Legislature(2019 - 2020)ADAMS ROOM 519
04/30/2019 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| SB36 | |
| SB37 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | SB 36 | TELECONFERENCED | |
| + | SB 37 | TELECONFERENCED | |
| += | HB 49 | TELECONFERENCED | |
| += | HB 145 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 20 | TELECONFERENCED | |
HOUSE FINANCE COMMITTEE
April 30, 2019
1:30 p.m.
1:30:34 PM
CALL TO ORDER
Co-Chair Wilson called the House Finance Committee meeting
to order at 1:30 p.m.
MEMBERS PRESENT
Representative Neal Foster, Co-Chair
Representative Tammie Wilson, Co-Chair
Representative Jennifer Johnston, Vice-Chair
Representative Dan Ortiz, Vice-Chair
Representative Ben Carpenter
Representative Andy Josephson
Representative Gary Knopp
Representative Bart LeBon
Representative Kelly Merrick
Representative Colleen Sullivan-Leonard
Representative Cathy Tilton
MEMBERS ABSENT
None
ALSO PRESENT
Jane Conway, Staff, Senator Cathy Giessel; Sara Chambers,
Director, Division of Corporations, Business and
Professional Licensing, Department of Commerce, Community
and Economic Development; Kris Curtis, Legislative Auditor,
Alaska Division of Legislative Audit; Jill Lewis, Deputy
Director, Division of Public Health, Department of Health
and Social Services; Dr. Lily Lou, Alaska State Medical
Officer, Department of Health and Social Services; David
Teal, Director, Legislative Finance Division.
PRESENT VIA TELECONFERENCE
Chris Logan, Alaska Advance Practice Registered Nurse
Association Alliance, Anchorage; Lynn Hartz, Self,
Anchorage; Karen Morton, Alaska Nurses Association,
Soldotna; Irina Obolentseva, Self, Delta Junction; Anna
Goncharova, Self, Delta Junction; John Zasada, AK Primary
Care Association, Anchorage; Roslayn Singleton, Self, ANC.
SUMMARY
HB 20 SEXUAL ASSAULT EXAMINATION KITS
HB 20 was SCHEDULED but not HEARD.
HB 49 CRIMES; SENTENCING;MENT. ILLNESS;EVIDENCE
HB 49 was SCHEDULED but not HEARD.
SB 36 EXTEND BOARD OF NURSING
SB 36 was HEARD and HELD in committee for
further consideration.
SB 37 RENEWAL OF VACCINE ASSESSMENT PROGRAM
SB 37 was HEARD and HELD in committee for
further consideration.
Co-Chair Wilson reviewed the agenda for the meeting.
SENATE BILL NO. 36
"An Act extending the termination date of the Board of
Nursing; and providing for an effective date."
1:31:18 PM
JANE CONWAY, STAFF, SENATOR CATHY GIESSEL, explained that
the sponsor could not be present, as she was attending
Floor Session. She explained that the bill extended the
Board of Nursing for six years. Otherwise, the board was
set to expire on June 30, 2019. She provided additional
details of the bill. The board was established for the
purpose of regulating the practice of nursing; and covered
advance-practice registered nurses, nurse anesthetists,
registered nurses, licensed practical nurses, and certified
nurse aides (CNA).
Ms. Conway continued that the board had almost 20,000
licensees, which she thought was near to one-third the
workload of professional licensees.
Co-Chair Wilson clarified she was addressing SB 36 rather
than SB 37.
Ms. Conway discussed education requirements for the
licensees, which spanned from high school diplomas to
doctoral degrees. The board of seven individuals served
four-year terms and were capped at two consecutive terms.
The board's mission was to actively promote and protect the
health of citizens of Alaska through safe and effective
practice of nursing as defined by law. The 2018 audit cited
four recommendations. She indicated the legislative auditor
was present to provide the audit findings. The board
received its revenue from licensing and renewal fees, and
deficits were shown on page 11 of the audit. The board was
self-sustaining and required no general funds. The audit of
the board concluded that the board continued to meet its
mission and recommended its six-year sunset.
1:34:33 PM
Co-Chair Wilson asked about page 11 of the audit. It
appeared there was a deficit for the board for the first
time. She wondered why.
Ms. Conway believed there had been a large influx of
licensees. There would be a fee analysis in May. She
thought the division director could provide more detail.
