05/05/2006 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| SCR28 | |
| SB251 | |
| SB48 | |
| Work Session | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| += | SCR 28 | TELECONFERENCED | |
| += | SB 251 | TELECONFERENCED | |
| += | SB 48 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
May 5, 2006
3:12 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Paul Seaton, Vice Chair
Representative Tom Anderson
Representative Carl Gatto
Representative Vic Kohring
Representative Sharon Cissna
Representative Berta Gardner
MEMBERS ABSENT
All members present
COMMITTEE CALENDAR
CS FOR SENATE CONCURRENT RESOLUTION NO. 28(HES)
Relating to the innovative application of education technology
tools to provide improved distance education programs in the
state.
- MOVED CSSCR 28(HES) OUT OF COMMITTEE
SENATE BILL NO. 251
"An Act relating to immunization for meningitis of postsecondary
students residing on campus."
- MOVED SB 251 OUT OF COMMITTEE
HOUSE CS FOR CS FOR SENATE BILL NO. 48(HES)
"An Act relating to recommending or refusing psychotropic drugs
or certain types of evaluations or treatments for children."
- MOVED HCS CSSB 48(HES) OUT OF COMMITTEE
WORK SESSION
- HEARD AND HELD
PREVIOUS COMMITTEE ACTION
BILL: SCR 28
SHORT TITLE: TECHNOLOGY FOR DISTANCE EDUCATION
SPONSOR(s): HEALTH, EDUCATION & SOCIAL SERVICES
04/13/06 (S) READ THE FIRST TIME - REFERRALS
04/13/06 (S) HES
04/19/06 (S) HES AT 1:30 PM BUTROVICH 205
04/19/06 (S) Heard & Held
04/19/06 (S) MINUTE(HES)
04/21/06 (S) HES AT 1:30 PM BUTROVICH 205
04/21/06 (S) -- Meeting Canceled --
04/24/06 (S) HES AT 1:30 PM BUTROVICH 205
04/24/06 (S) SCHOOL DIST. ENROLLMENT
SHARING/CORRESPON
04/26/06 (S) HES AT 1:30 PM BUTROVICH 205
04/26/06 (S) Heard & Held
04/26/06 (S) MINUTE(HES)
04/27/06 (S) HES RPT CS 3DP 2NR SAME TITLE
04/27/06 (S) DP: DYSON, WILKEN, OLSON
04/27/06 (S) NR: ELTON, GREEN
05/02/06 (S) TRANSMITTED TO (H)
05/02/06 (S) VERSION: CSSCR 28(HES)
05/02/06 (H) HES AT 3:00 PM CAPITOL 106
05/02/06 (H) Scheduled But Not Heard
05/03/06 (H) READ THE FIRST TIME - REFERRALS
05/03/06 (H) HES
05/03/06 (H) HES AT 2:00 PM CAPITOL 106
05/03/06 (H) -- Meeting Canceled --
05/04/06 (H) HES AT 3:00 PM CAPITOL 106
05/04/06 (H) POSTSEC. STUDENT MENINGITIS
IMMUNIZATION
05/05/06 (H) HES AT 3:00 PM CAPITOL 106
BILL: SB 251
SHORT TITLE: POSTSEC. STUDENT MENINGITIS IMMUNIZATION
SPONSOR(s): LABOR & COMMERCE
01/30/06 (S) READ THE FIRST TIME - REFERRALS
01/30/06 (S) HES
02/08/06 (S) HES AT 1:30 PM BUTROVICH 205
02/08/06 (S) Scheduled But Not Heard
02/27/06 (S) HES AT 1:30 PM BUTROVICH 205
02/27/06 (S) Moved SB 251 Out of Committee
02/27/06 (S) MINUTE(HES)
03/01/06 (S) HES RPT 3DP 1NR
03/01/06 (S) DP: DYSON, WILKEN, OLSON
03/01/06 (S) NR: ELTON
03/30/06 (S) TRANSMITTED TO (H)
03/30/06 (S) VERSION: SB 251
04/03/06 (H) READ THE FIRST TIME - REFERRALS
