Legislature(1995 - 1996)

03/26/1996 03:04 PM House HES

Audio Topic
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
          HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES                          
                       STANDING COMMITTEE                                      
                         March 26, 1996                                        
                           3:04 p.m.                                           
 MEMBERS PRESENT                                                               
 Representative Cynthia Toohey, Co-Chair                                       
 Representative Con Bunde, Co-Chair                                            
 Representative Gary Davis                                                     
 Representative Norman Rokeberg                                                
 Representative Caren Robinson                                                 
 Representative Tom Brice                                                      
 MEMBERS ABSENT                                                                
 Representative Al Vezey                                                       
 COMMITTEE CALENDAR                                                            
 * HOUSE BILL NO. 393                                                          
 "An Act relating to managed care for recipients of medical                    
 assistance; and providing for an effective date."                             
      - PASSED CSHB 393(HES) OUT OF COMMITTEE                                  
 HOUSE BILL NO. 435                                                            
 "An Act relating to employment contributions and to making the                
 state training and employment program a permanent state program;              
 and providing for an effective date."                                         
      - HEARD AND HELD                                                         
 HOUSE BILL NO. 506                                                            
 "An Act relating to establishment of a fire fighting and safety               
 training program by the University of Alaska."                                
      - PASSED OUT OF COMMITTEE                                                
 CONFIRMATION HEARINGS:                                                        
      Professional Teaching Practices Commission                               
           Peggy E. Conner Jones                                               
           Bruce F. Johnson                                                    
           Marsha K. Van Abel                                                  
           Jacquie Whitmore                                                    
      - CONFIRMATION FORWARDED                                                 
      University of Alaska Board of Regents                                    
           Joe L. Hayes, Jr.                                                   
      - CONFIRMATION FORWARDED                                                 
      Board of Chiropractic Examiners                                          
           Pam Aldersebaes                                                     
      - CONFIRMATION FORWARDED                                                 
      Board of Clinical Social Work Examiners                                  
          Beverly Haywood                                                      
      - CONFIRMATION FORWARDED                                                 
      Board of Dispensing Opticians                                            
           Mary C. Seutter                                                     
      - CONFIRMATION FORWARDED                                                 
      Board of Marital and Family Therapy                                      
          Mercy Dennis                                                         
          Dixie A. Hood                                                        
          Sandra M. Samaniego                                                  
      - CONFIRMATION FORWARDED                                                 
      State Medical Board                                                      
          Keith M. Brownsberger, MD                                            
          Beverly Fletcher                                                     
          Donald G. Hudson, DO                                                 
          Sarah A. Isto, MD                                                    
          Suzanne H. Lombardi                                                  
          Donald C. Olson, MD                                                  
          Irvin A. Rothrock, MD                                                
      - CONFIRMATION FORWARDED                                                 
      Board of Certified Direct-Entry Midwives                                 
           Marilyn Holmes                                                      
      - CONFIRMATION FORWARDED                                                 
      Board of Nursing                                                         
           Josephine Malemute                                                  
      CONFIRMATION FORWARDED                                                   
      Board of Pharmacy                                                        
           Chris E. Coursey                                                    
      CONFIRMATION FORWARDED                                                   
      State Physical Therapy and Occupational Therapy Board                    
           Leslie F. Schwartz                                                  
      CONFIRMATION FORWARDED                                                   
      Board of Psychologist and Psychological Associate Examiners              
           Gail C. Shortell, Esq.                                              
      CONFIRMATION FORWARDED                                                   
 HOUSE BILL NO. 529                                                            
 "An Act giving notice of and approving the entry into, and the                
 issuance of certificates of participation in, a lease-purchase                
 agreement for a centralized public health laboratory."                        
      - SCHEDULED BY NOT HEARD                                                 
 HOUSE BILL NO. 535                                                            
 "An Act relating to postsecondary education."                                 
      - SCHEDULED BUT NOT HEARD                                                
 (*First public hearing)                                                       
 PREVIOUS ACTION                                                               
 BILL:  HB 393                                                               
 SHORT TITLE: MANAGED CARE PROGRAM FOR MEDICAID                                
 SPONSOR(S): REPRESENTATIVE(S) ROKEBERG                                        
 JRN-DATE     JRN-PG               ACTION                                      
 01/05/96      2369    (H)   PREFILE RELEASED                                  
 01/08/96      2369    (H)   READ THE FIRST TIME - REFERRAL(S)                 
 01/08/96      2369    (H)   HES, STATE AFFAIRS, FINANCE                       
 03/21/96              (H)   HES AT  3:00 PM CAPITOL 106                       
 03/21/96              (H)   MINUTE(HES)                                       
 03/26/96              (H)   HES AT  3:00 PM CAPITOL 106                       
 BILL:  HB 435                                                               
 SPONSOR(S): RULES BY REQUEST OF THE GOVERNOR                                  
 JRN-DATE     JRN-PG               ACTION                                      
 01/19/96      2488    (H)   READ THE FIRST TIME - REFERRAL(S)                 
 01/19/96      2488    (H)   LABOR & COMMERCE, HES, STA, FINANCE               
 01/19/96      2488    (H)   3 FISCAL NOTES (2-DCRA, LABOR)                    
 01/19/96      2488    (H)   GOVERNOR'S TRANSMITTAL LETTER                     
 02/07/96              (H)   L&C AT  3:00 PM CAPITOL 17                        
 02/07/96              (H)   MINUTE(L&C)                                       
 02/14/96              (H)   L&C AT  3:00 PM CAPITOL 17                        
 02/14/96              (H)   MINUTE(L&C)                                       
 02/15/96      2772    (H)   L&C RPT  2DP 3NR                                  
 02/15/96      2773    (H)   DP: ELTON, KOTT                                   
 02/15/96      2773    (H)   NR: ROKEBERG, KUBINA, PORTER                      
 02/15/96      2773    (H)   ZERO FISCAL NOTE (GOV)                            
 02/15/96      2773    (H)   3 FNS (LABOR, 2-CRA) 1/19/96                      
 03/21/96              (H)   HES AT  3:00 PM CAPITOL 106                       
 03/21/96              (H)   MINUTE(HES)                                       
 03/26/96              (H)   HES AT  3:00 PM CAPITOL 106                       
 BILL:  HB 506                                                               
 SHORT TITLE: UNIVERSITY FIRE FIGHTING PROGRAM                                 
 SPONSOR(S): REPRESENTATIVE(S) NAVARRE,G.Davis,Phillips                        
 JRN-DATE     JRN-PG               ACTION                                      
 02/12/96      2727    (H)   READ THE FIRST TIME - REFERRAL(S)                 
 02/12/96      2727    (H)   HES, FINANCE                                      
 03/21/96              (H)   HES AT  3:00 PM CAPITOL 106                       
 03/21/96              (H)   MINUTE(HES)                                       
 03/26/96              (H)   HES AT  3:00 PM CAPITOL 106                       
 WITNESS REGISTER                                                              
