01/24/2008 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB234 | |
| HB337 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 234 | TELECONFERENCED | |
| *+ | HB 337 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
January 24, 2008
3:05 p.m.
MEMBERS PRESENT
Representative Peggy Wilson, Chair
Representative Bob Roses, Vice Chair
Representative Anna Fairclough
Representative Wes Keller
Representative Paul Seaton
Representative Sharon Cissna
Representative Berta Gardner
MEMBERS ABSENT
All members present
OTHER LEGISLATORS PRESENT
Senator Bettye Davis
COMMITTEE CALENDAR
HOUSE BILL NO. 234
"An Act relating to the education loan repayment program and
establishing the education loan repayment fund."
- HEARD AND HELD
HOUSE BILL NO. 337
"An Act establishing the Alaska Health Care Commission and the
Alaska health care information office; relating to health care
planning and information; repealing the certificate of need
program for certain health care facilities and relating to the
repeal; annulling certain regulations required for
implementation of the certificate of need program for certain
health care facilities; and providing for an effective date."
- HEARD AND HELD
PREVIOUS COMMITTEE ACTION
BILL: HB 234
SHORT TITLE: EDUCATION LOAN REPAYMENT PROGRAM
SPONSOR(s): REPRESENTATIVE(s) JOHNSON
04/13/07 (H) READ THE FIRST TIME - REFERRALS
04/13/07 (H) HES, FIN
05/01/07 (H) HES AT 3:00 PM CAPITOL 106
05/01/07 (H) Heard & Held
05/01/07 (H) MINUTE(HES)
01/24/08 (H) HES AT 3:00 PM CAPITOL 106
BILL: HB 337
SHORT TITLE: HEALTH CARE: PLAN/COMMISSION/FACILITIES
SPONSOR(s): RULES BY REQUEST OF THE GOVERNOR
01/22/08 (H) READ THE FIRST TIME - REFERRALS
01/22/08 (H) HES, FIN
01/24/08 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
JEANNE OSTNES, Staff
to Representative Craig Johnson
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented changes to HB 234, on behalf of
Representative Craig Johnson, sponsor.
RICK CALCOTE, Mental Health Clinician
Division of Behavioral Health
Department of Health & Social Services (DHSS)
Anchorage, Alaska
POSITION STATEMENT: Testified in support of HB 234.
DIANE BARRANS, Executive Director
Postsecondary Education Commission
Department of Education and Early Development
Juneau, Alaska
POSITION STATEMENT: Testified during the hearing on HB 234.
TAMARA COOK, Director
Legislative Legal and Research Services
Legislative Affairs Agency
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
234.
KARLEEN JACKSON, Commissioner
Department of Health & Social Services
Juneau, Alaska
POSITION STATEMENT: Introduced HB 337.
JAY BUTLER, M. D.; Chief Medical Officer
Office of the Commissioner
Department of Health & Social Services
Anchorage, Alaska
POSITION STATEMENT: Participated in the introduction of HB 337.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:05:01 PM.
Representatives Roses, Fairclough, Keller, Seaton, Cissna, and
Wilson were present at the call to order. Representative
Gardner arrived as the meeting was in progress.
3:06:11 PM
HB 234-EDUCATION LOAN REPAYMENT PROGRAM
3:06:27 PM
CHAIR WILSON announced that the first order of business would be
HOUSE BILL NO. 234, "An Act relating to the education loan
repayment program and establishing the education loan repayment
fund."
3:06:52 PM
JEANNE OSTNES, Staff to Representative Craig Johnson, Alaska
State Legislature, informed the committee that concerns about
the bill have been reviewed by Tam Cook, Director, Legislative
Legal and Research Services, Legislative Affairs Agency (LLA),
and that she has allowed an amendment that pertains to the 32
hour work week.
CHAIR WILSON requested that Ms. Ostnes present an overview of
the bill.
MS. OSTNES explained that the bill addresses two areas of
concern for the state: work force needs and the high cost of
education. She noted that the state is experiencing serious
work force shortages and college students are graduating with
high debt due to student loans. House Bill 234 provides a
solution by the creation of a loan repayment program that will
provide relief to college graduates and will fulfill the work
force shortage by attracting qualified people to jobs in
Alaska. The bill offers qualified individuals the repayment, up
to $7,500 per year, of an outstanding student loan debt, not to
exceed five years, or 50 percent of the total. Qualified
individuals are people working in professions that have been
identified by the Department of Labor & Workforce Development
(DLWD) as careers with severe worker shortages. Ms. Ostnes
further explained that the bill will entice students into high
demand programs and attract already qualified people into
professions with a critical workforce shortage to Alaska. In
addition, there is the added benefit of reversing the "brain
drain." The program is open to out-of state workers and will
encourage them to relocate in Alaska.