04/03/06 (H) EDU, HES
05/02/06 (H) EDU AT 11:00 AM CAPITOL 106
05/02/06 (H) -- Meeting Canceled --
05/03/06 (H) EDU REFERRAL WAIVED
05/04/06 (H) HES AT 3:00 PM CAPITOL 106
05/04/06 (H) PSYCH. EVALUATION/TREATMENT FOR
STUDENTS
05/05/06 (H) HES AT 3:00 PM CAPITOL 106
BILL: SB 48
SHORT TITLE: PSYCH. EVALUATION/TREATMENT FOR STUDENTS
SPONSOR(s): SENATOR(s) DAVIS
01/12/05 (S) READ THE FIRST TIME - REFERRALS
01/12/05 (S) HES, JUD
04/05/06 (S) HES AT 1:30 PM BUTROVICH 205
04/05/06 (S) -- Meeting Canceled --
04/12/06 (S) HES AT 2:45 PM BUTROVICH 205
04/12/06 (S) Moved CSSB 48(HES) Out of Committee
04/12/06 (S) MINUTE(HES)
04/13/06 (S) HES RPT CS 2DP 2NR SAME TITLE
04/13/06 (S) DP: DYSON, ELTON
04/13/06 (S) NR: WILKEN, OLSON
04/20/06 (S) JUD AT 8:30 AM BUTROVICH 205
04/20/06 (S) Scheduled But Not Heard
04/22/06 (S) JUD RPT CS(HES) 5DP
04/22/06 (S) DP: SEEKINS, FRENCH, GUESS, THERRIAULT,
HUGGINS
04/22/06 (S) JUD AT 9:30 AM BUTROVICH 205
04/22/06 (S) -- Continued from 04/20/06 --
04/26/06 (S) TRANSMITTED TO (H)
04/26/06 (S) VERSION: CSSB 48(HES)
04/27/06 (H) READ THE FIRST TIME - REFERRALS
04/27/06 (H) HES, JUD
05/02/06 (H) HES AT 3:00 PM CAPITOL 106
05/02/06 (H) Heard & Held
05/02/06 (H) MINUTE(HES)
05/03/06 (H) HES AT 2:00 PM CAPITOL 106
05/03/06 (H) -- Meeting Canceled --
05/04/06 (H) HES AT 3:00 PM CAPITOL 106
05/04/06 (H) Work Session (time permitting)
05/05/06 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
WES KELLER, Staff
to Senator Fred Dyson
Alaska Legislature
POSITION STATEMENT: Presented SCR 28 on behalf of the Senate
Health, Education and Social Services Committee, sponsor by
request, which is chaired by Senator Dyson.
JANE ALBERTS, Staff
to Senator Con Bunde
Alaska Legislature
POSITION STATEMENT: Presented SB 251, on behalf of the Senate
Labor and Commerce Committee, sponsor by request, which is
chaired by Senator Bunde.
SENATOR BETTYE DAVIS
Alaska Legislature
POSITION STATEMENT: Introduced committee substitute (CS) for
CSSB 48, as sponsor.
RICHARD BENAVIDES, Staff
to Senator Bettye Davis
Alaska Legislature
POSITION STATEMENT: Presented HCS CSSB 48, on behalf of Senator
Davis, sponsor.
DWAYNE PEEPLES, Director
Division of Health Care Services (HCS)
Department of Health and Social Services (DHSS)
POSITION STATEMENT: Participated in an informal work session.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:12:39 PM.
Representatives Gatto, Gardner, Cissna, and Wilson, were present
at the call to order. Representatives Kohring, Seaton, and
Anderson arrived as the meeting was in progress.
SCR 28-TECHNOLOGY FOR DISTANCE EDUCATION
3:13:17 PM
CHAIR WILSON announced that the first order of business would be
CS FOR SENATE CONCURRENT RESOLUTION NO. 28(HES), Relating to the
innovative application of education technology tools to provide
improved distance education programs in the state.