Representative Josephson had been told the board did not
have an executive administrator at present. He wondered if
the position would be filled in the near future.
Ms. Conway thought the board was actively pursuing the
recruitment of the position.
1:36:37 PM
SARA CHAMBERS, DIRECTOR, DIVISION OF CORPORATIONS, BUSINESS
AND PROFESSIONAL LICENSING, DEPARTMENT OF COMMERCE,
COMMUNITY AND ECONOMIC DEVELOPMENT, responded that the
department was actively recruiting for the executive
administrator position which would close the following day.
Representative Josephson thought the board consisted almost
entirely of new members. He referenced telemedicine
regulations and asked if Ms. Chambers could explain the
turnover.
Ms. Chambers was unsure of the reason for the turnover. She
assured the committee that every effort was being made to
bring new members up to speed and avoid a gap in service.
Co-Chair Wilson directed Ms. Chambers to respond to her
query about the deficit.
Ms. Chambers informed that she had submitted an updated
fiscal report to the committee on the previous Friday,
while the audit was a year old. She detailed that as of
March 30, 2019, the board had a $1 million surplus. The
funds were adequate to maintain the licensing program
activities for a biennial licensing period. She noted that
page 11 of the audit was based on a time just before a
renewal period. She stated that it was not unusual to see a
flux of funds based on the schedule of renewals.
Co-Chair Wilson asked for the document date.
Ms. Chambers answered that the latest document that was
provided was for the end of the third quarter and showed a
$1,441,000 surplus as of March 30, 2019.
1:39:17 PM
AT EASE
1:40:06 PM
RECONVENVED
KRIS CURTIS, LEGISLATIVE AUDITOR, ALASKA DIVISION OF
LEGISLATIVE AUDIT, reported that the audit concluded that
the board was serving the public interest. The audit also
concluded that the board was not serving the public's
interest by not establishing telehealth regulations; by not
adequately monitoring CNA training programs; and by not
notifying the appropriate entities when a licensee's
prescriptive authority had been suspended, revoked, or
surrendered. The audit also found that there needed to be
improvements in the investigative process of the Division
of Corporations, Business and Professional Licensing. The
audit recommended extension of the board for six years.
Ms. Curtis directed attention to page 7 of the audit
report, which showed licensing activity and a 46 percent
increase in activity since the previous 2010 sunset audit.
The amount of applications reflected a growing occupation.
She noted that the schedule of expenditures was on page 11
of the audit. She made note of the $337,000 deficit as of
March 2018. She continued that the fees were adjusted.
Ms. Curtis referenced page 14 of the audit which contained
the recommendations from the Division of Legislative Audit.
She read the four recommendations:
Recommendation No. 1:
The board should adopt regulations to address the
distance delivery of nursing services through
technology.
The board has permitted the distance delivery of
nursing services via technology (telehealth) without
formal statutory or regulatory guidance. In FY 15, a
licensee approached the board and asked for guidance
on providing telehealth services which prompted the
board to issue an advisory opinion. The board's
advisory opinion defined telehealth and provided
limited guidance on the scope of practice. The
guidance was inadequate to promote, preserve, and
protect the public's health, safety, and welfare.
Although the board discussed the need for regulations
to guide the distance delivery of nursing services,
the board could not agree on regulatory language.
Per AS 08.68.100(a)(1), the board shall adopt
regulations pertaining to the scope of practice of
nursing in Alaska. Providing insufficient guidance to
licensees increases the risk that nurses may not
maintain acceptable standards of practice or may not
adequately protect patients' confidentiality.
We recommend the board adopt regulations to address
the distance delivery of nursing services through
technology. Additionally, the board should ensure
statutes appropriately allow for the establishment of
telehealth regulations.
Recommendation No. 2:
The board should take steps to ensure the appropriate
entities are notified when a licensee's prescriptive
authority is suspended, revoked, or surrendered.
The audit identified eight APRNs that had their
prescriptive authority suspended, revoked, or
surrendered between July 1, 2014, and January 31,
2018. In all cases, the board did not notify the Board
of Pharmacy or the Drug Enforcement Administration
(DEA) about the licensing action. The entities were
not notified because there were no statutes or
regulations in place that require notification.