3:10:33 PM
MS. OSTNES stated that the Department of Administration (DOA)
issued Administration Order No. 237, that formed a work group to
address recruitment and retention issues in the state. She
recalled that Representative Fairclough requested the
identification of the meaning of "full time" and presented an
amendment that read:
Page 2, following line 31:
Insert a new subsection to read:
"(d) For purposes of (c) of this section,
"full time" means working on a regular basis for
a normal work period that averages at least 32
hours a week."
REPRESENTATIVE SEATON asked who determines which occupations
suffer a severe shortage.
MS. OSTNES explained that those occupations are already defined
in AS Sec. 14.43.415(b) (2).
3:13:36 PM
RICK CALCOTE, Mental Health Clinician, Division of Behavioral
Health, Department of Health & Social Services (DHSS),
encouraged the committee to support HB 234. He stated that the
Division of Behavioral Health, Department of Health & Social
Services (DHSS), believes the bill will be a great benefit to
the behavioral health workforce in Alaska. He pointed out that
there are severe shortages in the behavioral health workforce,
in fact, behavioral health vacancies account for 29 percent of
all vacancies in state positions. Further, the cost of
education and subsequent low salaries make the repayment of
college loans difficult, especially for those living in rural
areas.
3:15:47 PM
REPRESENTATIVE FAIRCLOUGH moved Amendment 1.
There being no objection, Amendment 1 passed.
3:16:54 PM
DIANE BARRANS, Executive Director, Postsecondary Education
Commission, Department of Education and Early Development (EED),
informed the committee that there are technical issues regarding
the administration of the program created by HB 234. She
explained that the Postsecondary Education Commission
(commission) is concerned about using the term "grant." In
financial aid terminology, the term grant usually means free aid
delivered as a result of an individual's demonstrated financial
need. However, in HB 234, the term is used as an award for
service in a particular capacity. Ms. Barrans opined that this
issue should be addressed to maintain conformity in statute and
to prevent confusion by the public.
CHAIR WILSON asked for a specific change.
MS. BARRANS suggested making a change from "grant" to "benefit"
on page 2, line 8, and additional conforming changes throughout
the bill.
3:19:43 PM
CHAIR WILSON stated that Tam Cook recommended that there not be
a change and asked Ms. Barrans to discuss it with her before the
bill comes before the next committee.
MS. BARRANS opined that there is understanding, but not
agreement, with Tam Cook. She offered that there must be a
clear communication to the public that this is different than
other grants.
CHAIR WILSON observed that, if [the recipient] does not fulfill
their obligation they will have to...
MS. BARRANS said, "They receive no benefits."
REPRESENTATIVE FAIRCLOUGH offered the substitution of "grant
benefit" for "a grant" or "a benefit" thereby allowing the
language in the document to remain consistent.
3:21:35 PM
MS. BARRANS then pointed out that on page 2, line 23, there is a
concern about the term "otherwise engaged."
CHAIR WILSON explained that, elsewhere in statute, "otherwise
engaged" stands for self-employed people.
MS. OSTNES said that "otherwise engaged" also includes those
working under a contract.
MS. BARRANS stated that the last issue is with respect to Sec.
14.43.438, on page 3, line 11. She explained that,
administratively, the concept of making a predetermination about
someone's future qualification for an award is concerning. A
predetermination could be considered binding, and make the
commission, or the fund, liable for some future action if a
person does not receive an award due to changes in the program
or the applicant's circumstances. In response to a question,
she opined that attempts to avoid similar problems in
regulation, or by contract, often lead to disputes. Ms. Barrans
offered to work with the sponsors and the DLWD; however, she
maintained her concern about the responsibility to predetermine
an individual.
3:25:08 PM
MS. OSTNES informed the committee that Tam Cook indicated that
this problem could be handled in regulation. Furthermore, by
the time the program is available, the DLWD would have the jobs
with shortages for the next 12 months identified, and thus the
program administrator would be in a position to obligate the
funds for distribution in 12 months.
3:25:08 PM
CHAIR WILSON observed that the award is not granted until the
end of 12 months.
