Legislature(2021 - 2022)ADAMS 519
03/29/2022 01:30 PM House FINANCE
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| Audio | Topic |
|---|---|
| Start | |
| SB33 | |
| HB265 | |
| HB296 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 265 | TELECONFERENCED | |
| + | HB 296 | TELECONFERENCED | |
| + | HB 291 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | SB 33 | TELECONFERENCED | |
HOUSE FINANCE COMMITTEE
March 29, 2022
1:32 p.m.
1:32:55 PM
CALL TO ORDER
Co-Chair Merrick called the House Finance Committee meeting
to order at 1:32 p.m.
MEMBERS PRESENT
Representative Neal Foster, Co-Chair (via teleconference)
Representative Kelly Merrick, Co-Chair
Representative Dan Ortiz, Vice-Chair
Representative DeLena Johnson
Representative Andy Josephson
Representative Bart LeBon
Representative Sara Rasmussen
Representative Steve Thompson
Representative Adam Wool
MEMBERS ABSENT
Representative Ben Carpenter
Representative Bryce Edgmon
ALSO PRESENT
Senator Gary Stevens, Sponsor; Tim Lamkin, Staff, Senator
Gary Stevens; Sara Chambers, Director, Division of
Corporations, Business and Professional Licensing,
Department of Commerce, Community and Economic Development;
Genevieve Mina, Staff, Representative Ivy Spohnholz;
Representative George Rauscher, Sponsor; Ryan McKee, Staff,
Representative George Rauscher; Representative Geran Tarr,
Sponsor; Kris Curtis, Legislative Auditor, Alaska Division
of Legislative Audit; Brenda Stanfill, Executive Director,
Alaska Network on Domestic Violence and Sexual Assault;
Diane Casto, Executive Director, Council on Domestic
Violence and Sexual Assault, Department of Public Safety.
PRESENT VIA TELECONFERENCE
Mark Palmer, President and chief Executive Officer, OBI
Seafoods; Abby Fredrick, Director of Communications, Silver
Bay Seafoods; Nicole Reynolds, Deputy Director, Tax
Division, Department of Revenue; Representative Ivy
Spohnholz, Sponsor; Nancy Merriman, Executive Director,
Alaska Primary Care Association; Tom Chard, Executive
Director, Alaska Behavioral Health Association; Andy Mills,
Legislative Liaison, Department of Transportation and
Public Facilities.
SUMMARY
HB 265 HEALTH CARE SERVICES BY TELEHEALTH
HB 265 was HEARD and HELD in committee for
further consideration.
HB 291 EXTENDING COUNCIL ON DOMESTIC VIOLENCE
HB 291 was HEARD and HELD in committee for
further consideration.
HB 296 DONATIONS/GIFTS FOR DOTPF SIGNAGE
HB 296 was HEARD and HELD in committee for
further consideration.
CSSB 33(FIN)
SEAFOOD PRODUCT DEVELOPMENT TAX CREDIT
HCS CSSB(FIN) was REPORTED out of committee with
seven "do pass" recommendations and with one "no
recommendation" recommendation and with one
previously published fiscal impact note:
FN2(REV).
Co-Chair Merrick reviewed the agenda for the day.
CS FOR SENATE BILL NO. 33(FIN)
"An Act relating to a fisheries product development
tax credit; and providing for an effective date."
1:33:53 PM
SENATOR GARY STEVENS, SPONSOR, thanked the committee for
hearing the bill. He explained that the bill was a value-
added bill which would allow seafood processors to use a
tax credit to purchase new equipment for their business. He
relayed that the process had worked well in the past and
there had been a similar program for salmon and herring
processing that started in 2003. However, the program came
to an end in 2020 because it was not extended. The bill
restored the salmon and herring tax credit that had become
obsolete and would also make pollock, pacific, and sable
fish products eligible for the credit. He reiterated that
the program had worked well in the past and suggested that
it would also work well in the future.
Co-Chair Merrick noted that Representative Rasmussen had
joined the meeting.
1:35:20 PM
MARK PALMER, PRESIDENT AND CHIEF EXECUTIVE OFFICER, OBI
SEAFOODS (via teleconference), wanted to discuss the
benefits of the tax credits. He indicated that the erosion
of the trade market in China due to hostile trade policies
had dramatically impacted the amount of raw material that
the United States could export. He shared that the Chinese
market had been the largest market for seafood products
from Alaska. As this changed, his business had become more
reliant on the domestic market and the European market. He
perceived these markets to be higher value, and thought it
was important to market Alaskan seafood products to them.
He thought there was more reason to target domestic markets
rather than exporting Alaskan fish. He explained that
Russian seafood products could no longer be imported into
the United States due to the war in Ukraine. This gave
Alaska an opportunity to replace Russian seafood in the
domestic and European markets. The tax credit proposed by
the bill would allow new infrastructure to be built in
Alaska. However, much of the money that OBI Seafoods
invested into projects was the company's own money, which
benefited the local communities and the fishermen. He
echoed Senator Stevens' comments that the program had
worked well in the past.
1:39:11 PM
ABBY FREDRICK, DIRECTOR OF COMMUNICATIONS, SILVER BAY
SEAFOODS (via teleconference), had submitted a letter of
support for the bill and did not need to make an additional
statement.
1:40:05 PM
Co-Chair Merrick OPENED public testimony.
1:40:19 PM
Co-Chair Merrick CLOSED public testimony.
1:40:26 PM
AT EASE
1:42:59 PM
RECONVENNNED
Co-Chair Merrick indicated the committee would be hearing
amendments for SB 33.
1:43:10 PM
Representative Wool MOVED to ADOPT Amendment 1, 32-
LS0308\N.6, Nauman, 3/14/22 (copy on file):
Page 3, line 14, following "section":
Insert "(I)"
Page 3, line 16:
Delete". For"
Insert "; for"
Page 3, line 17:
Delete "subsection"
Insert "paragraph"
Page 3, line 18, following "appeal":
Insert "; or
(2) for property that is the same type of
property as, or that is comparable to, property
(A) on which a tax credit has been
claimed under this section;
(B) that has been removed from the
state; and
(C) that was purchased in the previous
10 years"
Co-Chair Merrick OBJECTED for discussion.
