was  reenacted   at  a  later  time.                                                                    
Alternatively, he  asked if the amendment  would merely look                                                                    
at the provision  to determine if it should  be continued in                                                                    
three years.                                                                                                                    
                                                                                                                                
Co-Chair Neuman  replied that there  would be no  expense to                                                                    
have the  legislature look  at the  program in  three years.                                                                    
His  intent was  to review  the  program in  three years  to                                                                    
determine if it was something the state should continue.                                                                        
                                                                                                                                
Representative  Gattis  referred  to  constituents  who  had                                                                    
challenges  with the  database, while  others supported  it.                                                                    
She struggled with having a  database that included people's                                                                    
medicine,  but  she  recognized there  was  a  huge  problem                                                                    
facing the  state. She also understood  there were databases                                                                    
in hospitals and many other  places. She asked how the topic                                                                    
would be  reported back  to the  legislature in  three years                                                                    
and who would make the report.                                                                                                  
                                                                                                                                
Co-Chair  Neuman  answered  that  annually  the  legislature                                                                    
received  a  report from  the  department  on the  PDMP.  He                                                                    
talked  including  the  information   in  a  report  to  the                                                                    
legislature, but he  believed it would not  be broadly read.                                                                    
Therefore, the  amendment would bring  the issue  before the                                                                    
legislature.                                                                                                                    
                                                                                                                                
REX SHATTUCK, STAFF,  REPRESENTATIVE MARK NEUMAN, elaborated                                                                    
that there was  a provision in statute for  an annual report                                                                    
back  to the  legislature. He  continued that  several other                                                                    
reports came  out and requirements that  would indicate what                                                                    
a  legislator  may  be  looking  at.  For  example,  if  the                                                                    
database  was breached,  protocols were  in place  that were                                                                    
required to  be acted  upon. He detailed  that instead  of a                                                                    
full-fledged audit, the reports  would give an indication on                                                                    
the program's  effectiveness. The report would  also include                                                                    
information on the successfulness  of many of the provisions                                                                    
in the bill.                                                                                                                    
                                                                                                                                
Co-Chair Neuman  added that  he did not  want to  go through                                                                    
Legislative  Budget  and  Audit  due  to  the  expense.  The                                                                    
amendment would bring the provision  back to the legislature                                                                    
for review just like every other sunset.                                                                                        
                                                                                                                                
2:21:41 PM                                                                                                                    
                                                                                                                                
Representative Gara  was trying  to determine the  intent of                                                                    
the  amendment. He  asked whether  the amendment  intended a                                                                    
review of how  the database provision had  worked during the                                                                    
three-year  period  or whether  it  would  be eliminated  in                                                                    
three years, which could mean  the legislature would have to                                                                    
pass a new bill.                                                                                                                
                                                                                                                                
Mr.  Shattuck answered  that Amendment  1  would repeal  the                                                                    
provision.  He continued  that a  legislator  would need  to                                                                    
offer legislation to leave the statute as is.                                                                                   
                                                                                                                                
Representative   Gara  asked   for  verification   that  the                                                                    
amendment  would repeal  the PDMP  provision in  three years                                                                    
unless  another  legislator  picked  it  up  and  introduced                                                                    
another bill to extend it.                                                                                                      
                                                                                                                                
Mr. Shattuck answered in the affirmative.                                                                                       
                                                                                                                                
Representative Gara  observed that page 5,  lines 19 through                                                                    
21 of the  amendment returned to current law  and would make                                                                    
the PDMP voluntary. He read  from the amendment: "Nothing in                                                                    
this   section  requires   or  obligates   a  dispenser   or                                                                    
practitioner  to   access  or  check  the   database  before                                                                    
dispensing, prescribing,  or administering  a medication..."                                                                    
He asked how it differed from current law.                                                                                      
                                                                                                                                
Mr. Shattuck replied  that he had gone through  the bill and                                                                    
had been surprised  at the complexity of  redoing an action.                                                                    
In three years the amendment  would return statutes to their                                                                    
current existing  language. The language "insert  a new bill                                                                    
section  to read..."  returned the  statute  to its  current                                                                    
language. The  amendment would conform to  the original bill                                                                    
and reset statutory language to its language at present.                                                                        
                                                                                                                                
2:24:42 PM                                                                                                                    
                                                                                                                                
Representative   Gara  stated   that   whether  to   require                                                                    
physicians  to   look  up  Class   II  and   III  controlled                                                                    
substances was  a policy call.  He shared that  opioids fell                                                                    
under the Class II category.  He detailed in 2012 Alaska had                                                                    
more  than twice  the national  rate of  opioid prescription                                                                    
drug overdose deaths. Alaska was  one of the states that did                                                                    
not currently  require physicians to check  the database. He                                                                    
referred to testimony that Class  II and III drugs would not                                                                    
be  a huge  burden  and  were the  most  important drugs  to                                                                    
check. He  noted the  original bill  had included  Class IV,                                                                    
which  he did  not believe  was in  the current  version. He                                                                    
elaborated  that  Class  III   drugs  included  things  like                                                                    
steroids (a  person could have  a heart attack if  they took                                                                    
too many).  He characterized Class II  and III prescriptions                                                                    
as  death  drugs  if  over  prescribed.  He  could  be  more                                                                    
supportive  of  an  amendment  requiring  a  report  to  the                                                                    
legislature  in three  years about  whether the  program was                                                                    
working. He  did not support  repealing the section.  He had                                                                    
been  convinced  by  testimony  of the  need  to  check  the                                                                    
database  for Class  II and  III prescriptions.  He reasoned                                                                    
the state's heroin problem was  worsening, not improving. He                                                                    
specified that one  of the ways a person ended  up on heroin                                                                    
was starting  out on  opioid drugs. He  did not  support the                                                                    
amendment.                                                                                                                      
                                                                                                                                
Vice-Chair  Saddler echoed  comments made  by Representative                                                                    
Gara. He  stated that there  was a challenge to  balance the                                                                    
right to  privacy with  the need  for public  protection and                                                                    
health. The committee had  heard substantial testimony about                                                                    
the difficulties  with heroin and  opioid addiction  and had                                                                    
seen  evidence  that  mandating the  PDMP  consultation  and                                                                    
record keeping  had an  effect in  reducing over-prescribing                                                                    
and overdoses.  He also believed  it was fair to  review how                                                                    
the program would work in  Alaska's unique circumstances. He                                                                    
thought allowing a three-year  "pilot program" was good, but                                                                    
he wondered  about the amendment's  provision to  report. He                                                                    
supported requiring  someone to assess the  effectiveness of                                                                    
the  PDMP  and  report  to the  legislature  in  advance  to                                                                    
determine whether  the PDMP mandate  should be  extended. He                                                                    
supported  an amendment  to require  a report  to guide  the                                                                    
legislature in  two years on  whether the mandate  should be                                                                    
continued.                                                                                                                      
                                                                                                                                
2:28:41 PM                                                                                                                    
                                                                                                                                
Representative   Kawasaki   surmised   that   the   language                                                                    
repealing the  PDMP provision after three  years was located                                                                    
on  page  7, line  3.  He  asked  about  the effect  of  the                                                                    
repealer on  page 12, line  14 related to  section effective                                                                    
dates.  He asked  if the  language pertained  to new  or old                                                                    
sections.                                                                                                                       
                                                                                                                                
Mr. Shattuck  replied that  page 7 was  a repealer  and page                                                                    
12, line 14 included the sunset  of sections 22, 24, 26, 28,                                                                    
30,  and  32 of  the  bill,  which covered  the  adjustments                                                                    
proposed in the existing committee substitute (CS).                                                                             
                                                                                                                                
Representative Kawasaki  stated that  one of the  things the                                                                    
committee  had  heard  during public  testimony  related  to                                                                    
Schedule  I  (e.g.  experimental  drugs  and  marijuana)  or                                                                    
Schedule  V (e.g.  drugs that  could  be purchased  off-the-                                                                    
shelf in Canada). He surmised  the drugs in those categories                                                                    
appeared  to be  things  the state  could  not regulate  and                                                                    
there  was not  substantial risk  of addiction.  He believed                                                                    
the current CS  limited the PDMP requirement  to Schedule II                                                                    
and III  prescriptions (opioids and drugs  with an addictive                                                                    
property) and Schedule IV, which  he believed was on the far                                                                    
end of having  an addictive property. He  stated it appeared                                                                    
that by  adding Schedule I  through V drugs it  would result                                                                    
in extra  paperwork for  individuals working  in pharmacies.                                                                    
He did not know if it was good policy or the intent.                                                                            
                                                                                                                                
Mr. Shattuck responded that the  amendment did not intend to                                                                    
address   the   policies   the   committee   was   currently                                                                    
discussing. The  amendment would require a  review or repeal                                                                    
in 2020.  He explained  the amendment contained  many things                                                                    
related to policy calls the  legislature would have to make.                                                                    
He  elaborated  that  the  policy calls  would  be  made  at                                                                    
present  and the  PDMP portion  would come  back before  the                                                                    
committee in three years for review.                                                                                            
                                                                                                                                
Representative  Kawasaki observed  that under  the amendment                                                                    
pharmacists would  have to use  the database for all  of the                                                                    
schedule  drugs  instead  of  limiting  the  requirement  to                                                                    
addictive  drugs.   He  asked   if  his   understanding  was                                                                    
accurate.                                                                                                                       
                                                                                                                                
Mr. Shattuck  answered that  if the  statutes were  reset to                                                                    
the current  law, he believed  it was  fair to say  that the                                                                    
policy  calls made  by  the committee  at  present would  be                                                                    
undone, but only if the  legislature chose not to extend the                                                                    
program in its review.                                                                                                          
                                                                                                                                
Representative Kawasaki needed further clarification.                                                                           
                                                                                                                                
2:32:57 PM                                                                                                                    
                                                                                                                                
Co-Chair Neuman  clarified that the intent  of the amendment                                                                    
was  to maintain  the original  PDMP program.  The amendment                                                                    
would review  the PDMP expansion  in three years.  He stated                                                                    
that  the  language on  page  5  of  the amendment  was  not                                                                    
related to the intent of the amendment.                                                                                         
                                                                                                                                
Representative  Kawasaki  stated   that  under  the  current                                                                    
version of the  bill the state would not  be collecting data                                                                    
for pharmacy  transactions for Schedules  I and V  drugs. He                                                                    
stressed the  amendment included  those categories  as well.                                                                    
He observed  the amendment would  expand the amount  of data                                                                    
collected within the PDMP. He  did not know he would support                                                                    
that expansion.                                                                                                                 
                                                                                                                                
Co-Chair Neuman clarified that the  amendment did not intend                                                                    
to  change anything  currently in  SB 74.  He detailed  that                                                                    
different  drug  classifications   and  pharmacist  database                                                                    
requirements  would  remain  in  law.  The  amendment  would                                                                    
require  the legislature  to  determine  whether the  action                                                                    
under SB 74 had been appropriate in three years.                                                                                
                                                                                                                                
Representative   Kawasaki   addressed  a   requirement   for                                                                    
physicians  and pharmacists  to  use the  PDMP. He  believed                                                                    
testimony had reported that currently  only 30 to 35 percent                                                                    
of  those individuals  used the  database. He  recognized it                                                                    
took extra  work and time  to input data into  the database.                                                                    
He noted he had also  received calls from constituents about                                                                    
the  issue.  He  believed  either the  provision  should  be                                                                    
implemented  and looked  at in  three years  or not  done at                                                                    
all. He  opined it made  sense to  look at the  provision in                                                                    
three years  to determine if  it was harmful  to physicians'                                                                    
offices or  to ramp  up the  database requirement  over time                                                                    
versus making the program optional.                                                                                             
                                                                                                                                
Co-Chair Neuman  answered that the  intent of  the amendment                                                                    
was  to implement  all of  the changes  that were  currently                                                                    
included in SB  74 for a period of three  years. After three                                                                    
years,  the   legislature  would   review  the   statute  to                                                                    
determine if it should be continued.                                                                                            
                                                                                                                                
Vice-Chair Saddler MOVED to ADOPT  conceptual amendment 1 to                                                                    
Amendment 1.  He supported the  intended goals of  the PDMP.                                                                    
Additionally,  he   respected  Co-Chair   Neuman's  concerns                                                                    
related to  privacy and public  safety. The  amendment would                                                                    
direct the  Department of Health and  Social Services (DHSS)                                                                    
to  prepare and  deliver to  the presiding  officers of  the                                                                    
legislature, a  report evaluating  the effectiveness  of the                                                                    
mandated use of  the PDMP in reducing  over prescription and                                                                    
addiction  of opioid  drugs and  other  effects. The  intent                                                                    
would be for the report  to guide the legislature on whether                                                                    
to extend the mandate.                                                                                                          
                                                                                                                                
Representative   Wilson  OBJECTED.   She   asked  when   the                                                                    
committee became  "the enforcement  of everything."  She was                                                                    
unsure  what the  report  was  supposed to  be  and do.  She                                                                    
wanted to see the conceptual  amendment in writing if it was                                                                    
to be considered.                                                                                                               
                                                                                                                                
Vice-Chair Saddler  replied he  would be  glad to  draft the                                                                    
amendment in  writing. The  intent was  to have  the mandate                                                                    
exist for three years and  to evaluate its effectiveness. He                                                                    
remarked that  a previous speaker had  asked for information                                                                    
to base a decision on  in three years. He believed requiring                                                                    
the  department  to report  on  how  well the  database  was                                                                    
achieving its intended purposes would be useful.                                                                                
                                                                                                                                
2:38:43 PM                                                                                                                    
                                                                                                                                
Co-Chair  Neuman thought  it may  be  better for  Vice-Chair                                                                    
Saddler to offer a separate amendment.                                                                                          
                                                                                                                                
Vice-Chair  Saddler  WITHDREW   conceptual  amendment  1  to                                                                    
Amendment 1.                                                                                                                    
                                                                                                                                
Representative  Edgmon   asked  the  amendment   sponsor  to                                                                    
retrace  some  of  the earlier  comments.  He  believed  the                                                                    
amendment made  material changes  to the entire  section. He                                                                    
pointed to  the reinsertion  of language  in Section  25 and                                                                    
the removal of language in Section  26 of the bill. He asked                                                                    
about the impact of the changes.                                                                                                
                                                                                                                                
Mr. Shattuck replied that he  did not classify himself as an                                                                    
expert  on  the database.  He  detailed  that the  amendment                                                                    
addressed the CS currently before  the committee. He pointed                                                                    
to  page  1  of  the  amendment  to  bring  clarity  to  the                                                                    
following sections. Page  1, line 2 would insert  a new bill                                                                    
section. There were  a number of actions that  took place in                                                                    
the corresponding  section in the  bill. He referred  to the                                                                    
complex process  of reverting statutes back  to their former                                                                    
state. He  elaborated the process  included inserting  a new                                                                    
bill  section, which  would revert  statute to  its existing                                                                    
language. He  continued that the  committee may  make policy                                                                    
decisions during the current meeting,  which would alter the                                                                    
CS. All  of the changes would  be in place until  the review                                                                    
occurred  in  2020.  He communicated  the  same  explanation                                                                    
pertained to  Section 24, page 1,  line 17 and page  2, line                                                                    
27.                                                                                                                             
                                                                                                                                
Representative  Munoz asked  if the  amendment took  the law                                                                    
back to  the present  law, which  included a  voluntary PDMP                                                                    
program  instead  of  a   mandatory  program.  Mr.  Shattuck                                                                    
answered in the affirmative.                                                                                                    
                                                                                                                                
Representative  Munoz asked  for verification  the amendment                                                                    
would repeal  the mandatory  reporting requirement  in three                                                                    
years. Mr. Shattuck answered in the affirmative.                                                                                
                                                                                                                                
Representative  Edgmon  believed  the  amendment  seemed  to                                                                    
materially  weaken  the  section  of  the  bill,  which  was                                                                    
integral to the whole PDMP change.                                                                                              
                                                                                                                                
Co-Chair Neuman  reasoned that the legislation  expanded the                                                                    
PDMP reporting requirement and  made reporting mandatory for                                                                    
certain  drugs. He  remarked the  topic had  originally been                                                                    
implemented  in  2008.  He  explained  the  issue  had  been                                                                    
debated at that  time, which was the reason  the program was                                                                    
not  mandatory.  The  statute   would  revert  back  to  the                                                                    
original language if it sunset.                                                                                                 
                                                                                                                                
Representative   Edgmon  asked   to  be   directed  to   the                                                                    
prevailing  language,  which  would  override  the  language                                                                    
being  removed  in  Section  25.   He  cited  the  language:                                                                    
"Nothing in  this section requires or  obligates a dispenser                                                                    
or  practitioner  to access  or  check  the database  before                                                                    
dispensing, prescribing,  or administering a  medication, or                                                                    
providing medical care  to a person." He  noted the language                                                                    
would be removed with the  amendment, but he believed it was                                                                    
being replaced elsewhere.                                                                                                       
                                                                                                                                
2:44:49 PM                                                                                                                    
                                                                                                                                
Co-Chair  Neuman  explained  the amendment  would  not  take                                                                    
effect until  2020. He specified the  amendment would revert                                                                    
the law back  to its original state if an  extension was not                                                                    
approved  by the  legislature. The  intent of  the amendment                                                                    
was to  return to  the current  law, which  allowed optional                                                                    
reporting  and review  of  the PDMP.  He  believed a  doctor                                                                    
should  review  the PDMP  if  they  believed a  patient  was                                                                    
doctor shopping for prescriptions.                                                                                              
                                                                                                                                
Mr. Shattuck pointed  to Section 22, page 22, line  5 of the                                                                    
CS;  if the  current CS  was passed,  Section 22  would look                                                                    
exactly the same. If in  2020 the legislature did not choose                                                                    
to extend, the  section would revert to  current statute. He                                                                    
specified  there was  currently  an annual  report from  the                                                                    
department, which  covered some of the  performance measures                                                                    
a legislator may be concerned about.                                                                                            
                                                                                                                                
