Legislature(2013 - 2014)CAPITOL 106
03/18/2014 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| Presentation: Pediatric Partnership | |
| Presentation: Alaska Health Workforce Coalition & Vacancy Study | |
| HB324 | |
| HB361 | |
| Adjourn |
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ teleconferenced
= bill was previously heard/scheduled
| + | TELECONFERENCED | ||
| += | HB 324 | TELECONFERENCED | |
| *+ | HB 361 | TELECONFERENCED | |
| + | TELECONFERENCED |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 18, 2014
3:03 p.m.
MEMBERS PRESENT
Representative Wes Keller, Vice Chair
Representative Lance Pruitt
Representative Lora Reinbold
Representative Paul Seaton
Representative Geran Tarr
MEMBERS ABSENT
Representative Pete Higgins, Chair
Representative Benjamin Nageak
COMMITTEE CALENDAR
PRESENTATION: PEDIATRIC PARTNERSHIP
- HEARD
PRESENTATION: ALASKA HEALTH WORKFORCE COALITION & VACANCY STUDY
- HEARD
HOUSE BILL NO. 324
"An Act relating to the controlled substance prescription
database."
- HEARD & HELD
HOUSE BILL NO. 361
"An Act relating to licensing of behavior analysts."
- MOVED HB 361 OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: HB 324
SHORT TITLE: CONTROLLED SUBST. PRESCRIPTION DATABASE
SPONSOR(s): REPRESENTATIVE(s) KELLER
02/21/14 (H) READ THE FIRST TIME - REFERRALS
02/21/14 (H) HSS, FIN
03/04/14 (H) HSS AT 3:00 PM CAPITOL 106
03/04/14 (H) Heard & Held
03/04/14 (H) MINUTE(HSS)
03/18/14 (H) HSS AT 3:00 PM CAPITOL 106
BILL: HB 361
SHORT TITLE: LICENSING OF BEHAVIOR ANALYSTS
SPONSOR(s): REPRESENTATIVE(s) SADDLER
02/26/14 (H) READ THE FIRST TIME - REFERRALS
02/26/14 (H) HSS, FIN
03/18/14 (H) HSS AT 3:00 PM CAPITOL 106
WITNESS REGISTER
MATT HIRSCHFELD, M.D.
Medical Director
Maternal Child Health Services
Alaska Native Medical Center
Anchorage, Alaska
POSITION STATEMENT: Presented a PowerPoint titled "The Science
and Economics of Early Toxic Stress."
KATHY CRAFT, Director
Alaska Health Workforce Coalition
Anchorage, Alaska
POSITION STATEMENT: Presented a PowerPoint titled "Alaska
Health Workforce Coalition & The 2012 Health Workforce Vacancy
Study."
KATY BRANCH, Director
Alaska Center for Rural Health
Alaska Health Education Center (AHEC)
Anchorage, Alaska
POSITION STATEMENT: Presented a PowerPoint titled "Alaska
Health Workforce Coalition & The 2012 Health Workforce Vacancy
Study."
JIM POUND, Staff
Representative Wes Keller
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced the committee substitute for HB
324, on behalf of the bill sponsor, Representative Wes Keller.
WARD HURLBURT, M.D., Chief Medical Officer/Director
Division Of Public Health
Central Office
Department of Health and Social Services
Anchorage, Alaska
POSITION STATEMENT: Testified and answered questions during the
discussion of HB 324.
MARGARET BRODIE, Director
Director's Office
Division of Health Care Services
Anchorage, Alaska
POSITION STATEMENT: Testified and answered questions during
discussion of HB 324.
DIRK WHITE, Chairman
Board of Pharmacy
Sitka, Alaska
POSITION STATEMENT: Testified and answered questions during
discussion of HB 324.
PATRICIA SENNER, Family Nurse Practitioner
Alaska Nurses Association
Anchorage, Alaska
POSITION STATEMENT: Testified and answered questions during
discussion of HB 324.
LIS HOUCHEN, Director
State Government Affairs
National Association of Chain Drug Stores
Olympia, Washington
POSITION STATEMENT: Testified and answered questions during
discussion of HB 324.
BARRY CHRISTENSEN, Pharmacist
Co-Chair
Legislative Committee
Alaska Pharmacists Association
Ketchikan, Alaska
POSITION STATEMENT: Testified during discussion of HB 324.
DAN LYNCH
Soldotna, Alaska
POSITION STATEMENT: Testified during discussion of HB 324.
REPRESENTATIVE DAN SADDLER
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: Introduced HB 361 as the sponsor of the
bill.
LORRI UNUMB, Vice President
State Government Affairs
Autism Speaks
Raleigh, North Carolina
POSITION STATEMENT: Testified in support of HB 361.
RICHARD KIEFER O'DONNELL, MD
Associate Director
Center for Human Development
University of Alaska
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of HB 361.
RACHEL WHITE, Behavior Analyst
Good Behavior Beginnings
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of HB 361.
ANNETTE BLANAS, Project Director
Capacity Building and Autism Interventions
Center for Human Development
University of Alaska
Anchorage, Alaska
POSITION STATEMENT: Testified during discussion of HB 361.
SUZANNE LETSO
Alaska Center for Autism
Eagle River, Alaska
POSITION STATEMENT: Testified during discussion of HB 361.