3:13:52 PM
WES KELLER, Staff to Senator Fred Dyson, Alaska Legislature,
presented SCR 28 on behalf of the Senate Health, Education and
Social Services Committee, sponsor by request, which is chaired
by Senator Dyson, and directing attention to the committee
packet containing copies of the power-point slide program, he
explained the internet source material versus the locally
generated information contained therein. He referenced slide 5,
titled [Annual Yearly Progress (AYP)] and Alaska Schools, to
point out the trend indicating the growing number of schools
that are restructuring. Responding to a question, he said that
the level 5 indicator represents "the train wreck." When a
school reaches level 5, the district must create and implement a
plan for the major restructuring process; currently seven
schools are at the level 5 indicator. He conceded that this
resolution does not offer a silver bullet, but it is a very
positive statement that the legislature can make regarding the
technology as a means to address the issue. Technology reduces
the effects of distance, he explained, which is important in
Alaska due to the logistical situations of the rural schools.
In summary, he stated that this resolution is designed to
encourage school districts to seek out innovative responsible
means to apply educational technology. He reported that
national organizations are looking to Alaska, with its unique
logistical challenges to reach the states 130,000 students, to
create a model for technological use in education.
3:19:54 PM
REPRESENTATIVE GATTO referred to page 2, lines 2-4, which
indicate the federal, state, and local contributions averaging
$10,114 per student enrolled in the state, versus $16,665 as the
median cost for each student, and inquired as to the
discrepancy.
3:20:25 PM
MR. KELLER said that this demonstrates why this resolution is
important. He explained how the two costs are calculated, and
thus he said the median cost represents the true indicator of
the actual cost for a rural education.
3:21:13 PM
REPRESENTATIVE GARDNER stated that there are many problems with
the Alaska educational system, and the solutions may vary, but
she pointed out that every solution will relate in some way to
technological advances. She offered to move the resolution.
3:21:48 PM
REPRESENTATIVE GATTO observed that page 4, is not inclusive of
the states school districts, and asked if the omissions were
intentional.
MR. KELLER suggested that the language of page 3, line 20,
provides the distribution directives for the resolution, despite
whatever omissions were made in the listing.
3:22:49 PM
REPRESENTATIVE GATTO moved conceptual Amendment 1, as follows:
Page 4, line 15, following "Lower Yukon School
District;"
Insert the names of the remaining 21 school
Superintendents and Districts of Alaska.
3:23:07 PM
REPRESENTATIVE GARDNER moved to report CSSCR 28(HES), as
amended, out of committee with individual recommendations and
the accompanying fiscal notes. There being no objection, HCS
CSSCR 28(HES) was reported from the House Health, Education and
Social Services Standing Committee.
SB 251-POSTSEC. STUDENT MENINGITIS IMMUNIZATION
3:23:28 PM
CHAIR WILSON announced that the next order of business would be
SENATE BILL NO. 251, "An Act relating to immunization for
meningitis of postsecondary students residing on campus."
3:24:01 PM
JANE ALBERTS, Staff to Senator Con Bunde, Alaska Legislature,
presented SB 251, on behalf of the Senate Labor and Commerce
Committee, sponsor by request, which is chaired by Senator
Bunde, paraphrasing from the following statement which read
[original punctuation provided]:
Meningococcal disease is a seriously contagious, but
preventable bacterial infection that can quickly
impair or even be fatal if gone unnoticed. It spreads
through the air or from person to person through oral
contact or sharing of items. Given that knowledge, it
is quite obvious that college dormitories would be an
ideal breeding ground for meningitis. In order to
better inform students of this risk, legislation was
enacted in 2005 to require that post-secondary
education facilities inform its students of the risks
of meningitis and retrieve signed documentation that
the student has received this information. This is a
provision that was newly enacted with the passage of
HB 185 in 2005.