The board is established under AS 08.68 for the
purpose of controlling and regulating the practice of
nursing, including:
APRNs, nurse anesthetists, registered nurses, LPNs,
and CNAs. The board's mission statement is: "to
actively promote and protect the health of the
citizens of Alaska through the safe and effective
practice of nursing as defined by law." Per AS
17.30.200, the Board of Pharmacy is responsible for
administering the controlled substance prescription
database. The database is reviewed by pharmacists
prior to dispensing controlled substances, with
certain exceptions. Failure to notify the Board of
Pharmacy when prescriptive authority has been revoked,
suspended, or surrendered increases the risk that
controlled substances may be abused or diverted.
Per federal law, the DEA may rescind or revoke the
federal authority to prescribe controlled substances
if an existing DEA registrant loses his or her state
privileges. Failure to notify the DEA that an APRN's
prescriptive authority has been suspended, revoked, or
surrendered may result in improper or unauthorized
prescriptions.
We recommend the board take steps to ensure the
appropriate entities are notified when a licensee's
prescriptive authority is suspended, revoked, or
surrendered.
1:43:29 PM
Ms. Curtis continued discussing the audit:
Recommendation No. 3:
The DCBPL chief investigator should ensure nurse
investigations are adequately documented and performed
timely.
The audit identified 13 investigations with periods of
unjustified inactivity and two investigations which
were inadequately documented. Specifically:
Thirteen cases in a random sample of 2810 had periods
of unjustified inactivity ranging from 61 days to 3.6
years. Furthermore, 10 of the 13 cases had multiple
periods of inactivity. The periods of unjustified
inactivity were mainly due to changes in investigative
staff assigned to the case and competing priorities.
The long-term care ombudsman identified two licensees
for investigation that were potentially practicing
outside a LPN's scope of practice. Auditors could not
evaluate the investigations due to a lack of
documentation in the DCBPL case fi les. One of the
licensees continued to practice during the four years
that the investigation was open, potentially posing a
risk to public safety. The DCBPL investigator fi les
note that the two cases were put in storage from
October 2012 until April 2014 due to an office remodel
and did not progress during that time.
Per AS 08.01.050(a)(19), DCBPL is responsible for
investigating and monitoring occupational licensing
activity. Investigations and complaints that sit idle
for extended periods may pose a risk to public safety.
We recommend the DCBPL chief investigator ensure nurse
investigations are adequately documented and performed
timely.
Recommendation No. 4:
The board chair should take steps to ensure the
required CNA on-site training program reviews and
self-evaluations are conducted prior to reapproving
the programs.
The audit found the required self-evaluations were not
received and on.notdefsite reviews were not conducted prior
to board re.notdefapproval of CNA training programs. During
the audit, the process to approve five of 22 CNA
training programs was reviewed. Auditors found on site
reviews were not conducted for four of the five
programs as required prior to re-approval.
Additionally, self-evaluations were not obtained and
reviewed. The board's failure to adequately monitor
programs may lead to undetected deficiencies, which
could result in inadequately trained CNAs.
According to board staff, on-site reviews and
monitoring of self-evaluation forms were not completed
timely because the contractor hired to complete the
reviews was terminated in FY 14, and procurement to
hire another contractor was not successful. DCBPL
received approval for a nurse consultant position,
which was filled in October 2015; however, the nurse
consultant did not begin performing reviews until
spring 2016. Programs were approved by the board
without on-site visits or self-evaluations due to a
lack of resources to complete the reviews and a need
for the programs to continue to be available to train
CNAs.
Regulation 12 AAC 44.857(a) and (c) requires CNA
training programs be board-approved every two years
with an on-site review. Self-evaluations are to be
completed during a year in which an on-site review is
not scheduled.
We recommend the board chair take steps to ensure the
required CNA training program on-site reviews and
self-evaluations are conducted prior to reapproving
the programs.
1:46:22 PM
Ms. Curtis pointed out that the department response was
found on page 27 of the audit. The department did not
comment on recommendations 1 and 4, which were directed to
the board. The department agreed with recommendations 2 and
3. Administrative procedures had been implemented to notify
the Board of Pharmacy and the Drug Enforcement Agency when
licensing action was taken. Additionally, procedures had
been improved to help improve the timeliness of the
investigative process. She added that the board's response
was found of page 29 of the audit. The board did agree with
all four recommendations and planned to take corrective
action.