Representative Wool explained that Amendment 1 was a back-
stop amendment. He drew attention to Section 1 on page 3 of
the bill, which discussed recapture percentage. His
amendment stated that if an entity purchased a piece of
equipment, the entity would get a full 50 percent tax
credit after four years for the purchased equipment.
However, the entity could not buy a replacement for the
piece of equipment for 10 years. This would prevent
companies from buying equipment in Alaska and receiving a
tax credit after four years, shipping the equipment to a
different state, and buying a new piece of equipment and
repeating the process.
Representative Wool MOVED to ADOPT conceptual Amendment 1
to Amendment 1.
Co-Chair Merrick OBJECTED for discussion.
Representative Wool explained conceptual Amendment 1 to
Amendment 1. He referenced line 14 through line 15 [of
Amendment 1] and proposed removing language to ensure that
if an entity purchased the same type of equipment for which
it had already received a tax credit, it could not receive
an additional tax credit for another 10 years. Starting on
line 14 of Amendment 1, he proposed deleting: "as, or that
is comparable to, property".
Representative LeBon asked a clarifying question.
1:46:03 PM
AT EASE
1:46:43 PM
RECONVENED
Representative Wool reiterated that conceptual Amendment 1
to Amendment 1 proposed the deletion of language beginning
on line 14 of Amendment 1.
Co-Chair Merrick WITHDREW her OBJECTION.
There being NO further OBJECTION, it was so ordered.
conceptual Amendment 1 to Amendment 1 was ADOPTED.
1:47:31 PM
Representative LeBon asked if a business would be entitled
to receiving another tax credit if it shipped a piece of
equipment out of state and replaced the equipment four
years after receiving a tax credit for the equipment.
Representative Wool responded in the affirmative. An entity
would only be eligible to receive the tax credit for the
same type of equipment every 10 years, but there would be
no limit on the amount of equipment a company could
purchase. However, this was only applicable for
replacements. If an entity had an ice machine and purchased
an additional ice machine, it would still receive the tax
credit.
Representative LeBon wondered whether an entity could
purchase a new and improved ice machine and replace the
original and still qualify for the tax credit.
Representative Wool responded that if it was the same type
of property, it would not be eligible for the credit.
Representative LeBon wanted to not discourage the upgrading
of equipment.
Representative Wool agreed and did not think an upgrade in
technology would be the same. He thought it would still
qualify for the tax credit because the upgrades would make
the equipment a new type of machinery. That is why he chose
the language "same type" to ensure that different types of
equipment would remain eligible.
Co-Chair Merrick WITHDREW her OBJECTION to the original
Amendment 1 as amended.
There being NO further OBJECTION, it was so ordered.
Amendment 1 was ADOPTED as amended.
Co-Chair Merrick indicated Amendment 2 would not be
offered.
1:50:01 PM
Vice-Chair Ortiz MOVED to ADOPT Amendment 3, 32-LS0308\N.9,
Nauman, 3/23/22 (copy on file):
Page 2, line 23:
Delete "A"
Insert "Except as provided in (f) of this
section, a"
Page 3, line 9, following "service.":
Insert "In this subsection, "eligible fish" does
not include pollock, sablefish, or Pacific cod."
Page 3. line 14, following "section":
Insert "(1)"
Page 3, line 16:
Delete ". For"
Insert "; for"
Page 3, line 17:
Delete "subsection"
Insert "paragraph"
Page 3, line 18, following "appeal":
Insert "; or
(2) for property installed on a vessel used
primarily to process pollock, sablefish, or Pacific
cod"
Page 4, line 27, following "means":
Insert ", except as otherwise provided in (c) of
this section,"
Co-Chair Merrick OBJECTED for discussion.
Vice-Chair Ortiz asked Mr. Tim Lamkin to review the
amendment.
TIM LAMKIN, STAFF, SENATOR GARY STEVENS, reviewed the
amendment. He indicated that Amendment 3 addressed a
hypothetical loophole that a value-added tax credit could
be applied to processing activities in the facilities that
produced pollock, cod, or sablefish aboard vessels outside
of state waters. The amendment would ensure that processors
of the aforementioned fish would have to process the fish
at onshore processing facilities to qualify for the tax
credit.
1:51:44 PM
Representative Josephson shared his understanding that the
tax in question brought in around $50 million to the state.
He asked if this number was correct.
Senator Stevens deferred to Ms. Nicole Reynolds.
1:52:25 PM
NICOLE REYNOLDS, DEPUTY DIRECTOR, TAX DIVISION, DEPARTMENT
OF REVENUE (via teleconference), responded that the tax
collections for the fisheries business tax over the past
four fiscal years (FY) ranged between $34.6 million and
$46.2 million.
Representative Josephson reported that historically the
credit had been in the low millions of dollars. He wondered
about the impact of the proposed reform on the growth of
the credit and the tax.
Senator Stevens deferred to Ms. Reynolds.
Ms. Reynolds replied that the historic value of the credit
between 2017 and 2020 ranged between $2.3 million and $4.4
million. She referred to the fiscal note submitted by the
Department of Revenue (control code slwkY) and explained
that the department used historical value and utilization
rates of the existing salmon and herring credits to
estimate the way in which the revenue would be impacted by
adding pollock, cod, and sablefish to the eligibility. For
FY 23, the department estimated a negative $1.6 million for
the credit. Between FY 24 through FY 27, the department
estimated between $3 million and $3.6 million.
1:54:54 PM
Representative Josephson suggested that the tax might
increase as value was added to the product.
Ms. Reynolds responded that the value reflected the value
of the raw resource. The tax was not applied to the value-
added portion.
Representative Josephson thought, "it is what it is."
Ms. Reynolds noted that the tax revenue was not expected to
increase due to the credit.
Representative Wool asked about the total for fish business
taxes.