 BOB LABBE, Director                                                           
 Division of Medical Assistance                                                
 Department of Health & Social Services                                        
 P.O. Box 110660                                                               
 Juneau, Alaska  99811-0660                                                    
 Telephone:  (907) 465-3355                                                    
 POSITION STATEMENT:  Testified on HB 393                                      
 JAY LIVEY, Deputy Commissioner                                                
 Department of Health & Social Services                                        
 P.O. Box 110601                                                               
 Juneau, Alaska  99811-0601                                                    
 Telephone:  (907) 465-3030                                                    
 POSITION STATEMENT:  Testified on HB 393                                      
 HARLAN KNUDSON, Executive Director                                            
 Alaska State Hospital & Nursing Home Association                              
 319 Seward Street, Suite 11                                                   
 Juneau, Alaska  99801                                                         
 Telephone:  (907) 586-1790                                                    
 POSITION STATEMENT:  Testified in support of HB 393                           
 DWIGHT PERKINS, Special Assistant                                             
 Office of the Commissioner                                                    
 Department of Labor                                                           
 P.O. Box 21149                                                                
 Juneau, Alaska  99802-1149                                                    
 Telephone:  (907) 465-2700                                                    
 POSITION STATEMENT:  Testified in support of HB 435                           
 REMOND HENDERSON, Director                                                    
 Division of Administrative Services                                           
 Department of Community & Regional Affairs                                    
 P.O. Box 112100                                                               
 Juneau, Alaska  99811-2100                                                    
 Telephone:  (907) 465-4708                                                    
 POSITION STATEMENT:  Answered questions on HB 435                             
 DAVID STONE, President                                                        
 Council of Alaska Producers                                                   
 3100 Channel Drive, Suite 2                                                   
 Juneau, Alaska  99801                                                         
 Telephone:  (907) 463-5704                                                    
 POSITION STATEMENT:  Testified in support of HB 435                           
 MARK MICHAELSON, Coordinator                                                  
 Service Delivery Area Program                                                 
 Division of Community & Rural Development                                     
 Department of Community & Regional Affairs                                    
 P.O. Box 112100                                                               
 Juneau, Alaska  99811-2100                                                    
 Telephone:  (907) 465-4891                                                    
 POSITION STATEMENT:  Answered questions on HB 435                             
 TOM ACKERLY, Legislative Administrative Assistant                             
    to Representative Mike Navarre                                             
 Alaska State Legislature                                                      
 Capitol Building, Room 521                                                    
 Juneau, Alaska  99801-1182                                                    
 Telephone:  (907) 465-3779                                                    
 POSITION STATEMENT:  Testified on HB 506                                      
 MARYLOU BURTON, Director of Statewide Budget                                  
 University of Alaska Statewide                                                
 Juneau, Alaska  99801                                                         
 Telephone:  (907) 463-3086                                                    
 POSITION STATEMENT:  Testified on HB 506                                      
 ACTION NARRATIVE                                                              
 TAPE 96-33, SIDE A                                                            
 Number 001                                                                    
 The House Health, Education and Social Services Standing Committee            
 was called to order by Co-Chair Cynthia Toohey at 3:04 p.m.                   
 Members present at the call to order were Representatives Toohey,             
 Bunde, Rokeberg and Davis.  Members absent were Representatives               
 Robinson, Brice and Vezey.                                                    
 CO-CHAIR TOOHEY announced the agenda was HB 393, Managed Care                 
 Program for Medicaid; HB 435, State Training & Employment Program;            
 HB 506, University Fire Fighting Program; and Confirmation                    
 Hearings.  She noted that HB 535 was rescheduled for Thursday,                
 March 28.                                                                     
 HB 393 - MANAGED CARE PROGRAM FOR MEDICAID                                   
 Number 123                                                                    
 REPRESENTATIVE NORM ROKEBERG, Sponsor, said House Bill 393 provides           
 for the establishment of a pilot program for managed care for                 
 Medicaid recipients.  He noted that managed care can mean many                
 different things to many different people.  This particular bill              
 was brought forward for the precise reason of the legislature                 
 taking an active role in the development and implementation of a              
 managed care plan and program for the state of Alaska.  His                   
 involvement stems from his concern that national legislation is               
 leading the way and in a certain sense, forcing the state to go               
 this direction on the one hand; on the other hand, it's also                  
 potentially going to be giving the state an opportunity to embrace            
 some newer and innovative concepts in health delivery in the state.           
 REPRESENTATIVE ROKEBERG stated the Medigrant program that has been            
 proposed in Washington, D.C. is one form and there is also a per              
 capita type Medigrant program for Medicaid.  Potentially, there is            
 the National Governor's Association compromise plan.  All three of            
 these plans or basically a compromise, potentially could be coming            
 out of Congress this year, but if they do not do so this year for             
 partisan political purposes, he predicted it will happen within a             
 year or eighteen months, no matter who is elected President.                  
 Therefore, he felt it was important for the state of Alaska to                
 prepare for a new era of managed care health delivery to the                  
 Medicaid recipients of the state.  He explained that the grants               
 would allow flexibility, whereas presently waivers have to be                 
 applied for.  Ninety-four percent of the rest of the states have              
 some sort of managed care in their health delivery systems for                
 Medicaid recipients.  Managed care is a way to give high level of             
 care and quality services, while keeping the cost down.  For                  
 example, in the last four years the cost in the state of Alaska has           
 increased 50 percent.  The gross total spending for FY 97 is $336             
 million; that's number 2 to education as a line item in the state's           
 budget.  Much of that funding comes from the federal government,              
 but in the last year $145 million in general fund receipts went               
 into Medicaid services.  Another way to look at that is there has             
 been an average increase over the last five years of 13.9 percent             
 growth.  This is the fastest growing area of the state's budget, so           
 he felt it was important that something be done to try to contain             
 the cost increase.                                                            
 REPRESENTATIVE CAREN ROBINSON arrived at 3:07 p.m.                            
 Number 400                                                                    
 REPRESENTATIVE ROKEBERG pointed out that in 1994 the legislature              
 put intent language in the budget instructing the Department of               
 Health & Social Services to look into managed care.  The department           
 has been actively pursuing development of managed care programs and           
 ideas.  As a matter of fact, most recently they awarded a contract            
 to Fox Systems Health Management Associates in Scottsdale, Arizona            
 to review all the managed care options for the state.  Also, the              
 division is giving special consideration to implementation this               
 next fiscal year of a managed care model called "Primary Care Case            
 Management (PCCM).                                                            
 REPRESENTATIVE TOM BRICE arrived at 3:12 p.m.                                 
