03/02/2023 03:00 PM House HEALTH & SOCIAL SERVICES
| Audio | Topic |
|---|---|
| Start | |
| HB52 | |
| HB6 | |
| HB56 | |
| HB17 | |
| Adjourn |
+ teleconferenced
= bill was previously heard/scheduled
| *+ | HB 56 | TELECONFERENCED | |
| *+ | HB 6 | TELECONFERENCED | |
| *+ | HB 52 | TELECONFERENCED | |
| + | TELECONFERENCED | ||
| += | HB 17 | TELECONFERENCED | |
ALASKA STATE LEGISLATURE
HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE
March 2, 2023
3:01 p.m.
MEMBERS PRESENT
Representative Mike Prax, Chair
Representative Justin Ruffridge, Vice Chair
Representative Dan Saddler
Representative Jesse Sumner
Representative Genevieve Mina
MEMBERS ABSENT
Representative CJ McCormick
Representative Zack Fields
COMMITTEE CALENDAR
HOUSE BILL NO. 52
"An Act relating to the right of patients and residents to have
a support person in person during treatment and during stays at
certain facilities; and relating to a requirement that health
care facilities make certain information available to the
public."
- HEARD & HELD
HOUSE BILL NO. 6
"An Act relating to the duties of the Department of Education
and Early Development; relating to public education; relating to
opioid abuse awareness and prevention; and providing for an
effective date."
- HEARD & HELD
HOUSE BILL NO. 56
"An Act exempting controlled substances prescribed or dispensed
by a veterinarian to treat an animal from the requirements of
the controlled substance prescription database."
- HEARD & HELD
HOUSE BILL NO. 17
"An Act relating to insurance coverage for contraceptives and
related services; relating to medical assistance coverage for
contraceptives and related services; and providing for an
effective date."
- MOVED CSHB 17(HSS) OUT OF COMMITTEE
PREVIOUS COMMITTEE ACTION
BILL: HB 52
SHORT TITLE: NO PATIENT LEFT ALONE ACT
SPONSOR(s): REPRESENTATIVE(s) VANCE
01/30/23 (H) READ THE FIRST TIME - REFERRALS
01/30/23 (H) HSS, STA
03/02/23 (H) HSS AT 3:00 PM DAVIS 106
BILL: HB 6
SHORT TITLE: PUBLIC SCHOOLS; OPIOID AWARENESS PROGRAM
SPONSOR(s): REPRESENTATIVE(s) RAUSCHER
01/19/23 (H) PREFILE RELEASED 1/9/23
01/19/23 (H) READ THE FIRST TIME - REFERRALS
01/19/23 (H) HSS, EDC, FIN
03/02/23 (H) HSS AT 3:00 PM DAVIS 106
BILL: HB 56
SHORT TITLE: CONTROLLED SUB. DATA: EXEMPT ANIMAL RX
SPONSOR(s): REPRESENTATIVE(s) RUFFRIDGE
02/03/23 (H) READ THE FIRST TIME - REFERRALS
02/03/23 (H) HSS, L&C
02/18/23 (H) HSS AT 3:00 PM DAVIS 106
02/18/23 (H) -- MEETING CANCELED --
03/02/23 (H) HSS AT 3:00 PM DAVIS 106
BILL: HB 17
SHORT TITLE: CONTRACEPTIVES COVERAGE:INSURE;MED ASSIST
SPONSOR(s): REPRESENTATIVE(s) CARRICK
01/19/23 (H) PREFILE RELEASED 1/9/23
01/19/23 (H) READ THE FIRST TIME - REFERRALS
01/19/23 (H) HSS, CRA, L&C, FIN
02/07/23 (H) HSS AT 3:00 PM DAVIS 106
02/07/23 (H) Heard & Held
02/07/23 (H) MINUTE(HSS)
02/18/23 (H) HSS AT 3:00 PM DAVIS 106
02/18/23 (H) -- MEETING CANCELED --
03/02/23 (H) HSS AT 3:00 PM DAVIS 106
WITNESS REGISTER
REPRESENTATIVE SARAH VANCE
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: As prime sponsor, introduced HB 52.
