03/04/2008 03:00 PM House HEALTH, EDUCATION & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB337 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| += | HB 337 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH, EDUCATION AND SOCIAL SERVICES STANDING COMMITTEE
March 4, 2008
3:04 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
Representative Mike Hawker
COMMITTEE CALENDAR
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."
- MOVED CSHB 337(HES) OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
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
01/24/08 (H) Heard & Held
01/24/08 (H) MINUTE(HES)
01/31/08 (H) HES AT 3:00 PM CAPITOL 106
01/31/08 (H) Heard & Held -- Assigned to
Subcommittee
01/31/08 (H) MINUTE(HES)
02/09/08 (H) HES AT 9:00 AM CAPITOL 106
02/09/08 (H) Heard & Held
02/09/08 (H) MINUTE(HES)
02/19/08 (H) HES AT 3:00 PM CAPITOL 106
02/19/08 (H) Heard & Held
02/19/08 (H) MINUTE(HES)
02/23/08 (H) HES AT 9:00 AM CAPITOL 106
02/23/08 (H) Heard & Held
02/23/08 (H) MINUTE(HES)
02/26/08 (H) HES AT 3:00 PM CAPITOL 106
02/26/08 (H) Scheduled But Not Heard
03/04/08 (H) HES AT 3:00 PM CAPITOL 106
WITNESS REGISTER
REBECCA ROONEY, Staff
to Representative Peggy Wilson
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Presented the committee substitute for HB
337, on behalf of Representative Wilson.
REPRESENTATIVE MIKE KELLY
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Testified during the hearing on HB 337.
KARLEEN JACKSON, Commissioner
Department of Health and Social Services (DHSS)
Juneau, Alaska
POSITION STATEMENT: Testified during the hearing on HB 337.
STACIE KRALY, Chief Assistant Attorney General
Human Services Section
Civil Division
Department of Law
Juneau, Alaska
POSITION STATEMENT: Answered questions during the hearing on HB
337.
ACTION NARRATIVE
CHAIR PEGGY WILSON called the House Health, Education and Social
Services Standing Committee meeting to order at 3:04:01 PM.
Representatives Cissna, Keller, Seaton, Roses, and Wilson were
present at the call to order. Representatives Gardner and
Fairclough arrived as the meeting was in progress.
Representative Hawker was also present.
HB 337-HEALTH CARE: PLAN/COMMISSION/FACILITIES
3:04:17 PM
CHAIR WILSON announced that the only 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."
3:05:28 PM
REPRESENTATIVE ROSES moved that the committee adopt proposed
committee substitute (CS) for HB 337, Version 25-GH2050\L,
Mischel, 3/3/08, as a working document. There being no
objection, Version L was before the committee.
3:05:44 PM
CHAIR WILSON stated that the committee substitute was drafted
with the perspective of the consumer in mind. She said that it
is the responsibility of the committee to consider what is best
for Alaskans as a whole. Version L includes language from
Representative Hawker's bill regarding the commission and its
responsibilities, and components from the governor's bill and
committee substitute. Regarding the Certificate of Need (CON)
legislation, several changes have been made including: the
exemption of CON in cities and boroughs with a population of
over 110,000 residents; the exemption of Pioneer's Homes,
veteran's homes, tribal health entities, and physician's
offices; the inclusion of definitions as recommended by the
governor; and the addition of many components from HB 407 and HB
347. Chair Wilson announced that the committee will hear an
introduction of the committee substitute and testimony from
Representatives Hawker and Kelly, the Department of Health and
Social Services (DHSS), and the Department of Law (DOL).
3:09:31 PM
REPRESENTATIVE ROSES asked whether it was the chair's intention
to move the bill out of committee.
3:09:47 PM
CHAIR WILSON indicated that was her intention.
3:09:55 PM
REBECCA ROONEY, Staff to Representative Peggy Wilson, Alaska
State Legislature, began her presentation of Version L.
3:10:07 PM
REPRESENTATIVE SEATON asked whether there was a sectional
analysis for Version L.
3:10:22 PM
MS. ROONEY said no. She indicated that she would highlight the
six small changes that were made to Version K.
3:10:30 PM
REPRESENTATIVE GARDNER noted that the Alaska State Hospital and
Nursing Home Association (ASHNHA) has a sectional analysis.
3:10:43 PM
MS. ROONEY stated that Section 1 adds the legislative intent
from Representative Hawker's bill, HB 407. Section 2 provides
for no referrals, thereby prohibiting self-referrals by a
physician in all cases. She continued to explain that Sec. 3
allows for renumbering to accommodate the changes in previous
sections, and Sec. 4 redefines the word "expenditure" to include
only medical equipment and not leases or property costs.
Section 5 contains most of the changes to the Certificate Of
Need program and she pointed out that a CON would be required
for boroughs and municipalities with a population less than
110,000 residents, and for private, municipal, state, and
federal hospitals, psychiatric hospitals, independent diagnostic
testing facilities, tuberculosis hospitals, kidney disease
treatment centers, intermediate care health facilities,
ambulatory surgical facilities and any city with a critical
access hospital. A CON would not be required for Alaska Pioneer
Homes, Alaska Veteran Homes, offices of private physicians with
at least 75 percent ownership, federal tribal health entities,
and boroughs and municipalities with a population of more than
110,000 residents. In addition, a CON would always be required
for nursing homes and residential psychiatric treatment centers.
The governor's amendment provided Sec. 6, that adds definitions
that were pertaining to CON laws, and Sec. 7 creates the new
health care information office. Ms. Rooney indicated that there
was no change to Sec. 18.09.100; however, Sec. 18.09.110
redefines the information database using the governor's
amendment dated February, 2008. Section 18.09.990 also includes
changes to definitions requested by the governor. Section 8
creates the health care commission with the addition of the
purpose of the commission from HB 407; however, the commission
would be advisory, with four members appointed by the governor,
six members appointed by the public, and six members appointed
by the legislature. Subsection (c) defines the terms of office.
Subsections (d) through (k) outline the support and employees of
the commission, the requirements for by-laws, and a description
of the commission's deliverables, for example, the commission
must present an annual report to the legislature that meets
certain requirements and deadlines. Ms. Rooney concluded that
Sec.(s) 9, 10, 11, and 12, have no changes.
3:16:13 PM
REPRESENTATIVE SEATON asked whether the annual report by the
commission would be an "in-person" report to the legislature.
