Legislature(1999 - 2000)
05/15/1999 09:00 PM House FIN
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* first hearing in first committee of referral
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+ teleconferenced
= bill was previously heard/scheduled
HOUSE FINANCE COMMITTEE
May 15, 1999
9:00 P.M.
TAPE HFC 99 - 142, Side 1
TAPE HFC 99 - 142, Side 2
CALL TO ORDER
Co-Chair Therriault called the House Finance Committee
meeting to order at 9:00 p.m.
PRESENT
Co-Chair Therriault Representative Foster
Co-Chair Mulder Representative Grussendorf
Representative Austerman Representative Kohring
Representative Bunde Representative Moses
Representative J. Davies Representative Williams
Representative G. Davis
ALSO PRESENT
Senator Gary Wilken; Senator Loren Leman; Bill Kozlowski;
Elmer Lindstrom, Special Assistant, Department of Health and
Social Services; Mike Pauley, Staff, Senator Leman; Jerry
Luckhaupt, Legislative Legal Counsel, Legislative Affairs
Agency; Gina MacDonald, Department of Health and Social
Services; Lorna Rambert, Senator P. Kelly; Gina MacDonald,
Department of Health and Social Services; Pat Clasby, Alaska
State Hospital and Nursing Home Association;
SUMMARY
SCR 8 Creating the Long-Term Care Task Force of 1999.
SCR 8 was REPORTED out of Committee with a "do
pass" recommendation and with a published fiscal
impact note by the Legislative Affairs Agency
dated 4/21/99.
CS SSSB 94(FIN) am
"An Act relating to the medical use of marijuana;
and providing for an effective date."
HCS SSSB 94(FIN) was REPORTED out of Committee
with a "do pass" recommendation and with a
published fiscal impact note by the Department of
Health and Social Services dated 5/4/99.
CSSB 97(FIN) am
"An Act relating to mental health services and
programs; relating to liability for payment for
mental health evaluation and treatment services;
and providing for an effective date."
CSSB 97(FIN) am was REPORTED out of Committee with
a "do pass" recommendation and with a published
fiscal note by the Department of Health and Social
Services dated4/21/99.
CS FOR SPONSOR SUBSTITUTE FOR SENATE BILL NO. 94(FIN) am
"An Act relating to the medical use of marijuana; and
providing for an effective date."
MIKE PAULEY, STAFF, SENATOR LEMAN testified in support of SB
94 on behalf of the sponsor.
Senate Bil1 94 proposes several amendments to the
Medical Marijuana Act that took effect this year on
March 4. The changes address some serious law
enforcement and public health concerns with this new
statute, and also some practical concerns about how
state agencies are going to implement what the voters
have asked them to implement.
In crafting this legislation, we have worked closely
with the Department of Law, the Department of Public
Safety, and the Department of Health and Social
Services. I am pleased to report that these three
agencies are in support of the legislation before you.
SB 94 is also supported by the Alaska State Advisory
Board on Alcoholism & Drug Abuse, the Anchorage Police
Department, and the Alaska Association of Chiefs of
Police.
There are three major changes in the bill.
The first area is registration. The marijuana
initiative approved last fall by voters establishes a
state registry of patients who are entitled to use
marijuana for medicinal purposes. However, there is no
requirement that a patient register - the initiative
still provides legal protection for the use of medical
marijuana even if the person is not registered with the
state. This creates a problem for law enforcement.
Because pharmacies are prohibited by federal law from
dispensing marijuana, the drug must be obtained through
other channels, and it all looks the same through the
eyes of a police officer. To ensure that all patients
who need marijuana are protected from needless arrest
or unwarranted hassle, SB 94 requires patients and
their caregivers to register, and to carry a registry
ID card. We modeled this after our successful permit
system for those who qualify to carry concealed
handguns. This system will help police distinguish
between legitimate and illegitimate users of marijuana.