JANET OGAN, representing self
Palmer, Alaska
POSITION STATEMENT: Provided invited testimony in support of HB
52.
NATALIE BEYELER, DO
Internal Medicine Specialist
Dr. Natalie Beyeler and Associates
Palmer, Alaska
POSITION STATEMENT: Provided invited testimony in support of HB
52.
REPRESENTATIVE GEORGE RAUSCHER
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: As prime sponsor, introduced HB 6.
RYAN MCKEE, Staff
Representative George Rauscher
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: On behalf of Representative Rauscher, prime
sponsor, presented the sectional analysis on HB 6.
MICHAEL CARSON, Vice-President/Recovery Specialist
MyHouse Mat-Su Homeless Youth Shelter;
Chair
Mat-Su Opioid Task Force
Wasilla, Alaska
POSITION STATEMENT: Provided invited testimony in support of HB
6.
BUD SEXTON, Staff
Representative Justin Ruffridge
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: On behalf of Representative Ruffridge,
prime sponsor, presented the sectional analysis on HB 56.
TRACY WARD, DVM, Clinic Director/Veterinarian
Juneau Animal Rescue
Juneau, Alaska
POSITION STATEMENT: Provided invited testimony in support of HB
56.
REPRESENTATIVE ASHLEY CARRICK
Alaska State Legislature
Juneau, Alaska
POSITION STATEMENT: As prime sponsor, offered a brief summary
on HB 17.
BARBARA TYNDALL, representing self
North Pole, Alaska
POSITION STATEMENT: Testified in opposition to HB 17.
PAMELA SAMASH, President
Right to Life - Interior Alaska
Nenana, Alaska
POSITION STATEMENT: Testified in opposition to HB 17.
KATHERINE CHRISTENSON, representing self
Anchorage, Alaska
POSITION STATEMENT: Testified in opposition to HB 17.
MORGAN LIM, representing self
Juneau, Alaska
POSITION STATEMENT: Testified in opposition to HB 17.
ACTION NARRATIVE
3:01:53 PM
CHAIR MIKE PRAX called the House Health and Social Services
Standing Committee meeting to order at 3:02 p.m.
Representatives Ruffridge, Saddler, Sumner, Mina, and Prax were
present at the call to order.
HB 52-NO PATIENT LEFT ALONE ACT
3:03:06 PM
CHAIR PRAX announced that the first order of business would be
HOUSE BILL NO. 52, "An Act relating to the right of patients and
residents to have a support person in person during treatment
and during stays at certain facilities; and relating to a
requirement that health care facilities make certain information
available to the public."
3:04:28 PM
REPRESENTATIVE SARAH VANCE, Alaska State Legislature, as prime
sponsor, introduced HB 52. She paraphrased from the sponsor
statement [copy included in the committee packet], which read as
follows [original punctuation provided]:
HB 52 seeks to safeguard a patient's right to a
support person receiving emergency medical services,
or staying at hospital, nursing facility, assisted
living home, or hospice care. This bill ensures no
patient is left alone when they feel most medically
vulnerable and may not be withheld a support person
based on a state or federal declaration of disaster,
allows for civil penalties and requires healthcare
facilities to make visitation policies available to
the public.
The pandemic has caused great uncertainty and anxiety
across Alaska and has significantly affected the
medical community. Many unintended consequences have
happened to patients because of visitation policies
that have prohibited them from having any visitors,
including a spouse, parent, close family member,
guardian, health care agent, chaplain, or caregiver;
and as a result, many have been forced to be alone
during their treatment for serious conditions,
traumas, illnesses, heart attacks, and routine and
emergency surgeries.
Some of these patients have been forced to be alone
for the entire course of their treatment and in some
cases have died alone; and many families have been
unable to be physically present with their loved ones
while in a hospital, nursing home, hospice care, adult
care home, special care unit, or residential treatment
setting for mental illness, developmental or
intellectual disability, or substance use disorder.