3:16:41 PM
MS. ROONEY indicated yes.
3:17:05 PM
CHAIR WILSON invited Representative Hawker to testify. He
declined.
3:17:54 PM
REPRESENTATIVE MIKE KELLY, Alaska State Legislature, informed
the committee that he is a volunteer member of the Fairbanks
Community Hospital Foundation and was formerly a member of the
National Committee on Governance for the American Hospital
Association. He shared his previous experience with complicated
and difficult issues such as the CON program. Representative
Kelly stated that the bill he sponsored, HB 345, was a
compromise that recognized that those in the medical industry,
who have billions of dollars invested in facilities and who
provide essential services to everyone, need a voice in the
debate over CON laws. He opined that HB 345 would have settled
80 percent of the outstanding lawsuits pertaining to this issue.
Representative Kelly expressed his support of competition;
however, he urged caution in order to protect the system that
serves 600,000 Alaskans. He concluded that his preference would
be to pass HB 345 out of the committee.
3:21:03 PM
CHAIR WILSON said that she does not want to negate the work that
was done outside of the committee and by the governor's
negotiated rule making committee. She noted that the negotiated
rule making committee issued its recommendations at a 70 percent
level of agreement; however, there was a lot of compromise
achieved. Representative Wilson acknowledged that hospitals
still need the Medicare and Medicaid reimbursement issues
addressed; in fact, this concern influenced the decision to
retain the CON program for most of the cities in Alaska. She
opined that Anchorage was the only area appropriate for
competition in an open marketplace. Chair Wilson indicated that
the DHSS will testify and then the committee will hear
amendments.
3:24:50 PM
REPRESENTATIVE ROSES clarified that the intent of the bill is
that every area in Alaska is exempt, except for Anchorage.
CHAIR WILSON agreed.
3:25:57 PM
REPRESENTATIVE SEATON pointed out that there are two different
definitions of "health care facility."
3:26:32 PM
CHAIR WILSON explained that the different definitions are found
in different chapters.
3:26:50 PM
KARLEEN JACKSON, Commissioner, Department of Health and Social
Services (DHSS), reminded the committee that, with the
introduction of the health care transparency act, the first
intent of the governor was to create a health care commission
charged with developing a statewide plan that was responsive to
changing demographic market conditions and that can guide
private and public investments. She suggested that the
committee substitute moves the commission away from the planning
function desired by the governor. The second purpose of the
original bill was to give Alaskans new tools and options for
their individual health care through a web based information
source. Ms. Jackson opined that there has been a loss of focus
on the content of the database by the commission. Thirdly, the
governor's bill sought to enhance health competition between the
providers of health care through the repeal, not the
modification, of CON laws.
3:29:25 PM
STACIE KRALY, Chief Assistant Attorney General, Human Services
Section, Civil Division, Department of Law, offered to point out
items she noted in her review of the committee substitute. She
began her comments related to Sec. (s) 4, 5, and 6, of the bill.
3:30:35 PM
REPRESENTATIVE ROSES expressed his concern that Sec. 2 may
attempt to supersede federal law enacted by the Stark
amendments.
3:30:56 PM
MS. KRALY stated that she also has concerns about the Stark
amendments. The intent of the bill was that it relates to
referrals for non Medicare and non Medicaid payments; thus it
was not intended to conflict with federal law. She suggested
that the language needs to be more precise and may be corrected
by drafting. However, there are other issues about the
potential restraint of trade. Additional time and information
is needed to review this issue and her opinion will be offered
at a later time.
3:32:19 PM
REPRESENTATIVE ROSES then asked about the restriction on self-
referring. He gave an example of a small town with a sole
provider and asked whether the sole provider would be unable to
provide services without being subject to the restriction on
self-referral.
3:33:56 PM
MS. KRALY agreed that there is a cause for concern about how
this restriction was drafted. This question has been raised and
is beyond her area of expertise.
3:34:18 PM
CHAIR WILSON stressed that the language states, "the department
may seek." She opined that the DHSS would know the
circumstances of the provider in a rural area, thus there would
not a problem because the department has discretion.
3:35:15 PM
MS. KRALY maintained her concern about the administrative issues
surrounding the enforcement of the fine in small communities
versus larger communities.
3:35:42 PM
REPRESENTATIVE ROSES concurred.
3:36:14 PM
MS. KRALY explained that Sec. 4 amends the statutory definition
of expenditure under AS 18.07.031, and that the intent was to
only address the cost of medical equipment. She raised the
point that, although the intent was to increase the monetary
threshold, the committee should decide whether the legislative
intent was that expenditures need to be limited to health care
costs and not include construction costs. Ms. Kraly inferred
that this language may create loopholes.
3:38:16 PM
REPRESENTATIVE SEATON asked whether intent language can counter
the present statutory language. He requested new proposed
language.
3:39:00 PM
MS. KRALY turned to Sec. 5, that deals with definitions under
the CON program. She pointed out that on page 4, line 4, the
inclusion of "federal" creates an unintended conflict with the
exceptions to "health care facility" on line 22 and 23. She
stated that by this language a federal facility is both included
and then excluded. In addition, clarification is needed to
state whether this provision also applies to military
facilities. She continued to say that the language in this
section also excludes Anchorage from CON policies, except for
nursing homes and residential psychiatric treatment facilities,
and provides for CON policies everywhere else in the state.
3:40:48 PM
REPRESENTATIVE ROSES asked Ms. Kraly to repeat her statement on
the exclusions from CON policies.
3:41:05 PM
MS. KRALY re-stated that there is no CON required for the
Anchorage area, except for nursing homes, and residential
psychiatric treatment facilities. Certificates of Need are
required for everywhere else in Alaska, including nursing homes
and residential psychiatric treatment centers (RPTC)s.
3:41:37 PM
REPRESENTATIVE ROSES agreed that everyone in the state needs to
use CON except Anchorage, which is exempt.
3:42:33 PM
MS. KRALY then said that Anchorage is exempt for all, including
nursing homes and RPTCs. She remarked:
As I am reading this, Anchorage is exempt for
everything, including nursing homes and residential
psychiatric treatment centers. And I don't know if
that was the intent of the chair.
3:43:36 PM
CHAIR WILSON said it was not.