 REPRESENTATIVE ROKEBERG said his interest in the health care system           
 was primarily from the fact that as an independent businessman, he            
 was unable to obtain insurance, except at a very high cost.  He,              
 like many others, thought that Alaska could not sustain and support           
 an HMO or a managed care type system because we lacked the                    
 infrastructure, the size or the capabilities that many states have            
 to be able to implement such a system.  He mentioned that he                  
 attended a number of seminars last fall, including one on rural               
 managed health care, which convinced him that it could be done in             
 the state of Alaska.  There was testimony from small areas of the             
 country that have developed either statewide, regional or even                
 small community plans and adapted managed health care into their              
 communities.  He received a lot of information about how this plan            
 was implemented in the state of Arizona, which has 46 counties and            
 two competing managed care plans in each of the counties.  So                 
 essentially, even a Medicaid recipient has a choice of plans in the           
 counties in Arizona.  He said it was interesting to note that                 
 Arizona led the country in the development of their managed care              
 systems, since as a very conservative state politically, they for             
 years had not taken Medicaid money.  Until about 15 years ago, they           
 did not take any federal funds for public health, and at that point           
 in time they realized their public health clinics were so                     
 overburdened they couldn't supply the needed services to their                
 citizens.  They got an 1115 Waiver and developed a managed care               
 plan, which has taken a number of years to develop, but now it is             
 the most successful in the country.                                           
 Number 605                                                                    
 REPRESENTATIVE ROKEBERG advised the committee he had also gotten              
 some information from the state of Oregon where they were serving             
 280,000 people before they implemented their managed care plan, but           
 because of the cost savings they were able achieve by implementing            
 a managed care plan, they've expanded that service to 400,000                 
 people, which is a 43 percent increase.  The biggest segment of the           
 population in the United States are the uninsured.  They make just            
 enough money to get by, but they do not qualify for Medicaid or are           
 not fortunate enough to be involved in an insurance plan.  The                
 biggest concern among most health care professionals right now is             
 that the people who don't have insurance aren't able to get it.               
 The state of Oregon is one example where the number of people                 
 served was expanded and chipped away at the middle level of the               
 Number 672                                                                    
 REPRESENTATIVE ROKEBERG in conclusion said this bill before the               
 committee asks the department to come forward with a plan and new             
 legislation for the legislature's review.  He said that's all this            
 bill does; it doesn't matter if you're for or against the concept             
 of managed care.  The intent is that the legislature needs to be a            
 part of this process.  It sets up a pilot project, gives certain              
 guidelines, has findings and asks the department to come back next            
 year with their plan.                                                         
 CO-CHAIR TOOHEY asked if there were any questions of the sponsor.             
 Number 753                                                                    
 REPRESENTATIVE ROBINSON asked Representative Rokeberg why he                  
 believed legislation was needed if the department was already                 
 working on a plan.                                                            
 REPRESENTATIVE ROKEBERG acknowledged there was a process the                  
 department was going through, but it was being done on their own              
 time frame and based on decisions made by the department.  He                 
 reiterated the intent of this bill is to involve the legislature.             
 Additionally, one of his other motivations was to move this process           
 along because of the impact on the budget.                                    
 CO-CHAIR TOOHEY remarked that two years ago the legislature spent             
 a great deal of time on health care issues.  She asked                        
 representatives of the department to come forward to testify on HB
 Number 890                                                                    
 BOB LABBE, Director, Division of Medical Assistance, Department of            
 Health & Social Services, said the department has had some informal           
 discussions with Representative Rokeberg on HB 393 and provided               
 information as to what the department was working on in the area of           
 managed care.  They have a contractor who is assisting the                    
 department and he thought it had been primarily an educational                
 process for the staff.  He said being somewhat removed from the               
 Lower 48 development of managed care, it takes some time to learn             
 and understand the new concepts.  He noted that the department had            
 made some decisions which they believed were based on the 1994                
 legislation directing them to look into case management systems.              
 That was the basis for issuing the contract and they believe the              
 primary care case management option is consistent with that initial           
 direction and not inconsistent particularly with even the more full           
 blown capitation type model.  The department felt they would start            
 with that and do some piloting around that concept.  He noted in              
 that particular model, there's usually a physician, possibly a                
 nurse practitioner/physician assistant under contract with the                
 state to provide primary care services and act as a referral agent            
 for other specialty services.  Clients are then enrolled with a               
 primary care case manager and need to get approval for an outside             
 referral.  The payments are typically continuous fee for service              
 for the primary care case manager, as well as the specialty                   
 services, hospital care, etc.  There is not a lot of change in how            
 people are reimbursed.  It starts organizing the system so there              
 are linkages between the providers.  There's probably better access           
 in some ways for primary care services; typically one of the goals            
 is to have services provided without the use of an emergency room,            
 if the physician case manager is available or has to make                     
 arrangements to be available.  The department views this as a step            
 in the process and believes they can move in that direction.                  
 They've been working with their current resources and trying to               
 reprogram their own staff.  He said this bill as it's drafted, from           
 their purpose, seems to fit with their abilities to move ahead and            
 they could support it because it is in the interest of moving the             
 department along and getting another tool for improving management            
 of their program.                                                             
 Number 1119                                                                   
 CO-CHAIR TOOHEY asked Mr. Labbe when the department's plan would              
 start functioning.                                                            
 MR. LABBE said an actual target for enrollment hasn't been                    
 determined.  The department is gathering data and decisions will              
 need to be made about where to pilot the projects, which client               
 groups and which types of services will be included.  He commented            
 that usually not every Medicaid service is put into this.  The                
 department wanted to wait until the contract agency was finished,             
 which is expected to be around June 1, to make those decisions.  It           
 is his hope to get something going in the next fiscal year.  He               
 added that it would require involvement from the local community              
 providers, recipients and family members.  The department has                 
 announced the recruitment of a position in their Anchorage office             
 to focus on this.                                                             
 Number 1170                                                                   
 REPRESENTATIVE BRICE asked if the department had taken any steps to           
 rectify the concerns raised over the optical hardware contract;               
 specifically the undermining of instate resident businesses by                
 shipping out of state.                                                        
 Number 1227                                                                   
 JAY LIVEY, Deputy Commissioner, Department of Health & Social                 
 Services, said two or three years ago under the Medicaid program,             
 the department decided it would be cost effective for Medicaid to             
 bid a contract for a company to provide eye glasses to Medicaid               
 recipients.  The company that was awarded the competitive bid was             
 an out-of-state provider.  It saved the department a considerable             
 amount of money in Medicaid service to do that.  He thought that              
 Representative Brice was asking if there was a guarantee that under           
 future managed care programs the department would support the                 
 Alaska infrastructure.  He believed under a case management                   
 proposal, as explained by Mr. Labbe, they would because they would            
 be signing up local Alaskan physicians to provide that particular             
 CO-CHAIR TOOHEY asked if it would be under a competitive bid.                 