2:48:01 PM                                                                                                                    
                                                                                                                                
Co-Chair Thompson stated that  the statute would revert back                                                                    
to the  current statute in  2020. He asked  for verification                                                                    
that in order to  continue the mandatory requirement related                                                                    
to the PDMP it would require new legislation at that time.                                                                      
                                                                                                                                
Mr. Shattuck replied that the  legislature could pass a bill                                                                    
removing  the   section  with  the  repealing   language.  A                                                                    
legislator  could chose  to remove  or extend  the repealing                                                                    
language and make any adjustments.                                                                                              
                                                                                                                                
Representative  Wilson stated  that  if  the public  thought                                                                    
that the  database applied to  all citizens they  would have                                                                    
been  concerned. She  remarked  that SB  74  was a  Medicaid                                                                    
reform  bill.  She  initially  thought  the  provision  only                                                                    
pertained to individuals on Medicaid.  She was fine with the                                                                    
amendment. She  noted that someone paid  the Medicaid bills;                                                                    
therefore,  someone knew  about  prescribed medications  and                                                                    
whether medications  were overprescribed. She  reasoned that                                                                    
her insurance  company knew the  medication she  was taking.                                                                    
She surmised  the issue only  pertained to  the underinsured                                                                    
population,   which   she    believed   had   been   reduced                                                                    
substantially under  Medicaid expansion.  She was  trying to                                                                    
determine  what would  happen to  a person  if the  database                                                                    
alerted  a  misuse.  She  wondered if  a  patient  would  be                                                                    
arrested, if a doctor would be sanctioned, or other.                                                                            
                                                                                                                                
Co-Chair  Neuman replied  that  it was  one  of his  primary                                                                    
concerns.  He   provided  a  scenario  in   which  a  person                                                                    
attempted to shop doctors for  pain medication. He noted the                                                                    
database  would be  updated  weekly in  the  current CS.  He                                                                    
remarked  that there  was  no enforcement  if  "it gets  out                                                                    
there to the week." He shared  that his wife was currently a                                                                    
pharmacy  technician and  was  required  to destroy  illegal                                                                    
prescription scripts. He suspected  the technicians would be                                                                    
responsible for  telling a drug  addict or gang  member they                                                                    
were required to destroy the  prescription. He emphasized it                                                                    
was incredibly scary. He wondered  why the state was putting                                                                    
Alaskan  citizens in  that position.  He continued  that the                                                                    
technician  could call  the troopers;  however, he  remarked                                                                    
that  when  a  person  reported  a  home  break-in  troopers                                                                    
responded they would email a form.                                                                                              
                                                                                                                                
2:52:10 PM                                                                                                                    
                                                                                                                                
Representative Wilson stated that  she had received a letter                                                                    
from the Alaska Dental  Society, which specified requiring a                                                                    
person to  be licensed  to access  the database  would waste                                                                    
valuable    and    expensive   practitioners'    time    for                                                                    
administrative  task. She  remarked that  the change  in law                                                                    
would cost providers time and  money. She was concerned that                                                                    
if a  study needed  to be  done, she  believed it  should be                                                                    
done before  implementing the  mandatory requirement  in the                                                                    
CS in  order to know  the cost  ahead of time.  She wondered                                                                    
why the requirement would be  put on doctors' backs if those                                                                    
paying  the Medicaid  insurance or  private insurance  bills                                                                    
were  not  looking  close  enough at  the  issue.  She  also                                                                    
wondered if negative repercussions  would take place against                                                                    
a  doctor  if they  were  the  unlucky fourth  prescriber  a                                                                    
person  went to  for a  prescription. She  reasoned Alaskans                                                                    
had  a hard  enough time  getting doctors.  She believed  it                                                                    
would have a negative effect.                                                                                                   
                                                                                                                                
Representative  Gattis  asked   for  verification  that  the                                                                    
amendment would make the PDMP  effective for three years and                                                                    
would require checking  of the database for  Schedule II and                                                                    
III drugs.  She asked  for verification the  provision would                                                                    
sunset  after  the three-year  period,  at  which point  the                                                                    
legislature would review the program.                                                                                           
                                                                                                                                
Mr. Shattuck answered in the affirmative.                                                                                       
                                                                                                                                
Representative Gattis stated that  should the amendment pass                                                                    
it would require  Schedule II and III  drug prescriptions to                                                                    
be input  in the database.  She wanted  to be clear  that it                                                                    
was  mandatory  for three  years  and  that the  legislature                                                                    
would receive feedback after that time period.                                                                                  
                                                                                                                                
Co-Chair Neuman answered that the  amendment did not address                                                                    
the different schedule drugs. He  believed there may be some                                                                    
other  amendments addressing  some  of  the least  dangerous                                                                    
drugs.  He  noted SB  74  included  the mandatory  reporting                                                                    
requirement. The amendment left the  PDMP as it would be and                                                                    
asked  the legislature  to review  whether  the changes  had                                                                    
been appropriate in three years.                                                                                                
                                                                                                                                
Representative Munoz believed that  the amendment would make                                                                    
the  program voluntary  [after  three  years]. She  remarked                                                                    
that   currently   only   13   percent   of   doctors   were                                                                    
participating  in  the  program. She  believed  100  percent                                                                    
participation was  needed to be effective.  She wondered how                                                                    
the legislature could come back  in three years to determine                                                                    
the effectiveness  if only  13 percent  of the  doctors were                                                                    
utilizing the system.                                                                                                           
                                                                                                                                
Co-Chair Thompson  explained that  SB 74  required mandatory                                                                    
reporting.   The  amendment   would  remove   the  mandatory                                                                    
requirement in three years.                                                                                                     
                                                                                                                                
Representative Munoz  stated that the amendment  removed the                                                                    
mandatory requirement.                                                                                                          
                                                                                                                                
Co-Chair Neuman  clarified that  the amendment  would remove                                                                    
the  mandatory requirement  in 2020  unless the  legislature                                                                    
extended the  requirement. The amendment would  maintain all                                                                    
of the  requirements in SB  74 and would require  any doctor                                                                    
writing  a prescription  to enter  the information  into the                                                                    
database for  three years.  His goal was  to have  the issue                                                                    
come before the legislature [in 2020].                                                                                          
                                                                                                                                
2:58:50 PM                                                                                                                    
                                                                                                                                
Representative Munoz  asked for verification that  page 5 of                                                                    
amendment  (page 25  of the  bill) would  add back  language                                                                    
that had been deleted in the CS.                                                                                                
                                                                                                                                
JANE   PIERSON,   STAFF,  REPRESENTATIVE   STEVE   THOMPSON,                                                                    
explained that  the amendment  kept the  mandatory reporting                                                                    
requirements currently in  the CS; it would  create a sunset                                                                    
date  of  January  1,  2020, which  would  repeal  what  was                                                                    
currently in the bill. The  program would revert back to the                                                                    
optional program currently in  statute. The one problem with                                                                    
the amendment was  it would be necessary  to remove Schedule                                                                    
I drugs  off of the  amendment, because Schedule  I included                                                                    
marijuana  and would  be contradictive  to the  passed voter                                                                    
initiative. She explained the  amendment looked complex, but                                                                    
really was not.                                                                                                                 
                                                                                                                                
3:00:20 PM                                                                                                                    
AT EASE                                                                                                                         
                                                                                                                                
3:11:33 PM                                                                                                                    
RECONVENED                                                                                                                      
                                                                                                                                
Co-Chair Neuman  clarified the intent  of the  amendment. He                                                                    
addressed the  amendment drafter and relayed  there had been                                                                    
confusion  about the  effects  of Amendment  1. He  detailed                                                                    
there  had  been  questions   about  whether  the  amendment                                                                    
removed Schedule I  or II drugs. His intent  was to maintain                                                                    
the original  PDMP implemented in  2008. The only  thing the                                                                    
amendment  would do  was sunset  the mandatory  requirements                                                                    
included  in SB  74 related  to the  PDMP. He  explained the                                                                    
department or another legislator  would need to an amendment                                                                    
to  implement  the programs  as  they  originally were.  The                                                                    
intent of  the amendment was  for the legislature  to review                                                                    
the issue in three years.                                                                                                       
                                                                                                                                
KATE   GLOVER,  LEGISLATIVE   LEGAL  SERVICES,   LEGISLATIVE                                                                    
AFFAIRS   AGENCY  (via   teleconference),  replied   in  the                                                                    
affirmative. She explained the  impact of the amendment. She                                                                    
detailed  that  following  each section  in  the  bill  that                                                                    
changed the  PDMP requirement a  new section was  added that                                                                    
would  remove  the  changes and  return  statutes  to  their                                                                    
current state.  Sections 22,  24, 26,  28 would  take effect                                                                    
and  in three  years' time  they  would revert  back to  the                                                                    
current  statute.  There were  a  couple  of other  sections                                                                    
added by the  bill; therefore, the new sections  of the PDMP                                                                    
would be  repealed in  three years.  She summarized  that in                                                                    
three years the law would look just as it did at present.                                                                       
                                                                                                                                
Co-Chair Thompson remarked that  SB 74 was changing numerous                                                                    
aspects of  current statute. He  asked how it  would reflect                                                                    
on the current bill the committee was addressing.                                                                               
                                                                                                                                
Ms. Glover  replied that the items  added in SB 74  would be                                                                    
repealed  in  three years.  There  was  already a  PDMP;  AS                                                                    
17.30.200 was the  existing statute, but SB  74 would change                                                                    
the  requirements  related  to  the  database.  Amendment  1                                                                    
removed all of the changes made  by SB 74 [pertaining to the                                                                    
PDMP] in three years to revert back to current statute.                                                                         
                                                                                                                                
Representative  Edgmon  pointed  to   page  3,  line  26  of                                                                    
Amendment  1.  He noted  that  the  word subpoena  had  been                                                                    
added. He  thought a subpoena  was a lower threshold  than a                                                                    
search warrant.                                                                                                                 
                                                                                                                                
Ms. Glover answered that existing  statute included the word                                                                    
subpoena, but  it was removed  in SB  74. The word  would be                                                                    
added  back  into statute  in  three  years to  reflect  the                                                                    
current statutory language.                                                                                                     
                                                                                                                                
Representative  Gara  understood  that the  requirement  for                                                                    
physicians  to look  at the  PDMP  for Schedule  II and  III                                                                    
drugs would last for three  years and become voluntary again                                                                    
under the amendment.  He pointed to page 1  of the amendment                                                                    
and  noted   there  were  numerous  drugs   added  into  the                                                                    
database.  He remarked  on privacy  concerns  that had  been                                                                    
raised. He  observed that  it appeared  a pharmacist  had to                                                                    
enter  Schedule II,  III, and  IV  drugs into  the PDMP.  He                                                                    
asked if  the amendment  also required pharmacists  to enter                                                                    
Schedule IA, IIA, IIIA, IVA, VA, I, and V.                                                                                      
                                                                                                                                
Ms.  Glover answered  that  currently use  of  the PDMP  was                                                                    
optional,  but if  a pharmacist  chose to  use the  database                                                                    
items that  were supposed  to be  entered were  Schedule IA,                                                                    
IIA,  IIIA, IVA,  VA, as  well as  drugs under  federal law.                                                                    
The  language  in SB  74  removed  the state  schedules  and                                                                    
included only  the federal  Schedule II,  III, and  IV drugs                                                                    
for entry  into the  database. She  continued that  in three                                                                    
years' time  statute would return  to the  current language,                                                                    
which would  include the state  and federal  schedule drugs.                                                                    
The program would also revert to being optional.                                                                                
                                                                                                                                
3:17:34 PM                                                                                                                    
                                                                                                                                
Representative  Gara asked  if the  amendment would  require                                                                    
the  entry  of  the  additional  drugs  and  the  bill  only                                                                    
required the entry of federal Schedule II, III and IV.                                                                          
                                                                                                                                
Ms. Glover  responded that the  bill only  required entering                                                                    
federal  Schedule  II,  III,   and  IV  drugs.  Current  law                                                                    
required  all of  the schedule  drugs listed;  the amendment                                                                    
would revert back to current law [in three years].                                                                              
                                                                                                                                
Representative  Gara asked  if the  change would  take place                                                                    
now or  at a later  effective date. Ms. Glover  replied that                                                                    
none  of the  items in  the amendment  would take  place for                                                                    
three years.                                                                                                                    
                                                                                                                                
Representative   Pruitt   explained   that   the   amendment                                                                    
represented current statute. For  example, he referred to AS                                                                    
17.30.200(a) in the amendment  and explained current statute                                                                    
included identical  language. Currently all of  the schedule                                                                    
drugs  listed on  page 1  of  the amendment  were listed  in                                                                    
statute.  Section  21  showed   how  the  statute  would  be                                                                    
amended.  The  two  key  pieces of  the  amendment  were  in                                                                    
Section 52, page 7 that removed  anything new added in SB 74                                                                    
related to  the PDMP and in  the last part of  the bill that                                                                    
"took the new stuff in the  statute and replaced it with the                                                                    
stuff that's currently  in." He stated if  there was concern                                                                    
about  current statute  -  he  pointed to  Schedule  I as  a                                                                    
concern that had been vocalized  - the item would be amended                                                                    
one way or  another. He suggested amending  the amendment to                                                                    
deal  with  the  committee's  desired outcome  if  it  moved                                                                    
forward with a sunset period of three years.                                                                                    
                                                                                                                                
3:20:26 PM                                                                                                                    
                                                                                                                                
Representative   Guttenberg  stated   that  after   training                                                                    
pharmacies and doctors to abide  by a mandatory prescription                                                                    
drug database  the law  would be  repealed after  January 1,                                                                    
2020.  He continued  that theoretically  a legislator  would                                                                    
spend four months  trying to implement a new  law to replace                                                                    
it  and start  over.  He  noted there  would  be  a gap.  He                                                                    
countered that  it was not three  years and may not  even be                                                                    
two years.  He furthered that  the law would be  repealed on                                                                    
January  1, 2020,  which was  approximately  20 days  before                                                                    
session  started -  a time  the legislature  could not  take                                                                    
action on legislation. He elaborated  that if someone wanted                                                                    
to continue the database they would  have to pass the law in                                                                    
the 2019 legislature. He reasoned  that in order to pass the                                                                    
law in  the 2019  legislature it would  require a  report on                                                                    
the program's viability and successes,  which meant the work                                                                    
would need  to begin in 2018.  He explained that if  the law                                                                    
did not  pass in  2019, every doctor  and pharmacist  in the                                                                    
state  would  be  out  and  not  reporting  any  longer.  He                                                                    
continued  that the  individuals could  then be  required to                                                                    
start reporting  again three  or four  months later.  He was                                                                    
not  sure  the  amendment  was  workable.  He  believed  the                                                                    
concept in place  would help the legislature to  know if the                                                                    
requirement was  working. He reiterated  that a  repeal date                                                                    
of January  1, 2020  meant something would  have to  pass in                                                                    
2019. He believed the timeline was too short.                                                                                   
                                                                                                                                
Co-Chair  Neuman  replied  that  it was  a  good  point.  He                                                                    
believed another noted legislator  had suggested a report to                                                                    
the  legislature  in  two  years.  He  would  be  fine  with                                                                    
changing the effective date to 2021  or to April 1, 2020. He                                                                    
reasoned the  legislature would have  a year to take  a look                                                                    
at the issue.  The intent was to  implement the requirements                                                                    
for a few years to see whether they worked.                                                                                     
                                                                                                                                
3:25:09 PM                                                                                                                    
                                                                                                                                
Co-Chair Thompson asked the bill  sponsor's staff to address                                                                    
the amendment.                                                                                                                  
                                                                                                                                
HEATHER SHADDUCK,  STAFF, SENATOR  PETE KELLY, wanted  to be                                                                    
careful in  her response because the  sponsor understood the                                                                    
committee would make some policy  decisions. She relayed the                                                                    
sponsor had  tried to fix some  of the things that  had been                                                                    
brought  to the  legislature  through  various reports.  She                                                                    
referred  to  the  report   from  the  Controlled  Substance                                                                    
Advisory  Council asking  to strengthen  or fix  some things                                                                    
related to  the PDMP, which  were separate from  whether the                                                                    
database should  be mandatory or  not. One of the  items had                                                                    
been to  allow for a  delegated access to the  database. The                                                                    
version  from  the  Senate had  allowed  for  any  delegated                                                                    
access by  a doctor or  pharmacist. She detailed  that based                                                                    
on   public  testimony   the  CS   limited  the   access  to                                                                    
individuals  licensed or  registered by  the state's  boards                                                                    
and corporations,  which increased accountability.  The bill                                                                    
had  placed   the  mandatory   lookup  requirement   on  the                                                                    
prescriber  in  order  to  remove   the  pressure  from  the                                                                    
pharmacist. The  change also prevented the  pharmacists from                                                                    
being  faced with  awkward conversations;  the conversations                                                                    
would  happen more  appropriately on  the frontend  with the                                                                    
prescriber.  Additionally   the  schedule  drugs   had  been                                                                    
cleaned  up. She  specified that  state  schedule drugs  had                                                                    
been   removed  because   they   were  only   used  by   law                                                                    
enforcement.  She noted  that if  the  amendment passed  the                                                                    
state  schedule  drugs  would be  added  back  into  statute                                                                    
[after the  three-year period]. She furthered  that Schedule                                                                    
I had  been removed  because the drugs  had no  medical use;                                                                    
the classification  also included  marijuana, which  per the                                                                    
marijuana initiative,  the state could not  collect any data                                                                    
on  users. Schedule  V had  been  removed based  on the  low                                                                    
threshold  or likelihood  of  addiction.  She explained  the                                                                    
bill  included a  limited Schedule  II,  III, and  IV to  be                                                                    
monitored  under the  PDMP. The  sunset would  automatically                                                                    
put the schedules back into statute.                                                                                            
                                                                                                                                