3:43:46 PM
MS. KRALY called the committee's attention to page 4, lines 22
and 23, and suggested that military health facilities should
also be included in the exception for "tribal health entities
funded or operated by the federal government." In answer to a
question, she opined that there needs to be a specific reference
to "military facilities." Next, she expressed her understanding
of the compromise that resulted in the use of 75 percent
ownership for the definition of physician's office; however,
she stated her concern that the definition creates an exemption,
rather than providing an actual definition. Ms. Kraly suggested
that the definition should be moved to the definition section
under AS 18.07.111, rather than located in the definition of
"health care facility." Again, in Sec. 6, she suggested that
"physician's office" should be a definition, as opposed to an
inclusion within what is constituted as a health care facility.
Further, she advised that on page 6, line 10, "health care
providers licensed in the state" should read "health care
providers licensed and authorized in the state."
3:46:28 PM
REPRESENTATIVE GARDNER asked whether the language should read
"licensed or authorized."
3:46:59 PM
MS. KRALY said, "Either or." Her next comment was that there
are two definitions of health care facility in the bill, one for
CON purposes and one for the health care information office.
She pointed out that the definition on page 8, line 29,
references a facility licensed under AS 47.32; however, not all
facilities licensed under that statute are health care
facilities. Ms. Kraly urged the committee to further review the
language. Finally, Ms. Kraly opined that the transition
language for the administrative appeals should stay, but would
not resolve many of the lawsuits.
3:49:39 PM
CHAIR WILSON related that Jean Mischel, Legislative Legal and
Research Services attorney and drafter of Version L, advised
that nursing homes and RPTCs must have CONs statewide, including
Anchorage.
3:50:25 PM
REPRESENTATIVE GARDNER asked for Ms. Kraly to repeat her opinion
on the effect of this bill on pending lawsuits.
3:51:01 PM
MS. KRALY clarified that the original transition language from
the governor's bill, that repealed CON policies, would have
resolved all of the litigation. In fact, this committee
substitute will resolve only the litigation related to cases in
the Anchorage area and will not affect cases related to the
Fairbanks or Mat-Su areas.
3:51:51 PM
CHAIR WILSON said, "We were told that if we tightened up the
definitions, ... that would take care of [the lawsuits]."
3:52:13 PM
MS. KRALY acknowledged that there could be some resolution of
outlying issues; but the difficulty with the definition of the
physician's office remains. If HB 337 is enacted, with the CON
program continuing in some fashion, the language is compromised
and does not go as far as needed.
3:53:04 PM
CHAIR WILSON observed the difficulty of making decisions, when
changes are made.
MS. KRALY re-stated that the transition language in the bill has
remained the same, but the amendment has changed the repeal of
CON policies, thus the change in the effect of the bill on
pending litigation.
3:54:01 PM
COMMISSIONER JACKSON thanked the committee for its work and
encouraged a quick resolution of the bill.
3:54:51 PM
The committee took an at-ease from 3:54 p.m. to 3:56 p.m.
3:56:24 PM
REPRESENTATIVE GARDNER offered Amendment 1, identified as
GH2050\L.1, which read:
Page 1, lines 2 - 3:
Delete "relating to the certificate of need
program for certain health care facilities"
Insert "authorizing a study of the certificate of
need program"
Page 4, line 1, through page 5, line 14:
Delete all material.
Renumber the following bill sections accordingly.
Page 11, line 31, through page 12, line 7:
Delete all material and insert:
"* Sec. 7. The uncodified law of the State of
Alaska is amended by adding a new section to read:
CERTIFICATE OF NEED STUDY. The Department of
Health and Social Services may contract with an
independent entity to conduct a study of the
effectiveness of the certificate of need program in
the state in fulfilling the purpose of the program.
The department shall present a report to the
legislature on the study when it is completed."
Page 12, lines 14 - 15:
Delete all material and insert:
"* Sec. 9. Sections 7 and 8 of this Act take effect
immediately under AS 01.10.070(c).
* Sec. 10. Except as provided in sec. 9 of this
Act, this Act takes effect July 1, 2008."
CHAIR WILSON objected.
REPRESENTATIVE GARDNER recalled that she has received plenty of
conflicting data regarding the effects of CON policy on other
states. She opined that it is premature to make major
modifications, or to repeal the law, when there has not been a
study specific to Alaska. Amendment 1 would eliminate the
repeal of CON policy in Anchorage and would authorize a study of
the CON program, and its effects in Alaska, by an independent
third party.
3:58:42 PM
CHAIR WILSON observed that the amendment changes the title of
the bill and asked what was being deleted on page 4.
3:59:09 PM
REPRESENTATIVE GARDNER responded that the deletion eliminates
the reference to population that eliminates Anchorage from the
CON program.
3:59:53 PM
CHAIR WILSON suggested authorizing the study to take place prior
to the sunset date of the bill.
4:00:13 PM
REPRESENTATIVE GARDNER expressed her belief that a further
change, after five years, would result in another huge battle.
She stated the advantages of having a source of information
before decisions are made.
4:00:47 PM
REPRESENTATIVE CISSNA opined that Anchorage is the only place in
the state where the CON could be repealed without endangering
the economy; however, the strong economy in Anchorage may be
because of the health care industry. She pointed out that
Anchorage hospitals can be full at times. Furthermore, the
different hospitals operate on different economic systems.
Representative Cissna supported the authorization of a study to
provide facts to the health care commission.
4:03:00 PM
REPRESENTATIVE GARDNER cautioned the committee against enacting
legislation that inhibits businesses to operate independently,
especially without sufficient reason.
4:03:45 PM
REPRESENTATIVE KELLER stated his opposition to the amendment.
He recalled that legislative members spent the summer looking
for ways to avoid future problems due to high medical costs. He
observed that the market system has always worked and expressed
his support for a partial elimination of the CON. One of the
goals is for the consumer to become invested in his or her
health care.
4:05:59 PM
REPRESENTATIVE ROSES stated that his concern with the amendment
is that the public's perception may be that the legislature is
unwilling to take a position and vote. The study can be done
and the information given to the commission, but he spoke in
opposition to the amendment at this time.
4:07:14 PM
REPRESENTATIVE GARDNER stressed that she wants to make an
informed vote, which is not possible at this time. She added
that health costs are increasing in states with and without CON
policies, primarily due to pharmaceuticals, and a study will
reveal the effects of CON policies, if they exist.
CHAIR WILSON offered a conceptual amendment to the amendment
such that an additional purpose of the commission is to have a
study by the University of Alaska (UA) to see if CON policies
are beneficial to the state.
4:09:51 PM
REPRESENTATIVE GARDNER objected to the designation of the UA for
the study.