3:25:56 PM
REPRESENTATIVE SEATON gave an example of an applicant engaged in
a six year course of study, who wants to know whether they will
qualify and how to ensure eligibility.
CHAIR WILSON pointed out that the applicant needs to be employed
full-time for one year in an occupation or profession with a
severe shortage.
REPRESENTATIVE SEATON stated his confusion with the pre-
eligibility determination section, Sec. 14.43.438. He noted
that the section commits the commission to make a pre-
eligibility assurance that an applicant will qualify for a
grant, whether the funds have been appropriated or not.
REPRESENTATIVE FAIRCLOUGH inquired as to the sponsor's intent of
pre-qualifying a person.
3:29:02 PM
MS. OSTNES explained that the intent is that the person is
already a college graduate and contacts the commission to see if
their occupation is applicable to the program. If so, the
applicant would need to work in the state for one year, and then
submit the request for payment of the student loan.
3:30:46 PM
REPRESENTATIVE FAIRCLOUGH moved Amendment 2, as follows:
Page 3, line 1;
Delete "Continuing"
Page 3, line 13;
Delete "the individual engaged in"
REPRESENTATIVE FAIRCLOUGH explained that the aforementioned
changes would address qualifying the jobs instead of the
individual.
REPRESENTATIVE ROSES objected for discussion purposes.
REPRESENTATIVE FAIRCLOUGH re-stated Amendment 2.
CHAIR WILSON suggested that "future eligibility" on page 3, line
15, be deleted.
REPRESENTATIVE FAIRCLOUGH explained that she did not delete that
because if an applicant enters a five year education program,
they want to know whether the loan program will continue.
REPRESENTATIVE ROSES opined that this is not a solution for
Representative Seaton's concern. He suggested the removal of
the pre-eligibility section and to focus on the bill's purpose
to attract and retain qualified people to jobs in Alaska.
CHAIR WILSON offered an amendment to Amendment 2, as follows:
Page 3, line 14;
Delete "will become"
Insert "is."
3:34:33 PM
REPRESENTATIVE FAIRCLOUGH accepted the amendment to Amendment 2.
She then stated that her purpose in keeping this section is to
allow applicants to determine whether their jobs will remain
eligible; this qualification is not found in the bill,
otherwise.
3:35:54 PM
REPRESENTATIVE ROSES re-stated his choice to eliminate Section
14.43.438. He then suggested that the committee could add the
requirement to post all qualified jobs on a web site.
REPRESENTATIVE SEATON observed that one part of the bill is
meant to offer re-payment of a student loan to qualified workers
who come to Alaska and work for one year. The other part is
encouraging people to begin a course of study for a job in a
pre-qualified field with a promise of re-payment. He stated his
intention to vote against the amendment and pointed out that the
bill defines that the DLWD will make determinations on the
eligibility of jobs.
CHAIR WILSON agreed.
3:38:25 PM
REPRESENTATIVE GARDNER shared her concerns over the goal of the
bill. She then opined that the real question has to do with
changing behavior. She expressed hope that the students who
graduate from the [University of Alaska] nursing program already
fully intend to stay in the state, work in their home
communities, and thus, qualify for the program. She asked, "So,
what have we done with this money?"
3:39:33 PM
CHAIR WILSON commented that, if workers go to areas with severe
worker shortages, the program has changed their behavior.
REPRESENTATIVE GARDNER asked whether state money should go to a
student whose home is in an area of severe shortage, and who is
going to return there, anyway.
REPRESENTATIVE FAIRCLOUGH withdrew Amendment 2.
3:41:22 PM
CHAIR WILSON announced that HB 234 was held in committee.
3:41:42 PM
REPRESENTATIVE SEATON stressed that the bill does not identify
specific areas in the state with shortages. If that is the
intention, he encouraged further clarification by the DLWD.
REPRESENTATIVE FAIRCLOUGH re-stated, for the sponsor, that the
committee, with other departments, is interested in the "grant
benefit" versus "award" language on page 2, line 8.
3:43:02 PM
TAMARA COOK, Director, Legislative Legal and Research Services,
Legislative Affairs Agency, informed the committee that "grant"
is a word already used in the statutes that are being amended,
and in similar programs that are administered by the commission.
However, she stated that the committee can choose a different
word.
3:44:47 PM
REPRESENTATIVE FAIRCLOUGH asked Ms. Barrans to explain her
preference that "grant" not be used.