REBEKA EDGE
Behavior Matters
Eagle River, Alaska
POSITION STATEMENT: Testified in support of HB 361.
ACTION NARRATIVE
3:03:15 PM
VICE CHAIR WES KELLER called the House Health and Social
Services Standing Committee meeting to order at 3:03 p.m.
Representatives Keller, Reinbold, and Seaton were present at the
call to order. Representatives Tarr and Pruitt arrived as the
meeting was in progress.
^Presentation: Pediatric Partnership
Presentation: Pediatric Partnership
3:03:56 PM
VICE CHAIR KELLER announced that the first order of business
would be a presentation by the All Alaska Pediatric Partnership.
3:04:34 PM
MATT HIRSCHFELD, M.D., Medical Director, Maternal Child Health
Services, Alaska Native Medical Center, introduced a PowerPoint,
titled "The Science and Economics of Early Toxic Stress," as
well as the initiatives for early childhood development and
other ways to make kids healthier in Alaska. He shared a quote
from Frederick Douglas, which he declared to be the essence of
the All Alaska Pediatric Partnership: "It is easier to build
strong children than to repair broken men." Directing attention
to slide 1, "Goal of a Nation," he relayed that the goal was "to
produce a well-educated and healthy adult population that's
skilled and sufficiently able to participate in a global
economy," which he attributed to the American Academy of
Pediatrics technical report on childhood adversity and toxic
stress. Moving on to slide 2, "How Do We Do That," he explained
that sound science showed the necessity to invest in good
clinical practice that addressed complex social and economic
needs of kids, especially early on in their development. He
added that it was necessary to make sound investments in
interventions that would help the kids and the families. He
suggested that the health system change its focus from care of
the sick to, instead, preventative well care programs to
preclude sickness.
3:07:09 PM
DR. HIRSCHFELD addressed slide 3, "A New Framework," and
reported that science had now proclaimed both nature and nurture
equal in early development as environment could affect genes.
He declared that, as stress could not be avoided, slide 4,
"Physiologic Response to Stress in Kids," it was necessary to
ensure a strong family relationship for a child to learn to
adapt to stress in a healthy way. He reported that prolonged
stressful responses in a child without a strong family
relationship could lead to the release of stress hormones for a
prolonged period, resulting in a sometimes permanent change to
the regulation of the stress hormones with abnormal, adverse
responses to future stress. He explained the Adverse Childhood
Experience Study (ACE), slide 5, "Evidence," which was first
released in 1998, and surveyed 17,000 adults from childhood to
later adulthood, 57 years of age. The survey looked for ten
adverse childhood experiences, ranging from physical abuse to
parental separation, slide 6, "Adverse Childhood Experience
Study." Each of these adverse experiences was added to
determine the prevalence for risk as adults, slide 7, "ACE:
Prevalence data." He reported that a huge number of people,
more than anticipated, had various exposures to very traumatic
events as children, ranging from 21 percent who were sexually
abused to 5 percent who had a criminal household member. He
reported that almost two-thirds of the participants had at least
one adverse childhood experience, while the one-third without
any adverse childhood experiences were much healthier as adults,
slide 8, "ACE: Prevalence data."
3:10:43 PM
DR. HIRSCHFELD shared slide 9, "ACE Score," and explained that
the higher the ACE score, the greater the risk for health
problems and risky behavior as an adult, as shown on slide 10
and slide 11, "Risky Behavior & ACEs." He noted that there was
an increased risk for behavioral health problems, ranging from
depression, suicide and sleep disturbances, slide 12,
"Behavioral Health & ACEs," and increased risk for reproductive
health problems, slide 13, "Reproductive Health & ACEs." Moving
on to slide 14, "Health Measures Now Linked to Adverse Childhood
Experiences Score," he stated that all organ systems were fairly
significantly affected as adults. He declared that childhood
problems were also manifested, slide 15, "Increasing ACEs in
Spokane Elementary School Children," with academic failure,
attendance problems, and school behavior concerns. He noted
that there was sickness during the events, occurring as well
years later as adults.
3:12:36 PM
DR. HIRSCHFELD explained that the new science and the ACEs study
suggested that childhood surroundings affected the way that
genes were expressed, slide 16, "The Mechanism of Change
Epigenetics." These gene protein changes, histones, could be
modified and removed, depending on the severity of the stress.
He mentioned DNA methylation, a specific chemical compound added
to the DNA, which also affected how genes were regulated and the
resulting response to stress. He declared that these changes
could be permanent, depending on the severity of the stressful
event. He shared that this had first been discovered in the
nurturing grooming behavior of rats, slide 17, "Epigenetics in
Rats." He shared slide 18, "Epigenetics Passed from Moms to
Children," which stated that fetal exposure to maternal stress
influences could lead to pre-term births, kids with poor
emotional coping skills and decreased cognitive abilities,
increased anxiety, and an increased fear response to stimuli.