CHAIR WILSON withdrew her amendment to the amendment.
4:11:32 PM
A roll call vote was taken. Representatives Gardner and Cissna
voted in favor of Amendment 1. Representatives Keller, Seaton,
Roses, and Wilson voted against it. Therefore, Amendment 1
failed by a vote of 2-4.
4:12:09 PM
CHAIR WILSON offered Conceptual Amendment 2 to page 9, line 15,
which read:
(3) recommend an independent study on the pros and
cons of CON.
REPRESENTATIVE SEATON objected and asked about the commission's
role.
4:13:09 PM
[There ensued a brief discussion regarding the role of the
commission versus the role of DHSS in authorizing a study.]
4:13:28 PM
REPRESENTATIVE CISSNA suggested that the study should be
implemented as soon as possible.
4:13:57 PM
REPRESENTATIVE ROSES offered a conceptual amendment to Amendment
2 that specifies that the DHSS shall undertake a comprehensive
study to evaluate the impact of Certificate of Need on health
care for the state.
4:14:36 PM
REPRESENTATIVE KELLY observed that this will create tension
between the commission, which is instructed to produce a
statewide plan, and the DHSS.
4:15:21 PM
CHAIR WILSON advised that the study of CON policies is not
necessarily an obligation of the health care commission.
4:15:49 PM
REPRESENTATIVE GARDNER agreed and added that the results of the
study may be of interest to the committee, whether it implements
any of the suggestions, or not.
4:16:07 PM
REPRESENTATIVE ROSES questioned whether the commission has the
authority to spend funds or to contract for a study; thus the
DHSS may have to do this.
4:16:57 PM
CHAIR WILSON suggested that the commission can begin its work
simultaneously.
4:17:11 PM
REPRESENTATIVE CISSNA reminded the committee that HB 337
continues to address CON policies. The CON program is one of
the few regulatory statutes by which the state protects
communities with a safety net of services. She opined that, the
state has growing problems in that area, and since the bill
addresses the CON program, it seems to be a good idea to have an
independent study to help the commission.
CHAIR WILSON agreed.
4:18:33 PM
REPRESENTATIVE KELLY withdrew his objection.
4:18:50 PM
REPRESENTATIVE SEATON objected and asked Representative Roses to
repeat the amendment.
4:18:59 PM
REPRESENTATIVE ROSES re-stated that the amendment will provide
direction for the DHSS to contract for an independent and
comprehensive study to determine the impacts of Certificates of
Need on the state.
REPRESENTATIVE SEATON withdrew his objection.
4:19:22 PM
There being no further objection, the conceptual amendment to
Amendment 2 was adopted.
REPRESENTATIVE GARDNER withdrew her objection to Amendment 2.
4:19:54 PM
There being no further objection, Amendment 2 [as amended] was
adopted.
4:20:17 PM
REPRESENTATIVE SEATON offered Amendment 3, 25-GH2050\L.3, which
read:
Page 1, line 4:
Delete "physician-owned health care facilities"
Insert "health care facilities in which the
physician has a financial interest"
Page 2, lines 11 - 14:
Delete "that is owned by the physician. A
physician may, however, provide the name of a facility
that is owned by the physician to a patient on a list
with other health care facilities operating in the
community."
Insert "in which the physician has a direct or
indirect financial interest unless the physician
discloses the financial interest to the patient and
provides written information about known options. In
this subsection, "financial interest" means a legal or
equitable interest in the ownership or operation of
the health care facility."
4:20:49 PM
CHAIR WILSON objected.
4:20:53 PM
REPRESENTATIVE SEATON observed that much of the testimony on HB
337 focused on the problems of Fairbanks. He noted that the
medical health care statistics used for Fairbanks and environs
were skewed by the fact that the medical population included the
Indian Health Service (IHS) and military members. He informed
the committee that this amendment directs, on page 4, line 10,
the deletion of "110,000 or less" and inserts "60,000 or fewer
persons, excluding recipients of health care services provided
by the United States military or the Indian Health Service."
4:22:16 PM
CHAIR WILSON expressed her understanding of the intent to
exclude military hospitals; however, at this time, many military
hospitals are understaffed due to the active posting of staff,
and military dependents are being served by non-military
hospitals. She asked whether this situation should be taken into
account.
4:23:02 PM
REPRESENTATIVE SEATON agreed that military family members are
often treated in health care facilities off-base and clarified
that the intent of the amendment was to exclude military
personnel, not family members. He offered to make this a
conceptual amendment as the written amendment submitted by
Legislative Legal and Research excluded military family members.
Representative Seaton explained the process that resulted in the
population limit of 60,000 citizens. He called the committee's
attention to a population chart on which Alaska city and borough
populations were adjusted by subtracting Native and military
populations, to determine whether 60,000, minus those
populations, was a reasonable "cut-off" number. He pointed out
that the Mat-Su Borough, the Fairbanks North Star Borough, and
the City of Anchorage are all well above 60,000. The Kenai
Peninsula Borough is the closest below with an adjusted
population of 46,220. He opined that the 60,000 number would
not be reached by changes in population in the near future.
4:26:10 PM
REPRESENTATIVE CISSNA surmised that Representative Seaton was
assuming that the removal of the CON program would not harm the
delivery of health care services for the three communities of
Fairbanks, Mat-Su, and Anchorage.
4:26:47 PM
REPRESENTATIVE SEATON recalled testimony from Fairbanks that
patients must travel to Anchorage for services because an
ambulatory surgery center is not available in Fairbanks due to
the CON program. In addition, testimony from the Mat-Su area
also supports more diversity in health care. He expressed his
belief that those three boroughs have dynamic and large
populations that will allow competition in the areas of
ambulatory surgery centers and imaging centers.
4:28:32 PM
REPRESENTATIVE CISSNA stated that Representative Gardner's
amendment [for a study] made sense because the emotional
testimony presented on this issue did not match Representative
Cissna's experience in those communities. She pointed out that
the state is headed for uncertain times and was reluctant to
make sweeping changes. In fact, she heard that Fairbanks and
the Mat-Su were already having problems providing enough health
care for those moving in from outlying areas. Representative
Cissna urged the committee to move slowly.
4:30:49 PM
CHAIR WILSON shared that at Fairbanks Memorial Hospital, there
are only four doctors that can not use the facilities.