A consequence of this legislation is that now even
post-secondary schools that do not have on-campus
dormitories or overnight facilities must disseminate
related advisory information, obtain signed statements
acknowledging receipt of the information by each
student, and retain these records on file. This would
include "day school" type programs and short-course
programs such as software training or other similar
avocational workshops where students are on site only
for their instruction. The schools and training
facilities in question do not offer residential living
options, making the application of this notice and
records retention requirement inappropriate to the
circumstance. Doing so creates an undue administrative
burden for the short-course and nonresidential school
administrators and the students they serve.
SB 251 would ensure that they be exempted from the
notification requirement currently in place, while
insuring that students who will be utilizing school
residential facilities are advised of related health
risks prior to taking up residence there.
3:26:35 PM
REPRESENTATIVE GARDNER clarified that the intention of the
original bill was to address situations in residential
facilities only [making this a housekeeping measure], and
suggested that the testimony regarding this bill be waived.
3:27:06 PM
CHAIR WILSON concurred, and said that with agreement from the
committee members and the pending witnesses, she would request
that a motion could be proposed.
3:27:26 PM
REPRESENTATIVE GARDNER moved to report SB 251, Version 24-
LS1503\A, out of committee with individual recommendations and
the accompanying fiscal notes. There being no objection, SB 251
was reported from the House Health, Education and Social
Services Standing Committee.
SB 48-PSYCH. EVALUATION/TREATMENT FOR STUDENTS
CHAIR WILSON announced that the next order of business would be
CS FOR SENATE BILL NO. 48, "An Act relating to recommending or
refusing psychotropic drugs or certain types of evaluations or
treatments for children."
3:28:17 PM
SENATOR BETTYE DAVIS, Alaska Legislature, introduced committee
substitute (CS) for CSSB 48, as sponsor, outlining the
cooperating entities who provided input for the CS.
3:29:35 PM
REPRESENTATIVE ANDERSON moved to adopt HCS CSSB 48,Version 24-
LS0208\X, Mischel, 5/5/06, as the working document. There being
no objection, Version X, was before the committee.
RICHARD BENAVIDES, Staff to Senator Bettye Davis, Alaska
Legislature, presented HCS CSSB 48, on behalf of Senator Davis,
sponsor, and highlighted the alterations incorporated into
Version X. He directed attention to page 1, line 11, which were
rewritten to allow the school personnel to discuss with the
parents the need for a child to continue administration of a
prescribed medication. Moving to page 2, he pointed out that
the Version S, paragraph (6), was rewritten and incorporated
into the language of Version X, on page 3, lines 1-4, to clarify
that school personnel are considered mandatory reporters.
Continuing with Version X, page 2, paragraph (6), subparagraph
(C) was removed, which required the psychiatric or behavioral
health evaluation of a child; found in Version S, on page 2,
line 11. Finally, Version X, page 3, lines 5-8, defines the
compliance with federal education law, rewritten from Version S,
page 3, lines 1-2.
3:34:28 PM
REPRESENTATIVE ANDERSON inquired whether there is opposition to
this legislation, following these changes.
CHAIR WILSON suggested that the committee propose its
amendments, prior to debate, and said that everyone may be
satisfied following that process.
3:35:16 PM
REPRESENTATIVE GARDNER referred to page 1, line 12, she read
"when, in the opinion of the child's treating physician", and
asked:
If I were a parent and I decided that ... [I] wanted
to discontinue [my child's medication], I'd ... go to
another doctor, get another opinion, [and] which
opinion would the school use.
REPRESENTATIVE GARDNER related a personal experience from her
work as a guardian ad litem, to illustrate her point.
3:37:13 PM
SENATOR DAVIS stated that SB 48 does not require a parent to
medicate a child in order to have that child attend school.
3:37:52 PM
REPRESENTATIVE GARDNER directed attention to page 2, line 5,
paragraph (4), and stated that a teacher should be able to use
their expertise and experience to recommend a specific
professional who could be of help to a particular child.
3:39:28 PM
REPRESENTATIVE CISSNA added that in this specific instance only
one community, Anchorage, could even provide a list of resources
for psychiatric help. She expressed her concern for language
that would be in accord with services actually available in
Alaskan communities.