He pointed out that these were results of stress in utero, and
that continuation of the stress after birth would reinforce
these responses. He referenced earlier studies on the Romanian
orphanages, slide 19, "Adult and Childhood Epigenetics," which
reflected the abnormal brain development from a lack of nurture
and care during childhood. He stated that these epigenetic
changes included a smaller memory center, less connection
between parts of the brain, a larger area controlling anxiety,
and a smaller part of the brain dealing with reasoning and
emotional control, slide 20, "How Do These Epigenetic Changes
Affect People." He relayed that these kids also have
dysregulation of stress hormones, inflammation and immunological
changes, and shortened chromosomal telomeres, which were linked
to an early onset of chronic disease. Directing attention to
slide 21, "But These Effects Can Be Reversed," he reported that
a prevention program which reduced the ACEs score, and would
reduce suicide attempts, alcohol dependence, and other health
measurements studied to this point. He declared that early
intervention with good programs for a family could affect the
future health. He discussed the problem of mothers' neglect or
abuse, slide 22, "The Birth Experience and Bonding," and shared
that policy changes in many countries had ensured that mother's
bonded with their babies, with a resulting decrease in child
abandonment, neglect, and maltreatment.
3:18:24 PM
DR. HIRSCHFELD discussed slide 23, "Innate Influences:
Breastfeeding," and spoke about the study in Australia which
followed more than 6,000 mother-infant pairs over 15 years. It
encouraged breast feeding for four months, which resulted in the
2.6 times less likelihood for child maltreatment. He stated
that the initiation of breast feeding was good in Alaska;
however, as continuation was not as strong, encouragement could
make a big effect on the kids. He spoke about slide 24, "Costs
of Child Abuse: USA," which showed that, in 2007, $104 billion
was spent annually for the direct costs of child abuse, with an
additional $70 billion spent on indirect costs. He stated that
the cost per maltreated child was about $182,000. Moving on to
slide 25, "Costs of Child Abuse: USA," he spoke about another
study in 2012, which reflected the increase of costs to $124
billion annually, with a lifetime cost of $210,000 for each
nonfatal child maltreatment. The slide listed productivity
losses, criminal justice costs, and special education costs. He
discussed slide 26, "Econometrics of Early Intervention &
Prevention," a graph for rate of return for investment along
with the age of intervention for a child. He reported that the
rate of return was much higher when there was earlier
intervention. He said that behaviors were relatively set by the
age of 15 years. He declared an intervention goal for targeting
women when they get pregnant.
3:20:54 PM
DR. HIRSCHFELD reported on slide 27, "Washington State Institute
for Public Policy - WSIPP," which detailed that, as most early
childhood interventions had a benefit cost ratio greater than 1,
"these interventions are cost effective and make a lot of
sense." Introducing slide 28, "Public Investment in Children by
Age," he noted that the brain's capacity for change was the
highest under the age of three years; however, most programs
designed to address kids in trouble targeted much older
children. He showed slide 29, and explained that an
intervention would calm a child. He stated that the All Alaska
Pediatric Partnership (AAPP) focused on the first 1000 days of
life to address some of these aforementioned issues, slide 30,
"AAPP's First 1,000 Days of Life Campaign for Alaska's
Children," and that it somewhat mirrored the American Academy of
Pediatrics initiative for early brain and childhood development
to build nurturing relationships in families, slide 31. He
reported that the American Academy of Pediatrics wanted to
minimize toxic stress, promote positive parenting, promote a
great environment for kids, develop enhancing activities for
interpersonal relationships, and screen for families at risk,
slide 32 "Some steps for EBCD promotion." He shared that the
AAPP had various pediatricians, public health officials, nurses,
and others who cared about kids come together to define four
areas for the AAPP to have impact by reducing adverse childhood
events and toxic stress in kids, slide 33, "Collective Impact."
He shared the results on slide 34, "First 1,000 Days of Life
Campaign Workgroups," which listed increases for breastfeeding
rates, immunization rates, and access to a primary care
provider, with decreases to child abuse and neglect as the
goals.
3:24:19 PM
DR. HIRSCHFELD said that there was some great evidence based
practice from initiatives that could be implemented on a
community-wide and state-wide basis, slide 35, "AAPP
Initiatives: Triple P-Positive Parenting Program." This program
teaches parents how to be positive parents and build family
relationships, manage children's behavior in a good way, and
prevent developmental problems, and it was delivered in the
Primary Care setting. He pointed to the positive rate of return
from this program in the State of Washington. He directed
attention to slide 36, "AAPP Initiatives HelpMeGrow," which he
described as a great way to connect at-risk kids with the
services they needed. He explained slide 37, "Our Role," which
was to guide vision and strategy, and drive the conversation by
building public will, offering public talks, and mobilizing
funding as a 501(c)(3), instead of asking for support from
hospitals and clinics.
3:27:07 PM
REPRESENTATIVE REINBOLD declared that the recent resolution to
support breast feeding would be in agreement with the AAPP
campaign.
VICE CHAIR KELLER noted that a bill for inoculations would also
be presented in the future.
3:28:29 PM
REPRESENTATIVE SEATON declared that there would be coordination
with other studies for impaired learning and childhood
development from low Vitamin D levels.
^Presentation: Alaska Health Workforce Coalition & Vacancy Study
Presentation: Alaska Health Workforce Coalition & Vacancy Study
3:28:57 PM
VICE CHAIR KELLER announced that the next order of business
would be a presentation by the Alaska Health Workforce Coalition
& The 2012 Health Workforce Vacancy Study.
3:30:09 PM
KATHY CRAFT, Director, Alaska Health Workforce Coalition, gave a
brief refresher on the Alaska Health Workforce Coalition and its
vacancy study, slide 2 "Leadership." She said that a variety of
industry and government entities had been independently working
on the health workforce in 2009, and then formed a coalition.