4:31:13 PM
REPRESENTATIVE KELLER heard that there were scheduling issues
for some of the doctors and that the level of use, compared to
that of the hospital doctors, may be part of the question. He
then asked whether there were population guidelines for critical
access care hospitals.
4:32:03 PM
REPRESENTATIVE SEATON responded that there is a population
guideline that limits health facilities within 70 miles of a
critical access hospital.
4:32:23 PM
REPRESENTATIVE KELLER pointed out that critical access hospitals
have the revenue advantage of billing on a cost basis;
furthermore, they are often owned or managed by big health care
companies. Therefore, a financial arrangement can be made such
that a patient, who lives in an area with a critical care access
hospital, but who is a patient at a hospital in Anchorage can be
returned to his own community for treatment.
4:33:32 PM
CHAIR WILSON stated that the critical access designation and
rate is "locked-in" for several years.
4:33:53 PM
REPRESENTATIVE GARDNER recalled the rationale for removing the
CON program in Fairbanks and suggested that a more prudent
solution would be to find a way to legislatively encourage
Fairbanks Memorial Hospital to allow the "pain docs" to use the
facilities there.
4:34:37 PM
REPRESENTATIVE KELLER said that he was supporting the amendment
because it was a reasonable compromise.
4:34:53 PM
REPRESENTATIVE FAIRCLOUGH expressed her appreciation of the
testimony from all sides of the issue. She said that she
supports the amendment, but not the bill. By lowering the
threshold, there will be more communities affected by
competition. She opined that this creates a rural and urban
divide in that smaller communities believe that larger
communities are better able to regulate competition.
Representative Fairclough said that she believes that the
governor's proposal was usable, but the legislature has not been
able to do as much research into the community and relies on the
response of interested parties. She stated her support for
competition and would support the elimination of the CON
program; however, the consequences should be mitigated.
4:37:21 PM
REPRESENTATIVE SEATON concluded that the 60,000 population
number was originally in Representative Kelly's bill and is
supported by the research into the population that does not
receive medical service. He opined that this [number] is a good
place to be for the short time frame and still exempts nursing
homes, residential psychiatric treatment centers, and critical
care access hospitals.
4:38:47 PM
A roll call vote was taken. Representatives Fairclough, Roses,
Seaton, and Keller voted in favor of Conceptual Amendment 3.
Representatives Gardner, Cissna, and Wilson voted against it.
Therefore, Conceptual Amendment 3 was adopted by a vote of 4-3.
4:39:47 PM
REPRESENTATIVE ROSES offered Conceptual Amendment 4, which read:
Page 7, Line 8
Insert "(D) usual and customary fee structure and
method of determination"
4:39:56 PM
CHAIR WILSON objected.
REPRESENTATIVE ROSES explained that this amendment is an
addition to the list of mandated reported information for the
information office database.
CHAIR WILSON removed her objection.
REPRESENTATIVE GARDNER objected, and removed her objection.
There being no further objection, Conceptual Amendment 4 was
adopted.
REPRESENTATIVE GARDNER withdrew Amendment 5.
4:41:14 PM
REPRESENTATIVE KELLER offered Conceptual Amendment 6, which
would delete Section 2.
4:41:23 PM
CHAIR WILSON objected.
REPRESENTATIVE KELLER explained that this amendment deletes
Section 2 of the bill. He offered this amendment due to the
fact that there has not been any testimony on this section and
there was confusion about the language.
4:42:41 PM
REPRESENTATIVE SEATON asked whether the amendment deletes the
title portion and Section 2.
4:43:06 PM
CHAIR WILSON recalled that there was discussion of the Stark
amendments that prohibit doctors from self-referral of Medicare
and Medicaid patients. She spoke of the value of the same
protection for non Medicaid and non Medicare patients.
4:45:19 PM
REPRESENTATIVE GARDNER asked whether the amendment solves the
problem of self-referral when there is only one choice of a
medical service in a community.
4:45:47 PM
REPRESENTATIVE ROSES answered that the amendment would take out
all of Section 2; therefore, there would no longer be a
restriction on self-referral.
4:46:11 PM
REPRESENTATIVE SEATON spoke in support of the amendment. He
noted that the definitions and regulations in Section 2 are
problematic and outside of the area of legislative control.
4:47:33 PM
A roll call vote was taken. Representatives Cissna, Gardner,
Fairclough, Keller, Seaton, and Roses voted in favor of
Conceptual Amendment 6. Representative Wilson voted against it.
Therefore, Conceptual Amendment 6 was adopted by a vote of 6-1.
4:48:49 PM
REPRESENTATIVE KELLER withdrew Amendment 7.
4:49:25 PM
REPRESENTATIVE KELLER offered Conceptual Amendment 8, labeled
25-GH2050\K.3, Mischel, 3/3/08, which read:
Page 9, line 11:
Delete "issues"
Insert "policy options"
Page 9, line 14:
Delete "and foster"
Page 9, line 16, following "state":
Insert ";
(3) to provide an annual report to the
legislature that includes a comprehensive list of
policy options considered by the commission; and
(4) to advocate for policy options
recommended by the commission within advocacy
guidelines developed by the commission and reported to
the legislature in the annual report"
4:49:29 PM
REPRESENTATIVE SEATON objected.
4:49:45 PM
REPRESENTATIVE KELLER explained that replacing "issues" with
"policy options" would encourage the commission to look at
health care policies and make recommendations. Furthermore, the
amendment directs the commission to include a comprehensive list
of policy options in its annual report.
4:52:27 PM
CHAIR WILSON asked whether legislators would be giving up their
responsibility to direct policy.
4:52:58 PM
REPRESENTATIVE KELLER said that was what he was trying to avoid;
the commission would be required to include policy options in
its recommendations.
4:53:06 PM
CHAIR WILSON recalled that the governor's council made
recommendations that were not necessarily policy.
4:53:17 PM
REPRESENTATIVE KELLER asked the committee to keep in mind that
the commission needs to know that the legislature expects it to
be alert to all of the policy options available and should
include in its report everything that has been considered.
4:54:07 PM
REPRESENTATIVE CISSNA observed that there are various stages of
policy development, starting with citizen participation. She
acknowledged the value in the commission's annual report; but
wanted to avoid any duplication. In addition, having the
commission present its report to the legislature adds strength
to its recommendations.
4:55:30 PM
REPRESENTATIVE KELLER assumed that his amendment applies to the
commission's annual report to the legislature.