Ms. Reynolds responded that the fisheries business tax
revenue ranged between $34.6 million and $46.2 million over
the last four fiscal years.
Representative Wool shared his understanding that half of
the taxes went to municipalities and half went to the
state. He asked whether the credit only applied to the
state's portion. He calculated that that $34.6 million to
$46.2 million would become roughly $17 million to $23
million for the state.
Ms. Reynolds replied, "that's correct."
1:57:42 PM
Co-Chair Merrick WITHDREW her OBJECTION.
There being NO further OBJECTION, it was so ordered.
Amendment 3 was ADOPTED.
Vice-Chair Ortiz MOVED to report HCS CSSB 33(FIN) out of
Committee with individual recommendations and the
accompanying fiscal note. There being NO further OBJECTION,
it was so ordered.
HCS CSSB 33(FIN) was REPORTED out of committee with seven
"do pass" recommendations and with one "no recommendation"
recommendation and with one previously published fiscal
impact note: FN2(REV).
1:58:10 PM
AT EASE
2:00:05 PM
RECONVENED
HOUSE BILL NO. 265
"An Act relating to telehealth; relating to the
practice of medicine; relating to medical assistance
coverage for services provided by telehealth; and
providing for an effective date."
2:00:10 PM
REPRESENTATIVE IVY SPOHNHOLZ, SPONSOR (via teleconference),
introduced the PowerPoint presentation: "HB 265: Health
Care Services by Telehealth" (copy on file). She explained
that the bill would continue the expansion of telehealth
flexibilities to make healthcare more accessible and reduce
unnecessary travel during the COVID-19 pandemic. The bill
would provide a legislative framework to continue the
state's success with COVID-19 related telehealth
flexibilities with regard to state and federal oversight.
She noted that patients used to have to go to in-patient
clinics in order to receive telehealth care, but it was
discovered during the pandemic that was not necessary to
ensure safe healthcare in the state.
Representative Spohnholz advanced to slide 2 and relayed
that the presentation would cover telehealth in Alaska, the
importance of HB 265, and the specific actions of the bill.
She shared that the bill was a result of collaboration with
stakeholders and there were over 33 letters of formal
support for the bill.
Representative Spohnholz discussed the current barriers to
telehealth on slide 3, such as license regulations and
payment barriers. The legislature had been working for
years to expand access to telehealth. She noted that in SB
74 in 2016, the legislature expanded Medicaid access to
behavioral healthcare and in 2020, the legislature passed
HB 229 requiring insurance coverage in a private market for
telehealth. Even with the improvements made through the
bills, there continued to be barriers to telehealth.
Barriers included the lack of telehealth parity laws, lack
of coverage of some telehealth services under Medicaid, and
a higher burden for audio-only visits. There were also in-
person requirements for select healthcare providers that
acted as a barrier to service, including prescription of
controlled substances.
2:04:28 PM
Representative Spohnholz turned to slide 4 to review the
changes to telehealth in Alaska since COVID-19. There was a
State Public Health Emergency (SPHE) and a Federal Public
Health Emergency (FPHE), which both provided telehealth
flexibility. She noted that FPHE was slated to expire in
April of 2022 and SPHE expired in April of 2021. This made
the passage of HB 265 more urgent. Currently Medicaid had
temporarily expanded access to telehealth coverage and made
it easier to bill for audio-only visits, but these changes
were not permanent.
Representative Spohnholz explained why HB 265 was needed on
slide 5. She wanted to continue some of the telehealth
flexibilities from the COVID-19 pandemic by making them
permanent in statute. The bill would also reduce
bureaucracy by eliminating the need for in-person visits
for all licensed healthcare providers prior to a telehealth
appointment. It would also expand Medicaid coverage of
telehealth services which were reimbursed during the
pandemic and increase access to behavioral healthcare.
Finally, it would ensure Alaskans had an option to access
quality care in a timely manner when an in-person visit was
unnecessary or not possible.
Representative Spohnholz moved to slide 6 to review what HB
265 would do:
1. Creates a framework for telehealth in statute.
2. Enhances the telehealth delivery of substance use
disorder treatment.
3. Expands Medicaid coverage for telehealth services and
modalities.
Representative Spohnholz advanced to slide 7 and explained
that the bill created a framework for telehealth in
statute. There was a laundry list of healthcare providers
that could provide telehealth services in Alaska. The bill
would remove additional barriers such as unnecessary
efforts to document in-person visits prior to a telehealth
appointment. She spoke about the importance of having
telehealth appointments available for the various types of
providers eligible to provide telehealth services. For
example, she had talked to a podiatrist that diagnosed a
blood clot via telehealth.
Representative Spohnholz thought it was important to note
that HB 265 would not mandate that a patient receive care
through telehealth or that a provider offer services
through telehealth. For example, if there was a patient who
exhibited opioid addiction problems, it would be important
for a provider to meet with them in person to obtain
additional information before making a diagnosis. The bill
would simply remove red tape barriers to access to care. It
would also extend telehealth services to emergency medical
services.
2:08:52 PM
Representative LeBon asked about the list of providers she
had provided on slide 7, including dentist. He was trying
to envision dental services being provided by telehealth.
He asked how an annual dental checkup could be provided via
telehealth.
Representative Spohnholz responded that an annual dental
checkup would not be provided via telehealth. She suggested
that if there was a potential emergency, an examination
could take place via telehealth. This would be helpful for
individuals in rural areas to help them determine whether
they needed to travel to see a dentist or if it was not an
urgent problem.
Representative LeBon suggested that the first step of a
dental experience might be done via telehealth, but that
eventually a patient would have to go see the dentist in
person.
2:10:24 PM
Representative Rasmussen highlighted that the provided list
offered more flexibility. She offered an example of her
daughter having a bad stomachache and using telehealth as a
first step. She ended up admitting her daughter to the
hospital based on the information she learned during the
telehealth call. She thought in-person visits would still
be necessary, but that telehealth could help in the short-
term.