Alaskans have been limited to electronic video
communications, if any, with the patient; and the
patients who have been affected have included adults,
minors, and individuals with intellectual or
developmental disabilities; however it is my belief
that it is our moral obligation that these patients be
allowed at least one support person of their choice to
be physically present at reasonable times throughout
the period of hospitalization or residential
treatment.
3:07:19 PM
REPRESENTATIVE VANCE shared a recent story which related that a
father had resorted to camping on the lawn of a hospital in
order to be near his daughter who had been admitted to the
hospital with a severe asthma attack. She stated that the
father offered to test for COVID-19 and wear protective gear at
the hospital, as he believed his presence would improve his
daughter's health. She stated that the hospital had refused
access to the father. She related a story concerning a
constituent's experience after he was admitted to the hospital
with COVID-19. His wife was not allowed to be with him in the
hospital, and this had been mentally and physically challenging
for him. She said he had told her that he had not considered
the importance of having a loved one present during recovery.
She related that he had realized that this presence would
improve the patient as much as drugs and treatment. She
maintained that this is an issue of human dignity.
3:11:20 PM
REPRESENTATIVE VANCE presented a PowerPoint on HB 52, titled "No
Patient Left Alone Act." As listed on slide 2, she addressed
the main components of the bill: provide patients with a right
to a support person; allow for civil liability; not allow for
the rights of patients to be suspended; provide that facilities
have written policies; and allow for an investigation by the
Department of Health (DOH).
REPRESENTATIVE VANCE continued to slide 3, which addressed a
patient's right to a support person. She stated that the
proposed legislation would require health care facilities to
allow a support person to be present at all times during the
patient's stay. To eliminate the possibility of any loopholes,
she stated that the proposed legislation specifies "in person"
in reference to this. She continued that the support person's
privileges would not be limited to the visitation hours of the
facility, and the right to a support person could not be
withheld based on a declaration of disaster. She addressed
civil liability, as seen on slide 4. She explained this
provision would allow a patient or the support person to bring a
civil complaint against a health care facility or health care
professional.
3:13:36 PM
REPRESENTATIVE VANCE, continuing to slide 5, stated that the
proposed legislation would prohibit a state or federal
declaration of disaster to change a patient's rights. She
continued that the proposed legislation would also require
health care facilities to inform patients of the right to equal
treatment concerning a support person. Connected to this is the
requirement that the current version of a health care facility's
visitation policies and procedures be made widely available to
the public, as seen on slide 6. She moved to slide 7, stating
that this would include investigations by DOH, and individuals
would be able to file a complaint with DOH concerning any
violation. Moving to slide 8, she stated that, unless required
by federal law or regulation, a state agency may not take action
against a health care facility for prohibiting a visitor from
entering an operating room, isolation room, isolation unit,
behavioral health setting, or other typically restricted areas.
3:17:33 PM
CHAIR PRAX announced the committee would hear invited testimony
on HB 52.
3:18:09 PM
JANET OGAN, representing self, began her invited testimony in
support for HB 52. She shared the story that in July 2022 her
sister-in-law had been admitted to the Mat-Su Regional Medical
Center for pneumonia and tested positive for COVID-19. She
stated this became a nightmare for her family because the
sister-in-law was terrified at being alone and put on a
ventilator. Family members were unable to visit her, including
her husband, until she died nine days later. She expressed the
understanding that the hospital did not welcome the husband.
She stressed that sickness can be frightening, and the process
can be made easier by having a loved one present for comfort and
as an advocate. She described the distressed situation as
"helpless." The family had been notified that the sister-in-law
was dying but were not allowed in the room until after she had
passed away. She questioned, "What logic justified this
deprivation of human dignity?" She added that her family had
traditions around the death of family members, and that
tradition was robbed when they were unable to comfort her
sister-in-law or grieve her death. She stated that others have
suffered similar actions by health care institutions,
emphasizing that a society is judged by its treatment toward the
elderly, unborn, and sick. She stated that the COVID-19
pandemic had ushered in a "dark time" for the country, as
patients were denied the right to have loved ones make decisions
concerning care, and treatment protocols had been forced without
allowing alternatives. She stated that HB 52 would be a step in
the right direction.