4:55:44 PM
REPRESENTATIVE GARDNER pointed out that the pertinent language
is on page 11, beginning at line 13, of the bill.
4:56:06 PM
REPRESENTATIVE KELLER continued to explain that his amendment
would also delete "and foster" from page 9, line 14, and add
language that directs the commission to set criteria for the
advocacy of its recommendations.
4:57:18 PM
REPRESENTATIVE ROSES observed that replacing "issues" with
"policy options" creates a redundancy in the language of the
bill. He opined that the intent of the purpose as it is written
is that the commission is to look at all of the issues related
to health care in the state and then formulate and target policy
recommendations.
4:58:40 PM
REPRESENTATIVE KELLER accepted a friendly amendment.
4:59:02 PM
REPRESENTATIVE ROSES offered Amendment 1 to Conceptual Amendment
8, which would eliminate the change of the term "issues" to
"policy options" on page 9, line 11. There being no objection,
Amendment 1 to Conceptual Amendment 8 was adopted.
4:59:29 PM
REPRESENTATIVE GARDNER offered Amendment 2 to Conceptual
Amendment 8, which would eliminate the insertion of paragraph
(4) of Conceptual Amendment 8, as amended, on page 9, line 16.
She said that the methods of advocacy are well understood.
4:59:56 PM
REPRESENTATIVE KELLER spoke about the possibility of commission
members advocating for options that may be of a financial
benefit to the members; therefore, there is a need for the
commission to establish advocacy guidelines.
5:01:06 PM
CHAIR WILSON disagreed due to the fact that the commission is an
advisory board.
5:01:33 PM
REPRESENTATIVE GARDNER added that there is the responsibility to
interpret the source of one's recommendations.
5:02:06 PM
REPRESENTATIVE KELLER accepted a friendly amendment that would
delete lines 12, 13, and 14 of the written amendment.
5:02:20 PM
REPRESENTATIVE CISSNA reminded the committee of the severity of
some of the issues in the state and expressed her hope that the
commission will work on tough issues that require change. If
this commission bases its recommendations on consensus, some
ideas may not be heard. She stated her support for retaining
lines 12, 13 and 14 of the written amendment.
A roll call vote was taken. Representatives Roses, Gardner,
Fairclough, Seaton, and Wilson voted in favor of Amendment 2 to
Conceptual Amendment 8, as amended. Representatives Cissna and
Keller voted against it. Therefore, Amendment 2 to Conceptual
Amendment 8, as amended, was adopted by a vote of 5-2.
5:04:48 PM
REPRESENTATIVE SEATON offered Amendment 3 to Conceptual
Amendment 8, as amended, which would eliminate the deletion of
"and foster: on page 9, line 14. There being no objection,
Amendment 3 to Conceptual Amendment 8, as amended, was adopted.
REPRESENTATIVE GARDNER understood that the amendment is
conceptual and may be moved to the section of the bill that
describes the report.
REPRESENTATIVE KELLER agreed that the amendment is conceptual,
but re-stated that it needs to be included in the purposes of
the commission.
REPRESENTATIVE SEATON removed his objection to Conceptual
Amendment 8, as amended, which now read:
Page 9, line 16, following "state":
Insert ";
(3) to provide an annual report to the
legislature that includes a comprehensive list of
policy options considered by the commission; and
There being no further objection, Conceptual Amendment 8, as
amended, was adopted.
5:07:03 PM
REPRESENTATIVE KELLER offered Amendment 9, labeled 25-
GH2050\K.4, Mischel, 3/3/08, which read:
Page 10, line 9:
Delete "if there is no minority organizational
caucus in a house, the presiding officer of that house
shall appoint three members from the majority
organizational caucus of that house"
Insert "at least one legislator from each house
must be a member of the standing committee that has
jurisdiction over the Department of Health and Social
Services"
5:07:12 PM
CHAIR WILSON objected. She questioned why the deletion was
necessary.
5:07:18 PM
REPRESENTATIVE KELLER explained that page 10, line 8 and line 9,
was a new and interesting issue that warrants a thorough
discussion and should be deleted at this time for efficiency.
5:09:09 PM
REPRESENTATIVE SEATON expressed his belief that there has been a
time in which there was a single caucus in one body; to address
this possibility is the purpose of this language and it should
remain.
5:09:38 PM
REPRESENTATIVE KELLER asked whether the amendment can be split.
CHAIR WILSON offered Amendment 1 to Amendment 9 that would
delete lines 2, 3, and 4 of the written amendment. Therefore,
the deletion of the language "if there is no minority
organizational caucus in a house, the presiding officer of that
house shall appoint three members from the majority
organizational caucus of that house" from page 10, line 9, would
not occur.
REPRESENTATIVE FAIRCLOUGH objected.
5:10:09 PM
REPRESENTATIVE ROSES clarified that the amendment is conceptual.
A roll call vote was taken. Representatives Seaton, Cissna,
Gardner, and Wilson voted in favor of Amendment 1 to Amendment
9. Representatives Fairclough, Keller and Roses voted against
it. Therefore, Amendment 1 to Amendment 9 was adopted by a vote
of 4-3.
5:11:52 PM
REPRESENTATIVE SEATON removed his objection to Conceptual
Amendment 9, as amended. There being no further objection,
Conceptual Amendment 9, as amended, was adopted.
5:12:30 PM
REPRESENTATIVE KELLER moved Amendment 10, labeled 25-GH2050\K.5,
Mischel, 3/3/08, which read:
Page 9, line 17, following "members":
Insert "who are residents and qualified voters in
the state"
Page 11, line 25, following "(j)":
Insert "A commissioner shall file a financial
disclosure statement consistent with AS 39.50."
5:12:38 PM
REPRESENTATIVE SEATON objected.
5:12:43 PM
REPRESENTATIVE KELLER explained that the amendment requires that
members of the commission would be residents and qualified
voters in the state. In addition, it requires that a
commissioner shall file a financial disclosure statement.
CHAIR WILSON split the amendment into Amendment 10 and Amendment
11, such that Amendment 10 only addresses the insertion on page
9, line 17.
5:14:09 PM
Hearing no objection, Amendment 10 was adopted.
5:14:37 PM
REPRESENTATIVE KELLER moved Amendment 11, which read:
Page 11, line 25, following "(j)":
Insert "A commissioner shall file a financial
disclosure statement consistent with AS 39.50."
5:14:50 PM
REPRESENTATIVE ROSES objected.