The second change deals with possession limits. The
marijuana initiative established a presumptively legal
possession limit of one ounce in usable form, and six
plants. But the initiative also includes a paragraph
that allows patients and their caregivers to possess an
unlimited amount of marijuana, as long as it can be
medically justified. The problem is, there is no
definition of what is medically justified. The
Department of Law and the Department of Public Safety
have urged the Legislature to remove; any ambiguity in
this area and set the limit at the same amount
identified in the initiative, which is one ounce and
six plants. SB 94 implements this change.
The third area concerns the role of the primary
caregivers for patients who are using medical
marijuana. SB 94 establishes some wise precautions to
limit abuse. Each patient can have only one primary
caregiver, and each primary caregiver can care for only
one patient, with very limited exceptions. By creating
a "one to one", relationship between the patient and
caregiver, we will avoid scenarios such as what cropped
up in California, where marijuana clubs sprouted up
claiming to be the primary caregivers for 500 or 1000
patients. SB 94 also states that no person who has
committed a felony violation of drug laws can be a
primary caregiver, and no person who is on probation or
parole can be a primary caregiver.
Vice-Chair Bunde observed that possession and use of
marijuana is still against federal law. Mr. Pauley stated
that there is nothing that the state can do to provide
protection from federal prosecution. An United States Drug
Enforcement Agency administrator stated in response to an
inquiry by the Unites States Senate Judiciary Committee
regarding initiatives legalizing marijuana passed in Arizona
and California that:
"The California and Arizona initiatives do nothing to
change federal drug enforcement policy. The DEA will
continue to target major drug traffickers, including
major marijuana growers and distributors. We also can
take both administrative and criminal actions against
doctors who violate the terms of DEA drug registrations
that authorizes them to prescribe controlled
substances. Doctors are registered with the DEA to
prescribe only Schedule II-IV substances. Technically,
those doctors who prescribe or recommend Schedule I
substances are violating federal law. Then licenses of
over 900 physicians have either been surrendered or
revoked in the last two years for fraudulent
prescribing practices."
Vice-Chair Bunde questioned if $5 thousand dollars in
general fund program receipts is the charge for the
identification card. Mr. Pauley explained that the fee would
be $25 dollars. Vice-Chair Bunde suggested that the
recipients should pay for the cost of the program.
Representative J. Davies questioned if all 900 cases of
fraudulent prescribing practices were related to marijuana.
Mr. Pauley clarified that the figure includes all fraudulent
prescription charges, not all were related to marijuana.
Representative Foster asked how persons living in rural
areas would register.
Mr. Pauley explained that how a patient legally obtains the
substance was not addressed in the initiative or the
legislation. The patient would first need to obtain a
doctor's recommendation that they have a debilitating
medical condition that could be alleviated through the use
of medical marijuana. The doctor's recommendation would go
with an application to the Department of Health and Social
Services. If the application is approved the patient would
receive a card. The card would protect the patient from
state prosecution. The legislation addresses the card on
page 5, line 17.
Co-Chair Therriault referred to page 5, line 24. He stated
that "card" would be added as a technical correction.
In response to a question by Representative Grussendorf, Mr.
Pauley explained that the medical patient or their primary
care giver would be expected to grow their own marijuana.
Vice-Chair Bunde observed that an illegal act must be
committed before the legal use of marijuana occurs.
Mr. Pauley noted that there have not been federal
prosecutions of patients in the states that have passed
medical marijuana initiatives.
Vice-Chair Bunde expressed further concern that the fee was
not sufficient to support the program.
ELMER LINDSTROM, SPECIAL ASSISTANT, DEPARTMENT OF HEALTH AND
SOCIAL SERVICES testified in support of SB 94. He explained
that page 7; line 26 allows the department to adjust the
fee. The Bureau of Vital Statistic will administer the
program. The fee was based on comparisons to other services
by the bureau.
Co-Chair Therriault questioned if the language would allow
the department to charge for other services. Mr. Pauley
clarified that the legislation only refers to AS 17.37,
relating to medical marijuana.
JERRY LUCKHAUPT, LEGISLATIVE LEGAL COUNSEL, LEGISLATIVE
AFFAIRS AGENCY observed that the department could
theoretically extend the program to include other public
health areas. The legislation allows a fee to be
administered. The language was placed in statute by the
initiative.