MS. BARRANS clarified that her concern is that the program is
being nested into traditional student financial aid statute,
however, it is a workforce recruitment program that the
commission is being asked to administer. To use the term
"grant", that is traditionally thought of as a needs-based
grant, is confusing to someone who does not understand the
distinction.
3:46:04 PM
CHAIR WILSON re-stated Ms. Barran's objection.
MS. COOK stated that the distinction has no significance as a
matter of law and either word may be used.
REPRESENTATIVE FAIRCLOUGH expressed the intent to establish for
the legislative record that "grant" and "benefits" are
interchangeable in this case. She also asked for confirmation
that the definition of "otherwise engaged" is "self-employed" or
"on contract."
MS. COOK said that she had no request on that issue. In
response to a question, she said that she used "otherwise
engaged" as preliminary tracking to whatever structure might
exist.
3:48:22 PM
REPRESENTATIVE FAIRCLOUGH further asked Ms. Cook for her opinion
on liability for the state created by Sec. 14.43.438, on page 3,
line 11.
MS. COOK opined that pre-determination could trigger liability
depending on what the commission chooses to tell applicants.
The bill is drafted so that the commission is not required to
establish this procedure. One public policy question is that if
a pre-eligibility determination is made, one may have led
applicants along a path of a moral promise that can not be
fulfilled. Further, if the committee has concerns about these
issues, she recommended deletion of this provision as the
proposed amendments failed to serve a purpose.
REPRESENTATIVE FAIRCLOUGH asked whether the maker will concur
with the deletion of the paragraph.
MS. OSTNES concurred, representing Representative Johnson.
REPRESENTATIVE FAIRCLOUGH moved [Conceptual Amendment 3] which
would delete Section 14.43.438 on page 3.
3:51:16 PM
CHAIR WILSON announced that Conceptual Amendment 3 passed with
no objection.
3:52:37 PM
REPRESENTATIVE ROSES observed that the last issue is down to the
choice of the word grant or benefit, which the sponsor can do
prior to the hearing before the House Finance Committee.
REPRESENTATIVE ROSES then moved to report HB 234 out of
committee with individual recommendations and the accompanying
fiscal notes.
CHAIR WILSON objected and pointed out that the question of
whether areas of labor shortages should be defined still
remains.
REPRESENTATIVE KELLER noted that the definition of severe
shortage must also be addressed; a 15 percent shortage could be
claimed using regional criteria.
REPRESENTATIVE ROSES expressed his concern about making this a
regional issue. If regional shortages are established and
applicants qualify for a job in Fairbanks, and then move to
Anchorage, they may jeopardize their qualification. He stressed
that the objective of the bill was to attract and retain
employees in the state; adding regional definitions will make it
difficult to implement, monitor, and qualify for the program.
CHAIR WILSON asked whether the level of workforce shortage,
established by DLWD, is 15 percent.
MS. OSTNES responded that the level written in statute is 15
percent statewide. She gave the example of recruitment for an
engineer that demonstrated a failure of 15 percent.
3:56:13 PM
MS. BARRANS stated that what has been incorporated in the needs-
based grant statute illustrates the difference between trying to
encourage people into a field of study, and trying to encourage
them into the workforce. She explained that the needs-based
grant program selected 15 percent as a minimum vacancy rate, but
the commission has the discretion to update and publish a
partial list of occupations. Ms. Barrans continued to explain
that the definition is unique to the needs-based grant program
and she questioned whether it was appropriate to apply to this
program.
REPRESENTATIVE CISSNA opined that a financial incentive is
important to filling jobs. With a limited amount of funding,
the commission needs to have the flexibility and freedom to
decide how to fill the most crucial jobs.
CHAIR WILSON asked Ms. Ostnes and Ms. Barrans to work on two
areas before the bill is before the next committee: the wording
on page 1, line 8, regarding the severe shortage of labor; and
the wording on page 2, line 8, regarding "grant", "benefit", or
"award."
MS. BARRANS stated that, as the bill currently reads, an
applicant that is employed in a job of severe workforce
shortage, for at least one year, can submit an application and
qualify for benefits. This is a simply a reward for people who
are already in those jobs.
REPRESENTATIVE GARDNER said that that is her point exactly. The
legislation gives applicants money without changing their
behavior. She asked whether the Department of Education and
Early Development has taken a position on the bill.
4:02:07 PM
MS. BARRANS said no.