5:14:54 PM
REPRESENTATIVE KELLER explained that the language for this
amendment was from another state board. He stressed that
commission members need to disclose financial interests.
5:15:14 PM
REPRESENTATIVE ROSES pointed out that the ethics policy enacted
last year requires that all members of commissions are required
to file financial disclosure statements.
REPRESENTATIVE KELLER withdrew Amendment 11.
5:16:16 PM
REPRESENTATIVE KELLER offered Conceptual Amendment 12, labeled
25-GH2050\K.6, Mischel, 3/3/08, which read:
Page 10, lines 6 - 11:
Delete all material and insert:
"(5) six legislative members, appointed as
follows: two legislators appointed by the president of
the senate and two legislators appointed by the
speaker of the house of representatives, including at
least one member of the standing committee with
jurisdiction over the Department of Health and Social
Services in each house, and one legislator or
legislative staff member appointed by the chair of the
standing committee with jurisdiction over the
Department of Health and Social Services in each
house."
5:16:49 PM
REPRESENTATIVE SEATON objected.
5:16:54 PM
REPRESENTATIVE KELLER explained that this amendment ensures that
the commission will have representation from the House Health,
Education and Social Services Standing Committee and the Senate
Health, Education and Social Services Standing Committee.
5:18:46 PM
CHAIR WILSON noted that the only addition was "and one
legislator or legislative staff member."
5:19:13 PM
REPRESENTATIVE KELLER stated that the intent was that the
appointee can be a staff member assigned by the chair of the
respective standing committees.
5:19:38 PM
REPRESENTATIVE CISSNA understood that the amendment removes
minority membership.
5:19:54 PM
REPRESENTATIVE KELLER acknowledged that was unintentional.
5:20:08 PM
REPRESENTATIVE FAIRCLOUGH stated that her support was based on
the deletion.
5:20:22 PM
REPRESENTATIVE GARDNER pointed out that legislators do not
always serve on the same legislative committees after two years
and are not always still in office. The term for commission
members is three years and some of the legislative members will
change within the three year term.
5:21:10 PM
REPRESENTATIVE SEATON recalled that the purpose of appointing
legislative members to the commission was to ensure support when
its recommendations are presented to the legislature. He said
that it would be hard for staff members to carry that support
and indicated that he would not support the amendment.
5:21:43 PM
REPRESENTATIVE FAIRCLOUGH asked for the DOL to speak to whether
a member of a standing legislative committee has jurisdiction
over the department for which it hears legislation.
5:22:29 PM
MS. KRALY opined that jurisdiction is too broad of a word for
this purpose. However, she advised that the language was
acceptable for a conceptual amendment.
5:23:27 PM
REPRESENTATIVE FAIRCLOUGH suggested "include at least one member
of the standing committee HSS or HESS."
5:24:04 PM
REPRESENTATIVE KELLER agreed. He withdrew Amendment 12.
REPRESENTATIVE FAIRCLOUGH asked whether a revised fiscal note
has been submitted to the committee.
5:25:29 PM
CHAIR WILSON indicated no.
5:25:41 PM
REPRESENTATIVE ROSES offered Conceptual Amendment 13, as
follows:
Page 8, line 29, following "AS 47.32";
Insert "that are health care related facilities"
5:26:26 PM
There being no objection, Conceptual Amendment 13 was adopted.
5:26:33 PM
REPRESENTATIVE ROSES offered Conceptual Amendment 14, as
follows:
Page 6, line 10, following "licensed";
Insert "or authorized"
5:27:08 PM
There being no objection, Conceptual Amendment 14 was adopted.
5:27:17 PM
REPRESENTATIVE ROSES offered Amendment 15, as follows:
Page 4, line 20, following "owned";
Insert "and operated"
5:27:57 PM
REPRESENTATIVE GARDNER objected.
5:28:03 PM
REPRESENTATIVE ROSES explained that this change would require
that physicians not only own a facility, but are actually doing
diagnostic work there.
5:28:43 PM
REPRESENTATIVE GARDNER removed her objection.
5:28:53 PM
REPRESENTATIVE CISSNA objected.
The committee took an at-ease from 5:29 p.m. to 5:30 p.m.
REPRESENTATIVE CISSNA withdrew her objection.
There being no further objection, Amendment 15 was adopted.
5:30:30 PM
REPRESENTATIVE SEATON offered Conceptual Amendment 16, as
follows:
Page 4, line 19, following "is";
Delete "75"
Insert "50"
5:30:47 PM
CHAIR WILSON objected.
5:30:53 PM
REPRESENTATIVE SEATON explained that medical facilities are
quite costly and 75 percent ownership is very restrictive. He
opined that 50 percent ownership is sufficient to meet the
intent of the legislation, especially now with the requirement
that the facility must be partly owned and operated by doctors.
5:31:26 PM
REPRESENTATIVE ROSES expressed his support for the amendment due
to the fact that 50 percent ownership was a recommendation
from the negotiated rule making committee.
5:31:56 PM
CHAIR WILSON withdrew her objection.
5:32:07 PM
REPRESENTATIVE CISSNA objected. She advised that she may need
to reconsider at a later time.
5:32:51 PM
REPRESENTATIVE CISSNA withdrew her objection.
5:33:07 PM
There being no further objection, Conceptual Amendment 16 was
adopted.
5:33:23 PM
REPRESENTATIVE FAIRCLOUGH asked for advice from Ms. Kraly as to
whether the addition of "military" was still needed on page 4,
line 22 at item (iii).
5:34:06 PM
MS. KRALY advised that an amendment should also delete "or
federal", on page 4, line 4.
5:35:05 PM
REPRESENTATIVE FAIRCLOUGH offered Amendment 17, as follows
Page 4, line 4;
Delete ", or federal"
Page 4, line 22, following "(iii)";
Insert "military or"
5:35:43 PM
REPRESENTATIVE CISSNA objected. She asked whether the amendment
would apply to Veteran's Hospitals.
CHAIR WILSON said that Veteran's Hospitals are exempted.
5:36:36 PM
REPRESENTATIVE CISSNA withdrew her objection.
There being no further objection, Conceptual Amendment 17 was
adopted.
5:36:50 PM
REPRESENTATIVE FAIRCLOUGH asked Ms. Kraly to suggest language
for Amendment 18.