Representative Josephson asked about the telemedicine
recommendation. He was told that the board had submitted a
regulation packet the previous fall and wondered if the
auditor had seen it.
Ms. Curtis informed that the audit was dated April 2018.
The board's response to the audit indicated that it planned
to take corrective action in November 2018.
Ms. Chambers reviewed the fiscal note from the Department
of Commerce, Community and Economic Development (DCCED)
that reflected the cost of extending the board. The bill
did not change the licensing program. If the bill was
unsuccessful and the board sunset, there would be no
change. If there was an extension of the board; DCCED had
proposed $28,400 to cover travel for the board to meet as
required, to advertise public meetings, and for various
training and conference fees.
Co-Chair Wilson highlighted that page 3 showed the board
costs and licensing fees.
Representative Knopp asked Ms. Chambers about
recommendation 4 regarding CNAs. He referred to a previous
conversation.
Ms. Chambers reported that the board had addressed all four
of the audit recommendations and regulations were moving
forward. The CNA program was moving forward with
evaluations as prescribed by law. She discussed the
importance of licensing in a timely manner. She reported
that the division was fully staffed. The department was
always looking to do more streamlining of processes,
particularly with regard to military spouses and healthcare
facilities that needed to get people on staff quickly.
1:50:23 PM
Representative Knopp referred to the military spouse issue.
He asked how long it took for CNA licensees to receive a
license once they have applied.
Ms. Chambers stated that once a licensee submitted the
legally required elements, the department usually processed
the application in two weeks.
1:51:15 PM
Co-Chair Wilson OPENED Public Testimony.
CHRIS LOGAN, ALASKA ADVANCE PRACTICE REGISTERED NURSE
ASSOCIATION ALLIANCE, ANCHORAGE (via teleconference), spoke
in support of SB 36. She relayed that the alliance
supported the bill. She discussed the importance of the
Board of Nursing. She urged the committee to pass the bill.
1:52:28 PM
LYNN HARTZ, SELF, ANCHORAGE (via teleconference), spoke in
favor of advancing SB 36. She thanked the committee. She
thought the Board of Nursing was an essential government
tool in promoting the health and welfare of the Alaska
public. She expressed that through licensure, oversight of
education and discipline, the board and its staff exert
vital and unique functions on the states behalf and should
be allowed to continue their important work.
1:53:20 PM
KAREN MORTON, ALASKA NURSES ASSOCIATION, SOLDOTNA (via
teleconference), strongly supported SB 36. She read from a
prepared statement. She discussed the work of the Alaska
Nurses Association. She thought the board worked in a
transparent fashion and ensured that regulations utilizes
best practices.
1:54:50 PM
Co-Chair Wilson CLOSED Public Testimony.
Co-Chair Wilson indicated amendments were due on Wednesday,
May 1, 2019 by 5:00 P.M.
SB 36 was HEARD and HELD in committee for further
consideration.
CS FOR SENATE BILL NO. 37(FIN)
"An Act relating to the statewide immunization
program; and providing for an effective date."
1:55:14 PM
JANE CONWAY, STAFF, SENATOR CATHY GIESSEL, reviewed the
legislation. She read from the sponsor statement:
CS for Senate Bill 37(FIN)reauthorizes the statewide
immunization program in the Department of Health and
Social Services, which is scheduled for repeal January
1, 2021. Established in 2014, via Senate Bill169, the
program monitors, purchases and distributes all
childhood vaccines and select adult vaccines to
providers, making access to vaccines universal for all
Alaskans. By 2018, the program covered more than
333,000 Alaskans, 45% of the total population. Next to
clean drinking water and good nutrition, vaccines have
saved more lives than any other public health
intervention.
The statewide immunization program is fully funded by
the state Vaccine Assessment Account through
assessments (upfront fees) from health plans and
insurers and other fees. There are no undesignated
general funds needed for this program. The state
leverages its buying power to purchase vaccines in
bulk using the fees collected from healthcare payers.
The state distributes that vaccine to providers who
then administer them at no charge, improving health
and wellbeing while lowering overall vaccine costs by
20 -30%.