 MR. LABBE responded that for the primary care case management                 
 program, he would not anticipate a competitive bid.  The department           
 would encourage providers to meet a set of standards that would be            
 established and then sign up.  He said the plus side of having sort           
 of a performance expectation for the primary care case managers               
 goes beyond where we currently are with the fee for services, but             
 it's not to the point of having two or three plans that would                 
 compete for best price.  Based on his experience of working with              
 Oregon in the development of managed care, he wasn't sure he would            
 encourage competition initially.  He added that if there were                 
 already a number of commercial plans to select from, then he might            
 look at competition.                                                          
 CO-CHAIR TOOHEY commented that it wasn't being narrowed down to one           
 hospital versus the other.  She asked Mr. Labbe how this                      
 legislation would help the department and if he felt it was                   
 REPRESENTATIVE ROBINSON inquired if anything would change if this             
 legislation did not make it through the process.                              
 MR. LIVEY thought this bill provided some affirmation of the                  
 direction the department is headed anyway, which he felt was                  
 valuable in their discussions of managed care with providers and              
 clients.  In the absence of this legislation, he believed the                 
 department would proceed with their current project.  He                      
 reemphasized the bill does provide some impetus and general                   
 direction for the department.                                                 
 REPRESENTATIVE ROKEBERG commented the biggest difference and the              
 value of the bill is the speed at which things might get done,                
 which is a friendly intention.                                                
 Number 1453                                                                   
 HARLAN KNUDSON, Executive Director, Alaska State Hospital & Nursing           
 Home Association, testified in support of HB 393.  The association            
 had three reasons for their desire to see this bill passed and                
 signed by Governor Knowles.  The first is that managed care will              
 help control the Medicaid budget.  It changes the total incentive             
 of the current health care system.  Under a managed care system,              
 the incentive is on wellness.  Second, it provides a boost for the            
 department to reach out and work with providers, which they feel is           
 very important.  Third, it sets up pilot programs so instead of               
 attempting to move the whole system into managed care, it allows it           
 to be tried in both the rural and urban areas.  Mr. Knudson said              
 there is managed care in the Native Health Service, and asked why             
 areas like Bethel, Nome, Dillingham couldn't put together a                   
 contract on Medicaid with the department.  In areas such as                   
 Ketchikan or Kodiak where there isn't a prominence of a Native                
 system, why couldn't a managed program be put together and brought            
 back to the Indian Health Service or to the Medicaid system.  He              
 concluded that HB 393 opens those kinds of doors for health care.             
 He believes it is a good bill and urged the committee's support.              
 Number 1547                                                                   
 CO-CHAIR BUNDE said he had heard anecdotally of a system like this            
 being put in for Medicaid in a larger urban center, doctors were              
 assigned that were difficult to reach and use of the emergency room           
 increased because people would wait until the problem was acute               
 instead of having to take a bus or drive several miles to get to              
 the doctor.   He said he was describing the down side of managed              
 care for Medicaid and asked Mr. Knudson what his reaction was to              
 MR. KNUDSON replied that Co-Chair Bunde's comment was well taken              
 and in the beginning of some of the Medicare managed care programs            
 they were aware of situations where the incentive had been to keep            
 the patient out of the system; in other words make it difficult for           
 the patient.  He said that's growing pains and it is something that           
 Alaska will go through.  He didn't feel that should be a concern,             
 as he believed there would be good, competent managed care, but the           
 risk is there of shutting some people out of the system.                      
 CO-CHAIR BUNDE said his point was that they won't be shut out of              
 the system, they'll just go back to using the emergency room as               
 preventive care.                                                              
 CO-CHAIR TOOHEY asked if under managed care there was a set price             
 for a particular service such as a broken leg that Medicaid would             
 pay and could be collected, would the patient be able to go to the            
 physician of their choice or would it have to be a physician in the           
 managed care program?                                                         
 Number 1638                                                                   
 MR. LABBE responded that under the primary care case management               
 program, the client would have a choice of primary care providers,            
 and once the client had selected a primary care provider they would           
 stay with that primary care provider; in other words, that would be           
 their medical home.  If the client wished access to specialty care,           
 a referral from their primary care provider would be needed.                  
 CO-CHAIR TOOHEY noted for the record the Alaska State Medical                 
 Association has taken no position on this bill.                               
 REPRESENTATIVE ROKEBERG said he envisions this, because of the                
 rural nature of Alaska and the way many rural managed care                    
 organizations are established in the Lower 48, as there being a               
 small core group of primary care providers, but there will be                 
 backstops that will be networked in or have a relationship with a             
 tertiary care hospital in a large urban area.  He asked Mr. Knudson           
 if he could envision the networking and ability to use the tertiary           
 hospitals throughout the state in coordination with the rural                 
 clinics that exist today.                                                     
 MR. KNUDSON said he could see Cordova for example, that is isolated           
 but has a big influx of population, having a major relationship               
 with one of the major hospitals in Anchorage and being able to                
 offer a contract to either Medicaid or Aetna on a per capita basis.           
 Number 1756                                                                   
 REPRESENTATIVE ROKEBERG said by networking there were certainly               
 creatively ways that could be workable in the state of Alaska.                
 MR. KNUDSON said with the regard to networking, the integration is            
 already going on.  There is a lot of collaboration in every                   
 community in the state.  The Kenai Peninsula is way ahead on the              
 relationship between the doctors, the hospitals, the nursing home,            
 the community mental health center, local psychologist, etc., with            
 shared services, equipment and all those areas.                               
 CO-CHAIR TOOHEY asked if anyone else wished to testify on HB 393.             
 Hearing none, she closed public testimony.                                    
 Number 1797                                                                   
 REPRESENTATIVE ROBINSON moved to adopt CSHB 393, Version F, dated             
 3/21/96.  Hearing no objection, it was so ordered.                            
 REPRESENTATIVE BRICE asked if the state would consider, for                   
 example, a 5 percent for residents preference to providers who want           
 to bid competitively for these services?                                      