Representative LeBon drew attention back to slide 5. He
noted that one of the boxes indicated that the bill would
eliminate in-person visits for all healthcare providers
licensed with the State of Alaska prior to a telehealth
appointment. He wondered if it was conceivable for a doctor
from out-of-state to provide telehealth services to an
Alaska resident. He asked if an in-person visit would be
required prior to a telehealth appointment in this
scenario.
Representative Spohnholz indicated that any provider giving
care in Alaska had to be licensed in Alaska, whether or not
the provider resided in the state. There were already many
providers who did not reside in Alaska but were eligible to
provide care in the state via telehealth. The licenses were
registered with the state and the providers were registered
with a telemedicine registry. The bill dictated that a
patient should not have to attend an in-person examination
in order to receive care via telehealth. However, it needed
to be clinically appropriate and there were times where it
would not be appropriate; for example, Representative
LeBon's example of dental care. Alternatively, it would be
appropriate to use telehealth to consult an oncologist out-
of-state that specialized in a particular type of cancer. A
person should not have to fly out of state to receive this
kind of care.
Representative LeBon clarified that the out-of-state
provider licensed in Alaska would not be required to have
had an in-person appointment with the patient before
providing telehealth services.
Representative Spohnholz responded in the affirmative.
2:14:21 PM
Representative Josephson asked if a licensed provider who
was out-of-state and providing telehealth services in
Alaska, would the provider be considered licensed in two
states.
Representative Spohnholz indicated that a provider could
choose to be licensed only in Alaska or choose to be
licensed in their home state and in Alaska. She explained
that licensing laws in the United States looked to the
state of residence of the patient, not the provider.
Representative Josephson asked about international
licensure. He wondered whether this would welcome providers
from other countries to practice in Alaska.
Representative Spohnholz deferred to Ms. Sara Chambers.
2:16:00 PM
SARA CHAMBERS, DIRECTOR, DIVISION OF CORPORATIONS, BUSINESS
AND PROFESSIONAL LICENSING, DEPARTMENT OF COMMERCE,
COMMUNITY AND ECONOMIC DEVELOPMENT, clarified that as long
as a provider met the criteria for state licensure, the
provider could practice from any location.
2:16:48 PM
Representative Spohnholz continued on slide 8 of the
presentation. She reviewed how the legislation would
enhance telehealth access for substance use disorder
treatment. The bill would remove the in-person requirement
to prescribe controlled substances through telehealth for
physicians, podiatrists, osteopaths, physician assistants
(PAs), and advanced practice registered nurses (APRNs). It
would also allow registered practitioners such as
physicians, PAs, and APRNs to prescribe medicine such as
buprenorphine via telehealth without an additional
healthcare provider present with the patient. She noted
that she had heard from providers that it was important to
prescribe these types of medicine quickly because patients
could be going through opioid withdrawals and need
immediate help. She reiterated that all prescribers of
controlled substances were still required in the bill to
comply with drug enforcement regulations.
2:18:19 PM
Representative Josephson asked if the definition of
controlled substances included narcotics and opioids.
Representative Spohnholz responded that it did include
those substances. It was important to include opioids in
the definition because there were times when an opioid
could be prescribed via telehealth in urgent scenarios and
prescribers would still be required to comply with
controlled substance regulations.
Representative Josephson suggested there would be efforts
to abuse such a privilege, by both patients and providers.
He wondered if there were protections built into the bill
that would prevent abuse of prescriptions.
Representative Spohnholz agreed that it was likely that
some people would try to abuse the privilege. She indicated
that was why it was important to continue to require
providers to participate in federal Drug Enforcement
Administration (DEA) regulations and the prescription drug
monitoring program (PDMP). There had been some recent
advancements in this area and there was no requirement that
a provider must provide medication to a patient that was
thought to be seeking drugs. She deferred to her staff to
provide some additional detail.
2:20:19 PM
GENEVIEVE MINA, STAFF, REPRESENTATIVE IVY SPOHNHOLZ,
explained that federal law required that a patient must
receive behavioral health treatment as part of any
prescription for medications for opioid use disorder. The
bill pertained to buprenorphine in particular, which was a
medication that was allowed to be prescribed via telehealth
throughout the COVID-19 pandemic. Providers registered to
prescribe buprenorphine were also required to submit to
physical monitoring tools to ensure that misuse was not
occurring, such as regular urine tests. There were
additional restrictions such as the seven-day prescription
for opioids, which required that there had to be a new
prescription on a weekly basis. She echoed Representative
Spohnholz's earlier comments regarding the importance of
the requirement for providers to participate in DEA
regulations and the PDMP.
2:21:43 PM
Representative Josephson understood the importance of the
bill and supported it. However, earlier discussions about
the PDMP in the committee made it clear that the PDMP was
not being followed religiously. He recalled an instance of
an Eagle River provider who would have quick interactions
with patients and prescribe more and more medication. He
was worried about prescriptions getting out of hand. He
asked if the physician would be required to look at a
patient on a screen or could services be provided via a
phone call.
Representative Spohnholz deferred to Ms. Mina.
Ms. Mina responded that prior to the COVID-19 pandemic, the
DEA required that patients that received medications for
opioid use disorder must receive an in-person examination.
The provision was waived during the pandemic and was tied
to the FPHE that was set to expire in April of 2022.
Additionally, the DEA allowed audio-only prescriptions of
buprenorphine during the pandemic. According to providers
that she had spoken to, patients thought that in-person
examinations were a crucial part of their treatment. Even
if the requirement for an in-person visit prior to
providing a prescription was removed, a provider could
still choose to see a patient in-person first. The bill
deferred to the patient-provider relationship and allowed
the provider to make the decision rather than always
requiring an in-person visit no matter the circumstances.
She noted that access to opioid use disorder medications
had been crucial in places like rural Alaska during the
pandemic.
2:24:44 PM
Representative Josephson thought he would likely support
the bill. However, he expressed worry about the potential
for bad actors. He relayed that the occurrences of abuse
that he had read about were egregious.