In response to a question by Representative Foster, Mr.
Pauley noted that the initiative stated that individuals
suffering from cancer, glaucoma, positive HIV, and AIDS
would qualify for medical marijuana use. He added that the
use of marijuana has been discredited by a recent Institute
of Medicine Report of the Office of National Drug Control
Policy. The Alaska State Board of Examiners and Optometry
adopted a statement in December 1998 opposing the use of
marijuana as a treatment for glaucoma on the grounds that it
is not as effective as other treatment.
Representative Foster noted that rural Alaskans might have
difficulty with the quantity allowable under the
legislation. Mr. Pauley pointed out that one-ounce lasting
ten days is based on a very high rate scenario. He added
that the terminally ill person would also be allowed 6
plants. He did not imagine that terminally ill persons would
be working in fish camps. Representative Foster questioned
if marijuana could not be shipped by mail. Mr. Pauley did
not think that it would be legal to ship marijuana.
Co-Chair Therriault explained that the initiative is non-
specific. Mr. Luckhaupt pointed out that possession of
marijuana is still a crime under federal law. It cannot be
transported. Co-Chair Therriault observed that the
initiative could not affect federal law.
Mr. Lindstrom noted that law enforcement agencies identified
difficulties with the initiative. He observed that the
intent is to meet the law enforcement concerns without
interfering with the underlying patient doctor relationship
or making the administration cumbersome. The Administration
supports the bill. He assured Representative Foster that the
Administration is committed to making the program work in
rural Alaska.
Mr. Lindstrom discussed the fiscal note. He explained that
the legislation changes the program from permissive
registration to mandated registration. Registration would be
run thorough the Bureau of Vital Statistics for a reasonable
amount of money. The additional funds would allow the
Department to provide law enforcement agencies with a
nightly updated registration. There is a $25 dollar initial
registration fee annual fee of $15 or $20 dollars.
Co-Chair Therriault questioned if a full time position is
needed to take care of 200 permits. Mr. Lindstrom stressed
that it is a new program. Staff will have to verify
registration information.
In response to a question by Representative Foster, Mr.
Lindstrom stated that confidentiality laws would prohibit
state employees from sharing the information with federal
law enforcement agents. Mr. Pauley added that page 2, line
25 addresses confidentiality. The information can only be
shared with state or local law enforcement agencies in order
to verify registration.
Mr. Luckhaupt noted that state statutes protect the
caregiver. The state receives some immunity through the
tenth amendment. He noted that the federal government
started a federal marijuana program in the 1970's. He
acknowledged that a state employee could be required to give
up the information if subpoenaed by the federal government.
Representative J. Davies pointed out that the legislation
does not create a new program. It only modifies a program
created by the initiative. Mr. Pauley responded that there
is no money in the budget to implement any registration
without the legislation.
Co-Chair Therriault MOVED to ADOPT Amendment replace "and"
with "card" on 1 page 5, line 24. There being NO OBJECTION,
it was so ordered.
Representative J. Davies MOVED to ADOPT Amendment 2 (copy on
file). Amendment 2 would change "one-year" to 16-month". Co-
Chair Mulder OBJECTED for the purpose of discussion.
(Tape Change, HFC 99 - 142, Side 2)
SENATOR LOREN LEMAN, SPONSOR stated that he would not oppose
the amendment in the spirit of compromise. He did not think
that the 12-month requirement was unreasonable.
Co-Chair Mulder WITHDREW his objection.
There being NO OBJECTION, Amendment 2 was adopted.
Co-Chair Therriault clarified that the original request by
the Department of Health and Social Services in the
operating budget was higher.
Senator Leman pointed out that it is still illegal to posses
or use marijuana under federal law. Protection is only
granted under the state law.
Co-Chair Mulder ADOPT HCS CS SB 94 (FIN)
HCS SSSB 94(FIN) was REPORTED out of Committee with a "do
pass" recommendation and with a published fiscal impact note
by the Department of Health and Social Services dated
5/4/99.