CSSB37(FIN) creates the vaccine assessment fund as an
account in the general fund and will allow the
Commissioner of the Department of Health and Social
Services to administer the program and react more
nimbly in the event of an outbreak without first
seeking legislative approval. Alaska's immunization
program is an example of a successful public-private
partnership that ensures Alaskans a healthier future
at the lowest possible cost. The department reduces
vaccine -preventable diseases, and providers have
improved health outcomes for their patients and easier
vaccine stock management. The insurers pay less to
vaccinate individuals; we all save more money in the
long run due to decreased medical costs from vaccine-
preventable diseases.
Ms. Conway detailed that the state could purchase vaccines
in bulk, the providers could administer more vaccines and
have greater access with no waste. She relayed a number of
benefits to the program. Waste was eliminated, and patients
paid less for their vaccines. She concluded her portion of
the presentation. She conveyed the names of those available
for questions.
Co-Chair Wilson invited Ms. Lewis to the table.
2:00:39 PM
JILL LEWIS, DEPUTY DIRECTOR, DIVISION OF PUBLIC HEALTH,
DEPARTMENT OF HEALTH AND SOCIAL SERVICES, relayed that the
chief Medical Officer would begin testimony.
LILY LOU, ALASKA STATE MEDICAL OFFICER, DEPARTMENT OF
HEALTH AND SOCIAL SERVICES, introduced herself and relayed
she had served on the Council for the Alaska Vaccine
Assessment Program (AVAP) and was President of the American
Academy of Pediatrics Alaska Chapter. She noted there was a
letter (copy on file) authored in her capacity as chapter
president. She discussed the vaccine program, noting that
the program made access to vaccines universal, and did
include uninsured adults. Alaska was the only state that
provided the coverage for uninsured adults.
Ms. Lou continued her remarks. She discussed the cost of
the program. She discussed the discount in vaccine pricing
and the bulk purchasing benefits. The program was created
in January 15 and should sunset in 2021. In 2008, the
program had covered 50 percent of Alaskans. The department
had seen a significant improvement in vaccination rate. She
discussed national recognition for the state's increased
vaccination rates.
2:03:46 PM
Ms. Lou directed attention to a slide in member packets
[She pointed to the AVAP Handout - SB 37 Renewal of Vaccine
Assessment Program] (copy on file). She referenced a mumps
outbreak the previous year. The bill reauthorized the
program, removed the phase-in language, and removed the
sunset language. She emphasized that the bill did not
change or impact any regulations regarding vaccine
exemptions. She discussed the advantages of the program.
She discussed the advantage of a unified and effective
inventory system.
Mr. Lou shared an estimate that for every dollar spent on
vaccine programs, it saved $10 in medical costs. She
asserted that the program had proven itself. She thanked
members for the opportunity to speak.
2:07:11 PM
Vice-Chair Ortiz spoke to the issue of what the department
oversaw. He had gleaned that the bill would help improve
access to vaccinations. He mentioned diminished services in
public health clinics and rural areas. He wondered if
public health clinics were the best access to vaccinations
and he wondered about access if a public health clinic
closed.
Dr. Lou responded that the department was aware that public
health clinics provided an important service. She clarified
that the program provided vaccines to any provider that
administered vaccinations.
Vice-Chair Ortiz asked if the department had seen any
increase in outbreaks of disease that could be affected by
not having access to vaccines.
Dr. Lou appreciated the challenges when a health facility
closed.
Representative Sullivan-Leonard asked about
reauthorizations for the program. She wondered if other
diseases were coming to the forefront such as measles.
Dr. Lou responded that measles was the primary national
issue, although it had not been seen in Alaska yet. There
was a recent outbreak of measles in the State of
Washington. There were no current vaccine-preventable
outbreaks in Alaska. There were other outbreaks such as
tuberculosis.
2:10:47 PM
Ms. Lewis introduced the PowerPoint presentation: "SB 37
Renewal of Vaccine Assessment Program" (copy on file). She
began with slide 2, "SB 37":
?Reauthorizes the statewide Alaska Vaccine Assessment
Program in the Department of Health and Social
Services, scheduled for sunset January 1, 2021.
?Eliminates a temporary phase-in period that ended in
2017.
?Uses the state Vaccine Assessment Account to fully
fund the program.
o No unrestricted general funds are involved.
Ms. Lewis turned to slide 3, "What is the Alaska Vaccine
Assessment Program?":
Established in 2014, AVAP is a public-private
partnership making access to vaccines universal for
all Alaskans at no cost to the state.