She listed the current members in both industry and the State of
Alaska. She declared that all the work was based on the health
workforce data, slide 3, "Coalition Approach," and that the 2010
work plan had been endorsed by the Alaska Workforce Investment
Board as the health plan for Alaska.
3:32:27 PM
MS. CRAFT stated that the plan had identified six occupational
priorities, slide 4, "Action Agenda 2012-2015," which included
primary care providers, direct care workers, behavioral health
clinicians, physical therapists, nurses, and pharmacists. She
pointed out that there also needed to be work on systems change
and capacity building, and she listed the programs for focus.
Moving on to slide 5, "Action Agenda Scorecard-December 2013,"
she pointed to the 43 active strategies, reporting that only one
target would not be achieved, and that this action agenda would
be revised in the upcoming year. She pointed to slide 6, "AHWC
Successes," and listed House Bill 78, the legislation regarding
loan repayment and incentives, as a "good burst to our system."
She stated that funding for the nurse practitioner, the physical
therapist, and the perioperative nursing programs were all
successes. She declared that the advocacy items for 2014
included funding for the Alaska Area Health Education Center,
professional development and training, and the complex behavior
collaborative, slide 7, "2014 Advocacy Items."
3:35:43 PM
KATY BRANCH, Director, Alaska Center for Rural Health, Alaska
Health Education Center (AHEC), stated that the workforce
vacancy study was a full year, and she listed the project team,
slide 9, "Partners and Credits." Reviewing slide 10, "What is a
Vacancy Rate?" she explained that a vacancy rate was an
indicator of how many budgeted positions were expected to be
vacant, and it was a measure of industry demand and an indicator
of occupational need. She said that a vacancy rate should be
considered in conjunction with other data sources and data sets,
including resident/non-resident, turnover, and age. She stated
that the vacancy study data was used in a myriad of ways, slide
11, "Utility and Relevancy of Vacancy Data," which included
informing policy decisions, describing Alaska's health workforce
climate, and indicating the program impact. She pointed out
that it had been used to determine expansion of student capacity
at the university.
3:38:38 PM
MS. BRANCH stated that some of the goals during planning of the
Health Workforce Vacancy Study (HWVS) were for the data set to
be comparable with other data sets in both Alaska and
nationally, slide 13, "Goals of the 2012 HWVS." She explained
that, as the occupation titles had to crosswalk with the
Standardized Occupation Classification (SOC) codes used at both
the state and federal level, the group developed a taxonomy for
the occupations. She noted that the group had also utilized the
Department of Labor & Workforce Development labor market regions
so that easier comparisons were possible. She noted that the
data collection framework and the methodology were standardized
to allow the data to be trended, and that input from industry
experts was used at every step during the process. She reported
on slide 14, "Strategy - Alaska Standardized Health Occupations
Taxonomy," and stated that this taxonomy served as the
foundation of the health vacancy study. She reported that it
had defined 157 health occupations, based on scope of practice,
and aligned it with the aforementioned SOC codes. This
alignment allowed a crosswalk to more than 8,000 job titles, and
supported response to health industry workforce surveys. She
declared that it was "pretty staggering the differences we have
with employers and what they call positions," hence the
importance to define the occupation for what it did, and not
what it was called or where it was located. She said that,
although the vacancy study only had six questions, they were
difficult to answer, slide 16, "Vacancy Study Questions." She
stated that the first four questions were asked for each
occupation. Moving on to slide 17, "Vacancy Study Questions,"
she listed two more questions that were asked overall and not by
each occupation. Directing attention to slide 19, "Sample &
Responses by Region," she said that there was a statewide
aggregate response rate by employers of 67 percent, which
represented 79 percent of health workers, slide 20, "Health
Workers by Region." Discussing slide 21, "Sample & Response by
Organization," she pointed to the various organizational types
that were invited to respond.
3:44:22 PM
MS. BRANCH discussed the data and the key findings on slide 23,
"Statewide Aggregate: Vacancy Rate for Occupations with 500
Positions." She said there were 25 occupation types in Alaska
that represented 60 percent of the health workers in the state
and 62 percent of the vacancies. She had anecdotally called
colleagues at health organizations for their views on normal
vacancy rates for many positions, and then, using those
parameters, had determined that a 10 percent vacancy was within
the realm of reason. Above that rate, there were specific
strategies to bring that targeted rate down. She stated that
she had avoided any labeling to the data, as it should not be
generalized. Looking at slide 24, "Rural vs Urban:" she
discussed mental and behavioral health and related occupations
in rural and urban areas. She highlighted the specific
occupations that tended to have the highest vacancy rates. She
addressed slide 25, "Physician and Surgeons Occupation Detail by
Specialty by Rural/Urban," and reported that family and
emergency physicians were the highest vacancy need in rural
areas, whereas in urban areas the vacancies were for
specialists. She noted that there was a 16 percent vacancy for
pediatricians in rural communities. She pointed to lower
vacancy rates when there were training programs within the
state. Directing attention to nursing, slide 26, she pointed
out that specialists were needed.