Ms. Shadduck  believed there would  be a  separate amendment                                                                    
to talk about  a report or audit, which Amendment  1 did not                                                                    
include. She referred  to page 3 of the  amendment where the                                                                    
word  "subpoena" was  removed; the  amendment would  add the                                                                    
word  back into  statute. She  explained the  word had  been                                                                    
removed based on feedback in  working with the Department of                                                                    
Law  (DOL)  to  further  comply with  the  Health  Insurance                                                                    
Portability and  Accountability Act  (HIPAA) and  to further                                                                    
protect  individuals'   medical  records.  The   current  CS                                                                    
included a  search warrant  or an order  issued by  a court.                                                                    
She explained  that both items  required appearing  before a                                                                    
judge. She detailed  that a subpoena was  a lesser threshold                                                                    
and could be  issued by a staff member in  a courthouse. She                                                                    
explained removing the mandatory  lookup removed the benefit                                                                    
of  the  provision. She  furthered  it  was the  committee's                                                                    
policy call to make on whether  a sunset was the wise choice                                                                    
or not.  She believed the  sponsor would be  very supportive                                                                    
of a  more comprehensive audit after  the three-year period.                                                                    
She relayed  that one  of the  later amendments  proposed to                                                                    
change  the PDMP  effective date  sections to  July 1,  2017                                                                    
based  on conversations  with the  Division of  Corporations                                                                    
Boards and Professional Licensing  [within DCCED] to account                                                                    
for  the time  needed by  the agency.  She furthered  if the                                                                    
repealer remained  at [January  1] 2020  it would  require a                                                                    
bill to be  passed in 2019, which would only  mean 1.5 years                                                                    
of data.  She reasoned it may  not be possible to  tell what                                                                    
was going on based on the limited data at that time.                                                                            
                                                                                                                                
3:29:23 PM                                                                                                                    
                                                                                                                                
Representative Gattis  asked why  the amendment  sponsor had                                                                    
proposed rolling the statute back  to current statute at the                                                                    
time of sunset versus reverting back to the bill language.                                                                      
                                                                                                                                
Co-Chair Neuman answered  that he was trying  to keep things                                                                    
simple. His  intent was  to revert the  statute back  to the                                                                    
current statute  [in three years].  He understood  and could                                                                    
probably accept  a change to  an effective date of  2021. He                                                                    
suspected  future legislators  would change  the Schedule  I                                                                    
and V  and other. He  believed the major and  most objective                                                                    
portion of the provision  was the mandatory requirements for                                                                    
all  doctors and  the intervention  into people's  lives. He                                                                    
believed future  legislators would  have the  same concerns.                                                                    
He  remarked  that marijuana  will  have  been legal  for  a                                                                    
couple of years  and would be addressed. He  agreed with the                                                                    
changes that  were made. He  mentioned pharmacists  that had                                                                    
to  follow the  mandatory  requirements,  which he  believed                                                                    
would  be looked  at as  well.  He would  accept a  friendly                                                                    
amendment to change the effective date to 2021.                                                                                 
                                                                                                                                
Representative  Wilson wondered  why  there was  such a  low                                                                    
number  of doctors  (17 percent)  using the  PDMP currently.                                                                    
She wondered if it was too cumbersome or expensive.                                                                             
                                                                                                                                
Ms. Shadduck  clarified 13.5 percent of  current prescribers                                                                    
and 40 percent of pharmacies used  the PDMP based on a white                                                                    
paper   provided  to   the  committee   ["State  of   Alaska                                                                    
Controlled  Substances   Advisory  Committee   White  Paper:                                                                    
Increasing the  Effectiveness of Alaska's  Prescription Drug                                                                    
Monitoring  Program (Alaska's  PDMP)" (copy  on file)].  She                                                                    
shared that some doctors had  been unaware the PDMP existed;                                                                    
therefore,  part of  the issue  was  education. She  relayed                                                                    
that Dr. Zink  had provided testimony to  the committee that                                                                    
a couple of years ago the  emergency room she worked for had                                                                    
gone to  the Board of  Pharmacy and other  stakeholders with                                                                    
the request for  a PDMP, only to discover  that the database                                                                    
already existed. Additionally,  some doctors had experienced                                                                    
problems with using  the database, which had  been worked on                                                                    
extensively and  improved by the  Board of Pharmacy  and the                                                                    
Division of Corporations Boards and Professional Licensing.                                                                     
                                                                                                                                
3:32:58 PM                                                                                                                    
                                                                                                                                
Vice-Chair Saddler MOVED to ADOPT  an amendment to Amendment                                                                    
1. He  directed attention  to page 7,  line 5  and explained                                                                    
the amendment would change the  date 2020 to 2021. Likewise,                                                                    
the date  would be  changed from  2020 to  2021 on  page 12,                                                                    
line 14.                                                                                                                        
                                                                                                                                
Representative Gara  OBJECTED. He  did not support  a sunset                                                                    
date on the PDMP provision. He WITHDREW his OBJECTION.                                                                          
                                                                                                                                
Representative Gattis OBJECTED. She  asked if the date could                                                                    
be changed to  sometime after session started  such as April                                                                    
or June.                                                                                                                        
                                                                                                                                
3:35:03 PM                                                                                                                    
AT EASE                                                                                                                         
                                                                                                                                
3:36:03 PM                                                                                                                    
RECONVENED                                                                                                                      
                                                                                                                                
Vice-Chair  Saddler  WITHDREW   conceptual  amendment  1  to                                                                    
Amendment 1.  He MOVED  to ADOPT  conceptual amendment  2 to                                                                    
Amendment 1.  He directed  attention to page  7, line  5 and                                                                    
explained the amendment would change  the date of January 1,                                                                    
2020 to  July 1, 2021.  Likewise, the date would  be changed                                                                    
from date  of January 1,  2020 to July  1, 2021 on  page 12,                                                                    
line 14. There being NO OBJECTION, it was so ordered.                                                                           
                                                                                                                                
Representative  Wilson supported  Amendment  1. She  thought                                                                    
there  would  be  problems discovered  in  the  future.  She                                                                    
remarked the Dental Society had  already submitted a concern                                                                    
that she  did not  see addressed by  any of  the amendments.                                                                    
She  remarked a  huge number  of people  had never  used the                                                                    
PDMP.  She  thought it  would  be  about the  providers  and                                                                    
whether  or not  the program  was working  for them  to make                                                                    
sure  everything  kept  on  track.   She  reasoned  that  if                                                                    
everything  was  working  well the  amendment  would  merely                                                                    
bring the issue back before  the legislature to make sure it                                                                    
was addressing  anything the providers  had issue  with. She                                                                    
was  frustrated the  fiscal notes  only  reflected costs  or                                                                    
savings to  the state. She  was interested in the  costs and                                                                    
savings  to  the  state's  communities  and  providers.  She                                                                    
believed  there would  be  unintended  consequences and  the                                                                    
amendment would force the legislature to review the issues.                                                                     
                                                                                                                                
Representative Gattis  spoke in favor of  the amendment. She                                                                    
relayed that  the sponsor  knew that  some of  the committee                                                                    
members had been struggling with the data collection issue.                                                                     
                                                                                                                                
Representative Edgmon viewed the  changes to the database as                                                                    
one  of  the central  benefits  of  the  bill. He  spoke  to                                                                    
significant  opioid  abuse  in  his  district  in  Southwest                                                                    
Alaska.  He believed  the database  provisions  in the  bill                                                                    
seemed  to provide  a way  to  help combat  the problem.  He                                                                    
noted  there was  significant support  for the  database. He                                                                    
also respected the issues of  privacy and believed they were                                                                    
well  established, but  he believed  the support  outweighed                                                                    
the consequences.  He pointed out  that it would  cost about                                                                    
$25,000  to run  another bill  according to  the Legislative                                                                    
Affairs Agency  from several years earlier.  He wondered why                                                                    
an  audit  could not  be  conducted  as opposed  to  running                                                                    
another  bill. He  remarked on  time  and resources  running                                                                    
another  bill  required.  He would  support  the  amendment,                                                                    
albeit somewhat reluctantly.                                                                                                    
                                                                                                                                
Representative Pruitt stated  there would need to  be a bill                                                                    
either way. He  elaborated that a bill would  be required to                                                                    
extend or make the  PDMP provisions permanent. Additionally,                                                                    
a bill  would be required to  fix the Schedule I  drugs that                                                                    
would be  included [when  the statute  reverted back  to its                                                                    
current state]. He  thought it would be possible  to fix one                                                                    
of the  problems with a conceptual  amendment by eliminating                                                                    
Schedule  I  from  the  statute to  prevent  it  from  being                                                                    
included when  the law reverted  back. He explained  that if                                                                    
the  legislature  chose  to  let  the  new  PDMP  provisions                                                                    
sunset, the  provisions would sunset without  the Schedule I                                                                    
drugs being required  in the database, which  would fit with                                                                    
the [marijuana voter] initiative.                                                                                               
                                                                                                                                
3:41:23 PM                                                                                                                    
                                                                                                                                
Co-Chair Neuman  replied that  Representative Pruitt  made a                                                                    
good point. He supported  maintaining the original amendment                                                                    
as is,  but would ask  staff to work with  Legislative Legal                                                                    
Services on the issue as a separate amendment.                                                                                  
                                                                                                                                
Representative Gara  spoke in  opposition to  the amendment.                                                                    
He  discussed  that Alaska  was  currently  dealing with  an                                                                    
opioid epidemic,  which also related  to a  heroin epidemic.                                                                    
He agreed with the bill  sponsor that physicians should look                                                                    
up a  patient's prescription history related  to the limited                                                                    
class  of drugs  (i.e.  steroids, opioids,  and other  drugs                                                                    
that could  kill a person).  Additionally, in three  years a                                                                    
huge amount of extra work  would be created for pharmacists.                                                                    
He  pointed  to   page  1,  lines  6  and   7  and  detailed                                                                    
pharmacists  would   have  to  begin  entering   a  list  of                                                                    
additional drugs into the PDMP.  He reasoned that if privacy                                                                    
was a  concern, adding additional  drugs back in  would mean                                                                    
thousands more  people would be  entered into  the database.                                                                    
The bill  limited the  work of  the pharmacists  and limited                                                                    
the  information going  into the  database  to Schedule  II,                                                                    
III, and IV drugs.                                                                                                              
                                                                                                                                
Representative Guttenberg  testified against  the amendment.                                                                    
He   spoke  to   the  amendment   sponsor's  concern   about                                                                    
pharmacist   technicians   having   to   deal   with   false                                                                    
prescription  scripts. He  pointed  out  that retail  clerks                                                                    
were routinely faced with tearing  up people's credit cards.                                                                    
He  had not  heard  about  negative repercussions  resulting                                                                    
from  those  instances.  He  thought  it  was  a  legitimate                                                                    
concern,  but  he  did  not  think  it  existed  in  similar                                                                    
situations  in cities  in  Alaska and  the  broader U.S.  He                                                                    
considered  that   drug  addicts   did  not   have  rational                                                                    
behavior,  but  neither  did  people  using  other  people's                                                                    
credit  cards.  He  surmised  it  did not  appear  to  be  a                                                                    
substantial   problem.   He   did   not   believe   it   was                                                                    
justification for  undoing a  huge reform.  He spoke  to the                                                                    
need to  get a handle on  the drug problem in  Alaska and to                                                                    
get control of rising  pharmaceutical costs. He believed the                                                                    
concern was a  small piece of the overall  picture. He spoke                                                                    
to the importance of reform.  He believed the amendment went                                                                    
in the wrong direction for the PDMP.                                                                                            
                                                                                                                                
Co-Chair  Neuman  provided  wrap  up on  the  amendment.  He                                                                    
understood the opioid  problem in the state.  He referred to                                                                    
his work  on the issue  over the  past few years.  He stated                                                                    
that  doctors were  being more  and more  careful about  not                                                                    
overprescribing  prescriptions. He  remarked  that the  bill                                                                    
sponsor's  staff had  testified  that many  doctors did  not                                                                    
know  the PDMP  existed. He  remarked that  they would  know                                                                    
now; he  believed the  legislature needed  to listen  to the                                                                    
doctors.  He  thought  that scripts  that  were  being  over                                                                    
written would  be addressed. He  believed doctors  needed to                                                                    
start reporting their peers  who overwrite prescriptions. He                                                                    
stated there was  already a system in place  - doctors could                                                                    
make reports to the Board  of Medicine. He referred to prior                                                                    
testimony that some  doctors felt it was  not their business                                                                    
what another  doctor was  doing. He opined  that may  be the                                                                    
problem.                                                                                                                        
                                                                                                                                
3:47:22 PM                                                                                                                    
                                                                                                                                
Co-Chair Thompson WITHDREW his OBJECTION.                                                                                       
                                                                                                                                
Representative Guttenberg OBJECTED.                                                                                             
                                                                                                                                
A roll call vote was taken  on the motion to Adopt Amendment                                                                    
1 as amended.                                                                                                                   
                                                                                                                                
IN FAVOR: Edgmon, Gattis, Kawasaki,  Munoz, Pruitt, Saddler,                                                                    
Wilson, Neuman, Thompson                                                                                                        
OPPOSED: Gara, Guttenberg                                                                                                       
                                                                                                                                
The MOTION  to Adopt  Amendment 1  as amended  PASSED (9/2).                                                                    
There being NO further OBJECTION, it was so ordered.                                                                            
                                                                                                                                
3:48:23 PM                                                                                                                    
                                                                                                                                
Representative  Edgmon  MOVED  to  ADOPT  Amendment  2,  29-                                                                    
LS0692\T.13 (Glover, 4/8/16) (copy on file):                                                                                    
                                                                                                                                
     Page 24, lines 26 - 27:                                                                                                    
     Delete all material and insert:                                                                                            
     "(11)  a practitioner,  pharmacist,  or clinical  staff                                                                    
     employed  by  an  Alaska  tribal  health  organization,                                                                    
     including  commissioned corps  officers  of the  United                                                                    
     States   Public  Health   Service   employed  under   a                                                                    
     memorandum  of agreement;  in  this paragraph,  "Alaska                                                                    
     tribal health  organization" has  the meaning  given to                                                                    
     "tribal health program" in 25 U.S.C. 1603."                                                                                
                                                                                                                                
Co-Chair Thompson OBJECTED for discussion.                                                                                      
                                                                                                                                
Representative  Edgmon   explained  that  Amendment   2  was                                                                    
technical. He  pointed to page  24, lines  26 and 27  of the                                                                    
bill. The amendment  replaced language in the  bill with the                                                                    
above amendment  language as proposed  by the  Alaska Native                                                                    
Tribal Health  Consortium (ANTHC). He detailed  the language                                                                    
in the amendment  would do a cleaner job  of referencing the                                                                    
federal definition. He noted that  it was the provision that                                                                    
laid out the parties who would have access to the PDMP.                                                                         
                                                                                                                                
Co-Chair  Thompson WITHDREW  his OBJECTION.  There being  NO                                                                    
further OBJECTION, Amendment 2 was ADOPTED.                                                                                     
                                                                                                                                
Representative  Gattis  MOVED  to  ADOPT  Amendment  3,  29-                                                                    
LS0692\T.16 (Glover,  4/9/16) (copy on file).  [Note: due to                                                                    
amendment length  it has not  been included in  the minutes.                                                                    
See copy on file.]                                                                                                              
                                                                                                                                
Co-Chair Thompson OBJECTED for discussion.                                                                                      
                                                                                                                                
Representative Gattis  explained the amendment  would delete                                                                    
Section 31. She read a statement explaining the amendment:                                                                      
                                                                                                                                
     On the  surface requiring competitive bids  sounds like                                                                    
     the best  way to  ensure the best  price, unfortunately                                                                    
     this is not  always the case. That's  why I'm proposing                                                                    
     to eliminate  Section 31 calling for  competitive bids.                                                                    
     This  section wasn't  requested  by  the Department  of                                                                    
     Health  and   Social  Services  or   conceptualized  by                                                                    
     somebody  wanting  to  cut   the  budget.  Rather,  was                                                                    
     advocated   by    a   durable   medical    good   sales                                                                    
     representative. This  section ties  the hands  of DHSS.                                                                    
     It  would require  the department  to strictly  utilize                                                                    
     competitive bidding. By supporting  my amendment you do                                                                    
     not   negate  the   department's  ability   to  utilize                                                                    
     competitive  bidding, rather  you allow  the department                                                                    
     to  make the  best  business decisions  related to  the                                                                    
     care and costs of healthcare delivery system.                                                                              
                                                                                                                                
Representative Gattis referred to a  bill she had offered on                                                                    
durable  medical  goods  that  had  been  voted  on  by  the                                                                    
committee.  She  realized  the  State  of  Alaska  was  very                                                                    
different.  She  referred   to  not  including  hand-me-down                                                                    
durable medical  goods in her  past bill,  because sometimes                                                                    
it was  not the  least expensive way.  She remarked  that it                                                                    
could potentially be cheaper to  fly goods from Seattle than                                                                    
to drive  them up a  road from  somewhere else. She  did not                                                                    
want  to  tie the  department's  hands.  She continued  DHSS                                                                    
already  had  the  ability  to  go out  for  a  request  for                                                                    
proposal  (RFP) and  could use  competitive bidding.  As the                                                                    
state  crunched its  budget she  did not  want to  limit the                                                                    
department to a specific way  of doing things. She continued                                                                    
to read from a statement:                                                                                                       
                                                                                                                                