 REPRESENTATIVE ROKEBERG said that's why this legislation was before           
 the committee.  That's why this bill is needed so if there is a               
 concern about procurement and the preference the legislature has a            
 voice in it.  He's had discussions with the department about the              
 potentiality of exempting this particular provision from the                  
 procurement code.  One of his concerns in setting up a pilot                  
 program is that he thought something very close to a Request for              
 Proposal (RFP) should be put together to get demonstrated interest.           
 However, the ability to just grant a contract to the lowest                   
 performing bidder may not be in the best interest of the state on             
 the initial pilot level.  He didn't think there should be too much            
 concern about not having local providers, except in the secondary             
 areas like optical, drugs, prosthesis and things of that nature               
 where there may be some outside contractors that may be able to               
 provide those services.                                                       
 REPRESENTATIVE BRICE wanted some assurance, because it wasn't                 
 spelled out in the bill, that the pilot program should have that.             
 CO-CHAIR TOOHEY said HB 393 requests the department to look into              
 this and urges the department to bring their plan before the                  
 REPRESENTATIVE BRICE wanted it to be clear on the record by both              
 the sponsor and himself that any deleterious effects to the                   
 tertiary businesses associated with health care will be watched               
 with a great deal of scrutiny.                                                
 REPRESENTATIVE ROKEBERG said we want people to watch, that's the              
 whole idea of the bill.                                                       
 REPRESENTATIVE ROBINSON made a motion to move CSHB 393(HES) out of            
 committee with attached zero fiscal notes and individual                      
 CO-CHAIR TOOHEY objected and asked for a roll call vote.  Voting in           
 favor of the motion were Representatives Rokeberg, Robinson, Davis            
 and Bunde.  Voting against the motion were Representatives Brice              
 and Toohey.                                                                   
 HB 435 - STATE TRAINING & EMPLOYMENT PROGRAM                                
 Number 2089                                                                   
 CO-CHAIR TOOHEY turned the gavel over to Co-Chair Bunde.                      
 DWIGHT PERKINS, Special Assistant, Office of the Commissioner,                
 Department of Labor, read the following statement:  "For the past             
 six years the State Training and Employment Program (STEP) has                
 temporarily existed as a contingent training and employment program           
 for Alaska's workers.  The original 1989 legislation allowed the              
 state to collect from each worker in Alaska one-tenth of 1 percent            
 of their employee tax contribution to fund an alternative, flexible           
 training program designed with a threefold purpose:  1) to reduce             
 future claims against unemployment benefits; 2) to foster new jobs            
 for Alaskans by encouraging businesses to locate in Alaska due to             
 the availability of a skilled work force; and 3) to increase                  
 training opportunities to Alaskans severely affected by economic              
 and technological fluctuations.  Alaska private sector employers,             
 organized labor and the now-defunct Alaska Job Training Council are           
 in accord that STEP is a proven and valid approach to advancing               
 Alaska residents' opportunities for viable employment.  In the six            
 years since its inception as a temporary measure, STEP has                    
 demonstrated its efficiency.  We know that STEP works for Alaskans.           
 The legislation before you will enable STEP to take its rightful              
 place as an established permanent program to keep Alaskans'                   
 employment skills up-to-date and competitive in the rapidly                   
 changing world of work."  He introduced Rebecca Nance, Director of            
 Employment Security, and Arbe Williams, Director of Administrative            
 Services, who were available to answer questions.                             
 CO-CHAIR BUNDE asked Mr. Perkins if he would like to speak to the             
 reason behind the two sets of fiscal notes.                                   
 MR. PERKINS replied Remond Henderson from the Department of                   
 Community & Regional Affairs had drafted the fiscal notes and would           
 be happy to respond.                                                          
 Number 2236                                                                   
 REMOND HENDERSON, Director, Division of Administrative Services,              
 Department of Community & Regional Affairs (DCRA), explained that             
 the original fiscal notes were prepared based on instructions the             
 department had received from the Office of Management & Budget,               
 which was to show these numbers for information purposes only and             
 to show negative amounts as to what would happen if the bill was              
 not passed.  Those were the instructions from the DCRA's budget               
 analyst; Department of Labor on the other hand, got different                 
 instructions and put their numbers in as positive numbers for                 
 information purposes only.  Mr. Henderson revised his fiscal note             
 to be consistent with the Department of Labor, and the amounts                
 indicated in the fiscal notes are the amounts in the respective               
 budgets for DCRA and the Department of Labor.                                 
 Number 2295                                                                   
 REPRESENTATIVE ROKEBERG asked if the figures had been changed on              
 the fiscal notes?                                                             
 MR. HENDERSON responded affirmatively and explained the fiscal note           
 he prepared was based on the amount in DCRA's budget.  There was a            
 budget amendment that was prepared to reduce the amount in their              
 budget so that it matched the amount that was in the Department of            
 Labor's budget that they were going to RSA (reimbursable service              
 agreement) to the DCRA.  Now the amount in the fiscal note agrees             
 with the amount in the DCRA's budget and also agrees with the                 
 amount the Department of Labor is transferring to the DCRA.                   
 REPRESENTATIVE ROKEBERG asked if this was a wash transaction in               
 that regard.                                                                  
 MR. HENDERSON responded yes.                                                  
 REPRESENTATIVE ROKEBERG presumed there was no fiscal impact per se            
 to the general fund.                                                          
 MR. HENDERSON confirmed that.                                                 
 Number 2335                                                                   
 DAVID STONE, President, Council of Alaska Producers, said the                 
 council is a nonprofit corporation whose members are essentially              
 all of the major mining companies who are actively exploring,                 
 developing and operating in Alaska today.  Examples are Cominco and           
 the Red Dog Project, Kennicott and the Greens Creek Mine, Nevada              
 Gold Fields and Nixon Forks Mine.  On behalf of the council, he               
 expressed the mining industry's support for the reauthorization of            
 the State Training and Employment Program.  This program is and has           
 been business friendly and business accessible.  The program                  
 encourages businesses to invest in the skills of Alaskans.                    