REPRESENTATIVE ROSES withdrew his motion to report HB 234 from
committee.
4:02:49 PM
REPRESENTATIVE SEATON gave an example of teachers being
recruited, due to the teacher shortage in the Bush, but instead
the teachers go to work in Anchorage and get $7,500 to repay
their loans. He questioned whether this situation would
accomplish the purpose of the bill and asked for this
possibility to be addressed by the sponsor.
4:04:08 PM
REPRESENTATIVE CISSNA asked whether an applicant qualifies
"after the fact" and for information on job turn-over rates.
She referred to an anticipated report on job turn-over rates.
MS. OSTNES said that the Department of Administration (DOA) is
producing a report on the Alaska workforce that is due out in
February.
REPRESENTATIVE CISSNA observed that the key thing is data so
that the committee can makes its determination based on fact.
REPRESENTATIVE GARDNER opined that merit scholarships can
address shortages across the state as they encourage kids to
obtain their schooling in Alaska, and then stay here to work.
Regarding state employment, she said that she felt that
increasing pay scales for state workers is more effective than
paying people from out of state to come here to work.
CHAIR WILSON pointed out that some of the [workforce] areas can
not be trained in Alaska.
REPRESENTATIVE ROSES recalled that there has been emergency
certification legislation in the past that dealt with areas of
critical need in the field of education. The determination of
critical need in the field of education is reported by
individual school boards to the EED. Therefore, if the DOL
obtains its information from the EED, the source of the
information on shortages is actually the local school boards.
4:07:37 PM
CHAIR WILSON closed testimony on HB 234.
[HB 234 was held over.]
HB 337-HEALTH CARE: PLAN/COMMISSION/FACILITIES
4:09:09 PM
CHAIR WILSON announced that the next order of business would be
HOUSE BILL NO. 337, "An Act establishing the Alaska Health Care
Commission and the Alaska health care information office;
relating to health care planning and information; repealing the
certificate of need program for certain health care facilities
and relating to the repeal; annulling certain regulations
required for implementation of the certificate of need program
for certain health care facilities; and providing for an
effective date."
KARLEEN JACKSON, Commissioner, Department of Health & Social
Services, informed the committee that the first section of HB
337 states the requirement that the Department of Health &
Social Services (DHSS) will implement a statewide health plan
and create the Alaska Health Care Commission. Section 2
establishes a ten-member health care commission with the purpose
to develop a statewide plan to address the quality,
accessibility, and availability of health care in the state. In
addition, the commission will review and approve health care
facility information for placement on an Internet database.
Section 2 also specifies that the plan will contain strategies
for encouraging personal responsibility, reducing health care
costs, access to safe water and wastewater systems, the
development of a sustainable health care workforce, access to
quality health care, and an increase in the number of residents
who are covered by insurance.
REPRESENTATIVE ROSES asked the commissioner to discuss the
composition of the health care commission board. He noted the
lack of care providers.
4:12:10 PM
COMMISSIONER JACKSON explained that commission members include
representatives from different departments of the state, for
example, the Department of Administration (DOA), that need to be
involved in health care. There will also be a member appointed
by the House and one by the Senate, and three citizen members to
provide consumer representation. She observed that the
committee can make changes to the membership of the commission.
4:13:29 PM
REPRESENTATIVE ROSES stated his concern that boards and
commissions that are capable of making policy need to be
represented by stakeholders. He gave the example of the
Professional Teacher Practices Commission. Representative Roses
opined that medical and care giver representatives will be
needed to provide essential data.
4:15:04 PM
COMMISSIONER JACKSON agreed. However, she noted the difficulty
of deciding who will be excluded from the provider seats.
REPRESENTATIVE ROSES opined that excluding everybody is not the
best way.
REPRESENTATIVE GARDNER expressed her agreement with
Representative Roses. She then asked Commissioner Jackson to
explain the need to include a small business owner.
COMMISSIONER JACKSON stated that small business owners do not
often have a voice in health care negotiations.
CHAIR WILSON stated her agreement; the possibility of mandatory
employee insurance coverage for all businesses is an important
issue for small business owners.
4:17:18 PM
REPRESENTATIVE GARDNER added that many health care providers are
also small business owners.
REPRESENTATIVE KELLER expressed his belief that the
representation of many different interest groups will create
gridlock. He encouraged the formation of a small commission
that will not get caught up in disputes.
CHAIR WILSON asked how many members were on the health council.