     Also,  it's  a  tough  market with  lots  of  paperwork                                                                    
     requirements,  low margins,  and high  service demands.                                                                    
     Low  dollar bidding  requirements, without  considering                                                                    
     the other  needs and  service demands  of an  area also                                                                    
     greatly diminish  the quality of service  and care that                                                                    
     our Medicaid  patients receive. In  my area, we  have a                                                                    
     company  that  delivers   products  door-to-door.  They                                                                    
     assemble them and provide  other products and services.                                                                    
     They also  come back  and provide and  repair services.                                                                    
     Competitive  bidding  Section  31   that  needs  to  be                                                                    
     repealed - there  is no promise it will  save the state                                                                    
     money. In fact, strong arguments  can be made that this                                                                    
     section is penny-wise and  pound-foolish. So I'm asking                                                                    
     your vote  to eliminate  that particular section  to be                                                                    
     able  to  give the  department  the  opportunity to  go                                                                    
     what's least expensive and what works best for Alaska.                                                                     
                                                                                                                                
3:53:29 PM                                                                                                                    
                                                                                                                                
Representative Gara  stated that Section 31  did not include                                                                    
language  specifying  DHSS  "shall"  engage  in  competitive                                                                    
bidding.  He wanted  the department  to  utilize the  option                                                                    
when  it  could  bring  a  cost savings  to  the  state.  He                                                                    
observed  the  amendment  would  delete  page  28,  lines  6                                                                    
through  11  of the  bill.  He  explained  page 28,  line  7                                                                    
specified  the department  "may" enter  into a  contract for                                                                    
competitive bidding.  He believed the department  should use                                                                    
the competitive  bidding option when  it saved  money. Based                                                                    
on that he  did not support the amendment. He  did not see a                                                                    
directive to the department in the legislation.                                                                                 
                                                                                                                                
Representative Gattis  answered that the  department already                                                                    
may  [enter into  competitive  bidding].  She explained  the                                                                    
redundancy of the  section. She relayed she  had received an                                                                    
email specifying the issue.                                                                                                     
                                                                                                                                
Co-Chair Thompson WITHDREW his OBJECTION.                                                                                       
                                                                                                                                
Representative  Gara  OBJECTED. He  would  have  to read  AS                                                                    
47.07.030.  He   stated  the  amendment   included  language                                                                    
"notwithstanding  c of  this section."  He surmised  it must                                                                    
create a  concern the department  was not allowed  to engage                                                                    
in competitive bidding.                                                                                                         
                                                                                                                                
Co-Chair Thompson asked the bill  sponsor's staff to address                                                                    
the committee.                                                                                                                  
                                                                                                                                
Ms. Shadduck deferred the question to the department.                                                                           
                                                                                                                                
Representative  Gara restated  his question.  He stated  the                                                                    
bill included  language "notwithstanding  c of  this section                                                                    
the  department may  enter into  a contract  for competitive                                                                    
bidding."  He  wondered if  the  department  would have  the                                                                    
ability to  enter into  competitive bidding  without Section                                                                    
31 of the bill.                                                                                                                 
                                                                                                                                
ERIN NARUS, STATE MEDICAID  PHARMACIST, DEPARTMENT OF HEALTH                                                                    
AND  SOCIAL  SERVICES  (via  teleconference),  replied  that                                                                    
currently the durable medical equipment  program was able to                                                                    
enter  into contracts  for service  delivery. She  read from                                                                    
the  statute under  discussion AS  47.05.015(c): A  contract                                                                    
authorized   under  this   section   is   exempt  from   the                                                                    
competitive bid requirements of  AS 36.30." She explained AS                                                                    
36.30  was the  state  procurement code.  She detailed  that                                                                    
when awarding  a contract under the  section, the department                                                                    
shall request  proposals in  accordance with  regulations of                                                                    
the   Department   of   Administration  (DOA).   Under   the                                                                    
department's  current regulations  it had  the authority  to                                                                    
enter  into contracts  for service  delivery. She  furthered                                                                    
that within  the language in  the current CS  the department                                                                    
would  have the  ability to  enter into  competitive bidding                                                                    
contracts and its ability to do so would not be restricted.                                                                     
                                                                                                                                
Representative Gara  asked if the department  would have the                                                                    
ability to engage in competitive  bidding without Section 31                                                                    
of the bill.                                                                                                                    
                                                                                                                                
Ms.  Narus  replied  that the  section  related  to  durable                                                                    
medical  equipment  was not  a  requirement.  She could  not                                                                    
speak  to the  other specific  medical services  outlined in                                                                    
the section.                                                                                                                    
                                                                                                                                
Representative Gara  believed the bill should  remain as is.                                                                    
He reasoned the section  specified the department may engage                                                                    
in competitive  bidding. He  furthered there  was a  part of                                                                    
current statute  specifying the  department was  exempt from                                                                    
the competitive bidding part of  the procurement process. He                                                                    
explained  that   the  term  "may"   did  not   require  the                                                                    
department to  do anything. He  felt safer with  the current                                                                    
bill language.                                                                                                                  
                                                                                                                                
Ms.  Shadduck replied  that it  was  the committee's  policy                                                                    
call. She stated  the department could use  the authority if                                                                    
it was  granted or it  would continue with the  contracts it                                                                    
could currently do.                                                                                                             
                                                                                                                                
Representative Gattis  relayed that  she had seen  red flags                                                                    
that   a   particular   sales  person   had   been   looking                                                                    
specifically  for the  bill language.  She had  asked people                                                                    
providing  durable medical  goods  about the  issue and  had                                                                    
been  told there  were high  profit margins  in some  of the                                                                    
durable medical  equipment. The low profit  margins included                                                                    
items  such  as  diapers,  gloves,  and  other.  She  stated                                                                    
grocery stores  knew the  items as  "loss leaders"  but they                                                                    
brought people  in for other  items. She had been  told that                                                                    
the currently  under a competitive  bid an entity  could get                                                                    
the lowest  price for  high profit  margins, but  they would                                                                    
not backfill  the other  low profit  margin items  they were                                                                    
currently  providing. She  stressed that  on a  bigger scale                                                                    
the state lost money that  way. The department had indicated                                                                    
it could  submit RFPs to  keep expenses down.  She furthered                                                                    
the  department knew  it  had  to be  able  to purchase  all                                                                    
items.  In her  perfect  world  she would  like  to see  the                                                                    
department  have   the  ability   to  shop  at   Costco  for                                                                    
inexpensive  items.  She  did not  want  to  see  unintended                                                                    
consequences from the section.                                                                                                  
                                                                                                                                
4:02:13 PM                                                                                                                    
                                                                                                                                
Vice-Chair  Saddler asked  for clarification.  He asked  for                                                                    
verification that  while it could appear  to be advantageous                                                                    
for the state  to have competitive bidding  on all products,                                                                    
vendors  did not  participate in  the  competition for  some                                                                    
items, which would be to the state's detriment.                                                                                 
                                                                                                                                
Representative  Gattis  clarified   that  the  state  wanted                                                                    
competitive bidding on all items.  She provided an expensive                                                                    
electronic  wheelchair  with  a  high profit  margin  as  an                                                                    
example.  She explained  there  were  companies selling  the                                                                    
whole gamut.  She specified  that if a  company only  took a                                                                    
high profit  margin there  were people  left with  trying to                                                                    
fill  the bill  with the  low profit  margins and  the state                                                                    
still had to buy the products.  She did not want to enable a                                                                    
company from outside or inside Alaska to cherry pick.                                                                           
                                                                                                                                
Representative Gara MAINTAINED his OBJECTION.                                                                                   
                                                                                                                                
A roll call vote was taken on the motion.                                                                                       
                                                                                                                                
IN FAVOR: Gattis,   Guttenberg,  Pruitt,   Saddler,  Wilson,                                                                    
Edgmon, Thompson, Neuman                                                                                                        
OPPOSED: Gara, Kawasaki                                                                                                         
                                                                                                                                
Representative Munoz was absent from the vote.                                                                                  
                                                                                                                                
The MOTION  to Adopt Amendment  3 PASSED (2/8).  There being                                                                    
NO further OBJECTION, Amendment 3 was ADOPTED.                                                                                  
                                                                                                                                
4:04:25 PM                                                                                                                    
AT EASE                                                                                                                         
                                                                                                                                
4:19:18 PM                                                                                                                    
RECONVENED                                                                                                                      
                                                                                                                                
Representative  Gara   MOVED  to  ADOPT  Amendment   4,  29-                                                                    
LS0692\T.15 (Glover, 4/9/16) (copy on file):                                                                                    
                                                                                                                                
     Page 37, line 12:                                                                                                          
     Delete the first occurrence of "The"                                                                                       
     Insert "Subject to (b) of this section, the"                                                                               
                                                                                                                                
     Page 37, following line 29:                                                                                                
     Insert a new subsection to read:                                                                                           
     "(b)  After January  1, 2022,  the  department may  not                                                                    
     compensate  hospital   emergency  departments,  through                                                                    
     shared  savings,  for  a  reduction  in  hospital  fees                                                                    
     resulting from the project."                                                                                               
                                                                                                                                
     Reletter the following subsection accordingly.                                                                             
                                                                                                                                
Representative Wilson OBJECTED.                                                                                                 
                                                                                                                                
Representative Gara  wanted committee members to  be present                                                                    
to vote.                                                                                                                        
                                                                                                                                
4:19:59 PM                                                                                                                    
AT EASE                                                                                                                         
                                                                                                                                
4:20:59 PM                                                                                                                    
RECONVENED                                                                                                                      
                                                                                                                                
Representative Gara explained the  amendment related to page                                                                    
37 of the bill and was intended  to be a cost savings to the                                                                    
state, while  being fair to  the state's hospitals  as well.                                                                    
He stated  people had heard  for years that too  many people                                                                    
were using the emergency room  who should not be. He pointed                                                                    
to the  expense to hospitals and  individuals with insurance                                                                    
who had to  pay for uncompensated medical care.  Part of the                                                                    
bill's goal was to reduce the  number of people going to the                                                                    
emergency room  when they did  not need to. He  stressed the                                                                    
emergency  room was  a very  expensive  way to  deal with  a                                                                    
cold,  flu, and  other. Hospitals  had been  concerned about                                                                    
significant uncompensated medical  care, but Medicaid reform                                                                    
had  enabled  them to  receive  much  more compensation  for                                                                    
emergency room  medical care. The bill  included a provision                                                                    
specifying  now that  fewer people  would  be utilizing  the                                                                    
emergency  room  for  inappropriate care,  the  state  would                                                                    
share  its  savings with  hospitals.  He  stressed that  the                                                                    
individuals should  not be going  to the emergency  room for                                                                    
care. Hospitals  argued they  were making  significant money                                                                    
off people  who should not  be going to the  emergency room.                                                                    
He did not think the state  needed to pay for everything. He                                                                    
had spoken  to the  Alaska State  Hospital and  Nursing Home                                                                    
Association  (ASHNHA)  and  the   bill  sponsor's  staff  to                                                                    
determine  a compromise.  He believed  the  solution he  had                                                                    
selected was one  the groups could work around,  but was not                                                                    
one they were thrilled with. He  pointed to page 37 line 12.                                                                    
The amendment  would maintain shared savings  for five years                                                                    
[until January 1,  2022] and would allow  the hospitals time                                                                    
to adjust to the reduced  number of patients. He referred to                                                                    
the  state's  $4.4  billion  deficit.  He  did  not  support                                                                    
compensating  medical providers  in perpetuity  because they                                                                    
were  not  treating  patients  they  should  not  have  been                                                                    
treating in the first place.                                                                                                    
                                                                                                                                
4:24:43 PM                                                                                                                    
                                                                                                                                
Representative  Wilson WITHDREW  her OBJECTION.  There being                                                                    
NO further OBJECTION, Amendment 4 was ADOPTED.                                                                                  
                                                                                                                                
Representative  Guttenberg MOVED  to ADOPT  Amendment 5  29-                                                                    
LS0692\U.A.39  (Mischel/Glover,  3/31/16)  (copy  on  file).                                                                    
[Note: due to  amendment length it has not  been included in                                                                    
the minutes. See copy on file.] He OBJECTED.                                                                                    
                                                                                                                                
Co-Chair Thompson OBJECTED for discussion.                                                                                      
                                                                                                                                
Representative Guttenberg explained he  believed there was a                                                                    
loophole,  but the  issue was  challengeable. He  stated the                                                                    
bill removed Schedule III from  the database. He referred to                                                                    
the bill's  dealing with  rural Alaska  and how  people were                                                                    
able  to call  in for  prescription without  dealing with  a                                                                    
doctor  with only  a nurse  or  nurse's aide.  He wanted  to                                                                    
ensure  the  issue was  fixed.  He  wanted to  ensure  rural                                                                    
Alaskans had  the opportunity  to utilize  telemedicine like                                                                    
others in  the state.  He wanted  to make  sure telemedicine                                                                    
was available across the state,  but he wanted to ensure the                                                                    
amendment did  what he intended.  Therefore he  WITHDREW his                                                                    
OBJECTION  and the  Amendment. He  expressed  his intent  to                                                                    
offer the amendment on the House floor at a later date.                                                                         
                                                                                                                                
Co-Chair Thompson noted Amendment 5 had been WITHDRAWN.                                                                         
                                                                                                                                
4:26:25 PM                                                                                                                    
                                                                                                                                
Co-Chair Thompson MOVED to  ADOPT Amendment 6, 29-LS0692\T.8                                                                    
(Glover, 4/8/16) (copy on file):                                                                                                
                                                                                                                                
     Page 12, lines 10 - 11:                                                                                                    
     Delete "the earlier of'                                                                                                    
                                                                                                                                
     Page 12, line 13, following "Services,":                                                                                   
     Insert "whichever is later,"                                                                                               
                                                                                                                                
Representative Gara OBJECTED for discussion.                                                                                    
                                                                                                                                
Ms. Pierson  explained the amendment was  located in Section                                                                    
16,  page 12  of the  bill. The  amendment included  cleanup                                                                    
language on  the statute of limitations  for actions related                                                                    
to  claims based  on  medical payment  fraud.  She read  the                                                                    
updated sentence proposed by the amendment:                                                                                     
                                                                                                                                
     ...a person may not bring  an action under AS 09.58.010                                                                    
     -  AS 09.58.060,  unless the  action  is commenced  six                                                                    
     years after the  act or omission was  committed, or (2)                                                                    
     three years after  the date when facts  material to the                                                                    
     action  were  known,  or reasonably  should  have  been                                                                    
     known,  by the  attorney general  or the  Department of                                                                    
     Health and Social Services, whichever  is later, but in                                                                    
     no  event  more  than  10  years  after  the  date  the                                                                    
     violation under AS 09.58.010 occurred.                                                                                     
                                                                                                                                
Representative Gara  WITHDREW his OBJECTION. There  being NO                                                                    
further OBJECTION, Amendment 6 was ADOPTED.                                                                                     
                                                                                                                                
4:28:27 PM                                                                                                                    
                                                                                                                                
Co-Chair   Thompson  MOVED   to  ADOPT   Amendment  7,   29-                                                                    
LS0692\T.17 (Bruce/Glover, 4/9/16) (copy on file):                                                                              
                                                                                                                                
     Delete  "that  uses  remote identity  proofing  through                                                                    
     multiple layers of authentication"                                                                                         
                                                                                                                                
Representative Wilson OBJECTED for discussion.                                                                                  
                                                                                                                                
Ms. Pierson  explained the amendment was  located in Section                                                                    
32  of the  bill and  related to  the enhanced  computerized                                                                    
eligibility verification  system. The bill had  included the                                                                    
following  language:  "that  uses remote  identity  proofing                                                                    
through  multiple layers  of  authentication." She  detailed                                                                    
the  language   would  result  in  a   larger  fiscal  note;                                                                    
therefore,  the   amendment  sponsor  wanted   the  language                                                                    
removed.   She  furthered   the   department  would   ensure                                                                    
security.                                                                                                                       
                                                                                                                                
Representative  Wilson WITHDREW  her OBJECTION.  There being                                                                    
NO further OBJECTION, Amendment 7 was ADOPTED.                                                                                  
                                                                                                                                
4:29:19 PM                                                                                                                    
                                                                                                                                
Co-Chair Thompson MOVED to  ADOPT Amendment 8, 29-LS0692\T.5                                                                    
(Glover, 4/8/16) (copy on file):                                                                                                
                                                                                                                                
     Page 37, line 2:                                                                                                           
     Delete "support for and"                                                                                                   
                                                                                                                                
Representative Wilson OBJECTED for discussion.                                                                                  
                                                                                                                                
Ms. Pierson  explained the amendment was  located in Section                                                                    
38, page 37,  line 2 of the bill; it  would delete the words                                                                    
"support for  and." She detailed the  department thought the                                                                    
language could  mean an  open-ended payment  due; therefore,                                                                    
the amendment would delete the language.                                                                                        
                                                                                                                                
Representative  Wilson WITHDREW  her OBJECTION.  There being                                                                    
NO further OBJECTION, Amendment 8 was ADOPTED.                                                                                  
                                                                                                                                
4:30:03 PM                                                                                                                    
                                                                                                                                
Co-Chair Thompson MOVED to  ADOPT Amendment 9, 29-LS0692\T.4                                                                    
(Glover, 4/7/16) (copy on file):                                                                                                
                                                                                                                                
     Page 46, following line 30:                                                                                                
     Insert a new subsection to read:                                                                                           
     "(c)  The  Department  of Health  and  Social  Services                                                                    
     shall  procure a  study  analyzing  the feasibility  of                                                                    
     privatizing  select  facilities   of  the  division  of                                                                    
     juvenile  justice  and  privatizing  pharmacy  services                                                                    
     delivered at Alaska Pioneers'  Homes. The Department of                                                                    
     Health  and  Social  Services shall  deliver  a  report                                                                    
     summarizing  the  conclusions   of  the  Department  of                                                                    
     Health and Social Services to  the senate secretary and                                                                    
     the  chief clerk  of the  house of  representatives and                                                                    
     notify  the legislature  that the  report is  available                                                                    
     within  10  days  after  the  convening  of  the  First                                                                    
     Regular   Session  of   the   Thirtieth  Alaska   State                                                                    
     Legislature."                                                                                                              
                                                                                                                                