?Provides all childhood and certain adult vaccines for
privately insured children and some adults.
?Covers vaccine costs through assessments collected
from private health insurers, third party
administrators, and other program participants.
?Purchases vaccines at discounted rates off a bulk
contract.
?Distributes vaccine directly to healthcare providers
at no charge who administer the vaccines to their
patients.
Ms. Lewis detailed that providers could still bill for an
office visit or to administer the vaccines.
Ms. Lewis continued to slide 4: "What is the Alaska Vaccine
Assessment Program.":
? Through AVAP, Alaska continues to demonstrate
leadership in creating innovative solutions for
difficult public health issues.
? Alaska is one of only 11 states that has a universal
childhood vaccine program and one of only 3 states
that offers adult vaccines.
? Alaska is the only state that offers healthcare
providers the option of purchasing state-supplied
vaccine to serve uninsured adults.
2:14:10 PM
Ms. Lewis reviewed the flow chart on slide 5. She began at
the top of the slide with Alaska Vaccine Assessment Council
which set the annual assessment rate based on historical
information. To the right showed the payers who paid into
the assessment quarterly based on their reported covered
lives. The Division of Public Health purchased the vaccine
off a discounted bulk contract. The Division of Public
Health then distributed the vaccine at no cost to providers
or through the Vaccine Depot. Providers vaccinated covered
patients, only billing payers for office visits. Providers
then reported administered vaccines to the Division of
Public Health, and then provided data to the council for
rate setting. She remarked on the streamlined process
provided by the program.
2:17:40 PM
Vice-Chair Johnston understood that the program had gone on
for almost 5 years. She asked if the department had a good
idea of the amount of vaccines that were needed after
collecting data over time.
Ms. Lewis thought Vice-Chair Johnston was asking about the
department's ability to forecast the number of vaccines
needed. She thought the council was good at forecasting and
had been operating a central vaccine depot for more than 30
years. Previously the depot was federally funded until the
funds were lost when the former United States Senator Ted
Stevens left office. She asserted that the department was
very accurate with its data, and actively worked to manage
waste.
Representative Tilton referenced the flow chart on slide 5.
She asked if the "payers" referenced on the chart was
referencing insurance companies.
Ms. Lewis responded that the health plans and the insurers
were required to pay the assessment. In order to cover the
uninsured adult population, the program allowed providers
to opt into the program. If the providers had a large
community to serve, such as a community health clinic, the
providers could get the same price break by voluntarily
participating. Without participation, providers would have
to pay the retail cost and would not be able to avail
themselves of the 20 to 30 percent discount.
Representative Tilton asked how providers could participate
in the program.
Ms. Lewis responded that providers had to agree to certain
conditions in order to participate and provided information
about how many patients were in the caseload. The cost was
the same rate that health plans paid per member per month.
Co-Chair Wilson asked if the program required parents to
immunize their children.
Ms. Lewis stated that in Alaska there was the option to
decline vaccination due to medical or religious reasons,
and the bill did not affect the option. She returned to
speaking to the flow chart on slide 5.
2:22:55 PM
Ms. Lewis explained slide 6: "Vaccine Cost," which showed a
bar graph depicting the cost to vaccinate a person through
18 years of age for the AVAP program versus the private
sector. The overall vaccine costs were lowered 20-30
percent by the program and showed a savings of almost
$1,000 per child.
Ms. Lewis reported on slide 7: "Vaccine Coverage":
2018
? 366,000 Alaskans covered
? 50% of the population
? 86,000 children
? 44% of all children
? 280,000 adults
? 52% of all adults
Vaccination Coverage Awards
?Most improved among adolescents for HPV
?Most improved among adults aged 65+ for pneumonia
Ms. Lewis noted that Alaska was improving its vaccination
rates, which were lower than the rest of the country.
Ms. Lewis discussed slide 8: "Successes":
Win-Win-Win-Win
? The Division of Public Health reduces vaccine
preventable diseases.
? Providers have improved health outcomes for
vaccinated individuals and easier vaccine stock
management.
? The health insurance industry pays less to vaccinate
individuals.
? All Alaskans save more money in the long run due to
fewer medical costs from vaccine-preventable diseases.
Ms. Lewis reviewed the benefits of the program on slide 9:
"Return on Health":
Lowers direct and long-term healthcare costs and yields
numerous public health benefits:
? Ensures that every child and some adults who enter a
participating doctor's office or hospital can receive
recommended vaccines at no cost.