3:49:31 PM
MS. BRANCH moved on to slide 27 "Tribal Health Occupations
(extracted) Estimated Vacancy Rates by Rural/Urban," and noted
that the listed occupations had high turnover in rural areas as
the stress encountered in these positions made it very
challenging. She declared that rural hub and urban support was
critical for the health care infrastructure. She shared slide
28, "Sharp II - Tier I Professions Estimated Vacancy Rates,"
which offered data with regard to loan repayment programs. She
reported the high vacancy in rural areas for general
practitioners and family physicians, as well as pediatricians.
Pointing to slide 29, "Tier II Professions Estimated Vacancy
Rates," she relayed that physician assistants, family nurse
practitioners, physical therapists, and registered nurses all
had high vacancy rates in the rural areas. Referring to the two
more subjective questions in the vacancy study, asking why there
was trouble hiring, slide 30, "Reasons for not Hiring Employees"
she pointed to the most common responses as "inadequate pool of
trained or qualified support staff" and "insufficient
compensation package." She called these modifiable factors, as
they could be influenced. She discussed slide 31, "Reasons for
not Retaining employees," and stated that the "social/geographic
isolation" in rural communities and "relocation or reassignment"
in urban communities were the two biggest reasons.
3:54:16 PM
MS. BRANCH addressed slide 33, "Executive Summary - Data," and
stated that the disparity in distribution between the urban and
rural health workforce was a continuing trend, and a key to the
solution was for rural recruitment and retention, and
development for training Alaskans for these positions.
Concluding with slide 34, "Executive Summary - Recommendations,"
she reported that investment in programs with effectiveness in
"Growing Our Own" to fill health positions, and increasing
training availability and residency seats in under-represented
fields with a rural practice emphasis were very important. She
stated that the statewide loan repayment program helped drive
recruitment. She declared that an expansion of professional
development and training opportunities for the existing health
workforce was also a very important strategy to support
retention.
3:55:59 PM
MS. BRANCH, in response to Representative Reinbold, stated that
the area health education center programs were very effective
for the "Grow Our Own" program, especially for work in rural
communities. She pointed out that the Alaska Mental Health
Trust Authority had also invested heavily in a "Grow Our Own"
program for behavioral health providers.
3:57:17 PM
REPRESENTATIVE REINBOLD opined that the program investment
strategy was vague, and suggested that the "Grow Our Own"
program prepare a priority list for what was working and what
were the outcomes. She referenced an earlier suggestion to
retain the Statewide Loan Repayment plan, noting that there was
already the Alaska Performance scholarship. As she was unsure
of the current repayment plan details, she declared her support
for the former program.
MS. BRANCH suggested steering the repayment plan toward the most
needed occupations in order to recruit for and retain those
occupations in Alaska. She offered her belief that the
repayment plan should be a retention strategy, and therefore,
align the loan repayment with the characteristics of applicants
who would stay in Alaska.
3:59:31 PM
REPRESENTATIVE REINBOLD said that the repayment program had been
"a perfect example of bringing kids back that already have their
roots here." She asked about the impact of the Affordable Care
and Patient Protection Act, and expressed her concern for the
"deep needs in health care workers across the state."
MS. CRAFT replied that, as employees were aging and retiring and
the population was also aging, there would be a need for more
services.
REPRESENTATIVE REINBOLD expressed her concern that there would
not be enough providers to meet the future needs of Alaskans.
MS. CRAFT said that the group would look into this.
REPRESENTATIVE KELLER suggested that the committee be notified
for any trend changes.
4:01:41 PM
REPRESENTATIVE TARR asked about the collaborative specialty
programs with outside universities.
MS. BRANCH noted the occupational therapy program in conjunction
with Creighton University, which maintained seats for Alaskans.
She listed the programs planned for physical therapy and
pharmacy. She stated that these "sorts of agreements with other
universities allow us to not have to bear the entire burden of
the program, the accreditation costs... it allows us to
designate seats in high need areas like therapies and pharmacy
and others for Alaskans so that they can receive their training
here." She lauded the success of the program.
MS. CRAFT added that the psychiatric steering committee was
exploring a five year program with the University of Washington,
with the final two years of schooling in Alaska.
MS. BRANCH explained that there was a trend for students to
remain where they received their training.
REPRESENTATIVE TARR observed that the partnerships were
innovative as the start-up costs for these programs would be
cost prohibitive for the University of Alaska. She opined that
the loan forgiveness program was a good strategy to keep the
student in Alaska.
MS. CRAFT, responding to Representative Reinbold, said that the
behavioral health aides and the community health aides were two
more "Grow Your Own" programs that kept people in their
community.
HB 324-CONTROLLED SUBST. PRESCRIPTION DATABASE
4:05:08 PM
VICE CHAIR KELLER announced that the next order of business
would be HOUSE BILL NO. 324, "An Act relating to the controlled
substance prescription database."
4:06:34 PM
JIM POUND, Staff, Representative Wes Keller, Alaska State
Legislature, addressed the proposed committee substitute (CS)
for HB 324, labeled 28-LS1427\N, Strasbaugh, 3/7/14 which
proposed to answer some of the concerns from the previous
meeting. He directed attention to page 3, line 9, which added
"directly" so that the hospital would administer the drugs. He
noted that some rural providers did not have access to a
database, so "through an electronic database or another method"
was added on page 3, line 10. He pointed to page 3, line 30,
which added "a secure real-time" and stated that once the
prescription was given to the client the information would be
input to the database. Noting page 4, line 22, "who is
licensed" was added to ensure that access to data was only by a
licensed individual. He stated that the final change was on
page 4, line 29, whereby "provider" was changed to
"practitioner."