     Reletter the following subsection accordingly.                                                                             
                                                                                                                                
Representative Wilson OBJECTED for discussion.                                                                                  
                                                                                                                                
Ms. Pierson  explained the amendment applied  to Section 47,                                                                    
page 46,  line 30  of the  legislation. The  amendment would                                                                    
insert a  new subsection,  which would  provide for  a study                                                                    
analyzing  the   feasibility  of  privatization   on  select                                                                    
juvenile  justice homes  and  privatizing pharmacy  services                                                                    
delivered  to  Alaska  Pioneer   Homes.  She  specified  the                                                                    
language had been included in the original bill.                                                                                
                                                                                                                                
Representative Gara  objected to  spending money  on another                                                                    
study on  privatization. He believed the  study would result                                                                    
in the  same response as  a previous study showing  that the                                                                    
private sector  was not willing  to provide the  services at                                                                    
the current  cost unless there  was a  substantial reduction                                                                    
in  some of  the  protections and  services  for the  people                                                                    
living  at the  Pioneer Homes.  He knew  that Representative                                                                    
Munoz had expressed concern about  the study in the past. He                                                                    
noted  she  was  not  currently  present  in  the  room.  He                                                                    
believed the study  would be throwing good  money after bad.                                                                    
He continued  that every time  "we do  this to the  folks at                                                                    
the Pioneer  Home they get  nervous," which he  knew because                                                                    
he visited. He  stated the issue came up  often. He recalled                                                                    
the issue  [of privatization] coming  up for the  first time                                                                    
in 2007  when the  former Palin Administration  had proposed                                                                    
it. He stated that seniors  living in the Pioneer Homes were                                                                    
just  trying to  live with  dignity and  often did  not have                                                                    
substantial assets  and feared they  would have no  place to                                                                    
live.                                                                                                                           
                                                                                                                                
Representative  Wilson   believed  the  amendment   did  not                                                                    
address  a   question  of   privatizing  the   Pioneer  Home                                                                    
facilities.  She believed  the amendment  only pertained  to                                                                    
the privatization of pharmacy services.                                                                                         
                                                                                                                                
Co-Chair Thompson replied in the affirmative.                                                                                   
                                                                                                                                
Co-Chair Neuman  testified in support  of the  amendment. He                                                                    
spoke to the  point on juvenile justice  centers. He relayed                                                                    
he had brought  the issue up with DHSS when  he had overseen                                                                    
its budget  in the past.  He noted that there  were juvenile                                                                    
justice centers in Nome and  possibly Kotzebue or Bethel. He                                                                    
believed the centers  would be much better  served by moving                                                                    
more civil  law to tribal  courts. He believed  the programs                                                                    
would fit  well under  their oversight.  He had  spoken with                                                                    
the Alaska  Native Tribal Health Consortium  (ANTHC) and the                                                                    
consortium had  believed it  was a good  idea. He  noted the                                                                    
consortium  had  spoken  with rural  legislators  about  the                                                                    
issue.  He thought  additional  funding  would be  available                                                                    
from  the  federal  government if  the  centers  were  under                                                                    
tribal law.  He believed  it would be  better to  remove the                                                                    
oversight by  state government,  which would  provide better                                                                    
local control.  The problem had been  getting the department                                                                    
and  tribal  organizations  together  to take  care  of  the                                                                    
issue. He  believed a study showing  whether savings existed                                                                    
would  be  beneficial to  help  the  legislature and  tribal                                                                    
organizations  decide whether  the idea  was beneficial.  He                                                                    
believed it  would save the  state a considerable  amount of                                                                    
money. He  observed the discussions  would not start  on the                                                                    
topic until  the facts had  been obtained. He  stressed that                                                                    
to get the facts it was necessary to do the research.                                                                           
                                                                                                                                
Representative  Wilson WITHDREW  her OBJECTION.  There being                                                                    
NO further OBJECTION, Amendment 9 was ADOPTED.                                                                                  
                                                                                                                                
Representative  Gattis,  Vice-Chair  Saddler,  and  Co-Chair                                                                    
Neuman asked to be added as cosponsors to the amendment.                                                                        
                                                                                                                                
4:35:19 PM                                                                                                                    
                                                                                                                                
Co-Chair  Thompson   MOVED  to   ADOPT  Amendment   10,  29-                                                                    
LS0692\T.6 (Glover, 4/8/16) (copy on file):                                                                                     
                                                                                                                                
     Page 50, line 7:                                                                                                           
     Delete "January l"                                                                                                         
     Insert "July 17''                                                                                                          
                                                                                                                                
Representative Wilson OBJECTED for discussion.                                                                                  
                                                                                                                                
Ms.  Pierson explained  the amendment  applied  to page  50,                                                                    
line 7; it  would delete "January 1" and insert  "July 17" -                                                                    
the  effective   date  for   the  Department   of  Commerce,                                                                    
Community  and  Economic  Development  (DCCED)  to  get  its                                                                    
regulations for  the PDMP. The  date also  corresponded with                                                                    
the  department's licensure  date. She  explained the  later                                                                    
date would  give the  department the time  it needed  to get                                                                    
regulations in place.                                                                                                           
                                                                                                                                
Representative  Wilson WITHDREW  her OBJECTION.  There being                                                                    
NO further OBJECTION, Amendment 10 was ADOPTED.                                                                                 
                                                                                                                                
4:36:12 PM                                                                                                                    
                                                                                                                                
Co-Chair  Thompson   MOVED  to   ADOPT  Amendment   11,  29-                                                                    
LS0692\T.9 (Mischel, 4/8/16) (copy on file):                                                                                    
                                                                                                                                
     Page 14, lines 11 - 12:                                                                                                    
     Delete "unless the evidence shows that the agent or                                                                        
     apparent agent acted with intent to deceive the                                                                            
     principal"                                                                                                                 
                                                                                                                                
Representative Wilson OBJECTED for discussion.                                                                                  
                                                                                                                                
Ms.  Pierson explained  the amendment  applied  to page  14,                                                                    
lines 11  and 12 of  the legislation. The language  had been                                                                    
brought to  the committee by the  Alaska Medical Association                                                                    
(AMA)  due to  their concern  that  if an  agent acted  with                                                                    
intent to deceive  the principal they could  be held liable.                                                                    
The language had  been included in the bill  because the AMA                                                                    
thought it would help protect  the AMA, but she believed the                                                                    
department  had   some  issues  with  the   removal  of  the                                                                    
language.                                                                                                                       
                                                                                                                                
STACIE  KRALY,  ASSISTANT  ATTORNEY GENERAL,  DEPARTMENT  OF                                                                    
LAW,  explained   the  Department  of  Law   (DOL)  believed                                                                    
language added to  the CS on page 14, lines  11 and 12 would                                                                    
lead  to  difficulty  in getting  the  Office  of  Inspector                                                                    
General  (OIG) federal  certification for  the False  Claims                                                                    
Act  (found   in  Section  18   of  the   legislation).  The                                                                    
department was  concerned the language appeared  to create a                                                                    
hold-harmless  or   savings  clause  for   organizations  to                                                                    
present  affirmative  defenses  if   an  employee  acted  or                                                                    
created  a false  claim that  would lead  to a  filing of  a                                                                    
false claim.  She furthered the  concern was it  would allow                                                                    
the individual to avoid liability  in a situation where they                                                                    
should  have   specific  and  certain   corporate  integrity                                                                    
oversight  to   ensure  the  issues  did   not  happen.  The                                                                    
department  was  concerned  the   language  would  make  OIG                                                                    
certification difficult, which  would prevent the department                                                                    
from receiving its 10 percent federal match recoveries.                                                                         
                                                                                                                                
Representative  Wilson asked  for  further clarification  on                                                                    
how the state would be jeopardized.                                                                                             
                                                                                                                                
Ms.  Kraly  replied that  the  Office  of Inspector  General                                                                    
(OIG) had issued guidelines  for false claims certification.                                                                    
She  believed  the information  had  been  presented to  the                                                                    
committee  ["OIG  Guidelines   for  Evaluating  State  False                                                                    
Claims  Acts" dated  March  15, 2013  (copy  on file)].  She                                                                    
referred to  the rules and  tests set  forth by the  OIG for                                                                    
determining  whether or  not  the  federal government  would                                                                    
certify a state's False Claims  Act. When the department had                                                                    
reviewed the  language in  the guideline  and had  looked at                                                                    
the bill's proposed language it  had determined the proposal                                                                    
would create difficulty for certification.                                                                                      
                                                                                                                                
Representative  Wilson  asked for  a  copy  of the  document                                                                    
referred to  by Ms. Kraly.  She was assuming  the department                                                                    
was opposed to Amendment 11.                                                                                                    
                                                                                                                                
Ms. Kraly clarified  that DOL supported the  amendment - the                                                                    
department supported  the removal  of language from  the CS.                                                                    
She detailed the amendment would correct the issue.                                                                             
                                                                                                                                
4:40:07 PM                                                                                                                    
                                                                                                                                
Representative Wilson wanted to  see the document. Ms. Kraly                                                                    
replied that she had a copy of the guidelines.                                                                                  
                                                                                                                                
Representative Gara remarked  that he did not  know what OIG                                                                    
was and what the potential  monetary loss to the state would                                                                    
be  if  the amendment  did  not  pass.  He referred  to  the                                                                    
suggestion  that without  the  amendment the  state may  not                                                                    
receive authority or funding.                                                                                                   
                                                                                                                                
Ms. Kraly  replied DOL  was concerned  that if  the language                                                                    
was  maintained in  the CS  there  was a  potential the  OIG                                                                    
federal oversight  agency would  determine the  language did                                                                    
not meet its  terms and therefore, it would  not certify the                                                                    
False  Claims Act,  which  would mean  the  state would  not                                                                    
receive  its enhanced  federal match.  She explained  it was                                                                    
the  interpretation  of  DOL. The  department  believed  the                                                                    
language was  too prescriptive  and protective  of corporate                                                                    
entities in the context of a  False Claims Act. As a result,                                                                    
the language would put the act at risk.                                                                                         
                                                                                                                                
Representative Gara  referred to Ms. Kraly's  testimony that                                                                    
the language  would put the  act and federal match  at risk.                                                                    
He  asked   for  verification   that  if   the  department's                                                                    
interpretation was accurate, the state  would not be able to                                                                    
use the False Claims Act and  the federal funds to help with                                                                    
cases  under the  False Claims  Act may  be in  jeopardy. He                                                                    
asked  for   clarification  which   federal  funds   may  be                                                                    
jeopardized.                                                                                                                    
                                                                                                                                
Ms. Kraly  answered that  without federal  certification the                                                                    
False Claims Act  would still be on the  books and available                                                                    
for   the  department   to   utilize.   She  detailed   that                                                                    
certification  provided enhanced  match for  recoveries. She                                                                    
was uncertain  whether the enhanced federal  funding for the                                                                    
Medicaid Fraud Control  Unit could be used  to prosecute the                                                                    
claims if the state's False  Claims Act was uncertified. She                                                                    
specified the  Medicaid Fraud Control Unit  would manage the                                                                    
caseload; it  received a 75  percent match from  the federal                                                                    
government (the  state paid the  remaining 25  percent). She                                                                    
elaborated that  she was uncertain  how the funding  for the                                                                    
services  would be  impacted if  the federal  government had                                                                    
not approved funding for Medicaid recovery purposes.                                                                            
                                                                                                                                
4:43:32 PM                                                                                                                    
                                                                                                                                
Representative Pruitt  asked if  all nine  pages of  the new                                                                    
act  would  potentially  be in  jeopardy  if  the  amendment                                                                    
language  was  not  included.  Mr.  Kraly  answered  in  the                                                                    
negative. She detailed  that the act would  remain in place.                                                                    
She  clarified   the  department  supported   the  amendment                                                                    
because  it  believed  the change  would  help  DOL  receive                                                                    
federal  certification. She  detailed  that without  federal                                                                    
certification the  False Claims Act would  remain in effect,                                                                    
but the  department would not  receive the  enhanced federal                                                                    
match for recoveries.                                                                                                           
                                                                                                                                
Representative Pruitt asked about  the financial amount. Ms.                                                                    
Kraly  replied that  the  enhanced federal  match  was a  10                                                                    
point swing. She explained that  instead of receiving 50/50,                                                                    
the department would receive 55  percent of any recovery and                                                                    
the  federal  government  would   receive  45  percent.  The                                                                    
reduction would be percentage split from the formula.                                                                           
                                                                                                                                
Representative  Pruitt surmised  it sounded  like the  state                                                                    
would  be  placing  additional weight  on  the  organization                                                                    
based  on a  bad  actor  who may  be  working  for them.  He                                                                    
observed they were  trying to help someone  with an employee                                                                    
that  was  intentionally deceiving  them.  He  asked how  to                                                                    
account for the fact that there  were people who may not act                                                                    
in appropriate  ways and  the employer may  not have  been a                                                                    
part of the problem. He wondered how to handle the issue.                                                                       
                                                                                                                                
Ms. Kraly  replied that the  state's best partners  were the                                                                    
organizations  (providing  the  services)  in  the  goal  of                                                                    
avoiding fraud,  abuse, and waste  in the  Medicaid program.                                                                    
The  department  believed   the  organizations  should  have                                                                    
sufficient  internal  control  standards to  identify  those                                                                    
sorts  of  activities  that  were   happening  and  to  take                                                                    
sufficient  action  to  avoid those  sorts  of  events.  The                                                                    
current bill  language basically  gave the provider  a hold-                                                                    
harmless or  defense to say  it did not ratify  the activity                                                                    
or  know  it  was  happening.  The  department  believed  an                                                                    
organization  should  have  the   ability  to  identify  the                                                                    
information,  avoid that  sort of  construct, and  should be                                                                    
held liable for failure to have those internal controls.                                                                        
                                                                                                                                
Representative   Pruitt   remarked    that   some   of   the                                                                    
organizations  were  very  small  and may  not  be  watching                                                                    
everything  taking  place  underneath the  organization.  He                                                                    
surmised  the  organizations  may have  to  hire  additional                                                                    
people  if the  state was  putting an  additional burden  on                                                                    
them, which  would elevate the  company's cost, the  cost to                                                                    
the  consumer, and  the cost  to the  state as  the Medicaid                                                                    
payee. He  wondered if there  was a certain point  the state                                                                    
needed to  recognize that all  organizations were  not giant                                                                    
and could  afford to continue  to pay numerous  employees to                                                                    
provide  a service.  He  reiterated  that the  organizations                                                                    
were small in some cases.                                                                                                       
                                                                                                                                
Ms. Kraly deferred the question to a colleague.                                                                                 
                                                                                                                                
ANDREW  PETERSON,  ASSISTANT  ATTORNEY  GENERAL,  OFFICE  OF                                                                    
SPECIAL   PROSECUTION,   MEDICAID    FRAUD   CONTROL   UNIT,                                                                    
DEPARTMENT OF  LAW (via  teleconference), answered  that due                                                                    
to  the  cost  of  filing  the  False  Claims  Act  and  the                                                                    
associated  litigation it  was  not the  type of  litigation                                                                    
that would  focus on small providers  and low-dollar claims.                                                                    
The  claims would  generally  be  significant, amounting  to                                                                    
hundreds  of thousands  of dollars  or more  in loss  to the                                                                    
State of Alaska.  The concern was the bill  language gave an                                                                    
out  for corporations  (that were  in the  best position  to                                                                    
police their  employees to be  on the lookout for  fraud) to                                                                    
have a  financial interest in  not looking for  or ferreting                                                                    
out fraud that  may be occurring within  their own industry.                                                                    
He  referred  to a  committee  member's  question about  the                                                                    
amount of  money the state  may lose.  He detailed it  was a                                                                    
difficult  number  to place  -  it  would have  been  around                                                                    
$300,000 or  more in the past  3 to 4 years;  in prior years                                                                    
the amount  would have been  higher. He noted the  state did                                                                    
not have  the False  Claims Act at  that time;  however, for                                                                    
example, financial  loss had occurred when  a pharmaceutical                                                                    
company  had  off-labeling  or was  using  a  pharmaceutical                                                                    
product for  a service it  should not  be used for.  In that                                                                    
instance there  could be a  nation-wide class  action, which                                                                    
Alaska  would  join. The  state  also  received an  enhanced                                                                    
recovery on  any suit to  which the  state was a  victim of,                                                                    
for  civil   suits  filed  within  or   outside  Alaska.  He                                                                    
concluded that  it could be  a fairly substantial  amount of                                                                    
money over  time, but  the ultimate  figure depended  on the                                                                    
number  of  suits  and  the end  result.  He  did  recognize                                                                    
Representative Pruitt's  concern with respect  to additional                                                                    
burdens placed on smaller employers.                                                                                            
                                                                                                                                
4:50:30 PM                                                                                                                    
                                                                                                                                
Representative  Wilson  asked   whether  the  language  [the                                                                    
amendment proposed to delete] could  be left in the bill and                                                                    
the  committee could  insert additional  language noting  it                                                                    
would only be effective if  determined to be consistent with                                                                    
the False Claims Act.                                                                                                           
                                                                                                                                
Mr. Peterson  deferred the question  to Ms. Kraly.  He noted                                                                    
that in reviewing  the OIG document, the  language added did                                                                    
appear to  include an additional safeguard  for corporations                                                                    
that was  not consistent with  the OIG guidelines.  When DOL                                                                    
had drafted  the False Claims  Act language it had  aimed to                                                                    
design it as close to  the federal guidelines as possible in                                                                    
order to avoid  any surprises or questions  about whether it                                                                    
would meet federal guidance.                                                                                                    
                                                                                                                                