3:25:08 PM
NATALIE BEYELER, DO, Internal Medicine Specialist, Dr. Natalie
Beyeler and Associates, provided invited testimony in support of
HB 52. She shared that she currently runs her own clinic, but
for 16 years she had been the director of critical care and
intensive care at Mat-Su Regional Medical Center, and for 25
years she had been the director of pulmonary care. She said
that after the hospital began employing its own physicians,
privately employed physicians, like herself, were relegated to
"backseat drivers." She explained that this is why her
testimony is important. She expressed the opinion that not
recognizing the importance of family members for a patient's
recovery process is "absolutely insane." She referenced a
recovery-unit study which indicated patients recuperated 80
percent better when they had a view of a tree; however, she
argued that a study is not needed to know that the presence of a
familiar face or squeeze of a hand improves medical outcomes for
patients. She stated that many times patients can be confused,
over medicated, sedated, or experiencing intensive-care
psychosis. She continued that, whether it is a tooth extraction
or a brain surgery, there is no substitute for having a support
person present. She voiced the opinion that this could improve
medical outcomes for the patient.
3:29:26 PM
DR. BEYELER continued that not being able to take care of a
family member in the hospital leaves those remaining with
regret, remorse, long-lasting grief, anxiety, depression, and
guilt. She stated that this is a terrible testimony on health
care facilities and expressed shame over being a doctor. She
pointed out that hospitals are currently overrun, and the nurse-
to-patient ratio is "high," so having the presence of a loved
one to rely on is important. She referenced the medical
condition of "cryptic shock," which has no outward signs for
nurses or other providers to notice, especially with
understaffing. She expressed the opinion that a loved one at
the bedside would more readily notice this condition, and this
could save the patient's life.
3:32:41 PM
DR. BEYELER stated there are many stories of patients who had
improved outcomes because they were surrounded by loved ones.
She shared a recent account of a husband who had contracted a
very serious illness and was taken to the hospital. The wife
had learned that his outcome would worsen if he were intubated.
The wife was not allowed into the hospital room, but she could
hear talk through the door concerning intubation. She described
the wife as "banging on the intensive care doors" and
"screaming" to stop her husband's intubation. She stated that
the husband had relied on his wife to be his spokesperson, and
when he heard her screaming, whether it was the adrenaline pump
or her voice, he was shocked into survivor mode and his oxygen
levels went up.
3:35:14 PM
DR. BEYELER stated she has researched hospital admissions,
discharges, readmissions, and post-hospitalization mortality;
however, she has not found one study addressing the presence of
a support person. She expressed the opinion that depriving a
parent from being present with a minor patient defies civility
and should be "punishable by incarceration." She argued that
individuals in the hospital would not have the capacity to
answer for themselves, so someone must be present to stand in
for them. She offered to follow up with any needed materials in
support of the proposed legislation.
3:38:33 PM
REPRESENTATIVE SUMNER, concerning health care facility
liability, pointed out language that would be added to statute
as Section 18.20.630 [under Section 1 of HB 52, on page 4,
beginning on line 24], which would preclude any state agency
from taking any action against a facility. He expressed the
understanding that most of the testimony concerned
hospitalizations in COVID-19 isolation wards. He questioned
whether the legislation would actually address this situation.
3:39:31 PM
REPRESENTATIVE VANCE expressed the understanding that not all
patients during the pandemic were in isolation wards. She
expressed appreciation for the comment; however, many
constituents have informed her of situations in regular hospital
rooms where they were not allowed a support person. She
referred to seniors in assisted living homes who were not
allowed to see loved ones. She referenced an example where a
doctor prescribed anti-depressants to an individual who was
quickly failing in a senior care facility because of the
inability to see family. She commented that a variety of
facilities limited the rights of patients.