5:37:17 PM
MS. KRALY recommended that the definition of private physician's
office should be moved to Sec. 6 such that page 4, line 17,
would read: "(ii) the offices of private physicians or dentists,
whether in individual or group practice." In addition, there
would be a new paragraph in Sec. 6, "'physician's office
facility' means an office or clinic that is 50 percent owned and
operated by physicians."
5:38:32 PM
REPRESENTATIVE FAIRCLOUGH moved Amendment 18, as specified by
Ms. Kraly above.
5:38:37 PM
There being no objection, Amendment 18 was adopted.
REPRESENTATIVE FAIRCLOUGH requested that the DOL submit
Amendment 18 in writing to Chair Wilson's staff.
5:39:23 PM
CHAIR WILSON re-stated the intent of Amendment 18. She then
asked whether the meaning of "expenditure" on page 3 needed
clarification.
5:39:53 PM
REPRESENTATIVE SEATON offered to work with the next committee of
referral on that problem.
5:40:09 PM
CHAIR WILSON offered Amendment 19, as follows:
Page 11, line 17, following "present";
Insert "in person"
5:40:52 PM
REPRESENTATIVE GARDNER objected and asked whether all of the
members of the commission would be expected to make the
presentation. She suggested "offer a presentation of the annual
report."
5:41:22 PM
CHAIR WILSON stressed that there are legislators who need to
hear the report on health care.
5:41:44 PM
REPRESENTATIVE ROSES offered Amendment 1 to Amendment 19, as
follows:
Page 11, line 17, following "(i)";
Insert "A member of"
5:42:02 PM
REPRESENTATIVE CISSNA objected and pointed out that the
restriction of the presentation to "a member" would limit
participation by other members of the commission, thus limiting
its credibility.
5:42:55 PM
REPRESENTATIVE ROSES related his experience that most members of
commissions participate during testimony.
5:43:50 PM
REPRESENTATIVE CISSNA withdrew her objection.
5:43:59 PM
There being no further objection, Amendment 1 to Amendment 19
was adopted.
5:44:09 PM
CHAIR WILSON offered Conceptual Amendment 20 such that page 11,
line 17, would read: "(i) A member of the commission shall
present in person ..."
There being no objection, Conceptual Amendment 20 was adopted.
5:44:51 PM
REPRESENTATIVE ROSES moved to report CSHB 337, Version 25-
GH2050\L, Mischel, 3/3/08, as amended, out of committee with
individual recommendations and the forthcoming fiscal note.
5:45:20 PM
REPRESENTATIVE FAIRCLOUGH objected and stated that she will vote
to pass the bill out of committee with a "do not pass"
recommendation. She observed that the forthcoming fiscal note
will be over one million dollars to develop the health care
commission and transparency in the deliverance of some types of
health care services in the state. Representative Fairclough
expressed her support for the governor's plan for the disclosure
of health care costs through the information office; however,
most of the discussion on the bill has been related to the issue
of CON policies. She said that she believes in competition, and
stated her concern about the anti-trust issues brought up by the
U. S. Department of Justice. On the other hand, there has been
testimony on mitigating the effect of the repeal of CON laws by
limiting its scope. She recalled that ninety percent of the
testimony on this issue stems from litigation surrounding one
hospital in Fairbanks; nevertheless, the problem is affecting
health care statewide. The administration and the commissioner
of the DHSS agree that the management of negotiations between
providers of health care is not the state's role. She spoke of
her constituents who want to see a broader base of competition,
but, in Anchorage, there is competition that is counterbalanced
by non-profit and for profit organizations, some of whom provide
services for the underserved in the community. Representative
Fairclough said that she supports two parts of the bill and is
interested in further dialog on the financial implications of
the proposed commission and the future benefits of the bill.
She withdrew her objection.
5:50:14 PM
REPRESENTATIVE ROSES explained that his original support for the
bill has wavered. Furthermore, he stated that the committee
process allows for the bill to continue evolving during
discussion and it is important to move the bill to another
level, even if committee members recommend "do not pass," so
that others may participate.
5:52:14 PM
REPRESENTATIVE SEATON agreed that this is a very complicated
issue for any area of the state with higher populations.
5:52:53 PM
REPRESENTATIVE KELLER opined that CON policies have not
controlled costs and that he is disappointed with the bill. In
fact, CON policy creates a hidden tax for hospitals and is a
system with many problems. However, he said that he would not
prevent the bill from moving out of committee.
5:53:50 PM
REPRESENTATIVE CISSNA advised that she would vote to pass the
bill out of committee even though there have been many changes.
She recalled that when CON policy was originally written, in the
1970s, there were other elements to ensure its purposes. She
expressed her hope that the creation of the health care
commission may be what the state needs to improve the situation
and urged the passage of the bill.
5:55:01 PM
REPRESENTATIVE GARDNER appreciated the generous discussion of
this complex issue. She stressed that this proposal should have
been three different health care bills. On the first part,
commissions are regularly formed as a way to postpone
legislative action; in fact, the legislature does not always
take their advice, as in the case of the negotiated rule making
committee. Secondly, she opined that it is premature to pass
the database because the costs are unknown. Thirdly, CON policy
continues to require further discussion. Representative Gardner
agreed that the committee should not prevent a major bill from
open discussion by the legislature body and that the bill should
not be held further.
CHAIR WILSON thanked the DHSS for its assistance to the
committee. She recalled that this is her eighth year hearing
testimony surrounding the CON issue and it is not an easy issue
to understand; however, the new study may provide answers. She
cautioned against changing the laws before really knowing the
consequences. Chair Wilson supported the creation of the health
care commission and opined that the information office will be
helpful to the public, but at a high cost.
REPRESENTATIVE KELLER voted yea, and qualified that his vote was
"from committee with individual recommendations."
REPRESENTATIVE FAIRCLOUGH remarked:
I'll qualify that too, this is to move it out of
committee and my individual recommendation, on the
record, would be to extend the, for the next committee
to consider, extending the certificate of need
implementation date only, so that you could have the
study first, but, yes.
6:01:08 PM
A roll call vote was taken. Representatives Keller, Seaton,
Cissna, Roses, Fairclough, and Wilson voted in favor of CSHB
337, Version 25-GH2050\L, Mischel, 3/3/08, as amended.
Representative Gardner voted against it. Therefore, CSHB
337(HES) was reported out of the House Health, Education and
Social Services Standing Committee by a vote of 6-1.
6:02:14 PM
ADJOURNMENT
There being no further business before the committee, the House
Health, Education and Social Services Standing Committee meeting
was adjourned at 6:02 p.m.
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