Representative Spohnholz concurred that there were bad
actors and that nothing in the bill would prevent that from
happening. However, there were robust prescription drug
limits in place and additional enforcement mechanisms in
licensing. She thought the PDMP was vital. She noted that
buprenorphine was a medication assisted treatment and
controlled substance and could be prescribed via telehealth
under the bill. There were times where people would need to
be on medication assisted treatment for many years. Some of
these individuals would be living in remote areas that
would make regularly visiting a provider very difficult. It
was important for everyone to have access to medication
assisted treatment if they needed it.
Representative Wool agreed that all bad actors could not be
eliminated. He suggested that a patient seeing a provider
for the first time via telehealth and immediately
requesting opioids would be a red flag for the provider and
assumed that it would not be applicable to first-time
patients. He thought that the bill would not apply to
veterinarians for animal prescriptions, even though they
were registered with the DEA.
Representative Spohnholz responded that the bill did not
apply to veterinarians. She indicated that it would be
possible for a first-time patient to receive a prescription
for medication assisted treatments via telehealth. She
relayed that emergency room physicians shared that they
often see patients who were going through withdrawals, and
it was imperative to ensure that the patients received
access to medication assisted treatment immediately. The
situation was time-sensitive, and telehealth made it more
possible to respond to the situation in a timely manner.
Representative Rasmussen asked if there were other
instances where it would be reasonable to expect first-time
patients to be prescribed controlled substances. She
provided potential examples of situations that would not
qualify as a first-time visit, such as a patient receiving
controlled substances after a surgery.
2:29:26 PM
Representative Spohnholz explained that there were other
examples where a first-time patient would need a
prescription immediately, such as a patient needing
Adderall, which was a controlled substance. Complete
examinations with psychiatrists could occur via telehealth
and could offer certainty to a provider that the patient
was not seeking drugs. She did not want to unnecessarily
require someone to see a provider in-person for an
examination when it could be thoroughly done via
telehealth.
Representative Spohnholz turned to slide 9 of the
presentation. She relayed that the bill would also expand
Medicaid coverage for telehealth. The bill allowed for
reimbursement for services that were already billable via
Medicaid if the services were provided in person. Such
reimbursable services included behavioral health services,
home and community-based services, Medicaid waiver and
demonstration services, and services provided at rural
clinics and federally qualified health centers.
Representative Spohnholz concluded the presentation on
slide 10. She reiterated that HB 265 would ensure robust
patient protection in Alaska while expanding some of the
flexible services that were permitted during the COVID-19
pandemic. She thanked the stakeholders that had written
letters of support for the bill.
Co-Chair Merrick indicated there were invited testifiers.
2:32:44 PM
NANCY MERRIMAN, EXECUTIVE DIRECTOR, ALASKA PRIMARY CARE
ASSOCIATION (via teleconference), expressed support for HB
265. The Alaska Primary Care Association (APCA) supported
the operations and development of Alaska's 29 federally
qualified health centers. She explained that health centers
provided comprehensive care including medical, dental,
behavioral, pharmacy, and care coordination services. She
relayed that APCA supported the bill because it increased
access to primary care and behavioral health services and
expanded telehealth access in Alaska. The bill would
directly impact health centers by allowing for audio-only
telehealth services and allowing for patients and providers
to engage outside of a clinical setting if they so choose.
The bill would also provide adequate reimbursement for
telehealth visits including for substance and behavioral
health treatments.
Ms. Merriman shared that in 2020, health centers served
over 105,000 patients and telehealth was the fastest
growing service provided by health centers. About 40
percent of patients were seen via telehealth, and about
half of total opioid use disorder patients were seen via
telehealth. The majority of telehealth patients had
experienced challenges accessing healthcare including a
long distance to reach providers, cost of care, language,
and cultural barriers. She suggested that telehealth
ultimately would lead to better health outcomes, save
lives, and save money. She urged support for the bill.
2:36:54 PM
Representative Rasmussen asked if Ms. Merriman could
identify a circumstance where a first-time patient would
require a prescription for a narcotic or opioid.
Ms. Merriman responded that she could return to the
committee with that information.
2:37:31 PM
TOM CHARD, EXECUTIVE DIRECTOR, ALASKA BEHAVIORAL HEALTH
ASSOCIATION (via teleconference), relayed that the Alaska
Behavioral Health Association (ABHA) fully supported the
bill because it improved Alaskans' access to behavioral
healthcare. He stated that the Alaska Department of Health
and Social Services' (DHSS) annual Medicaid report stated
there was a 134 percent increase in telehealth claims paid
in FY 21 as compared to FY 20. The report noted that four
out of the five top diagnosis codes delivered via
telehealth were behavioral health diagnoses. The data
suggested that Alaskans were struggling to access
behavioral healthcare, but also pointed to the economic
opportunity afforded by early intervention. National
insurance companies were rushing to offer virtual-first and
digital-first benefits because the companies realized that
it saved money to avoid expenses like travel. It also saved
money by avoiding the cost of readmission at hospitals and
higher acute care. He indicated that the state DHSS
reported that Medicaid travel costs decreased by $45
million from FY 20 to FY 21. By offering preventative care,
savings were provided to the overall budget. The economic
benefits were merely a small part of the reason ABHA
supported HB 265. He hoped that members would support the
legislation as well.
Co-Chair Merrick appreciated hearing from the testifiers.
She thanked the bill sponsor.
HB 265 was HEARD and HELD in committee for further
consideration.
2:40:48 PM
AT EASE
2:41:31 PM
RECONVENED
HOUSE BILL NO. 296
"An Act relating to program receipts; and relating to
the acceptance of gifts, donations, and grants for the
purpose of providing signage for assets under the
control of the Department of Transportation and Public
Facilities."
2:41:41 PM
REPRESENTATIVE GEORGE RAUSCHER, SPONSOR, suggested that it
was important for legislators to acknowledge individuals
who had contributed to their community. One of the ways to
achieve recognition was to name a geographical location or
structure after a person of note. However, this naming
could be expensive to implement and the cost alone had
caused legislators to vote against legislation proposing a
commemorative naming. He explained that HB 296 would
provide a mechanism for funding a commemorative name to a
project by allowing receipt authority to the Department of
Transportation and Public Facilities (DOT) so it could
collect donations for signage. It would not require the
costs to be paid by outside groups, but it would ensure
that the process not be necessarily reliant on state funds.