Representative   Wilson   expressed  confusion   about   the                                                                    
testimony. She  addressed testimony  about the  False Claims                                                                    
Act  and trying  to avoid  the  loss of  federal money.  She                                                                    
stated the department's testimony  was that the language was                                                                    
also being tightened for other purposes.                                                                                        
                                                                                                                                
Ms. Kraly  answered that  DOL had  drafted the  False Claims                                                                    
Act as  closely and  as narrowly as  possible to  follow the                                                                    
OIG guidelines.  The department  believed that  the language                                                                    
added  in the  CS created  a potential  problem for  federal                                                                    
certification.  The  department  would prefer  to  have  the                                                                    
language  removed  from  the  CS because  it  would  be  the                                                                    
cleanest  outcome.  She did  not  know  whether or  not  the                                                                    
language   Representative   Wilson    suggested   would   be                                                                    
sufficient  to meet  federal approval.  She was  not certain                                                                    
how a savings clause would  be drafted or evaluated. She did                                                                    
not know how  to specify that a portion of  the language was                                                                    
good  except for  the one  narrow provision  if inconsistent                                                                    
with False Claims Act.                                                                                                          
                                                                                                                                
Representative Wilson was not  convinced there were no other                                                                    
reasons  for  the proposed  deletion  of  the language.  She                                                                    
thought  there  could  be  other  impacts  of  the  language                                                                    
deletion apart  from the False  Claims Act. She  thought the                                                                    
deletion of the language may  cause more problems for people                                                                    
who were not guilty. She  preferred to maintain the language                                                                    
and to deal with  it another way if it did  not fit into the                                                                    
False Claims Act.                                                                                                               
                                                                                                                                
Representative Gara provided a  scenario where the state was                                                                    
improperly billed $1 million under  the False Claims Act. He                                                                    
asked if the  state would still have a way  to get the money                                                                    
back if the amendment did not pass.                                                                                             
                                                                                                                                
Mr. Peterson  replied that  the state  would still  have the                                                                    
ability to  go after  the provider  in one  of two  ways. He                                                                    
detailed  the  state  could proceed  if  the  hold  harmless                                                                    
provision  in  the  bill  was  maintained  the  state  could                                                                    
proceed, but  it would  not be eligible  for the  10 percent                                                                    
bump in recovery.  Second, if the state was  unable to prove                                                                    
the  elements of  a  false  claim, the  state  could seek  a                                                                    
recovery of the money through  the provider, but no portions                                                                    
of the False Claims Act would be applicable.                                                                                    
                                                                                                                                
Vice-Chair Saddler  wanted to ensure the  language (page 14,                                                                    
lines 7  through 12) simply  said a corporation  was liable,                                                                    
but if a  rouge employee was determined to  be deceiving the                                                                    
principal  the corporation  was not  liable. He  surmised it                                                                    
seemed to be a reasonable  protection. He had missed part of                                                                    
the conversation  about why it  was essential for  a portion                                                                    
of  the  language to  be  removed,  such  that it  would  be                                                                    
consistent with a federal act.                                                                                                  
                                                                                                                                
Ms.  Kraly replied  when reviewing  the OIG  guidelines, DOL                                                                    
became concerned the language  gave an additional protection                                                                    
to  a corporate  organization that  would limit  the state's                                                                    
ability  to recover  false claims.  The department  believed                                                                    
the additional  language created  a difficulty  in obtaining                                                                    
federal certification.                                                                                                          
                                                                                                                                
Vice-Chair Saddler  reasoned the  provision was like  a get-                                                                    
out-of-jail-free card.  He surmised  a corporation  could be                                                                    
engaged  in bad  faith,  but if  it was  able  to blame  the                                                                    
employee  for acting  with intent  to deceive,  the language                                                                    
could exculpate the corporation.                                                                                                
                                                                                                                                
Ms. Kraly replied in the affirmative.                                                                                           
                                                                                                                                
Representative Wilson stated she  was hearing two sides. She                                                                    
remarked she  had first  heard the  amendment was  all about                                                                    
the False  Claims Act.  She was  also hearing  the amendment                                                                    
was related  to corporations  and who the  state may  or may                                                                    
not be  able to  go after.  She did not  know if  the people                                                                    
being held  harmless were actually guilty  of something. She                                                                    
questioned whether the amendment  would broaden the spectrum                                                                    
of  entities it  could charge  even though  they may  not be                                                                    
guilty.                                                                                                                         
                                                                                                                                
Representative  Gattis  stated  another  representative  had                                                                    
communicated the  amendment was  a good idea.  She supported                                                                    
the amendment.                                                                                                                  
                                                                                                                                
4:58:57 PM                                                                                                                    
AT EASE                                                                                                                         
                                                                                                                                
4:59:27 PM                                                                                                                    
RECONVENED                                                                                                                      
                                                                                                                                
Ms. Kraly believed one of  the committee's concerns was that                                                                    
there  was no  protections for  a corporate  entity when  an                                                                    
individual acted  outside the scope of  their authority. She                                                                    
explained there were protections  for that circumstance. She                                                                    
furthered that when looking at  the False Claims Act and OIG                                                                    
guidelines what  constituted knowing behavior and  how there                                                                    
had to be  a reckless disregard for the truth  or falsity of                                                                    
the claim  all played into  the situation and  a corporation                                                                    
would  not be  in trouble  for certain  activities. However,                                                                    
under  certain  circumstances  identified in  the  bill  the                                                                    
corporations  should  be  responsible  for  the  actions  of                                                                    
employees.  There were  circumstances  when an  organization                                                                    
would  not be  subject  to  a false  claims  because of  the                                                                    
activities   of   an   employee,   but   there   should   be                                                                    
circumstances when they should  be responsible. The language                                                                    
currently in the  CS gave companies almost  an automatic out                                                                    
- in most circumstances companies  would have the ability to                                                                    
say they were unaware of  what had taken place, the employee                                                                    
had been  acting outside the  authority of the  company, and                                                                    
the company  should not be  held liable. The  department was                                                                    
trying to avoid the situation.                                                                                                  
                                                                                                                                
Representative  Wilson  asked  how the  issue  would  impact                                                                    
Pioneer Home.  She asked if  it would add  another liability                                                                    
to the Pioneer Home if the language was deleted.                                                                                
                                                                                                                                
Ms.  Kraly believed  that as  an enrolled  Medicaid provider                                                                    
the  Pioneer Home  would  be subject  to  a potential  False                                                                    
Claims  Act.  She  explained  enrolled  providers  would  be                                                                    
subject to the  provision under the CS. She  detailed in the                                                                    
context of  a state action  or entity like the  Pioneer Home                                                                    
was if an  issue occurred it would be remedied  at the level                                                                    
of the  commissioner's office; a corporate  provider did not                                                                    
have the same corrective measure imposed.                                                                                       
                                                                                                                                
Representative Wilson MAINTAINED  her OBJECTION. She thought                                                                    
the deletion could cause more issues than were known.                                                                           
                                                                                                                                
Representative Pruitt opposed the  amendment. He thought the                                                                    
issue  had been  simple  at first.  He  was concerned  about                                                                    
placing  strict  liability  on providers  and  believed  the                                                                    
amendment would  place an additional liability.  He remarked                                                                    
on  the balancing  act of  making sure  there was  liability                                                                    
placed on  providers, but that protections  were provided in                                                                    
certain cases where an individual  [employee] may have acted                                                                    
inappropriately.  He furthered  it was  not as  difficult to                                                                    
try  someone   for  an  affirmative  defense,   but  it  was                                                                    
something that could be overcome.                                                                                               
                                                                                                                                
A roll call vote was taken on the motion.                                                                                       
                                                                                                                                
IN FAVOR: Guttenberg,  Kawasaki,   Munoz,  Saddler,  Edgmon,                                                                    
Thompson, Neuman                                                                                                                
OPPOSED: Pruitt, Wilson, Gattis, Gara                                                                                           
                                                                                                                                
The MOTION to  Adopt Amendment 11 PASSED  (7/4). There being                                                                    
NO further OBJECTION, it was so ordered.                                                                                        
                                                                                                                                
5:06:14 PM                                                                                                                    
                                                                                                                                
Co-Chair  Thompson   MOVED  to   ADOPT  Amendment   12,  29-                                                                    
LS0692\T.12 (Glover,  4/8/16) (copy on file).  [Note: due to                                                                    
amendment length  it has not  been included in  the minutes.                                                                    
See copy on file.]                                                                                                              
                                                                                                                                
Co-Chair Neuman OBJECTED for discussion.                                                                                        
                                                                                                                                
Ms.  Pierson explained  the amendment  applied  to page  27,                                                                    
line  18  of the  legislation.  She  detailed the  amendment                                                                    
would  insert  a new  bill  section  that  had been  in  the                                                                    
original bill.  The section would  create a new  account for                                                                    
monetary  recoveries  under  the Alaska  Medical  Assistance                                                                    
False  Claim and  Reporting Act.  The amendment  sponsor had                                                                    
worked with  the Legislative Finance Division  (LFD) and Ms.                                                                    
Kraly with DOL on the amendment.  She believed it was a good                                                                    
provision to  include in  the bill.  She specified  that LFD                                                                    
had  created a  new account  in order  for the  money to  be                                                                    
accounted  for,   which  would  give  the   state  a  better                                                                    
perspective on what the act was doing.                                                                                          
                                                                                                                                
Co-Chair Neuman WITHDREW his OBJECTION.                                                                                         
                                                                                                                                
Representative Wilson  OBJECTED. She asked why  the language                                                                    
had been removed.                                                                                                               
                                                                                                                                
Ms.  Pierson  answered  that  during  the  drafting  of  the                                                                    
committee  substitute  LFD  had  been  uncertain  about  the                                                                    
issue. She  had wanted to  look further into the  idea prior                                                                    
to  including  it  in  the  legislation.  The  division  had                                                                    
recommended putting the language  back into the bill because                                                                    
it believed establishing the account  would be a cleaner way                                                                    
to track the money.                                                                                                             
                                                                                                                                
Representative  Wilson  asked   for  verification  that  the                                                                    
provision had  been in the bill  when it had come  over from                                                                    
the Senate. Ms. Pierson answered in the affirmative.                                                                            
                                                                                                                                
Representative  Wilson remarked  on  the  inability to  have                                                                    
dedicated funds.  She understood that for  tracking purposes                                                                    
money could sometimes be put  into a certain fund. She asked                                                                    
whether the funding  could be utilized for  anything once it                                                                    
had been deposited into the fund.                                                                                               
                                                                                                                                
Ms. Pierson  answered that  the new fund  would be  the 88th                                                                    
account  under  AS  37.05.146(c).  The funds  would  not  be                                                                    
designated and  would still have  to be appropriated  by the                                                                    
legislature.  The funds  would merely  be directed  into the                                                                    
account in order for tracking.                                                                                                  
                                                                                                                                
Representative Wilson asked if  there were other funds going                                                                    
into the  account or if it  was being created to  track only                                                                    
the  recovered  funds  [resulting from  the  Alaska  Medical                                                                    
Assistance False Claim and Reporting Act].                                                                                      
                                                                                                                                
Ms. Pierson  answered the  account would  be brand  new with                                                                    
the sole purpose of tracking the funds.                                                                                         
                                                                                                                                
Representative  Wilson WITHDREW  her OBJECTION.  There being                                                                    
NO further OBJECTION, Amendment 12 was ADOPTED.                                                                                 
                                                                                                                                
Co-Chair  Thompson   MOVED  to   ADOPT  Amendment   13,  29-                                                                    
LS0692\T.11 (Mischel/Glover, 4/8/16)  (copy on file). [Note:                                                                    
due  to amendment  length it  has not  been included  in the                                                                    
minutes. See copy on file.]                                                                                                     
                                                                                                                                
Co-Chair Neuman OBJECTED for discussion.                                                                                        
                                                                                                                                
Ms.  Pierson explained  the amendment  applied  to page  42,                                                                    
lines 19 through 22 of  the bill. The amendment would delete                                                                    
Section 42. She asked Ms. Kraly to speak to the amendment.                                                                      
                                                                                                                                
Co-Chair  Thompson clarified  the  section was  on page  42,                                                                    
lines 23 through 30.                                                                                                            
                                                                                                                                
Ms. Pierson clarified that it was on page 43 of the bill.                                                                       
                                                                                                                                
Ms.  Kraly relayed  that the  amendment had  been more  of a                                                                    
communication issue. She explained  that DOL had spoken with                                                                    
Co-Chair Thompson's  office about  a potential  amendment to                                                                    
address   the  added   authority  for   the  Department   of                                                                    
Corrections (DOC) to apply for  inmates in need of inpatient                                                                    
hospitalization to be covered  by Medicaid. She detailed the                                                                    
language [to  be deleted by  Amendment 13] had been  part of                                                                    
that   potential   amendment.   Upon  further   review   and                                                                    
consideration   DOL  had   determined   the  provision   [in                                                                    
Amendment  13] was  not required  because the  statute being                                                                    
amended under  AS 47 related  to the general  relief program                                                                    
and not  the medical  assistance program; therefore,  it was                                                                    
unnecessary. The department believed  it would be cleaner to                                                                    
remove the unnecessary provision.                                                                                               
                                                                                                                                
Co-Chair  Neuman  WITHDREW  his OBJECTION.  There  being  NO                                                                    
further OBJECTION, Amendment 13 was ADOPTED.                                                                                    
                                                                                                                                
5:10:57 PM                                                                                                                    
                                                                                                                                
Co-Chair  Neuman MOVED  to ADOPT  a conceptual  amendment to                                                                    
Amendment 1 as adopted [conceptual amendment 1.A].                                                                              
                                                                                                                                
5:11:32 PM                                                                                                                    
AT EASE                                                                                                                         
                                                                                                                                
5:25:06 PM                                                                                                                    
RECONVENED                                                                                                                      
                                                                                                                                
Co-Chair Neuman  MOVED to ADOPT conceptual  amendment 1.A to                                                                    
previously adopted Amendment 1.                                                                                                 
                                                                                                                                
Co-Chair Thompson OBJECTED for discussion.                                                                                      
                                                                                                                                
Mr.  Shattuck   explained  the  conceptual   amendment.  The                                                                    
amendment  would remove  language from  adopted Amendment  1                                                                    
(page 1,  line 6; and  page 1, lines 19,  20, 22, and  23 of                                                                    
Amendment 1).  The amendment would remove  Schedule IA, IIA,                                                                    
IIIA, IVA, and  VA along with federal Schedule I  and V from                                                                    
Sections 22  and 24 of  Amendment 1. He referred  to Section                                                                    
21,  page 21,  lines 29  through 31  of the  bill where  the                                                                    
language would  be removed. The  amendment would  remove the                                                                    
list  of drugs  from the  specific section,  which would  be                                                                    
maintained in  2021 when the provision  was repealed. [Note:                                                                    
see Amendment 1 discussion related to the PDMP.]                                                                                
                                                                                                                                
Co-Chair  Thompson WITHDREW  his OBJECTION.  There being  NO                                                                    
further OBJECTION, Amendment 1.A was ADOPTED.                                                                                   
                                                                                                                                
5:28:27 PM                                                                                                                    
                                                                                                                                
Vice-Chair  Saddler   MOVED  to  ADOPT  Amendment   15,  29-                                                                    
LS0692\T.2 (Glover,  4/6/16) (copy  on file). [Note:  due to                                                                    
amendment length  it has not  been included in  the minutes.                                                                    
See copy on file.]                                                                                                              
                                                                                                                                
Co-Chair Thompson OBJECTED for discussion.                                                                                      
                                                                                                                                
Vice-Chair  Saddler explained  the  amendment. He  discussed                                                                    
committee members had  expressed desire to have  a report to                                                                    
the legislature with information  about the effectiveness of                                                                    
making  the  PDMP  participation  mandatory.  The  amendment                                                                    
would  add a  small  addition to  the  existing PDMP  annual                                                                    
report requirement  in AS 17.32.00(m)  referenced on  line 3                                                                    
of  the  amendment.  The goal  was  to  receive  information                                                                    
regarding database security. He  believed everyone should be                                                                    
concerned about the security of  the database (referenced on                                                                    
page 1,  line 16  of the amendment).  The report  would also                                                                    
include information  on the effectiveness of  mandating PDMP                                                                    
participation (line 17)  and the effect on  the reduction of                                                                    
any   inappropriate  use   or  prescription   of  controlled                                                                    
substances. He referred to  earlier committee dialogue about                                                                    
receiving a  report with sufficient  time in advance  of the                                                                    
repealer  [passed  in Amendment  1]  in  order to  determine                                                                    
whether the  PDMP provision was working  as planned. Current                                                                    
statute  required  an  annual   report  from  the  Board  of                                                                    
Pharmacy  to the  department about  the PDMP.  The amendment                                                                    
would require a  bit more information to be  included in the                                                                    
report.  He  believed  the  amendment  would  require  extra                                                                    
information  the legislature  would want  to know  about the                                                                    
effectiveness  and impact  of the  mandatory PDMP  reporting                                                                    
when it considered whether or not to extend the mandate.                                                                        
                                                                                                                                