SENATE CONCURRENT RESOLUTION NO. 8
Creating the Long-Term Care Task Force of 1999.
SENATOR GARY WILKEN, SPONSOR observed that the legislation
continues the effort of the Long-Term Care Task Force. He
anticipated that there would only be a meeting or two of the
Task Force. He did not think that the entire funding amount
of $15.7 thousand dollars would be needed.
Representative J. Davies spoke in support of the
legislation.
Representative Grussendorf MOVED to report SCR 8 out of
Committee with the accompanying fiscal note. There being NO
OBJECTION, it was so ordered.
SCR 8 was REPORTED out of Committee with a "do pass"
recommendation and with a published fiscal impact note by
the Legislative Affairs Agency dated 4/21/99.
CS FOR SENATE BILL NO. 97(FIN) am
"An Act relating to mental health services and
programs; relating to liability for payment for mental
health evaluation and treatment services; and providing
for an effective date."
LORNA RAMBERT, SENATOR P. KELLY testified on behalf of the
sponsor in support of SB 97. She read the sponsor statement:
DHSS reimburses private community hospitals (Designated
Evaluation and Treatment Facilities) throughout Alaska
to provide emergency mental health inpatient evaluation
and treatment services. Hospitals provide these
services to individuals who are at risk of harming
themselves or others. or who are so severely impaired
by mental health symptoms that they are unable to care
for themselves. Often these individuals are
experiencing severe psychiatric symptoms, such as
depressive or psychotic symptoms, and need intensive
inpatient mental health services.
Senate Bill 97 seeks to clarify the state's
responsibility for payment for services and the
responsibility of the state to determine the ability of
patients to pay for those services. The proposed
legislation clarifies client eligibility for these
services. Additionally, it establishes
procedures for determining eligibility, processing
applications, and paying claims. SB 97 creates an
entitlement for eligible clients, thus allowing payment
for serving those individuals whose mental illness
increases their danger to themselves or others. The
following are criteria for eligibility:
* A patient is determined to be "suffering from a
mental illness, and as a result is likely to cause
serious harm to themselves or others, or is
gravely disabled." and;
* The patient's gross monthly household income falls
below 185% of the federal poverty guideline.
SB 97 amends current statutes defining the state's
responsibility for payment for inpatient psychiatric
service for those patients needing intensive services.
Historically the Department of Health and Social
Services (DHSS) has reimbursed hospitals for only those
patients who are committed by the courts for evaluation
and treatment services. This legislation would require
the department to reimburse hospitals for individuals
who meet the commitment criteria, but who voluntarily
admit themselves into the hospital. These individuals
are therefore, not court ordered into care, but could
be held under court order if they attempted to leave
the hospital.
GINA MACDONALD, DEPARTMENT OF HEALTH AND SOCIAL SERVICES
offered to answer questions. She noted that the Department
does support the bill. She noted that the API 2000 project
will reduce the number of beds at the Alaska Psychiatric
Institute from 79 to 54. The legislation would provide a
clear structure to direct how private hospitals would be
paid to perform some emergency mental health functions.
In response to a question by Representative Austerman, Ms.
MacDonald explained that federal funds would be used through
FY 2001.
PAT CLASBY, ALASKA STATE HOSPITAL AND NURSING HOME
ASSOCIATION stated that the Association supports the
legislation. Most hospitals in the state provide some type
of emergency mental health evaluation services. Several
hospitals also provide treatment services beyond 72 hours.
The hospitals around the state have been working with the
state as Alaska Psychiatric Institute is downsized. She
emphasized that there needs to be a clear understand of when
patients are the state's responsibility. Hospitals would be
concerned if the services were developed and became an
unfunded mandate.
Representative Kohring MOVED to report CSSB 97 FIN) am out
of Committee with individual recommendations.
There being NO OBJECTIONS, it was so ordered.
CSSB 97(FIN) am was REPORTED out of Committee with a "do
pass" recommendation and with a published fiscal note by the
Department of Health and Social Services dated4/21/99.
ADJOURNMENT
The meeting adjourned at 10:05 p.m.
House Finance Committee 7 5/15/99
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