2:43:47 PM
RYAN MCKEE, STAFF, REPRESENTATIVE GEORGE RAUCHER, read the
sectional analysis:
Section 1: AS 37.05.146(c) Page 1, Lines 5-7 This
section adds gifts, donations, and grants received by
DOT & PF to the definition of program receipts and
non- general fund programs receipts found in the
Fiscal Procedures Act in accordance with section 2 of
this bill.
Section 2: AS 44.42.060 Page 1, Lines 8-14, Page 2,
Lines 1-3 This section adds that the department may
receive gifts, donations, and grants in accordance
with a memorandum of understanding with the donor
party. This section also outlines that the funds may
not be used until the necessary funds have been
collected from the donor.
2:45:02 PM
Representative Wool asked if the bill required the approval
of a sign before collecting fees.
Representative Rauscher deferred to Mr. Andy Mills.
2:45:47 PM
ANDY MILLS, LEGISLATIVE LIAISON, DEPARTMENT OF
TRANSPORTATION AND PUBLIC FACILITIES (via teleconference),
responded that when a bill that sought to name state
infrastructure was introduced, it would include a provision
pointing to the codifying language in HB 296 that would
allow the bill to be paid for through outside donations.
The interested donators would then sign a memorandum of
understanding (MOU) as outlined in the bill's language. The
naming legislation would be taken from a legislator to
instigate a fiscal note and point to statutorily designated
program receipts as the source of funding.
Representative Wool commented that if a group raised money
for a sign and received the funding, the group could
potentially influence the bill. He was glad there was a
solution to the funding problem through donations, but
thought it was important that the bill had to come first.
2:47:44 PM
AT EASE
2:47:49 PM
RECONVENED
Co-Chair Merrick indicated the Senate version of the bill
was an exact match and the committee would be taking that
version up in the future.
HB 296 was HEARD and HELD in committee for further
consideration.
2:48:19 PM
AT EASE
2:49:37 PM
RECONVENED
HOUSE BILL NO. 291
"An Act extending the termination date of the Council
on Domestic Violence and Sexual Assault; and providing
for an effective date."
2:49:45 PM
REPRESENTATIVE GERAN TARR, SPONSOR, explained that the bill
would extend the Council on Domestic Violence and Sexual
Assault (CDVSA) through June 30, 2028. The council was set
to sunset on June 30 of 2022 and action needed to be taken
quickly. She noted that there was a sunset provision in
statute that would trigger an audit, which members had
copies of in their bill packets.
Representative Tarr highlighted some of the audit report
conclusions. She read from the audit report (copy on file):
The audit concluded that the council generally
operated in the public's interest by funding and
monitoring Alaskan domestic violence and sexual
assault programs and prevention activities. The
council served as the central coordinator for related
services throughout the state, conducted meetings in
accordance with council bylaws, effectively met most
statutory duties, and did not duplicate the efforts of
other entities.
Representative Tarr referred to page 13 of the audit which
listed the audit findings. The audit recommended that the
council address its statutory responsibility to consult
with the Department of Health and Social Services (DHSS) to
formulate standards and procedures, that the council's
executive director implement written procedures to ensure
that public notices were posted timely, and the director
should improve grant award and monitoring policies and
procedures. She relayed that the council was interested in
meeting the recommendations.
Representative Tarr indicated that the bill would add some
additional positions to the council. The council was
currently comprised of four public members and five state
members, and the bill would add a fifth public member. This
individual would be part of an Alaska Native organization.
The addition was recommended to ensure that Alaska Native
communities were represented. The bill also proposed that
the governor confer with the council and the Alaska Native
Women's Resource Center (ANWRC) to appropriately fill this
position. An additional government agency member would be
added to the council to balance the additional public
member. The issue of whether the Alaska Mental Health Trust
Authority (AMHTA) wanted to participate in the council came
up in the House State Affairs Committee. She relayed that
the executive director of AMHTA was very interested in the
trust having a seat on the council.
2:55:08 PM
Representative Rasmussen thanked the bill sponsor for
bringing the bill forward. There was funding that had been
secured to offset the rising cost of utilities for many of
the groups that belonged to AMHTA, and she thought that
funding would be irrelevant if the bill did not pass. She
hoped the legislation would be passed into law.
Co-Chair Merrick invited the Legislative Auditor to the
table.
2:55:49 PM
KRIS CURTIS, LEGISLATIVE AUDITOR, ALASKA DIVISION OF
LEGISLATIVE AUDIT, conveyed the conclusions of the audit.
She read from page 7 of the audit:
The audit concluded that the council generally
operated in the public's interest by funding and
monitoring Alaskan domestic violence and sexual
assault programs and prevention activities. The
council served as the central coordinator for related
services throughout the state, conducted meetings in
accordance with council bylaws, effectively met most
statutory duties, and did not duplicate the efforts of
other entities.
The audit also concluded that the council should
improve document retention, access to the Battering
Intervention Program (BIP) database, and timeliness of
annual report submission and regulation changes.
In accordance with AS 44.66.010(a)(5), the council is
scheduled to terminate June 30, 2022. We recommend the
legislature extend the council's termination date six
years, to June 30, 2028.
Ms. Curtis referred to the reports on page 9 that showed
financial information about the council's expenditures and
revenues. The grant funding increased substantially during
the audit period as a result of increasing federal funds.
She referred to page 25, which depicted the schedule of
grant payments. It showed which entities were receiving
funds in various locations in Alaska. There were four
recommendations beginning on page 14 of the audit:
Recommendation No. 1: The executive director should
allocate resources to ensure the annual report is
submitted in accordance with council bylaws.
Recommendation No. 2: The executive director should
improve training to help ensure document retention
procedures are followed.
Recommendation No. 3: The executive director should
work with the Department of Law (LAW) to expedite
regulatory updates.