4:09:05 PM
REPRESENTATIVE PRUITT moved to adopt the proposed committee
substitute (CS) for HB 324, labeled 28-LS1427\N, Strasbaugh,
3/7/14, as the working draft.
VICE CHAIR KELLER objected for discussion.
REPRESENTATIVE TARR asked if the payment portion would remain
the same as the previous draft.
MR. POUND replied that it would remain the same.
4:09:47 PM
[VICE CHAIR KELLER opened public testimony].
WARD HURLBURT, M.D., Chief Medical Officer/Director, Division Of
Public Health, Central Office, Department of Health and Social
Services, stated that the administration had not taken a
position on the proposed bill. He referred to the passage of a
similar law in Missouri, noting that all 50 states now had a
controlled substance prescription data base program. He said
there was an array for how robust the programs were, and he
pointed to the Oklahoma program with a 10 minute real time
accessibility. He declared that had been a benefit to the
program. He reported that Alaska downloaded the information on
a monthly basis. He declared that all the programs had value
for addressing the national epidemic of controlled substance
prescription drug abuse. He said that annual deaths from the
illicit use of these legal controlled substances had now
surpassed the annual deaths from automobile accidents. He
stated that the more robust the program, the more it would cost.
He noted that the responsible department would have to determine
the program with the greatest value for the cost. He shared an
anecdote of his work prior to working in Alaska. He stressed
that availability of these databases was helpful and important
to medical professionals.
4:12:48 PM
REPRESENTATIVE REINBOLD asked who paid for these programs, and
for his recommendations for funding.
DR. HURLBURT replied that he clearly recognized the challenge
for a reasonable, prudent approach to funding for this important
program.
4:14:01 PM
REPRESENTATIVE TARR asked for clarification that the fees
through the Board of Pharmacy would finance the program.
DR. HURLBURT replied that it was a reasonable cost to impose on
the health care businesses.
REPRESENTATIVE TARR asked if any other programs were charging
the patient for this service.
DR. HURLBURT replied that he did not know, though he offered his
belief that it would be difficult. If a cost was imposed at the
point where the controlled substance was dispensed, then the
patient, or the third party payer, would bear the cost.
4:16:58 PM
MARGARET BRODIE, Director, Director's Office, Division of Health
Care Services, said that it was necessary to study who would
benefit from the database, and look for funding from those who
benefited.
VICE CHAIR KELLER offered his belief that the funding would need
to come from the pharmacists. He suggested that there could be
other funding sources, including private donations, and he asked
for any suggestions from Department of Health and Social
Services (DHSS).
4:18:37 PM
MS. BRODIE stated that DHSS supported the database and would
work with whomever to make it successful.
REPRESENTATIVE REINBOLD declared that the community, as a whole,
benefited from the database. She suggested finding funding
alternatives to avoid conflict with the pharmacies.
4:20:27 PM
DIRK WHITE, Chairman, Board of Pharmacy, reported that the Board
of Pharmacy had taken on the responsibility of overseeing the
program when it was passed in 2008. At that time, there was a
letter of intent that there would not be a financial burden on
the Board of Pharmacy or the pharmacists for running the
program. He declared that it was a public safety issue, and
that everyone in the state benefited by the prevention of
narcotics and other dangerous prescription medication from
reaching the street. He said that, as all the citizenry
benefited, there should not be fees imposed on the providers.
He asked how the fees would be collected and then disseminated.
He said that this would become a non-funded state mandate, and
he listed other non-funded federal mandates for which
pharmacists were responsible. He said that all the providers
had similar fees. He stated that this benefit to all the
citizens of the state needed to be funded by the state.
4:24:15 PM
VICE CHAIR KELLER stated that the fees would get passed on to
the customers.
MR. WHITE explained that these fees would not be passed on, as
the pharmacists cannot change their reimbursement rates, and any
increased costs had to be absorbed by the pharmacist.
4:25:27 PM
PATRICIA SENNER, Family Nurse Practitioner, Alaska Nurses
Association, expressed her support for the change in wording for
entry data users. She relayed that the Legislative Budget and
Audit Committee was holding hearings regarding the accounting
practices of the Division of Corporations, Business, and
Professional Licensing [Department of Commerce, Community &
Economic Development], with some possible "deficiencies or
problems in that area" and she did not want to add any further
responsibilities to that division. She suggested a tax on the
pharmaceutical companies that make the controlled substances.
She pointed to the state tobacco tax and the state liquor tax,
which were collected from the distributors and not the
individual dispensers. She expressed support for the real time
mandate, though she expressed concern for any cost increase over
management of the current system.
4:27:43 PM
VICE CHAIR KELLER said that the proposed bill would be held
over.
4:28:09 PM
LIS HOUCHEN, Director, State Government Affairs, National
Association of Chain Drug Stores, directed attention to the
letter [Included in members' packets] that she had submitted
which listed suggestions for the proposed bill. Referring to
page 2, line 31, and continuing on to page 3, line 1, she
suggested deleting "other than the state." She stated that the
organization was very supportive of this program, noting that
only one state did not have a similar program. She noted the
current lack of ability for online real time, and she asked that
this be removed from the proposed bill. She explained that the
program was trying to discern a history of abuse by a specific
individual, and, as that was revealed by activity over a period
of time, the online real time was not necessary. She asked that
the pharmacist and the prescriber not be taxed, as they were
already paying to provide the information and the materials.