Representative Gara  thought studies  were always  good, but                                                                    
he  believed it  was necessary  to  pause for  a moment.  He                                                                    
stated  that the  committee did  not  know the  cost of  the                                                                    
study. He reasoned it would  not be a difficult amendment to                                                                    
add the  following year when  the cost could  be determined.                                                                    
There was no fiscal note  associated with the report, but he                                                                    
believed it would cost money.  He continued it would require                                                                    
determining reductions  in the  number of  individuals using                                                                    
and getting  addicted to controlled  substances; it  was not                                                                    
information that could be looked  up in a book. He explained                                                                    
it  would  require  a  field  study. He  did  not  know  how                                                                    
evidence  would be  compiled without  some associated  cost.                                                                    
First,   it  was   necessary   to   determine  whether   the                                                                    
legislature  wanted  to  spend  the money.  Second,  it  was                                                                    
necessary  to determine  the fiscal  note instead  of asking                                                                    
the department (that had received  $142 million in cuts over                                                                    
the past couple  of years) to absorb the cost  of the study.                                                                    
He believed  at a minimum there  needed to be a  fiscal note                                                                    
for work  associated with  discovering "reductions,  if any,                                                                    
in   inappropriate  use   or   prescription  of   controlled                                                                    
substances resulting from the use of the database."                                                                             
                                                                                                                                
Vice-Chair  Saddler disagreed.  He  had  consulted with  the                                                                    
state's chief  medical officer Dr.  Jay Butler  (the state's                                                                    
leading  authority for  epidemiology)  who had  communicated                                                                    
the state already  collected data on the  number of injuries                                                                    
and deaths attributable to overdose.  The cause of death was                                                                    
determined  and reported  to  the department.  Additionally,                                                                    
DCCED  issued  the  report  on  overdoses  or  inappropriate                                                                    
prescriptions - it established a  threshold and measured how                                                                    
many times  an individual  obtained prescriptions at  a rate                                                                    
exceeding the  threshold. He  concluded the  information was                                                                    
already gathered,  simple to collate,  and should  be fairly                                                                    
simple  to   append  the  information  about   any  possible                                                                    
breeches  of  the  database.  He  added  there  was  not  an                                                                    
additional cost and he did not  believe there was a need for                                                                    
a fiscal note.                                                                                                                  
                                                                                                                                
Ms.  Shadduck  agreed  with   Vice-Chair  Saddler.  She  had                                                                    
previously spoken with Janey Hovenden  the DCCEC director of                                                                    
the  Division  of  Corporations, Business  and  Professional                                                                    
Licensing about  adding to the  DCCED report.  She explained                                                                    
the  report  did not  come  from  DHSS. The  current  4-page                                                                    
report  had been  added to  the committee's  backup for  the                                                                    
bill  ["2016  Alaska  Prescription Drug  Monitoring  Program                                                                    
Report" dated February 11, 2016  (copy on file)]. She agreed                                                                    
the  amendment should  not  add an  additional  cost to  the                                                                    
existing annual reporting.                                                                                                      
                                                                                                                                
5:34:39 PM                                                                                                                    
                                                                                                                                
Co-Chair  Thompson asked  for verification  that the  report                                                                    
already existed.  Ms. Shadduck answered in  the affirmative.                                                                    
Amendment 15 would amended part  of the current PDMP statute                                                                    
that  required  an annual  report  to  the legislature.  The                                                                    
amendment added  more prescriptive  language about  what the                                                                    
report  should include,  including security  information and                                                                    
the reductions discussed by Vice-Chair Saddler.                                                                                 
                                                                                                                                
Representative Gara  requested to  hear from Dr.  Butler. He                                                                    
wondered  if  it was  a  simple  "yes" that  the  additional                                                                    
information required  by Amendment  15 was  already compiled                                                                    
and would not result in any additional cost.                                                                                    
                                                                                                                                
JAY BUTLER, CHIEF MEDICAL OFFICER,  DEPARTMENT OF HEALTH AND                                                                    
SOCIAL SERVICES, replied "yes."                                                                                                 
                                                                                                                                
Representative   Kawasaki   believed   the   amendment   was                                                                    
important  because  of  the  passage   of  Amendment  1.  He                                                                    
detailed  the legislature  wanted to  hear more  information                                                                    
about  how  the  PDMP  would  be  utilized.  He  noted  that                                                                    
currently 40 percent of the  state's pharmacies and 13 to 14                                                                    
percent of  the state's  prescribers utilized  the database.                                                                    
The bill  would require 100  percent of the  prescribers and                                                                    
pharmacies to utilize the PDMP.  He wanted to ensure items C                                                                    
and D [of  the amendment] would give  the legislature enough                                                                    
information so  it could understand the  new pharmacists and                                                                    
prescribers and how they felt the PDMP was working.                                                                             
                                                                                                                                
Representative Wilson  asked about the  federal prescription                                                                    
drug   monitoring  program.   She  asked   if  the   state's                                                                    
monitoring  program  went  into the  federal  database.  She                                                                    
wondered why the amendment mentioned the federal program.                                                                       
                                                                                                                                
Vice-Chair  Saddler answered  the  language referencing  the                                                                    
federal  program was  current  statute. He  deferred to  Ms.                                                                    
Shadduck for further information.                                                                                               
                                                                                                                                
Ms.  Shadduck answered  that the  state's PDMP  was a  state                                                                    
database, not  a federal database. The  amendment related to                                                                    
the report required by current state statute.                                                                                   
                                                                                                                                
Representative  Wilson  asked  if the  federal  prescription                                                                    
drug monitoring program  would provide the same  data as the                                                                    
state's PDMP was intended to  provide. Ms. Shadduck answered                                                                    
the state was  only collecting and monitoring  data from the                                                                    
state  database. She  explained  the language  had been  put                                                                    
into statute  in 2008 and she  did not know why  it included                                                                    
the federal database.                                                                                                           
                                                                                                                                
Representative Wilson  asked if  the federal  government was                                                                    
already  collecting the  data. If  so, she  wondered how  it                                                                    
differed from the state PDMP.                                                                                                   
                                                                                                                                
Ms. Shadduck  answered that  the language on  line 6  of the                                                                    
amendment   referred   to   a  federal   prescription   drug                                                                    
monitoring  program  grant.  She explained  that  since  the                                                                    
start of the program in 2008  the cost had been covered by a                                                                    
grant instead  of being  charged to  the Board  of Pharmacy.                                                                    
She  furthered there  had been  grant programs.  She assured                                                                    
the committee the  state did not share  any information with                                                                    
the federal government unless there  was a search warrant or                                                                    
court order.                                                                                                                    
                                                                                                                                
5:39:28 PM                                                                                                                    
                                                                                                                                
Representative  Guttenberg was  cynical about  the amendment                                                                    
and  was  unsure whether  he  supported  or opposed  it.  He                                                                    
referenced subsection  A of the amendment:  "reduce the rate                                                                    
of  inappropriate use  of  prescription  drugs by  reporting                                                                    
education  efforts..." He  read  subsection  B: "reduce  the                                                                    
quantity  of pharmaceutical  controlled substances  obtained                                                                    
by individuals  attempting to engage  in fraud  and deceit."                                                                    
He  countered that  the state  was only  informed about  the                                                                    
individuals  who   were  caught.   He  read   subsection  C:                                                                    
"increase  coordination among  prescription drug  monitoring                                                                    
program  partners," which  he believed  the state  should be                                                                    
doing. He  addressed involving stakeholders in  the planning                                                                    
process (subsection D). He  discussed that unfortunately the                                                                    
stakeholders  the state  wanted  to talk  to  were the  ones                                                                    
acting illegally.  He was concerned  about the  validity and                                                                    
productiveness  of the  subsections, with  the exception  of                                                                    
subsection  C. He  reasoned  "if we're  doing  all of  these                                                                    
already, we're  just repeating ourselves." He  observed that                                                                    
the subsections  were performance measures. He  detailed the                                                                    
database  was  aimed at  reducing  the  inappropriate se  or                                                                    
prescription  of  controlled  substances. He  wondered  what                                                                    
exactly  the   items  specified   in  the   amendment  would                                                                    
accomplish.                                                                                                                     
                                                                                                                                
Ms.  Shadduck  replied that  subsections  A  through D  were                                                                    
already in current statute and  were required to be included                                                                    
in the annual  report on the PDMP. She did  not know how the                                                                    
items had  been decided  in 2008. She  knew the  reports had                                                                    
been helpful  for the legislature  to determine  whether the                                                                    
PDMP was doing what it was designated to do.                                                                                    
                                                                                                                                
Representative Guttenberg  looked at item 2  in Amendment 15                                                                    
related to security of the  database. He agreed security was                                                                    
important. He  read subsection B under  item 2: "reductions,                                                                    
if  any,  in  the   inappropriate  use  or  prescription  of                                                                    
controlled  substances   resulting  from  the  use   of  the                                                                    
database."  He did  not believe  the  information should  be                                                                    
difficult. He stated the problem  with the process was about                                                                    
what the state did not know.  He wanted the database to work                                                                    
and target things that were  currently unknown with data the                                                                    
state had never  collected. He stated at the end  of the day                                                                    
the legislature was looking for  answers to questions it did                                                                    
not yet  have. He  was not  sure the  amendment accomplished                                                                    
the goal, but he hoped it would.                                                                                                
                                                                                                                                
5:43:11 PM                                                                                                                    
                                                                                                                                
Co-Chair  Neuman  spoke  in support  of  the  amendment.  He                                                                    
remarked on the controversial  nature of the PDMP provision.                                                                    
He stated  that more  information would  not hurt.  He noted                                                                    
that  the  committee  had  been   told  there  would  be  no                                                                    
additional cost.                                                                                                                
                                                                                                                                
Vice-Chair Saddler responded  to Representative Guttenberg's                                                                    
questions.  He  reasoned  it   was  appropriate  to  package                                                                    
additional information with  information the legislature was                                                                    
already  receiving in  existing annual  reports required  by                                                                    
law  in order  to get  better information  about work  being                                                                    
accomplished with the federal grants.  He noted there was no                                                                    
additional  cost  to  receive   the  information  about  the                                                                    
security of  the database and  about the reductions  in over                                                                    
prescription  that  may  be  achieved  by  the  bill's  PDMP                                                                    
mandate. The  intent of  the report was  to evaluate  the 4-                                                                    
year temporary PDMP mandate. He  believed putting all of the                                                                    
information  in   one  place  made  it   easier  for  future                                                                    
legislatures to evaluate whether  to continue the mandate in                                                                    
the future.                                                                                                                     
                                                                                                                                
Co-Chair  Thompson WITHDREW  his OBJECTION.  There being  NO                                                                    
further OBJECTION, Amendment 15 was ADOPTED.                                                                                    
                                                                                                                                
Vice-Chair  Saddler addressed  the bill's  17 fiscal  notes.                                                                    
The first fiscal  note was from DHSS related  to the Pioneer                                                                    
Homes (OMB  Component Number 2671).  The second  fiscal note                                                                    
was from  DHSS for  the Division  of Behavioral  Health (OMB                                                                    
Component Number 2665).                                                                                                         
                                                                                                                                
Representative Wilson asked about  the costs associated with                                                                    
the fiscal notes.                                                                                                               
                                                                                                                                
Vice-Chair  Saddler  asked   if  Representative  Wilson  was                                                                    
requesting the annual costs.                                                                                                    
                                                                                                                                
Representative Wilson  explained she  was interested  in the                                                                    
cost or savings  reported on the fiscal  notes. For example,                                                                    
the first  fiscal note included  $1,660,700 in  General Fund                                                                    
(GF)  savings  that  would   be  interagency  receipts.  She                                                                    
thought  the  information was  supposed  to  be put  on  the                                                                    
record. She was fine with whatever the chair preferred.                                                                         
                                                                                                                                
Co-Chair  Thompson asked  Vice-Chair Saddler  to report  the                                                                    
full detail to the committee.                                                                                                   
                                                                                                                                
5:47:04 PM                                                                                                                    
                                                                                                                                
Vice-Chair  Saddler  addressed  fiscal  note  OMB  Component                                                                    
Number  2671 from  DHSS for  the Alaska  Pioneer Homes.  The                                                                    
note contained zero operating expenditures  in FY 17 through                                                                    
FY 21, with a reduction in  GF of $1,660,700 and an increase                                                                    
in  interagency receipts  in the  same amount.  He addressed                                                                    
the DHSS  fiscal impact note  OMB Component Number  2665 for                                                                    
the  Division  of Behavioral  Health.  There  was no  fiscal                                                                    
impact  in  FY  17  and  FY 18.  There  were  decrements  of                                                                    
$226,700  in FY  19, $453,400  in FY  20 through  FY 22.  He                                                                    
moved to  the DHSS fiscal  impact note OMB  Component Number                                                                    
242  for the  Division  of Health  Care  Services. The  note                                                                    
included  a cost  of $697,600  in FY  17 through  FY 19  and                                                                    
$316,200 in FY 20 through FY 22.                                                                                                
                                                                                                                                
5:50:55 PM                                                                                                                    
                                                                                                                                
Vice-Chair  Saddler addressed  the DHSS  fiscal impact  note                                                                    
OMB Component  Number 2696 for  the Division of  Health Care                                                                    
Services. The note included a cost  of $500,000 in FY 17 and                                                                    
$200,000  in FY  18  through FY  22. He  moved  to the  DHSS                                                                    
fiscal  impact  note  OMB  Component   Number  237  for  the                                                                    
Division of Public  Assistance. The total cost in  FY 17 was                                                                    
$980,000 and zero  in FY 18 through FY 22.  He turned to the                                                                    
DHSS fiscal  impact note OMB  Component Number 2663  for the                                                                    
Division of Senior and Disabilities Services.                                                                                   
                                                                                                                                
Co-Chair Thompson asked Vice-Chair  Saddler to read only the                                                                    
OMB  Component  Numbers  and departments  for  the  sake  of                                                                    
brevity.                                                                                                                        
                                                                                                                                
Vice-Chair Saddler reviewed the  DHSS fiscal impact note OMB                                                                    
Component  Number  2875  for  the  Division  of  Senior  and                                                                    
Disabilities   Services.  Additional   notes  included   OMB                                                                    
Component Number 2787  from DHSS for the  Division of Senior                                                                    
and  Disabilities Services;  OMB Component  Number 309  from                                                                    
DHSS for  the Division of Senior  and Disabilities Services;                                                                    
OMB Component Number 317 from  DHSS for departmental support                                                                    
services;  OMB  Component  Number  2660 from  DHSS  for  the                                                                    
Division  of Medicaid  Services; OMB  Component Number  2077                                                                    
from  DHSS  for  the  Division  of  Medicaid  Services;  OMB                                                                    
Component  Number  2662  from   DHSS  for  the  Division  of                                                                    
Medicaid Services;  OMB Component  Number 2203 from  DOL for                                                                    
the Criminal Division; and OMB  Component Number 45 from DOA                                                                    
for centralized administrative services.                                                                                        
                                                                                                                                
5:56:02 PM                                                                                                                    
AT EASE                                                                                                                         
                                                                                                                                
5:56:29 PM                                                                                                                    
RECONVENED                                                                                                                      
                                                                                                                                
Vice-Chair Saddler  reread OMB Component Number  45 from DOA                                                                    
for centralized  administrative services.  Additional fiscal                                                                    
notes included OMB Component Number  2360 from DCCED for the                                                                    
Division   of   Corporations,  Business   and   Professional                                                                    
Licensing;  OMB  Component  Number  2203 from  DOL  for  the                                                                    
Criminal Division;  and OMB Component  Number 2952  from DOC                                                                    
for the Division of Health and Rehabilitation Services.                                                                         
                                                                                                                                
5:58:09 PM                                                                                                                    
AT EASE                                                                                                                         
                                                                                                                                
5:58:22 PM                                                                                                                    
RECONVENED                                                                                                                      
                                                                                                                                
Vice-Chair Saddler MOVED  to REPORT HCS CSSB  74(FIN) out of                                                                    
committee   with   individual    recommendations   and   the                                                                    
accompanying  fiscal notes.  Legislative Legal  Services was                                                                    
directed  to make  any appropriate  conforming or  technical                                                                    
changes.                                                                                                                        
                                                                                                                                
Representative  Wilson  OBJECTED.   She  explained  she  was                                                                    
trying to add  up the fiscal notes related  to General Funds                                                                    
and  did not  see  $31  million in  savings  in  FY 17.  She                                                                    
observed costs going out and  possible savings in out-years.                                                                    
She  relayed she  would continue  to add  the savings  while                                                                    
others comments on the bill.                                                                                                    
                                                                                                                                
Representative Kawasaki  could not  recall if  the committee                                                                    
had  an  opportunity to  ask  the  bill sponsor  [or  staff]                                                                    
questions about  the CS. He pointed  to page 23 of  the bill                                                                    
that dealt  with new licensing.  He detailed that  under the                                                                    
legislation  there would  be  agents  or employees  licensed                                                                    
under  statute.  He  asked  how  the  individuals  would  be                                                                    
licensed.                                                                                                                       
                                                                                                                                
Ms. Shadduck answered  that the changes had  been made based                                                                    
on  public testimony  in the  House  Finance Committee.  She                                                                    
explained  that previously  the  bill had  not included  the                                                                    
language "licensed or registered under  AS 08" and there had                                                                    
been a concern there would be  no oversight related to who a                                                                    
practitioner was delegating access  to. The specific statute                                                                    
AS  08 included  all  of the  boards  and commissions  under                                                                    
DCCED  - it  would include  individuals who  fell under  the                                                                    
department's licensing  or registration  requirements, which                                                                    
would ensure some accountability to boards.                                                                                     
                                                                                                                                
Representative Kawasaki  pointed to  page 26 related  to the                                                                    
establishment  of  registration  fees  for  pharmacists  and                                                                    
practitioners.   He   asked    if   every   pharmacist   and                                                                    
practitioner  would have  to pay  a fee  established by  the                                                                    
department given the bill's  requirement for all pharmacists                                                                    
and   practitioners   to   review    the   PDMP   prior   to                                                                    
administration of medication in many cases.                                                                                     
                                                                                                                                