Recommendation No. 4: The executive director should
continue to work with DPS and the Office of
Information Technology (OIT) to improve access to the
BIP database.
Ms. Curtis noted that the improvements under Recommendation
No. 4 would require that new users of the BIP database be
subject to a background check and fingerprinting. She
indicated that the new requirements would make the process
cumbersome to users. She relayed that management's response
to the audit began on page 29. The commissioner of the
Department of Public Safety (DPS) and the CDVSA chair both
agreed with the findings and recommendations of the audit.
Co-Chair Merrick moved to invited testimony.
2:59:46 PM
BRENDA STANFILL, EXECUTIVE DIRECTOR, ALASKA NETWORK ON
DOMESTIC VIOLENCE AND SEXUAL ASSAULT (ANDVSA), supported
the passage of HB 291 and adding two additional seats to
the council. She explained that ANDVSA was different than
CDVSA and that people often mistake one for the other. She
indicated that ANDVSA was made up of the membership of the
direct service providers within Alaska. The providers met
quarterly to discuss possible improvements in the field,
how to support one another, and to note potential
statistical trends. The network worked in tandem with the
council to ensure that issues were being worked on
throughout Alaska in a unified manner. Both entities worked
toward ending domestic violence in Alaska but had
distinctly different roles.
Ms. Stanfill indicated that ANDVSA members worked together
on the ground to provide support to victims while CDVSA
worked to ensure that funding was being dedicated to the
cause and was being spent in the way it was intended. The
network relied on the council to hold quarterly meetings to
allow space for individuals to speak about what was
happening in their communities. The council also
commissioned studies and ensured that the administration
was aware of the work that was being done on the ground.
She reiterated that the network strongly supported the
addition of two seats to the council. She shared that when
she began working in behavioral health 25 years ago, the
shelters in the state were being filled up with individuals
with substance abuse issues and it was unclear what should
be done to address the problem. The issue was just as
pervasive today, and there was still no appropriate
solution. Additionally, Alaska Native people were
overrepresented in every shelter in every situation in the
state. She thought it was important for there to be a
designated seat on the council for a representative from an
Alaska Native organization. It was also important for ANWRC
to have a voice in selecting the induvial who would get
appointed for the seat.
3:05:06 PM
DIANE CASTO, EXECUTIVE DIRECTOR, COUNCIL ON DOMESTIC
VIOLENCE AND SEXUAL ASSAULT, DEPARTMENT OF PUBLIC SAFETY,
thanked the committee for hearing the bill and
Representative Tarr for introducing it. She appreciated the
audits and reviews of the council because they brought
about improvements. She relayed that in FY 18 there was an
in-depth audit done through funding from the Victims of
Crime Act (VOCA). It was a long and complete audit and
there were 14 recommendations, which was a significant
amount. The audit was a catalyst for change and brought
about critical improvements in the council's process. For
example, the council began to require federal funding be
given to grantees as reimbursement, not an advance. The
changes improved the council's work, but also placed a
large strain on the agency's funding. Overall, it made the
council better. In FY 21, there was an audit of the chief
financial officer (CFO) of the Department of Justice (DOJ)
and the three federal grants from DOJ programs were
examined. She shared that there was only one recommendation
from that audit. She thought all the changes the council
had made were significant and overall improved the program.
3:08:56 PM
Ms. Casto relayed that CDVSA was created in 1981 to build a
sustainable structure to fund and support community-based
services and to address the needs of victims, survivors,
and others impacted by domestic and sexual violence.
Ultimately, CDVSA was created to accept federal money and
distribute it appropriately to address these needs. In
addition to the nine-member board, there were nine full-
time staff members at the council. The council funded 35
community-based agencies serving Alaskans impacted by
domestic violence and within the agencies, managed a total
of 101 grant awards. There were many grant types included
within the 101 grant awards. Another finding in the audit
in FY 18 was that the council was comingling its grant
awards, but when there were separate funding services,
there needed to be a separate grant award. The council
managed 26 victim services programs and 18 enhanced service
programs, which included child advocacy centers, legal
services, and mental health services for youth. There were
also 13 community prevention grants and a total of 10 BIPs
that were approved by the state.
3:12:02 PM
Ms. Casto indicated that the council had made progress on
the recommendations made in the most recent audit. She
spoke to the first recommendation, which was for the
executive director to allocate resources to ensure the
annual report was submitted in accordance with council
bylaws. There were a number of challenges in 2020 and 2021
due to the significant drop in federal funding during the
COVID-19 pandemic. There was also an 18-month period where
the council only had six to seven staff due to vacancies
and hiring difficulties during the pandemic. As of Monday,
April 4, 2022, the council would be fully staffed for the
first time in two years. She noted that there was a
perception that there was a lack of transparency in the
council, but all information and minutes from the quarterly
meetings was required to be posted on the state's website
for publicly noticed meetings. The council was not trying
to hide anything by not having an annual report available
on time. The following year's report would be on time and
would be released soon.
3:15:23 PM
Ms. Casto spoke about the second recommendation of the
audit which was to train staff to ensure document
retention. She indicated that the more important element
above training staff was to ensure that the many changes
that had been made were operationalized better. At the time
the audit had occurred, all staff were not yet up to speed
on the new operational changes. She thought that the
council was now "out of that forest" and that everything
would be well documented going forward.
Ms. Castro referred to recommendation 3, which was for the
executive director to work with the Department of Law (DOL)
to expedite regulatory updates. During the audit, DOL
appointed a regulatory lawyer for the council to have at
its disposal. Once legislative session was over, the
council would be in the queue to distribute regulatory
information to the public. Anything in current regulation
that was not in-line with federal requirements was covered
in special conditions for the grant awards. Although the
regulations were not up to speed, all of the grantees that
were receiving funds adhered to the federal requirements
due to the special conditions written into the grant
awards.