 TAPE 96-33, SIDE B                                                            
 Number 001                                                                    
 MR. STONE continued this program helps the Alaskan work force keep            
 up-to-date with new technologies and techniques, keeping it                   
 competitive in the world economy.  The program is more flexible and           
 has less restrictions than most federal job training programs.  The           
 primary reason for that is due to the fact that this program has              
 been designed and is administered by Alaskans.  The program has               
 been well integrated with other existing employment and training              
 programs to the delivery of the already established and proven                
 private industry councils and complements those efforts.  The STEP            
 has already trained Alaskans and resulted in jobs for Alaskans in             
 the mining industry such as the Nixon Forks mine in McGrath and the           
 Greens Creek Mine near Juneau.  The program has also helped workers           
 who have lost their jobs.  As the mining industry grows and                   
 hopefully creates new high paying jobs in Alaska, STEP can help               
 ensure that it's Alaskans that are trained and qualified to fill              
 these jobs.                                                                   
 MR. STONE said the Council of Alaska Producers views STEP as a true           
 partnership between the state of Alaska and industry which will               
 result in the jobs being filled by Alaskans.  He urged the                    
 committee to pass HB 435.                                                     
 Number 046                                                                    
 CO-CHAIR TOOHEY asked Mr. Stone if there was some reason he hadn't            
 mentioned Echo Bay.                                                           
 MR. STONE said that Echo Bay has been very supportive of STEP                 
 because those monies have been used for the mine training school in           
 Juneau at the University of Alaska Southeast.  Echo Bay sees the              
 potential of 400 jobs for the AJ mine project, and in order to hire           
 Alaskans, there's going to be training involved and Echo Bay would            
 like to see STEP be a part of that training.                                  
 REPRESENTATIVE ROBINSON asked how the STEP integrated into the                
 university program as she understood the program was being shut               
 MR. STONE responded the instructor is taking a leave of absence and           
 the university is willing to start the program again when Echo Bay            
 gives the go ahead that indeed they have the permits and are ready            
 to start training for those jobs.                                             
 REPRESENTATIVE ROBINSON understood that this training program took            
 place through the university.                                                 
 MR. STONE said that was one aspect of the training.  These monies             
 can be used for individuals to go to the Alaska Vocational                    
 Technical Center (AVTC) as an example, depending on the type of               
 training.  In the case of the underground mine training school,               
 these can monies can also be used for that.                                   
 Number 110                                                                    
 REPRESENTATIVE ROKEBERG asked if he understood correctly that there           
 has actually been a program in Juneau training miners for jobs that           
 don't exist.                                                                  
 MR. STONE said no, the university's mine training school is                   
 basically going into a "mothball" state.                                      
 REPRESENTATIVE ROKEBERG said he was talking about previously.                 
 MR. STONE explained the last class had trained workers here in                
 Juneau for the Nixon Fork mine in McGrath because this is the only            
 underground mine training school site.  So people were trained for            
 jobs that did exist.                                                          
 Number 135                                                                    
 CO-CHAIR BUNDE asked what kind of tuition the participants are                
 expected to pay.                                                              
 MR. STONE said he didn't know the figure, but the council partners            
 with the university so the costs are quite reasonable.                        
 Participants need appropriate clothing and tools to learn their               
 trade, some of which are provided by the mining industry.                     
 CO-CHAIR BUNDE said he was curious about the industry's                       
 MR. STONE noted that the industry has contributed a great deal and            
 is ongoing, as long as the school exists.  Industry has provided              
 heavy equipment, tools, spare parts, employees as trainers, etc.              
 He emphasized that it has been a true partnership arrangement.                
 CO-CHAIR TOOHEY asked if this was what she referred to as a                   
 proprietary education, with a specified time period and the                   
 participants graduating with a degree.                                        
 MR. STONE said this was a 6 week school and the participants                  
 receive a 40-hour Mining Safety & Health Administration (MSHA)                
 certification which is an underground certification that is                   
 required to go underground.  The participants get basic exposure to           
 explosives, drilling and all the basics of underground mining, as             
 well as their math skills, etc.  When they complete the training,             
 it conveys to the industry that these people are ready for work and           
 have the basic skills to be exposed to underground mining.                    
 CO-CHAIR BUNDE clarified that proprietary schools are private for             
 profit schools; this is a certificate program through the                     
 CO-CHAIR TOOHEY said she understood that and asked if the                     
 certificate was valid in other states.  She inquired as to the cost           
 of the school.                                                                
 MR. STONE responded that the certificate is valid in other states             
 and he guessed the cost to be somewhere in the neighborhood of                
 $1200 for the 6 weeks.                                                        
 Number 237                                                                    
 REPRESENTATIVE ROBINSON asked Mr. Stone to explain how it would               
 work when Greens Creek, for example was ready to start training.              
 MR. STONE gave a hypothetical situation where the Kensington                  
 project is the next one; Kensington says they will have a need for            
 a certain number of entry level employees and they'd like them to             
 be Alaskans.  The university then will actually recruit for the               
 program and run that program when it is filled with approximately             
 20 students.  That is how it has been done in the past.  When Nixon           
 Forks notified the university of their need to train locally,                 
 residents from McGrath were brought to Juneau, trained and those              
 individuals who graduated were able to get jobs.                              
 Number 282                                                                    
 REPRESENTATIVE ROKEBERG referenced the supporting documents in                
 committee members' packets which indicated that some of the state             
 training was conducted out of state.  He asked what the breakdown             
 was regarding the location of the training that had taken place.              
 MR. PERKINS explained that the first three pages of the supporting            
 documents were current expenditures; the estimated FY 97 budget,              
 the estimated FY 96 budget and the FY 95 actuals.  He directed the            
 committee's attention to the documents pertaining to the                      
 Anchorage/Mat-Su area which listed the vendor's name, the type of             
 training and the amount.                                                      
 REPRESENTATIVE ROKEBERG asked if the assistance and the training              
 were summed together for a total of $453,000 for Anchorage or was             
 it $253,000?                                                                  
 MR. PERKINS said the FY 95 actuals were $253,819 for training and             
 $200,351 for employee assistance.  He commented that Mark                     
 Michaelson or Remond Henderson could probably give a more detailed            
 CO-CHAIR BUNDE asked Mr. Henderson if he had an answer to                     
 Representative Rokeberg's question.                                           
 MR. HENDERSON referred to the FY 95 actual amounts with a summary             
 schedule for the three service delivery areas.  The first one was             
 the Alaska Statewide Service Delivery Area which represented the              
 amount spent by the Alaska Statewide Service Delivery areas handled           
 by Mark Michaelson.                                                           
 Number 468                                                                    
 MARK MICHAELSON, Coordinator, Service Delivery Area Program,                  
 Division of Community & Rural Development, Department of Community            
 & Regional Affairs, said the packet of information before the                 
 committee needed to be viewed in the context under which programs             
 and services were provided.  The State Training & Employment                  
 Program was established six year ago in the attempt not to                    
 duplicate any existing programs or services offered by the federal            
 program, but to complement and supplement.  The administrative                
 structure selected was one set up by the Job Training Partnership             
 Act (JTPA).  That particular federal program recognized three                 
 distinct areas in the state of Alaska:  The Anchorage/ Mat-Su                 
 consortium, the Fairbanks Private Industry Council, and the                   
 statewide, which as Mr. Henderson indicated, is what the DCRA works           
 with.  The information before the committee references activity,              
 expenditures and services provided within those three                         
 jurisdictions.  He explained that he is a state employee located in           
 Juneau, but his counterparts are not state employees; they are                
 employees of the Fairbanks Productivity Improvement Center (PIC)              
 and have an affiliation with the local government, as well as in              
 Anchorage where there is an affiliation with the municipality of              
 MR. MICHAELSON said that Representative Rokeberg had referenced               
 some out of state expenses or training outside the state of Alaska            
 and added that activity is not prohibited with the STEP program nor           
 is it prohibited with the JTPA, the federal source; however, the              
 policy taken is that people will only be sent to out of state                 
 training if comparable training for a particular occupation is not            
 available for a particular individual and under some circumstances.           