Ms. Shadduck  answered that  it was  a stopgap  measure. She                                                                    
detailed if there  was a need for fees, there  had been some                                                                    
concerns  about  placing  fees   only  on  pharmacists.  The                                                                    
Division of Corporations,  Boards and Professional Licensing                                                                    
had asked  for the  authority to spread  the fees  among all                                                                    
registered  users  out  of  fairness.  She  pointed  to  the                                                                    
language  "minus   all  federal   funds  acquired   for  the                                                                    
operational  costs of  the database"  on page  26, lines  26                                                                    
through 30. She  specified the federal funds  would come off                                                                    
first. She furthered  if there were federal  grants to cover                                                                    
the costs,  as in the  past and through 2020,  the licensing                                                                    
fees would not  increase. In the event  federal money ended,                                                                    
it had  been determined it  would not  be fair to  place all                                                                    
potential increases on the Board of Pharmacy.                                                                                   
                                                                                                                                
Representative Kawasaki discussed that  a large bill section                                                                    
dealing  with civil  asset forfeiture  had been  removed. He                                                                    
referred to earlier testimony from  Mr. Peterson and another                                                                    
staff from  a state fraud  unit had addressed  the necessity                                                                    
of the ability to do civil  asset forfeiture in the cases of                                                                    
physician offices and fraud cases.  He asked Ms. Shadduck to                                                                    
speak to the removal of the provision.                                                                                          
                                                                                                                                
Ms.  Shadduck  agreed that  the  language  had been  brought                                                                    
forward by the governor and  had been included in the Senate                                                                    
Finance Committee  CS. She  discussed it  had been  a policy                                                                    
decision  in the  House Finance  Committee  based on  public                                                                    
testimony  and   concerns  by   the  committee   that  civil                                                                    
forfeiture could be problematic.                                                                                                
                                                                                                                                
Representative  Kawasaki  relayed  his appreciation  of  the                                                                    
work  by  the sponsor  and  his  staff. He  appreciated  the                                                                    
process that had gone into building the legislation.                                                                            
                                                                                                                                
6:05:57 PM                                                                                                                    
                                                                                                                                
Representative  Guttenberg asked  who  would be  responsible                                                                    
for entering the  data into the PDMP.  Ms. Shadduck answered                                                                    
that the  issue had been cleaned  up in the CS.  She pointed                                                                    
to Section  22, which listed  how pharmacists put  data into                                                                    
the PDMP.  She explained  that only pharmacists  would enter                                                                    
data; the prescribers only looked up data.                                                                                      
                                                                                                                                
Representative Gara  thanked Ms.  Shadduck for her  work. He                                                                    
spoke to a  document showing the bill would  bring over $100                                                                    
million in savings by 2021. He  asked to go over a couple of                                                                    
the fiscal  notes. He referenced  OMB Component  Number 2077                                                                    
that  included  a  savings  in General  Fund  match  of  $58                                                                    
million  in  2021.  The note  indicated  an  additional  $30                                                                    
million in federal receipts in 2021.  He did not see how the                                                                    
number went down to $27 million  in net savings shown on the                                                                    
bottom line of  the note. He had the same  question with the                                                                    
subsequent fiscal note.                                                                                                         
                                                                                                                                
Ms. Shadduck deferred the question to DHSS.                                                                                     
                                                                                                                                
6:08:55 PM                                                                                                                    
                                                                                                                                
JON SHERWOOD, DEPUTY COMMISSIONER,  MEDICAID AND HEALTH CARE                                                                    
POLICY, DEPARTMENT  OF HEALTH AND SOCIAL  SERVICES, spoke to                                                                    
the DHSS  fiscal note OMB  Component Number 2077  related to                                                                    
Medicaid  Services.  The  GF  savings for  FY  22  would  be                                                                    
$60,224,600;  the  note  there  were  also  expenditures  of                                                                    
federal receipts. He  spoke to a new fund  source related to                                                                    
recovery of  money under the  False Claims Act.  He detailed                                                                    
the total  change in funding  would be $31,829,400 in  FY 22                                                                    
when  considering  all of  the  items.  He reiterated  there                                                                    
would be a  GF savings of over $61 million,  but there would                                                                    
also be an expenditure of federal and recovered funds.                                                                          
                                                                                                                                
Representative Gara  remarked if the concern  was only about                                                                    
state money,  it appeared there  was $60 million  in savings                                                                    
in  FY 22,  but  he did  not  know if  it  included the  $32                                                                    
million in [federal]  grant money. He reasoned  they did not                                                                    
usually subtract  additional federal funds from  savings. He                                                                    
asked for clarity.                                                                                                              
                                                                                                                                
Mr.  Sherwood  answered  that  the  fiscal  note  convention                                                                    
totaled the  expenditures and fund  source. He  explained it                                                                    
may  not make  logical  sense  to combine  all  of the  fund                                                                    
sources  when some  went up  and others  went down.  For the                                                                    
previous  version of  the fiscal  notes  the department  had                                                                    
submitted  a  consolidated  page   showing  all  GF  savings                                                                    
without other  fund source changes.  He apologized,  but the                                                                    
department had  not had time to  use the same method  on the                                                                    
current fiscal note.                                                                                                            
                                                                                                                                
Representative  Gara   understood  they  did   not  subtract                                                                    
getting  additional  federal  funds and  spending  them.  He                                                                    
referred to  $60.2 million  in GF savings.  He asked  if the                                                                    
state was also receiving $32 million in additional grants.                                                                      
                                                                                                                                
Mr.  Sherwood  answered  that the  $32  million  represented                                                                    
expenditures and  the $60 million  on the note related  to a                                                                    
fund  source change.  He explained  that total  expenditures                                                                    
needed  to  balance total  fund  source  changes. The  first                                                                    
block  of numbers  on the  note was  an expenditure  and the                                                                    
second block showed where the money was coming from.                                                                            
                                                                                                                                
6:13:04 PM                                                                                                                    
                                                                                                                                
Representative  Wilson  pointed  to  DHSS  fiscal  note  OMB                                                                    
Component Number  2077. She referred  to the $20  million in                                                                    
GF match  in FY  17 that  would be  replaced by  the federal                                                                    
receipts fund source.  She asked if the  state would receive                                                                    
the federal receipts without the  bill; if not, she wondered                                                                    
what action  the bill  took that would  enable the  state to                                                                    
bring in the $20,548,400.                                                                                                       
                                                                                                                                
Mr.  Sherwood answered  that primarily  the reduction  in GF                                                                    
and increase in federal funds in  FY 17 came from the change                                                                    
in the  federal matching funds claiming  policy for services                                                                    
provided  through the  tribal health  system.  There were  a                                                                    
couple of other  small pieces that would take  time to delve                                                                    
into.                                                                                                                           
                                                                                                                                
Representative  Wilson  understood  that  the  majority  was                                                                    
related  to  the tribal  health  system.  She asked  if  the                                                                    
savings  could be  achieved without  the bill.  Mr. Sherwood                                                                    
believed the state  would still have the  latitude to pursue                                                                    
the change in federal policy without the legislation.                                                                           
                                                                                                                                
Representative  Wilson  pointed  to  DHSS  fiscal  note  OMB                                                                    
Component Number  2662. She detailed the  note included $2.9                                                                    
million  GF  matching  funds that  would  be  replaced  with                                                                    
federal  receipts  [in FY  17].  She  asked if  the  federal                                                                    
receipts  would  be  available  to  the  state  without  the                                                                    
legislation.                                                                                                                    
                                                                                                                                
Mr. Sherwood  replied in  the affirmative  related to  FY 17                                                                    
and  noted  that  fell under  tribal.  In  subsequent  years                                                                    
savings were attached to provisions in the bill.                                                                                
                                                                                                                                
Representative Wilson understood the  provisions were in the                                                                    
bill,  but   she  believed  there   were  many   things  the                                                                    
department could  do without the  legislation. She  asked if                                                                    
the department  could apply for  the 1915(i)  waiver without                                                                    
the bill.                                                                                                                       
                                                                                                                                
Mr.  Sherwood  answered  that  he  believed  waiver  1915(i)                                                                    
required legislation.                                                                                                           
                                                                                                                                
Representative Wilson  pointed to OMB Component  Number 2952                                                                    
was from DOC showed $6  million in savings in the governor's                                                                    
bill but not in any other  areas. She assumed the $6 million                                                                    
in  savings  had  to  do  with  individuals  placed  in  the                                                                    
hospital for over 24 hours.                                                                                                     
                                                                                                                                
Ms. Shadduck answered in the affirmative.                                                                                       
                                                                                                                                
Representative Wilson asked for  verification the $6 million                                                                    
in savings to the state  could be achieved without the bill.                                                                    
Ms. Shadduck  replied in  the negative.  She pointed  to the                                                                    
second  page   of  the  fiscal   note  and   explained  some                                                                    
individuals had refused  to allow DOC to  apply for Medicaid                                                                    
on their behalf.  The bill provision ensured  the $6 million                                                                    
in savings to the state would occur.                                                                                            
                                                                                                                                
Representative  Wilson  provided   a  hypothetical  scenario                                                                    
about  a prisoner.  She asked  if there  was a  mechanism to                                                                    
force a prisoner to sign over.                                                                                                  
                                                                                                                                
6:17:55 PM                                                                                                                    
AT EASE                                                                                                                         
                                                                                                                                
6:18:20 PM                                                                                                                    
RECONVENED                                                                                                                      
                                                                                                                                
Ms. Shadduck  answered that when  DOC had a prisoner  in its                                                                    
custody  who had  to  leave  the facility  for  24 hours  or                                                                    
longer, the  care could  qualify for  Medicaid, but  only if                                                                    
the  prisoner agreed  for the  application to  be submitted.                                                                    
The provisions  in the  bill allowed DOC,  only in  the case                                                                    
for hospitalizations, to apply  for Medicaid. Otherwise, the                                                                    
state paid 100 percent GF.                                                                                                      
                                                                                                                                
Representative Wilson  wondered what  the state could  do if                                                                    
the  prisoner would  not  agree to  sign  for Medicaid.  Ms.                                                                    
Shadduck pointed to Section 28, page 27 of the bill.                                                                            
                                                                                                                                
Representative Wilson asked for further detail.                                                                                 
                                                                                                                                
Ms. Shadduck  read from  Section 28,  subsection (c)  of the                                                                    
bill:                                                                                                                           
                                                                                                                                
     The  commissioner shall  apply  for medical  assistance                                                                    
     under AS 47.07 and  for general relief assistance under                                                                    
     AS  47.25.120  -  47.25.300 on  behalf  of  a  prisoner                                                                    
     incarcerated  in a  correctional facility  to establish                                                                    
     medical   assistance   coverage   or   general   relief                                                                    
     assistance  for   the  prisoner  during  a   period  of                                                                    
     hospitalization outside of the correctional facility.                                                                      
                                                                                                                                
Ms. Shadduck  elaborated that  subsection (d)  addressed how                                                                    
the commissioner may obtain the necessary information.                                                                          
                                                                                                                                
Representative  Wilson would  not stop  the bill  from going                                                                    
forward,  but she  observed only  one fiscal  note accounted                                                                    
for the  majority of the  savings. She  remarked substantial                                                                    
expenditures would  result from  the legislation.  She noted                                                                    
the legislation  called for approximately 23  new positions,                                                                    
which  she believed  was substantial.  She believed  most of                                                                    
the  things  in  the  bill  could already  be  done  by  the                                                                    
department.  She wondered  what made  the legislature  think                                                                    
the  department would  do something  because it  was put  in                                                                    
statute. Additionally,  she wondered  if all of  the choices                                                                    
were  right.  She  recalled testimony  that  putting  out  a                                                                    
request for  information would be a  better strategy because                                                                    
so many  states had  already gone  through the  process. She                                                                    
continued the  state could  then possibly  issue an  RFP for                                                                    
much of the work.                                                                                                               
                                                                                                                                
Representative   Wilson  was   also   concerned  about   the                                                                    
database.  She  believed  the legislature  would  hear  from                                                                    
numerous physicians when they  realized what the legislature                                                                    
had done  in the bill.  She stated  the database was  a very                                                                    
expensive program.  She referred to  the time it  would take                                                                    
to use the program and who  may or may not qualify under the                                                                    
certification section. She detailed  the committee had heard                                                                    
from the dental  community that most of their  staff did not                                                                    
qualify under  the certification requirement.  She continued                                                                    
it would mean a higher-tier employee  would have to sit at a                                                                    
computer  to  input the  detail.  She  guaranteed that  many                                                                    
constituents  did  not  know the  specific  provisions  were                                                                    
about everyone  and not just about  Medicaid. She understood                                                                    
that there was  a drug problem, but she  was concerned about                                                                    
privacy. She opined it was  possible to find the individuals                                                                    
with  drug problems  already. She  stated  bills were  being                                                                    
brought in and red flags should  be going up if doctors were                                                                    
not doing  the right  thing. She  was still  concerned about                                                                    
Amendment 11. She  would follow up with an  amendment on the                                                                    
House floor.                                                                                                                    
                                                                                                                                
Representative Wilson  understood that significant  work had                                                                    
gone into the bill. Her  biggest concern was she thought "we                                                                    
could have  already done this"  and the bill  would increase                                                                    
the size of  government. She furthered the  state was hoping                                                                    
for  savings.  She  referred  to  $20  million  in  proposed                                                                    
savings she  thought the state  would have  received without                                                                    
the  bill. She  believed it  had only  been included  in the                                                                    
bill  to  show the  savings.  She  stressed the  bill  would                                                                    
increase the  size of  government at a  time when  the state                                                                    
did not have any money.                                                                                                         
                                                                                                                                
Representative   Wilson   WITHDREW    her   OBJECTION,   but                                                                    
reiterated  her concerns.  She thought  the biggest  concern                                                                    
was  how to  get the  department to  access savings  without                                                                    
legislation.                                                                                                                    
                                                                                                                                
6:23:13 PM                                                                                                                    
                                                                                                                                
Representative  Gara  thanked DHSS  for  its  work. He  gave                                                                    
credit to the department. He  discussed that a number of the                                                                    
federal  funds  the  department   was  leveraging  had  been                                                                    
available  for  many  years; the  department  was  replacing                                                                    
state  expenditures with  federal money.  He continued  that                                                                    
some of the  federal money had been available  for years and                                                                    
some of it  was new. The department was  taking advantage of                                                                    
as many areas as possible  to find replacement federal funds                                                                    
(roughly $100  million after the  years three and  four). He                                                                    
believed DHSS  deserved credit for  the work. He  noted that                                                                    
the  bill sponsor  [Senator Pete  Kelly] and  the department                                                                    
had not seen  eye-to-eye on some issues in the  past and had                                                                    
been able to  come together with a bill that  would help the                                                                    
state.                                                                                                                          
                                                                                                                                
Co-Chair  Neuman  had serious  concerns  with  the bill.  He                                                                    
believed  it started  numerous pilot  programs  and spent  a                                                                    
significant amount  of money. He  was uncertain of  the net-                                                                    
back. He  had huge concerns about  the PDMP that he  did not                                                                    
think  was part  of the  original Medicaid  reform bill.  He                                                                    
thought  it "gets  glossed over  that the  Prescription Drug                                                                    
Database was added  into it and making it  mandatory for all                                                                    
doctors to use." The committee  had also heard that numerous                                                                    
organizations thought it was a  great deal and no complaints                                                                    
had  been heard.  However, the  committee  also heard  there                                                                    
were  probably  many  doctors  who were  not  aware  of  the                                                                    
changes. He  noted that  the Alaska  Dental Society  did not                                                                    
like the change related to  the PDMP. The committee had also                                                                    
heard  from the  Family  Medicine Department  at the  Alaska                                                                    
Regional  Hospital,  the American  Osteopathic  Association,                                                                    
and Alaska Osteopathic Medical  Association that opposed the                                                                    
PDMP change.                                                                                                                    
                                                                                                                                
Co-Chair  Neuman  referred  to  a  retired  dentist  in  his                                                                    
district  who  wanted to  start  a  practice in  Alaska.  He                                                                    
detailed the  individual did  not have  a licensed  staff to                                                                    
access the  database, which  would mean  more work  and cost                                                                    
for him.  He used  his personal  doctor's office  as another                                                                    
example. He stressed  the busy nature of  doctor offices and                                                                    
believed the  PDMP provision added an  additional burden. He                                                                    
emphasized  that the  bill imposed  increased government  in                                                                    
people's lives.  He noted many  of his constituents  did not                                                                    
know about the PDMP and were  in shock when they heard about                                                                    
it.  He was  glad the  issue  would be  reviewed in  several                                                                    
years.  He  thought the  legislature  would  hear about  the                                                                    
issue  once it  had  become  law. He  referred  to the  high                                                                    
medical costs in Alaska and  believed the bill increased the                                                                    
costs. He stated the bill  invaded some of the most personal                                                                    
privacies of Alaskans.                                                                                                          
                                                                                                                                
There being NO further OBJECTION, it was so ordered.                                                                            
                                                                                                                                
HCS  CSSB 74(FIN)  was  REPORTED out  of  committee with  an                                                                    
"amend" recommendation  and with 13 new  fiscal impact notes                                                                    
from the  Department of  Health and  Social Services;  1 new                                                                    
fiscal  impact   note  from  the  Department   of  Commerce,                                                                    
Community  and Economic  Development;  1  new fiscal  impact                                                                    
note from  the Department of  Law; 1 new fiscal  impact note                                                                    
from  the  Department  of Corrections;  and  one  previously                                                                    
published fiscal note: FN29 (ADM).                                                                                              
                                                                                                                                
Co-Chair Thompson  discussed the schedule for  the following                                                                    
Monday.                                                                                                                         
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
6:30:13 PM                                                                                                                    
                                                                                                                                
The meeting was adjourned at 6:30 p.m.                                                                                          
                                                                                                                                
                                                                                                                                

Document Name Date/Time Subjects