3:18:21 PM
Ms. Casto continued to the topic of recommendation 4, which
was for the executive director to work with DPS and OIT to
improve access to the BIP database. She felt strongly that
BIP was a critical piece of ending domestic and sexual
violence. The council needed to have strong prevention
programs, available services for victims, and services to
address the root causes of abusive behavior. All three
elements were vital to make progress. She explained that
when she first came to the council, she reviewed all of the
programs and one of the programs in particular horrified
her because it was not being properly managed. The
mismanagement was due to insufficient funding and the
person who had been managing the program resigned, and then
the position was removed altogether. She made it her
mission to tackle the issues with the BIP program.
Ms. Casto indicated that she started a work group in April
of 2021 to determine how to build successful programs that
would impact behavior. She needed data which she was told
was not available when she first joined the council. She
investigated and discovered that there was a database, but
that all OIT employees that were aware of the database had
since resigned. The council was currently working with OIT
and the IT program within DPS to move the database to a
different platform, such as a cloud-based platform, to make
it easier for grantees to access the database and enter
data. She reminded the committee that the process currently
required fingerprinting to access the database. The process
became so egregious that it was no longer deemed worthwhile
to submit data. She hoped that the new system would be
completed within the next six months and that it would
require everyone to submit data. The influx of data would
inform the council's decision on what needed to be added to
the BIP system.
3:22:38 PM
Representative Rasmussen asked if there was anything in the
database that would track offenders and the number of
victims they had abused. She thought recidivism would be
better if these numbers were provided.
Ms. Casto responded that the council did not track the
specific data Representative Rasmussen was looking for.
However, there was some data that looked at whether an
offender had prior victims and whether the offender
continued to be engaged with victims after an incident. She
thought the issue of recidivism was difficult because the
only way to tell if an offender had recidivated was if the
offender was caught again. The question was how to track
elements beyond recidivism. The council had been
researching other methods and looking at the ways in which
other states collected data. Researchers found that
Alaska's database was one of the best and included great
information; it was simply a matter of having access to it.
The database in Alaska looked at the Adverse Childhood
Experiences (ACEs) of offenders, which laid a great
foundation for discovering the root cause of abuse.
3:25:03 PM
Representative Rasmussen thought much of the conversation
was about modernizing domestic abuse policy. She spoke of a
video she saw on Facebook showing abuse without
repercussion. She thought there needed to be a broader
discussion that looked at childhood.
Ms. Casto agreed and stated that domestic violence and
child abuse were interconnected. Many children experienced
abuse in the home and a violent atmosphere created
tremendous trauma. She started her career in child abuse
and neglect prevention and the issue was important to her
as well.
3:27:03 PM
Representative LeBon asked for an example of the data
points that would be entered into the database.
Ms. Casto assumed Representative LeBon was talking about
the BIP database. She explained that arrest data was not
collected. She had a link that she could provide to the
committee that showed all collected data. It was also
important for victims to be served and protected in some
way. One of the things that was found was that when an
individual was going through a domestic violence class,
program, or treatment, the individual would often become
more aggressive because they were being challenged. Victim
safety was a key piece of the program.
Representative LeBon noted Ms. Casto had presented to the
Public Safety Finance Subcommittee on the same topic. He
was aware of a fiscal note and wondered if the fiscal note
would be addressed.
Co-Chair Merrick indicated she was not planning on
addressing it but would discuss it if Ms. Casto was
prepared.
Representative LeBon noted that in 2021, the reduction in
VOCA funding was consequential. He referred to the fiscal
note [by the Department of Public Safety, control code
PqrQf] and asked if Coronavirus State and Local Fiscal
Recovery Funds (CSLFRF) funding was used to back-fill the
council's budget. He asked whether she was confident in the
federal funding.
Ms. Casto was not confident in the federal funding. In the
prior year, the council received a 34 percent reduction in
VOCA funding from 2020 to 2021. It was a significant loss
of money and it had been dropping significantly in recent
years. It had dropped from almost $8 million in 2018 at the
time of the award to $2.8 million in 2021. The council was
unprepared for the substantial 34 percent reduction in one
year. She noted that one of the federal grants through DHSS
provided to the council three American Rescue Plan Act
(ARPA) grants. She relayed that the council was piecing
together one-time funding sources to build the FY 22 and FY
24 budgets. There were grants that the council hoped to be
awarded to help contribute to the budget. She had been told
that the crime victim fund, which was what supported the
VOCA funding, was at its lowest level ever. The council
would be seeking additional funding in FY 24 and FY 25.
3:35:32 PM
Representative LeBon pointed to the designated general fund
(DGF) money listed on the fiscal note. He asked where the
$2 million listed came from, whether it was predictable,
and whether it was subject to the sweep.
Ms. Castro responded that it was predictable now and had
also been predictable in the past. It was money that had
been given to CDVSA in FY 18 that came about due to SB 91
and came from the marijuana tax fund. So far, the funding
had been steady. She was worried when SB 91 was rescinded
but the money was not impacted. The money was specifically
designated to fund the 13 community-based prevention
programs.
Representative LeBon asked if the money was spent before
the sweep.
Ms. Casto responded that the money was spent and none was
left on the table.
3:37:13 PM
Representative Rasmussen asked if Ms. Casto knew if any of
the organizations that received funding qualified as non-
profits. She knew that some organizations were able to
qualify and receive money through avenues like pull-tabs.
Ms. Casto responded that she did not know. She had worked
for organizations in the past that were able to utilize
pull-tab money. She elaborated that normally the council
supplemented the budget with fundraising events, but the
pandemic had gotten in the way of those efforts.
Representative Rasmussen noted legislation in circulation
that would allow for the expansion of pull-tab
requirements. The addition of electronic pull-tabs invited
new participants and the amount of money was sizable. She
was open to working on the issue.
Co-Chair Merrick thanked the testifiers. She noted that in
House State Affairs Committee there was one "do not pass"
recommendation and wondered about the reason for the
opposition.
Representative Tarr responded that Representative Eastman
voted "do not pass" because he did not support the addition
of a member from an Alaska Native organization.
HB 291 was HEARD and HELD in committee for further
consideration.
Co-Chair Merrick relayed the agenda for the following day.
ADJOURNMENT
3:41:19 PM
The meeting was adjourned at 3:41 p.m.