3:40:26 PM
SENATOR DAVIS pointed out that legislative bills do not meet the
requirements for every area of the state. Also, she disagreed
with the statement that a teacher would have the expertise to
make a recommendation for specialized health care.
3:41:27 PM
REPRESENTATIVE ANDERSON provided a hypothetical scenario of a
teacher who may also have a background in specialized health
care, and asked how such expertise could be accessed, even for
referral purposes.
3:42:27 PM
REPRESENTATIVE GARDNER stated:
I understand teachers are not psychiatrists, they ...
can't recommend treatments or [a] course of
treatments, but ... if we tie peoples hands where they
cannot use their best judgment when they have
something to offer and if I as a parent, [ask the
teacher] "can you recommend somebody," I don't want to
put [a] teachers back up against a wall where they
don't know what they're allowed to do.
SENATOR DAVIS maintained her position stating that there is a
possibility that even though a teacher may have the best
intentions by making a recommendation, "the parent could then go
out and say to someone else, the teacher told me this is where I
should take my child." However, she said this discussion is in
the hands of the committee now.
3:44:33 PM
REPRESENTATIVE GATTO emphasized that parents ask for advice
routinely from school personnel, sometimes calling them at home.
Also, teachers may find themselves dealing with parents who are
at odds with each other, and the teacher's recommendation may
serve to exacerbate the situation.
3:48:00 PM
SENATOR DAVIS provided that there is nothing in the bill to
preclude someone from providing advice. Further , she said that
school nurses are only allowed to provide medications that were
prescribed by a doctor who has made a determination.
REPRESENTATIVE GATTO maintained that advice is frequently sought
and given.
SENATOR DAVIS stated that there is nothing in SB 48 which would
disallow such advice.
3:49:35 PM
CHAIR WILSON advised the committee of four pending amendments
that the school district would like the committee to consider.
3:50:12 PM
REPRESENTATIVE GARDNER explained that the law stipulates that a
mandated child abuse reporter must make a declaration of
suspected harm, founded or not, for the Office of Children's
Services (OCS) to investigate. However, she pointed out that
paragraph (6), page 2, line 10, "puts a sidebar on the mandate
to make a report of harm." She opined that although the intent
is clear, the language may hinder a teacher from making a
report.
3:52:26 PM
CHAIR WILSON concurred and added that if a person in a position
requiring them to be a mandated reporter, if they have any
inkling of abuse, they are bound to provide a report to OCS and
allow the division to take appropriate action. She reminded the
committee that this is in accordance with state and federal
laws.
3:53:04 PM
REPRESENTATIVE GARDNER moved Amendment 1, as follows:
Page 2,
Delete lines 10-15
There being no objection, Amendment 1 was adopted.
3:54:24 PM
SENATOR DAVIS asked for clarity of the intent behind Amendment
1.
REPRESENTATIVE GARDNER provided that this makes clear that
teachers are mandated reporters without limitations. She
stated:
As I understand it, the way that the bill addresses a
teacher's obligation to report suspected harm, is ...
that a teacher is not allowed to do it based on a
parent or guardian refusing to give signed consent.
... There's nothing in our [Child In Need of Aid
(CINA)] statutes that says ....
SENATOR DAVIS asked, "But where do you see that in this bill ...
that they have to have a signed consent."
3:55:53 PM
CHAIR WILSON directed attention to page 1, line 7, and read:
"'they may not, unless'", and [page 2, line 10] (6) says ...
they 'make a report of suspected child abuse or neglect to
authorities, ....'"
SENATOR DAVIS acknowledged that a teacher must, or should, make
a report.
CHAIR WILSON maintained that under the circumstances stipulated
in the bill, a report could not be made.
MR. BENEVIDES offered that the intent in paragraph (6) [page 2,
line 10] is not to preclude teachers from making a report which
should be made. Rather, he said it is to ensure that the report
is not based solely on subparagraphs (A) or (B). He pointed out
that the language on page 3, lines 1-4, was written to clarify
the mandatory reporting aspect.