She suggested a search for alternative sources of funding, and
mentioned a user fee for those who access the information. She
stated that the pharmacies could not pass on this cost, as the
rates were already fixed, and she asked that an alternative
source of funding be sought.
4:31:43 PM
VICE CHAIR KELLER replied that there was a conceptual amendment
to be proposed that would address some of those concerns.
4:31:53 PM
BARRY CHRISTENSEN, Pharmacist, Co-Chair, Legislative Committee,
Alaska Pharmacists Association, declared support by the
membership for the prescription substance data base, as it
ensured public safety. He pointed out that the Alaska
Pharmacists Association had submitted a letter [Included in
members' packets]. He expressed appreciation for licensed staff
to have access to the data base, and suggested that it include
licensed staff in other medical practices. He pointed out that
there was not any real time statewide data base for
pseudoephedrine. He asked for a response to why there was not
real time in Alaska.
4:34:47 PM
DAN LYNCH referred to an earlier proposal for a similar bill in
2008 and maintained that his testimony remained unchanged, the
proposed bill was "unconstitutional in the USA, including
Alaska." He referred to the Fourth Amendment [Bill of Rights]
and its statement against unreasonable search and seizure. He
offered his belief that success statistics had determined that
it "won't work now in real time or dream time." He referred to
the letter of intent from the earlier proposed bill, "it is not
the intent of the legislature that the professional users of the
data base absorb the cost of managing this public program
through their license fees or other fee structure," and declared
that this had already been established. He questioned the
change for increased access to the data base, or contracting
with a private data base provider. He declared that the state
was unable to monitor its own employees. He pointed out that
the internet was now the global marketplace for purchases. He
said it was a waste of funds for this "silly, incompetent, feel
good legislation." He suggested using the time, effort and
finances "to address reality, treatment, real issues and real
solutions."
4:38:04 PM
VICE CHAIR KELLER held over HB 324.
4:38:25 PM
The committee took a brief at-ease.
4:38:55 PM
VICE CHAIR KELLER removed his earlier objection to the proposed
work draft. There being no further objection, it was adopted.
HB 361-LICENSING OF BEHAVIOR ANALYSTS
4:39:07 PM
VICE CHAIR KELLER announced that the final order of business
would be HOUSE BILL NO. 361, "An Act relating to licensing of
behavior analysts."
4:39:21 PM
REPRESENTATIVE DAN SADDLER, Alaska State Legislature,
paraphrased from the sponsor statement:
Autism is a significant and growing problem in Alaska.
Statistics show that one in 110 Alaska children -
about 1 percent - are born with this developmental
disability, characterized by a diminished ability to
communicate, social isolation, and other symptoms.
While not curable, autism is treatable. Scientific,
peer-reviewed studies have shown that early intensive
treatment in the form of Applied Behavioral Analysis
offers the best opportunity to help people with autism
improve their ability to function productively in
society.
Applied Behavior Analysis is recognized as the basis
for the most effective form of treatment for autism by
the U.S. Surgeon General, The National Institute of
Child Health, and the American Academy of Pediatrics.
You can best understand ABA as behavior modification
therapy: It seeks to encourage appropriate behavior
by assessing and managing the relationship between the
environment and the desired behavior.
Forty years of research shows that nearly half of
people with autism who receive intensive early
intervention and treatment do not require lifelong
services and support - and half can achieve normal
functioning after two to three years. This can mean
lifetime savings of $200,000 to $1.1 million for a
person through the age of 55.
One of the most important elements in successful
autism treatment is having it provided by well-trained
behavioral therapists - those who hold the nationally
recognized credential of Board-Certified Behavioral
Analyst, or BCBA.
To qualify as a BCBA, applicants must have a minimum
of a master's degree, plus extensive training and
experience requirements of up to 1,500 hours of
supervised practice in the field, 225 hours of
graduate-level classroom work, or a year's experience
teaching ABA at the university level. They must also
pass the challenging BCBA certification examination.
The Board-Certified Assistant Behavioral Analyst, or
BCaBA credential, requires slightly lower standards.
The state already supports the training of BCBAs
through a grant to the Center for Human Development,
at the University of Alaska Anchorage. There are
about 20 to 30 BCBAs and BCaBAs in Alaska today,
although not all of them are currently working in the
field.
Under current state law, Alaskans with BCBAs cannot
bill health insurance companies or Medicaid for their
services at a rate that reflects their high degree of
training and professional skill because they are not
formally licensed.
HB 361 addresses this situation by providing for those
holding the BCBA or BCaBA credentials in Alaska to be
licensed by the Division of Professional Licensing, in
the Alaska Department of Commerce, Community and
Economic Development. Fourteen other states currently
provide licensing and regulate behavior analysts.
This approach has the strong support of Alaska BCBAs
and of national autism advocacy groups.
By ensuring licensing and higher standards of practice
for BCBAs and BCaBAs, HB 361 will:
· encourage more people to provide autism services in
Alaska
· offer higher reimbursement rates for professional
providers
· provide better outcomes for Alaska children with
autism
· save the state money by avoiding the need for costly
institutional care, and
· improve the quality of life for hundreds of Alaskans
and their families.