 For example, if the wait was going to be 9 to 12 months to get                
 someone into a university program, then out of state training would           
 be looked at.  He added those decisions are made after an                     
 individual assessment of that particular person's request.  The               
 greatest amount of training takes place instate with Alaska                   
 institutions and often times with the support and participation of            
 Alaskan businesses.                                                           
 REPRESENTATIVE ROKEBERG said it appeared to him that Anchorage or             
 the Kenai Peninsula would be allocated under the statewide                    
 appropriation.  He asked if the Department of Community & Regional            
 Affairs was only a part of this program?                                      
 MR. HENDERSON interjected he believed Representative Rokeberg was             
 asking in terms of what Anchorage gets, how are the funds allocated           
 to the geographical locations within the Anchorage area, how does             
 Fairbanks allocate their funds, and how does the balance of the               
 state allocate their funds.                                                   
 REPRESENTATIVE ROKEBERG said actually it's how much each area got.            
 MR. MICHAELSON said the total allocation of the total STEP                    
 resources is determined by an unemployment figures formula applied            
 by the Department of Labor.  It's based upon population,                      
 unemployment and those types of data.  He wasn't able to provide              
 specific details, but thought perhaps representatives from the                
 Department of Labor could provide additional information.                     
 REPRESENTATIVE ROKEBERG asked how much of the $3.4 million budget             
 was paid by the employees of the state and how much by the federal            
 MR. MICHAELSON responded with that particular budget, the entire              
 cost is incurred by the State Training & Employment Program.  There           
 are additional programs and services made available through the               
 federal Job Training Partnership Act.  He asked committee members             
 to bear in mind that the JTPA serves approximately 4 to 5 percent             
 of those individuals potentially eligible, so there is not a                  
 plethora of resources and training dollars available for people who           
 are looking for assistance.                                                   
 Number 674                                                                    
 CO-CHAIR BUNDE noted that Representative Rokeberg had asked how               
 much was the student's responsibility.                                        
 REPRESENTATIVE ROKEBERG interjected he was referring to employees             
 of the state.  He asked where was the money coming from?                      
 MR. HENDERSON said the unemployment insurance trust fund.  One-               
 tenth of one percent of the....                                               
 REPRESENTATIVE ROKEBERG asked if that was funded 100 percent?                 
 MR. HENDERSON said this comes directly from the unemployment                  
 insurance trust fund - one-tenth of 1 percent; the entire amount              
 that is spent by the DCRA for this program comes from that fund.              
 REPRESENTATIVE ROKEBERG asked if 100 percent of all these dollars             
 are coming from the paychecks of the employees of this state or is            
 there a federal contribution.                                                 
 MR. HENDERSON remarked he thought there was a federal contribution.           
 REPRESENTATIVE ROKEBERG noted that the people of the state are                
 paying a contribution.                                                        
 Number 748                                                                    
 REPRESENTATIVE DAVIS presented a scenario where AVTC in Seward                
 wanted to establish a police training standards school, where all             
 the state troopers, city policeman and correctional officers could            
 be trained.  He asked how they would go about getting funds for               
 that, other than drawing from the those departments who have a                
 current budget to do that.  He said they pay for the training of              
 troopers and correctional officers and then they give them a job.             
 He asked how would that scenario fit in?                                      
 MR. MICHAELSON said he could give Representative Davis a real life            
 example that involved another industry.  A few years ago with the             
 advent of the community development quota program for the fisheries           
 in the Bering Sea, AVTC wanted to participate and industry needed             
 trained workers.  There was an opportunity to put together a                  
 customized program for residents primarily in the Bering Sea                  
 coastal communities.  AVTC bid on a competitive Request for                   
 Proposal.  He noted the department lets their money out on a                  
 competitive RFP for approximately 70 percent of the training                  
 resources and the balance is made available for individual referral           
 for a direct referral to a preexisting program.  With the                     
 competitive RFP, AVTC did bid and was awarded training funds.  In             
 turn they provided a very valuable training program with in excess            
 of 100 western Alaskans going through that program and being able             
 to secure employment.                                                         
 REPRESENTATIVE DAVIS asked if there was an opportunity to charge a            
 tuition, also?                                                                
 MR. MICHAELSON responded that was correct.                                    
 Number 890                                                                    
 CO-CHAIR BUNDE commented that if there were a number of in-depth              
 questions still remaining about this proposal, he would rather they           
 be addressed to the various departments and the bill would be                 
 brought up again on Thursday, March 28.                                       
 REPRESENTATIVE ROKEBERG stated he would like a breakdown on the               
 statistics for the Anchorage area and the statewide delivery area.            
 He was curious if the Kenai Peninsula and Mat-Su were considered              
 part of the Anchorage delivery area or if they were part of the               
 statewide area.  He also requested information on the formula based           
 on unemployment and population statistics.                                    
 Number 933                                                                    
 CO-CHAIR BUNDE asked the representatives from the various                     
 departments to address Representative Rokeberg's questions.  He               
 announced that HB 435 would be held over until Thursday.                      
 HB 506 - UNIVERSITY FIRE FIGHTING PROGRAM                                   
 Number 963                                                                    
 TOM ACKERLY, Legislative Administrative Assistant to Representative           
 Mike Navarre, said that HB 506 attempts to make a separate entity             
 out of the Mining and Petroleum Training Service (MAPTS) which is             
 currently a university program.  The purpose of doing that is to              
 ensure that its funding is secure and not used by other parts of              
 the university program.  In several past sessions there have been             
 stipulations on the university budget that MAPTS would be able to             
 keep at least $150,000 of the money it makes during the course of             
 the year for the purpose of improving its program and keeping it a            
 state of the art program.  Another part of this is they not only              
 need the carry forward ability, but they also need the ability to             
 accumulate funds because some years they may need $50,000 while in            
 other years they may need $200,000.  Representative Navarre was               
 hopeful that through legislative efforts, MAPTS could be made a               
 stand alone, autonomous program still affiliated with the                     
 university, but ensure its perpetual funding.                                 