3:41:18 PM
REPRESENTATIVE SUMNER expressed the understanding that isolation
rooms would be needed in the case of extremely contagious
outbreaks. He expressed agreement that in the case of COVID-19,
[family support] should not have been restricted; however, he
advised that there could be a potential need for isolating
patients.
3:42:42 PM
REPRESENTATIVE SADDLER questioned Dr. Beyeler on the Mat-Su
Medical Center's policies prior to the COVID-19 pandemic.
DR. BEYELER responded that there have always been visiting
hours, and at least one family member could be with the patient
in the critical care unit. She stated that every single room in
the hospital has a bed available for a family member, and rarely
does a patient explicitly ask to not have a support person. She
stated that having a support person present makes providers'
jobs easier in regard to bathing, feeding, monitoring
medication, and more.
3:44:49 PM
REPRESENTATIVE SADDLER, with a follow-up question for
clarification, asked whether hospitals currently have no limits
on the presence of a support person, even in the emergency room,
recovery room, or operating room.
DR. BEYELER responded that operating rooms are restricted
because of distractions and the need for a sterile environment.
In situations with the critically ill, she said, there may be
limited space in the room for a support person. She stated that
patients in the recovery room would always have at least one
support person, but not more than two in a post-operation area.
She expressed the importance of having a support person present
when a patient is given instructions or a diagnosis.
3:47:10 PM
REPRESENTATIVE MINA thanked the bill sponsor. She pointed out
that the examples presented had been during the COVID-19
pandemic. She directed attention to the language on page 2,
lines 2-3, which concerns a provider's ability to restrict
access to patients during emergency-medical services. She
continued that the language is repeated within the bill in
relation to hospitals, mental health facilities, long-term care
facilities, and hospice. She questioned whether the provider's
ability to restrict access would apply to COVID-19 concerns.
REPRESENTATIVE VANCE, in regard to the intent of the
legislation, responded that health care facilities would not
restrict access to the patient, regardless of a pandemic or
declared disaster, and medical center policies should reflect
this intent. She stated that the term "reasonable" would apply,
and this would mean detriment to the care of the patient. She
expressed the opinion that it had been learned during the COVID-
19 pandemic that withholding a support person is not
"reasonable." She stated that health care facilities would need
some flexibility to care for patients in a medically appropriate
way, while clarifying the right of an individual to have a
support person.
3:50:36 PM
REPRESENTATIVE MINA provided the example of a highly infectious
pneumonic plague and questioned whether the proposed legislation
would allow hospitals to apply restrictions, or whether the
hospital would be sued based on the civil liability section.
REPRESENTATIVE VANCE expressed the belief that she would not be
the best person to answer the question. She stated that, in
regard to the intent of the legislation, the health care
facility would have the ability to make the decision, as long as
it is "reasonable" and every individual is treated equally. She
suggested that this was not the case during the pandemic.
3:52:40 PM
REPRESENTATIVE RUFFRIDGE voiced the opinion that few people
would dispute the necessity of having a loved one present in a
critical care situation; however, he concurred with
Representative Mina. He expressed the concern that the current
version of the proposed legislation may not accomplish its
intent. He surmised that it does not clearly define a
"reasonable restriction". He expressed the opinion that
throughout the COVID-19 pandemic most of these issues came to
light, and most health care facilities would have "driven pretty
hard" on the "clinically necessary" component of the bill. He
suggested that the language be clarified. He stated that the
provisions in Section 18.20.610 and Section 18.26.620 already
exist through DOH. He said that if HB 52 were to become law,
then both of these would be redundant.
REPRESENTATIVE VANCE responded that she was not aware of the
redundancy. She expressed the willingness to work with the
committee on clarifying the language.