4:43:17 PM
VICE CHAIR KELLER opened public testimony.
4:43:46 PM
LORRI UNUMB, Vice President, State Government Affairs, Autism
Speaks, reported that she worked on autism insurance reform
legislation, she founded an applied behavior analysis treatment
center, and she taught law classes, including autism and the
law. She declared that, most importantly, she was the mother of
a severely affected 13 year-old autistic son. She stated her
strong support of HB 361. She reported that she had worked on
many of the 34 insurance laws nationwide, as well as many of the
professional licensure bills in 14 states. She offered her
belief that HB 361 was well written and "strikes an appropriate
balance; it recognizes the appropriate levels of professional,
the board certified behavior analyst, as well as the associate
level for those with lesser education experience." She noted
that the proposed bill allowed for a temporary license for those
licensed in another state, a disciplinary mechanism to sanction
those who violate the ethical and professional standards,
appropriate exemptions for those who did not need to be
licensed, and a two year transition for those already certified
elsewhere, but now practicing in Alaska. She noted that the
proposed bill reflected on the trend in creating professional
licensing.
4:47:06 PM
RICHARD KIEFER O'DONNELL, MD, Associate Director, Center for
Human Development, University of Alaska, shared that he had
started his work with the Center for Human Development in 2008
as part of a partnership with many other agencies and parents.
This partnership was tied to the core question for what type of
training and workforce development was necessary in Alaska to
serve the population of children with autism. He relayed that
this was a partnership with two other universities to offer the
program, and that there were now 20 certified analysts, with 17
others working toward the degree. He noted that many of the
graduates were now actively involved with the complex behavior
collaborative.
4:50:41 PM
RACHEL WHITE, Behavior Analyst, Good Behavior Beginnings, said
that she worked with children with autism, and that she provided
in-home services in the Anchorage and Mat-Su areas. She
declared her support for the proposed bill, as it would provide
access to services for clients with insurance that required
state licensing, as opposed to national certifications. She
expressed support for the regulation of services so clients
would receive quality and ethical behavior analytic services.
4:52:44 PM
ANNETTE BLANAS, Capacity Building and Autism Interventions
Project Director, Center for Human Development, University of
Alaska, reported that she was on the autism task force, and that
she was a board certified behavior analyst, as well as the
mother of a son with autism. She declared her support for the
proposed bill. She added that licensure brought a protection
for families in rural communities, as they were more vulnerable
to practices "that are not necessarily good." She pointed out
that, as many families were desperate for early intervention,
the licensure would add a component of protection for consumers.
4:54:20 PM
SUZANNE LETSO, Alaska Center for Autism, reported that she
operated a school, was a board certified behavior analyst, and
was the mother of a child with autism. She directed attention
to her previously submitted testimony [Included in members'
packets]. She stated that the proposed bill was well written
and would protect consumers, ensure appropriate interventions,
and safeguard the funding for education of children with autism.
She stated that the BCBA (Board-Certified Behavioral Analyst)
was the international organization recognized for setting the
standard for behavior analytics and qualifications worldwide.
She offered her belief that it was important to tie into this
standard, as it would allow recruitment into Alaska and would
reduce the cost for implementing licensure. She declared the
need for a funding stream to support the UAA graduates in
certified behavior analysis.
REPRESENTATIVE REINBOLD asked if teachers were getting enough
support with autistic children in the public classroom.
MS. LETSO offered her belief that they were not, and that it was
necessary for more training and more experts.
5:00:19 PM
REBEKA EDGE, Behavior Matters, reported that she was a board
certified behavior analyst, and had two children with autism.
She said that, although her business billed multiple insurance
companies, Tri-Care was the only reliable payer. She said that
most insurance companies required licensure.
5:02:32 PM
REPRESENTATIVE SADDLER asked if the proposed bill would inhibit
the ability of not licensed staffers to do their work.
MS. EDGE said that it would not as there were also behavioral
technicians.
5:03:21 PM
VICE CHAIR KELLER asked about the acceptance of national
certification by the insurance companies, and noted that Premera
Blue Cross did support the proposed bill. He asked if the
proposed bill would set up a self-regulating board.
REPRESENTATIVE SADDLER replied that private insurers were making
intermittent payments for claims, although the coding for
services was often questioned. He pointed out that Premera Blue
Cross supported the "approach of this bill" and they did see the
benefit of licensure, although they interpreted the need for an
independent professional licensing board. He reported that the
proposed bill envisioned departmental licensing, which he opined
would meet the licensure requirements for insurance billing and
Medicaid.
VICE CHAIR KELLER suggested allowing the indeterminate fiscal
note be passed on to the House Finance Committee.
5:05:07 PM
REPRESENTATIVE TARR commented that a recent article had linked
autism to environmental causes.
REPRESENTATIVE REINBOLD offered her belief that the increasing
rates of autism should be researched, especially if there was a
link to environmental causes. She suggested that early
intervention could cut the associated long term cost.
5:06:40 PM
REPRESENTATIVE PRUITT moved to report HB 361, labeled 28-
LS1474\A, out of committee with individual recommendations and
the accompanying fiscal notes.
VICE CHAIR KELLER objected. He then removed his objection.
There being no further objections, HB 361 was moved from the
House Health and Social Services Standing Committee.
5:07:07 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:07 p.m.