CHAIR WILSON explained that it causes confusion and difficulty,
when one part of a bill stipulates an allowable action and
another section reads as a denial.
3:57:30 PM
REPRESENTATIVE GARDNER offered that Amendment 1, as passed, is
to prevent a teacher from being inhibited in making a decision
on whether to file a report of harm. She opined that a teacher
should not be hampered with concern regarding CINA compliance,
other than to know that they are mandated reporters. Further,
she said that if a teacher has a suspicion of child abuse, it is
important that they not be worried when making a report of harm
that they will suffer repercussions or disciplinary action for
alerting OCS.
3:58:26 PM
CHAIR WILSON moved Amendment 2, as follows:
Page 3, line 2, following "of"
Insert "subsection (1) of"
3:59:32 PM
CHAIR WILSON moved Amendment to Amendment 2, as follows:
Page 3, line 2, following "AS 47.17.020"
Insert ","
and following "or"
Insert "subsection (2)"
REPRESENTATIVE GATTO removed his objection to the amendment.
CHAIR WILSON announced that there being no objection, Amendment
to Amendment 2 was adopted, and there being no objection,
Amendment 2, as amended, was adopted.
CHAIR WILSON proposed Amendment 3, as follows:
Page 4,
Delete lines 4-5
Insert "an employee violating AS 14.30.171-14.30.176
maybe subject to disciplinary action."
4:02:11 PM
REPRESENTATIVE ANDERSON moved Amendment 3, as proposed. There
being no objection, Amendment 3 was adopted.
4:03:56 PM
CHAIR WILSON moved Amendment 4, as follows:
Page 3
Delete lines 13-14
REPRESENTATIVE SEATON objected for discussion.
4:04:22 PM
CHAIR WILSON read page 3, lines 5-8 and lines 13-14, paragraph
(3), and explained that this duplication of federal law, within
the bill creates confusion.
4:05:01 PM
REPRESENTATIVE GARDNER clarified that federal law does allow a
behavioral health evaluation of a child with the appropriate
guardianship consent.
REPRESENTATIVE SEATON removed his objection. There being no
objection, Amendment 4 was adopted.
CHAIR WILSON opined that the intent of the bill was not affected
by the amendments which the committee adopted.
CHAIR WILSON suggested reviewing Amendment 2.
4:06:03 PM
REPRESENTATIVE SEATON moved to rescind Amendment 2, as amended.
There being no objection, Amendment 2, as amended, was
rescinded.
The committee took an at-ease from 4:07:02 PM to 4:11:48 PM.
4:11:48 PM
REPRESENTATIVE SEATON moved New Amendment 2, as follows:
Page 3,
Delete lines 13, 14
and
Page 3, Line 2, following "of"
Insert subsections "(a) and (b) of"
There being no objection, Amendment 4 was adopted.
4:12:42 PM
REPRESENTATIVE CISSNA moved Conceptual Amendment 5:
Page 3, Line 29, following "services"
Insert ", and psychiatric specialists"
CHAIR WILSON objected for discussion, and stated that her
understanding is that "mental health services" would be
inclusive of "psychiatric specialists", thus preempting the need
to make such a specification necessary.
REPRESENTATIVE CISSNA maintained that this would provide a
benefit to parents seeking appropriate guidance, and also allows
the school authorities to clearly respond to parental inquiries.
4:14:57 PM
CHAIR WILSON said that the amendment would serve to imply a
limitation, where the intent is not to create such a limit.
REPRESENTATIVE CISSNA disagreed.
4:15:15 PM
REPRESENTATIVE GATTO supported Amendment 5, and said that the
language "mental health services" appears to refer to
organizations, and by inserting "specialists", individual
practitioners are then inferred.
4:15:36 PM
MR. BENEVIDES pointed out that the continuing lines 30-31 [page
3], and page 4, lines 1-2, encompass any type of entities that
may be included on a list for the welfare of the parent.