? More healthcare providers can offer vaccination
services
? less up-front costs to finance out of their own
pockets for vaccines, and
? reduces staff burdens required to separate
private and public vaccine stock.
? Allows the State to manage the supply of vaccines,
? ensuring that the state can quickly supply
vaccines to vulnerable patient groups during
emergencies or vaccine shortages, and
? reducing waste through centralized inventory
management.
Ms. Lewis discussed the challenges of stocking vaccine
supply before the centralized program.
2:26:45 PM
Ms. Lewis discussed slide 10: "For every $1 spent on a
vaccine in the US?". She noted that the MMR vaccine saved
$26 for every dollar spent.
Vice-Chair Johnston asked if the flu vaccines and shingle
vaccines were covered.
Ms. Lewis responded that the state covered both vaccines.
Vice-Chair Johnston asked if the newer shingles vaccine was
covered.
Ms. Lewis responded that the newer shingles vaccine was
covered. She discussed the restructuring of the Vaccine
Assessment Account. The new vaccine was more expensive and
estimated to cost $1 million more per year. The new vaccine
also applied to a broader age group and thereby required
more vaccines. Under the fund transfer, the program would
be limited to the appropriation amount in a single year.
She noted with the fund capitalization the program was not
as limited and could spend assessments that had been
collected.
Co-Chair Wilson asked if shingles vaccines were available
for retired state employees.
Ms. Lewis believed that the state did provide the vaccine
but was considered in terms of covered lives. She thought
the vaccine coverage for retirees was limited.
Representative Merrick noted Ms. Lewis had mentioned that
unused vaccines were returned. She wondered how ensure to
vaccines had been properly cared for while in other hands.
Ms. Lewis indicated that the quality control was well
managed for vaccines. The depot spent a great deal of its
time on quality assurance including site visits, mandatory
temperature checks, and reports.
2:30:26 PM
Representative LeBon referenced slide 7 and asked about the
44 percent of children covered. He wondered if the number
indicated the number of children vaccinated.
Dr. Lou reported that the 44 percent denoted the children
covered by the AVAP, which was different than vaccine
rates. She noted that 100 percent of Alaskan children were
covered.
Representative LeBon asked about the record of vaccine
participation in the state.
Dr. Lou responded that vaccination rates were tracked by
vaccine at the point of vaccine administration. The state
did not have the best vaccination rates. She mentioned
"herd immunity" and thought the state was close to the
cusp. She mentioned that the percentage required for herd
immunity of the community was different for each disease.
Representative LeBon asked Dr. Lou about measles in Alaska
and if she had concerns.
Dr. Lou replied that as a pediatrician she had concerns
about the trend, and thought the state had a 93 percent to
94 percent vaccination rate for the disease. She expressed
concerns that there were communities where vaccine
hesitancy was at much higher rates and a vaccine-
preventable disease could take hold and spread to the rest
of the state.
Co-Chair Wilson asked if the program sunset was being
removed. She wondered if the legislation allowed for fees
to be adjusted.
Ms. Lewis responded that the AVAP Council had the ability
to adjust the rate if needed.
2:34:05 PM
Vice-Chair Johnston understood that the bill would not have
a sunset date. She asked if the program had ever been
audited.
Ms. Lewis indicated that the program was audited annually
by an independent auditor.
Representative Josephson referenced cuts to public health
nursing. He wondered if the cuts had affected provision of
vaccines.
Dr. Lou responded that Representative Josephson's question
was a separate question from the bill. However, she thought
cutting public health care resources did impact the
provision of vaccines.
2:35:40 PM
Co-Chair Wilson OPENED Public Testimony.
KAREN MORTON, ALASKA NURSES ASSOCIATION, SOLDOTNA (via
teleconference), spoke in favor of the bill. She reviewed
the many benefits of the program and urged support of the
bill.
2:36:43 PM
IRINA OBOLENTSEVA, SELF, DELTA JUNCTION (via
teleconference), read a doctor's opinion about autism and
vaccinations. She relayed that certain vaccinations were
unsafe products that she felt the state should not pay for.
She argued that one-shot-fits-all was not a smart thing to
do.