COMMISSIONER JACKSON answered that there were twelve voting
members and two ex-officio members.
REPRESENTATIVE CISSNA acknowledged that the difficult problem of
health care is a topic that has not been very accessible to
legislators. She stated her concern that, with the high number
of state representatives on the commission, there will not be
enough voices from across the state, especially when developing
policy for the state. In addition, legislators are only now
beginning to get analysis of the most recent health care data
available. Representative Cissna encouraged the study of that
data in order to develop the proper kind of health care
commission.
4:21:59 PM
COMMISSIONER JACKSON advised that there is a component for
travel for the commission to allow for visitations all over
state in order to hear from community stakeholders. She asked
for clarification of Representative Cissna's other concern.
REPRESENTATIVE CISSNA explained that the analysis the
legislators have received is incomplete. In fact, Alaska has
behavioral health treatment studies that have not been reported
to the legislature. She noted that $2 billion is being spent on
health care and asked for details on what amount is being spent
on aspects of behavioral and physical health care.
4:24:19 PM
COMMISSIONER JACKSON informed the committee that there are 70
reports posted on the health care council website.
REPRESENTATIVE CISSNA clarified that she was referring to all of
the divisions within health care. She expressed her intention
to develop a list of issues to address at the next hearing,
including, what the commission needs to look at and from whom it
should hear testimony. The previous health care plan, written
in the 70s and 80s, should be reviewed in order to learn from
the history of the state.
4:26:24 PM
COMMISSIONER JACKSON said that the second component in Section 2
establishes an Alaska health care information office that will
provide, at a website, consistently updated health care facility
information to consumers. She continued to explain that, to
provide health care transparency, the state must provide
consumers with information on the health care industry
including: where to find services; what is the cost; what the
other options are; and the possibility of outcomes for
procedures. Florida has a website currently available to its
residents.
4:29:34 PM
JAY BUTLER, M. D.; Chief Medical Officer, Office of the
Commissioner, Department of Health & Social Services, described
his search for a prescription on the Florida website that
provided information on the price of the prescription at various
pharmacies in the area. The prices ranged from $11 to $41.
Websites in other states allow searches for insurance carrier
coverage and descriptions of services available at health
centers. Dr. Butler provided descriptions of the variety of
information, including prevention, that can be posted.
4:32:28 PM
REPRESENTATIVE ROSES asked whether the prescription quotes
compared brand names with generic equivalents.
DR. BUTLER responded that he was not sure; however, specific
information like this can be designed into the website.
REPRESENTATIVE FAIRCLOUGH asked whether there are multiple
definitions of medical codes. She also asked how a consumer
could compare the costs for different types of fractures.
DR. BUTLER explained that the goal of the information website is
to focus on the greatest majority of health care costs. It
would be impossible to try to capture the costs of all
procedures.
REPRESENTATIVE FAIRCLOUGH asked how expensive it will be for the
state to develop a criteria process, to define the most common
drugs and treatments, so that consumers can make an informed
choice. To protect the physician, accuracy must also be
maintained when quoting rates, and she asked how other states
provide a continuous update of information.
DR. BUTLER stated that the most common procedures are determined
by a review of claims data.
COMMISSIONER JACKSON reminded the committee that the fiscal note
provides for employees to create the web based technical
components of the website, and two health planners who will
begin developing the website using best practices procedures.
Alaska is at the beginning of the process and the health care
commission will be providing many of the details.
REPRESENTATIVE FAIRCLOUGH asked how much Florida spent to
establish its website. She noted that the "software world" can
be very expensive.
REPRESENTATIVE GARDNER suggested that the state could buy the
software from an existing site.
COMMISSIONER JACKSON said that the DHSS would provide answers to
both of these questions at a later date. She continued to
explain that a committee substitute (CS) would be introduced
next week with more detailed information on this section.
REPRESENTATIVE ROSES expressed his support of reporting
information on the Internet. However, he stated his concern
about the potential harm of inaccurate reporting, absent a
strict protocol for the provision of services. He gave an
example of costs that only seemed comparable, and cautioned
about creating an opportunity for improper, unethical, or
illegal behavior.
4:40:08 PM
COMMISSIONER JACKSON agreed and assured the committee that the
site would be under the authority of the chief medical officer.
DR. BUTLER added that an aspect of the disclosure of reporting
is that quality data, like cost data, can be difficult to
determine. There are certain benchmarks; for example, one of
the states reports in-hospital complication rates and mortality
rates, along with costs.