 CO-CHAIR BUNDE asked Marylou Burton to present the university's               
 position on HB 506.                                                           
 Number 1083                                                                   
 MARYLOU BURTON, Director of Statewide Budget, University of Alaska            
 Statewide, said the university is neutral on HB 506.  It doesn't              
 appear to expand the university's existing authority to run an                
 effective MAPTS program.  However, the university is supportive of            
 Representative Navarre's intent which they believe is to encourage            
 the industry to support instate training and instate facilities to            
 conduct that training.  The university has no stand on the bill               
 beyond that.                                                                  
 CO-CHAIR TOOHEY asked if the MAPTS program collects fees?                     
 MS. BURTON responded affirmatively.                                           
 CO-CHAIR TOOHEY asked if the fees go into the university budget?              
 MS. BURTON replied yes.                                                       
 CO-CHAIR TOOHEY asked if that gave the MAPTS program some degree of           
 comfort they would be there forever?                                          
 MS. BURTON suspected this bill would give some comfort.  On the               
 other hand, to her knowledge the fees that are collected relative             
 to this program go right into the program.  For example, the                  
 program last year was subsidized with general funds; the amount               
 that was collected relative to the program went into the program,             
 and the university put in approximately another $300,000 last year.           
 CO-CHAIR TOOHEY said she would like some assurance that the                   
 university was aware of the program and would indeed continue to              
 fund the program.                                                             
 MS. BURTON said it was her assumption the university would continue           
 to fund the program.                                                          
 Number 1158                                                                   
 REPRESENTATIVE DAVIS thought this legislation gave a comfort level            
 to the MAPTS program as to their ability to plan.  The                        
 opportunities are becoming more and more abundant as to who they              
 can draw from; their training is becoming necessary worldwide and             
 they've gained the reputation of being able to provide a service.             
 He added that if there is a competitive spirit among the                      
 university, then the best proposal wins.                                      
 CO-CHAIR BUNDE asked if there was further testimony.  Hearing none,           
 public testimony was closed.                                                  
 Number 1225                                                                   
 REPRESENTATIVE ROKEBERG moved to pass HB 506 out of committee with            
 individual recommendations and attached zero fiscal note.  Hearing            
 no objection, it was so ordered.                                              
 Number 1283                                                                   
 CO-CHAIR BUNDE announced the committee would be considering                   
 confirmations appointments.  The first appointment before the HESS            
 Committee was for the Professional Teaching Practices Commission.             
 The slate was Peggy Conner Jones, Anchorage; Bruce F. Johnson,                
 Kodiak; Marsha K. Van Abel, Anchorage; and Jacquie Whitmore,                  
 Number 1332                                                                   
 REPRESENTATIVE ROKEBERG moved to forward the appointment of Peggy             
 Conner Jones, Bruce F. Johnson, Marsha K. Van Abel and Jacquie                
 Whitmore, Professional Teaching Practices Commission.  Hearing no             
 objection, it was so ordered.                                                 
 Number 1371                                                                   
 REPRESENTATIVE ROKEBERG moved to forward the appointment of Joe L.            
 Hayes, Jr. of Fairbanks, University of Alaska Board of Regents.               
 Hearing no objection, it was so ordered.                                      
 Number 1383                                                                   
 CO-CHAIR TOOHEY moved to forward the appointment of Pam Aldersebaes           
 of Juneau, Board of Chiropractic Examiners.  Hearing no objection,            
 it was so ordered.                                                            
 Number 1397                                                                   
 REPRESENTATIVE ROKEBERG moved to forward the appointment of Beverly           
 Haywood of Juneau, Board of Clinical Social Work Examiners.                   
 Hearing no objection, it was so ordered.                                      
 Number 1406                                                                   
 REPRESENTATIVE ROKEBERG moved to forward the appointment of Mary C.           
 Seutter of Wasilla, Board of Dispensing Opticians.  Hearing no                
 objection, it was so ordered.                                                 
 Number 1417                                                                   
 REPRESENTATIVE ROKEBERG moved to forward the appointment of Mercy             
 Dennis, Anchorage; Dixie A. Hood, Juneau; and Sandra M. Samaniego,            
 Fairbanks, Board of Marital and Family Therapy.  Hearing no                   
 objection, it was so ordered.                                                 
 Number 1443                                                                   
 CO-CHAIR TOOHEY moved to forward the appointment of Keith M.                  
 Brownsberger, MD, Anchorage; Beverly Fletcher, Juneau; Donald G.              
 Hudson, DO, Anchorage, Sarah A. Isto, MD, Juneau; Suzanne H.                  
 Lombardi, Anchorage; Donald C. Olson, MD, Nome; and Irvin A.                  
 Rothrock, MD., Fairbanks, State Medical Board.  Hearing no                    
 objection, it was so ordered.                                                 
 Number 1457                                                                   
 REPRESENTATIVE ROKEBERG moved to forward the appointment of Marilyn           
 Holmes of Juneau, Board of Certified Direct-Entry Midwives.                   
 Hearing no objection, it was so ordered.                                      
 Number 1461                                                                   
 REPRESENTATIVE ROKEBERG moved to forward the appointment of                   
 Josephine Malemute of Fairbanks, Board of Nursing.  Hearing no                
 objection, it was so ordered.                                                 
 Number 1467                                                                   
 REPRESENTATIVE ROKEBERG moved to forward the appointment of Chris             
 E. Coursey of Eagle River, Board of Pharmacy.  Hearing no                     
 objection, it was so ordered.                                                 
 Number 1475                                                                   
 REPRESENTATIVE ROKEBERG moved to forward the appointment of Leslie            
 F. Schwartz of Petersburg, State Physical Therapy and Occupational            
 Therapy Board.  Hearing no objection, it was so ordered.                      
 Number 1486                                                                   
 CO-CHAIR TOOHEY moved to forward the appointment of Gail C.                   
 Shortell, Esq., of Anchorage, Board of Psychologist and                       
 Psychological Associate Examiners.  Hearing no objection, it was so           
 Number 1514                                                                   
 CO-CHAIR BUNDE announced that all the confirmations before the HESS           
 Committee had been moved forward.                                             
 Number 1519                                                                   
 CO-CHAIR TOOHEY noted that she had sent out questionnaires to the             
 boards and associations the confirmation nominees were associated             
 with.  She received an affirmative response of every nominee.                 
 CO-CHAIR BUNDE announced a Joint House/Senate HESS Committee                  
 meeting the following day at 9:00 a.m. in the Butrovich Room.                 
 Number 1559                                                                   
 CO-CHAIR BUNDE adjourned the House Health, Education & Social                 
 Service Committee at 4:28 p.m.                                                

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