Additionally, he maintained that creating and offering a list is
optional to a school district.
4:16:53 PM
CHAIR WILSON maintained her objection.
4:17:09 PM
REPRESENTATIVE GARDNER opined that the existing language appears
to be inclusive.
A roll call vote was taken. Representatives Gatto, Anderson,
and Cissna voted in favor of Amendment 5. Representatives
Kohring, Seaton, Gardner, and Wilson voted against it.
Therefore, Amendment 5 failed to be adopted by a vote of 3-4.
4:18:31 PM
REPRESENTATIVE ANDERSON moved to report HCS CSSB 48, Version 24-
LS0208\X, Mischel, 5/5/06, as amended, out of committee with
individual recommendations and the accompanying fiscal notes.
There being no objection, HCS CSSB 48(HES) was reported from the
House Health, Education and Social Services Standing Committee.
4:19:15 PM
The committee took an at-ease from 4:19:15 PM to 4:22:22 PM.
4:22:22 PM
CHAIR WILSON counseled that Amendment 4 was incorporated into
New Amendment 2, thus eliminating the need for Amendment 4. She
requested that Amendment 4 be struck from the record.
4:22:47 PM
The committee took an at-ease from 4:22:47 PM to 4:24:11 PM.
^WORK SESSION
4:24:11 PM
CHAIR WILSON announced that the final order of business would be
a work session.
CHAIR WILSON instructed participants that the intention of this
informal work session would be to garner information that will
assist the committee to make recommendations for measures to
help contain state health care costs; specifically in the
Department of Health and Social Services (DHSS) budget. She
expressed her expectation to conduct a number of these work
sessions, during the Special Session, with the possibility of
developing draft bills in preparation of the next regular
legislative session. To that end, she stated that various
guests would be invited to participate, including Representative
Mike Hawker, Alaska Legislature, House Finance Committee, and
said that an official from DHSS, would work with the committee
today. Further, she said that recommendations for consideration
should not cut services, but focus on cost saving measures.
Acknowledging a suggestion for taking this work up during the
interim, she maintained the importance of proceeding at this
time.
4:28:35 PM
DWAYNE PEEPLES, Director, Division of Health Care Services
(HCS), Department of Health and Social Services (DHSS),
explained that cost containment represents an ongoing concept
and effort that has been in the forefront of the department's
goals for many years. He described how areas for saving costs
are identified within the health care system and adjustments are
made, but inflation and growth overwhelm these efforts in one to
three years time. As an example, he highlighted the successful
preferred drug list model, created two years, which has saved
the state between $7-8 million each year. He stated that the
department is continually seeking opportunities to implement
cost saving measures. Other situations routinely reviewed
include the utilization of the Medicaid program, investigating
"off the norm" utilization of pharmaceuticals, emergency room
visits, and physician visits. When a recipient is identified as
abusing the system, the individual is placed in a case
management program. If a physician is identified as not
practicing to the best of their ability, appropriate action is
also taken. In the pharmacy area, he said that dispensing fees
are being revised, and partnerships with other states are being
reviewed/established in an effort to reduce wholesale drug
costs. House Bill 426 is an example dealing with an identified
utilization concern; eligible individuals not enrolling in
Medicare. He said that the area of over medication limits is
also being reviewed.
CHAIR WILSON identified over medication as a point of concern,
and an area for possible savings. She suggested that even six
prescriptions at one time might indicate the need to review a
recipient's profile. She asked how many individuals who take
multiple prescriptions have had their cases reviewed.
MR. PEEPLES stated that a report had been provided to the
committee "a couple of years ago," and he offered to provide an
updated utilization report.
CHAIR WILSON suggested that this report should be reviewed on a
routine basis, and she provided a personal anecdote to highlight
her concern. Not only is this a health issue, but it is could
also be an important money saving area, she opined.
REPRESENTATIVE CISSNA offered that multiple prescription use is
known as polypharmacy, and is a wide spread concern.