2:39:49 PM
ANNA GONCHAROVA, SELF, DELTA JUNCTION (via teleconference),
spoke in opposition to the bill. She spoke of chronic
symptoms related to vaccinations. She listed a number of
repercussions resulting from vaccinations. She did not
support SB 37 and urged members to vote against the bill.
2:42:05 PM
JOHN ZASADA, AK PRIMARY CARE ASSOCIATION, ANCHORAGE (via
teleconference), reported his members strongly supported
the bill. He discussed health center participation in the
program. The program allowed non-profit practices to
purchase and administer vaccines, and also allowed them to
provide services for infectious diseases. He continued to
discuss the benefit of the vaccination program no matter a
person's ability to pay.
2:44:50 PM
ROSLAYN SINGLETON, SELF, ANC (via teleconference), strongly
supported SB 37. She discussed a time when vaccines were
not available in rural locations. As a pediatrician, she
had seen children die of preventable diseases. She recited
some rates of debilitating infection. She talked about the
importance of vaccinating for measles. She urged support of
the bill.
2:46:46 PM
Co-Chair Wilson CLOSED Public Testimony.
2:47:07 PM
DAVID TEAL, DIRECTOR, LEGISLATIVE FINANCE DIVISION, noted
that the department had testified that the program had
reduced the cost and increased the availability of
vaccines, and the bill would re-establish AVAP as a fund
capitalization rather than as a fund transfer. He used an
example to show the advantages of a fund capitalization. He
referenced the Regional Education Attendance Area (REAA)
School Fund, which was used to build and maintain schools
in the REAAs. The fund was established as a fund transfer,
into which the legislature had appropriated approximately
$40 million per year. Additionally, the legislature
appropriated money to individual school capital projects.
Mr. Teal continued with his example of a fund
capitalization. Three years previously the attorney general
had indicated that the REAA fund transfer was being done
incorrectly, and money should have been put in the fund
without the state choosing projects. The Department of
Education and Early Development should have ranked the
school construction projects, and the funding should be
used in the prioritized order. It used to be a fund
transfer where money was appropriated to the fund then
appropriated from the fund to the capital project. After
the attorney general's ruling the fund was converted to a
fund capitalization; after which monies were appropriated
to the fund and it flowed out without further
appropriations. The same thing would happen with the
vaccination program.
Mr. Teal explained that the fiscal notes would change the
language in both the House and Senate versions of the
operating budget bill. There were 3 fiscal notes. The
fiscal note with OMB component number 296 was no longer
needed due to the change he described. The second note OMB
component 3083 was also no longer needed. The third fiscal
note was a new fiscal note and was a fund capitalization
that would add language to the bill that deposited money to
the fund. The deposit would be an appropriation the program
could immediately spend to purchase vaccines. The fiscal
notes were a net zero.
2:51:42 PM
Mr. Teal further discussed the fiscal notes.
He discussed increased flexibility for using funds for
immediate needs. He suggested that with an open-ended
appropriation from the insurers (and perhaps providers)
into the fund, then AVAP could increase the assessments and
money in the fund, which could be spent with no legislative
action. The change would eliminate double counting with a
single appropriation to the fund. The change made the fund
no longer subject to the annual sweep into to the
Constitutional Budget Reserve. He discussed the conditions
under which funds were swept. He thought the fiscal notes
seemed more complicated than a simple bill should warrant,
but assured that the notes resulted in a net zero to the
state.
2:54:38 PM
Representative LeBon asked if the program went through all
its money every year, or if there was a fund that was
building up.
Mr. Teal informed that the program set its assessment fees.
In years of high outflow, AVAP didn't lose the money. There
was no advantage to building a big fund balance, so the
program should tailor the assessments to the amount of
money expected to be needed.
Representative Tilton had a question for the bill sponsor's
staff. She had heard in public testimony about adverse
reactions to vaccinations. She wondered if there was a
reporting mechanism for adverse reactions.
Dr. Lou responded that there was a very stringent reporting
system for adverse reactions to vaccinations that was
maintained by the Center for Disease Control and was
accessible to anyone any time.
Co-Chair Wilson informed members that amendments were due
by 5:00 P.M. on Wednesday, May 1, 2019.
[Recessed to the Call of the Chair. The meeting never
reconvened.]
ADJOURNMENT
2:57:17 PM
The meeting was adjourned at 2:57 p.m.