REPRESENTATIVE FAIRCLOUGH recalled that the committee discussed
self medication, over-dosing, and drug seeking. She asked
whether the state can prevent abuse of the system.
4:42:51 PM
DR. BUTLER said that he was not sure how reporting price data
would alter drug seeking behavior.
REPRESENTATIVE FAIRCLOUGH pointed out that medical providers
have testified that advertising a pharmaceutical product
encourages patients to advocate for its use.
CHAIR WILSON expressed her understanding that this bill will put
on-line the cost of health care for an individual who wants to
know how much a procedure will cost, and thus will help people
help themselves.
4:45:06 PM
DR. BUTLER demonstrated how to use the Florida website, using an
illustrative patient and medication.
REPRESENTATIVE FAIRCLOUGH asked whether there is recourse for a
consumer if the information is not accurate.
DR. BUTLER said that he did not know and advised that a consumer
should call the provider and confirm prices. He acknowledged
that the accuracy of the information is critical.
REPRESENTATIVE ROSES related a personal anecdote and re-stated
his caution about the state's website providing "advertising"
for products.
4:50:25 PM
REPRESENTATIVE KELLER stressed the importance of the
individual's responsibility in his or her health care,
particularly in the price that is paid for drugs. He commended
the DHSS for its work.
CHAIR WILSON asked whether the information website was a
recommendation of the health care council.
REPRESENTATIVE GARDNER said yes.
COMMISSIONER JACKSON agreed and noted that the Florida website
was endorsed by the Florida attorney general.
4:51:39 PM
DR. BUTLER continued to demonstrate the comparison of drug
prices on the Florida website.
4:52:48 PM
COMMISSIONER JACKSON said that the proposed bill will require
health care facilities, home and community based waiver
services, and personal care attendants, to provide the DHSS with
information related to their costs, types of insurance,
location, and facilities.
DR. BUTLER added that web site data that is customized and
interactive can make a difference in the prevention of disease.
He related the success of a Kentucky wellness website that
improved the health of state employees.
4:54:36 PM
COMMISSIONER JACKSON informed the committee that part 3 of the
bill, with the exception of Section 5 that establishes
administrative support for the health care commission, addresses
the repeal of the Certificate of Need program. She recalled
that the CON program was put in place to increase access to care
and to keep the cost of facility care down; however, better
tools to serve these purposes are now available. Commissioner
Jackson noted that there are nine active lawsuits that the state
must defend concerning denied CON applications. She referred to
the CS that proposes to repeal the CON by a two year process.
REPRESENTATIVE ROSES reminded the committee that past testimony
regarding the CON was heard last session and the parties were
encouraged to work on a compromise. He expressed his
understanding that the offered compromise has not been
incorporated into the bill.
COMMISSIONER JACKSON expressed her appreciation of the work that
was done by the negotiated rule-making task force. There were
recommendations made, although the recommendations were not
unanimous. Some of the recommendations suggested the addition
of staff for enforcement and data collection. She encouraged
the committee to read the report that was issued by the task
force.
5:00:11 PM
CHAIR WILSON pointed out that the report is very detailed and
will be reviewed at a later hearing.
REPRESENTATIVE GARDNER asked how the health care commission and
health information website is related to the repeal of the CON.
If they are related, she suggested that the repeal should be
delayed until after the commission and website are underway.
5:02:09 PM
COMMISSIONER JACKSON explained that part of the issue is that
the work done so far, by the CON task force, would not remove
current or future lawsuits. She opined that the health care
commission and the website will begin to serve the purposes of
the CON; furthermore, the current lawsuits would become moot
under the proposed bill.
REPRESENTATIVE GARDNER expressed her doubt as to how listing
costs and consumer information will affect the cost to hospitals
of providing necessary services.
REPRESENTATIVE FAIRCLOUGH asked for the purpose of proposing
three bills in one, as opposed to three separate components.
She suggested that the committee could delete the controversial
issue in order to move forward with other components. She
further asked about the liability of an open market and
deregulation.
REPRESENTATIVE CISSNA asked whether there has been a
comprehensive market study done on the communities that may be
affected by the legislation.
5:05:25 PM
COMMISSIONER JACKSON said that she was not aware of one.
[HB 337 was held over.]
5:06:10 PM
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 5:06:10 PM.
| Document Name | Date/Time | Subjects |
|---|