4:35:36 PM
CHAIR WILSON interjected that it often occurs when an individual
consults with multiple doctors.
4:35:41 PM
REPRESENTATIVE GARDNER suggested reasons why this might be a
difficult situation to track.
CHAIR WILSON reiterated the need to maintain attention to this
situation for health reasons as well as for cost saving
measures.
REPRESENTATIVE CISSNA asked by what means the department would
be able to facilitate this type of drug usage tracking.
4:36:22 PM
MR. PEEPLES explained that within the Medicaid management
information system, a subsystem records the actions of
pharmacists and feeds directly to a data base that performs
multiple functions. The department's Drug Utilization and the
Pharmacy and Therapeutic committees, comprised of health care
professionals, meet separately once a month to analyze the
reports, and to make the type of evaluations being discussed.
Additionally, he said a professional firm is employed to analyze
the behavioral health drug usage. In the field of behavioral
health drugs, he said that the physicians engage peer counselors
to work with the prescribing physicians to ensure that current
practices are being adhered to, and that appropriate reviews are
conducted of recipient prescriptions.
REPRESENTATIVE CISSNA reported her familiarity with a program
that deals with the homeless, and asked whether it could be
expanded.
MR. PEEPLES explained that the most beneficial means for
monitoring a recipient's drug intake is to employ a case
management system with a sole physician prescribing and a sole
pharmacist dispensing.
4:40:07 PM
REPRESENTATIVE GARDNER stated her understanding that
pharmaceuticals are the fastest growing sector of the escalating
costs of medical care, and said that Representative David
Guttenberg has introduced a bill to establish a prescription
drug task force within the DHSS. She asked whether Mr. Peeples
was familiar with this endeavor.
MR. PEEPLES replied that he had apprised himself of the bill in
question, which deals with pharmaceutical purchasing.
CHAIR WILSON asked how that would be different from current
purchasing practices.
MR. PEEPLES explained that the pooling that DHSS engages in with
the Medicaid program is supervised under the federal Centers for
Medicare and Medicaid Services(CMS), which authorized Alaska
and partner states a plan amendment, to pool for the purchase of
Medicaid drugs. Representative Guttenberg's bill is more
global in order to serve a variety of organizations. Under the
current rules of engagement with CMS Medicaid could not be
incorporated into this global plan; a separate pool would need
to be established.
MR. PEEPLES stated that other states have set up commissions as
separate entities, "quasi governmental agencies," which work to
govern benefit practices and health care procurement.
CHAIR WILSON described the issue in outlying communities where
one pharmacy endeavors to dispense drugs, cost effectively, to a
small populace. She explained that it is difficult for these
pharmacies to make any profit given the current dispensing fee
policy, and reimbursement arrangements, and asked whether the
department is planning to address this problem.
4:44:07 PM
MR. PEEPLES explained how dispensing fees are established, based
on a longitudinal survey to create a fee structure. Further, he
said this is a wide-ranging undertaking, handled similar to a
regulation review, and involves a hearing process.
MR. PEEPLES reported that another area of health care, which HCS
is beginning to scrutinize is chronic disease management. Other
states have models available for review, and the Division of
Public Health now has a section/unit dedicated to chronic
disease management. There will be a big growth in Medicaid
diabetes costs, as an example, thus targeting prevention is an
important avenue to address.
CHAIR WILSON opined that obesity may be the culprit to the rise
in diabetes, thus the committee may be able to introduce a bill
around that subject. Further, she said that Karleen Jackson,
Commissioner, HESS, would be invited to work with the committee
towards creating meaningful legislation for the 2007 session.
4:47:11 PM
MR. PEEPLES stated that the department is also expecting to
create an experimental treatment committee to help provide
increased quality control of drug utilization.
CHAIR WILSON expressed appreciation for everyone's efforts in
this informal work session.
ADJOURNMENT
The House Health, Education and Social Services Standing
Committee meeting was recessed at 4:48:25 PM to a call of the
chair. [The meeting was never reconvened.]
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