3:55:33 PM
REPRESENTATIVE MINA stated that emergency room physicians have
brought forward situations where providers have had to separate
the patient, who is a victim, from an abuser. She pointed out
that the provision on page 4, line 3 of the proposed legislation
would prohibit a health care facility from separating a minor
from a support person, except in a case of suspected abuse. She
questioned the reasoning for not including this language in
other sections related to facilities and providers of emergency
medical services.
REPRESENTATIVE VANCE responded that the section on page 5, line
7 addresses this, with the intent to make sure patients are
safeguarded.
3:57:41 PM
REPRESENTATIVE MINA pointed out the provision on page 5, line 7,
wherein restricted access could be requested by a patient, law
enforcement agency, or court order. In other words, in the case
of a dangerous situation, restricted access would have to be
requested by the patient, agency, or court before the facility
could restrict access. Referring back to page 4, line 3, she
pointed out that this provision would not require a court order
or a request from the patient before access could be restricted.
She expressed the opinion that the language on page 4 should be
mirrored fully in the other sections.
REPRESENTATIVE VANCE stated that this could be easily
accommodated.
3:59:19 PM
CHAIR PRAX announced that HB 52 was held over.
HB 6-PUBLIC SCHOOLS; OPIOID AWARENESS PROGRAM
3:59:54 PM
CHAIR PRAX announced that the next order of business would be
HOUSE BILL NO. 6, "An Act relating to the duties of the
Department of Education and Early Development; relating to
public education; relating to opioid abuse awareness and
prevention; and providing for an effective date."
4:00:30 PM
REPRESENTATIVE GEORGE RAUSCHER, Alaska State Legislature, as
prime sponsor, introduced HB 6. He paraphrased from the sponsor
statement [copy included in the committee packet], which read as
follows [original punctuation provided]:
House Bill 6 addresses the need to better educate the
youth in Alaska on the dangers of opioid misuse. Many
communities around Alaska are feeling the impacts of
the rising misuse of opioids and an increase in
fentanyl related deaths.
This legislation would instruct the Department of
Education and Early Development to put in place a 60-
minute curriculum that would cover opioid abuse
awareness and prevention. This curriculum would be for
students grades six through 12 and would cover
information about the dangers of using opioids,
awareness of opioids that target children, and early
warning signs related to opioid addiction, among other
things.
The department would also be directed to consult with
other entities around the state that have experience
in dealing with opioid related problems. Some of these
groups would include The Department of Health, state
and tribal entities, and family members of individuals
who had an opioid overdose.
House Bill 6 will educate our kids on the dangers of
opioid use and help prepare them to deal with this
ever-growing danger in Alaska.
REPRESENTATIVE RAUSCHER stated that fentanyl is a problem in the
state. He suggested that the drug can look like "Skittles" and
tempt children. He suggested that children are being subtly
taken over by the drug world, and the proposed legislation would
deal with this aspect.
4:03:34 PM
RYAN MCKEE, Staff, Representative George Rauscher, Alaska State
Legislature, on behalf of Representative Rauscher, prime
sponsor, gave a sectional analysis on HB 6 [included in the
committee packet], which read as follows [original punctuation
provided]:
Section 1: AS 14.30
Adds a new section to explain the awareness and
prevention curriculum for students in grades six
through twelve. Details are provided on who will
be consulted and how the curriculum will be
developed.
Section 2:
The uncodified law of the State of Alaska is
amended by adding a new section related to DEED
regulations.
Section 3: AS 14.30.363(c)
Enacted by Section 1, the effective date is
September 1, 2023.
Section 4:
With the exception of Section 3 of this Act, this
Act takes effect immediately.
4:04:36 PM
MICHAEL CARSON, Vice-President/Recovery Specialist, MyHouse Mat-
Su Homeless Youth Shelter; Chair, Mat-Su Opioid Task Force,
shared that he also sits on the state's opioid steering
committee. He thanked the committee for the invitation to
testify in support of HB 6. Discussing the current data on the
opioid epidemic, he stated the first phase involved pain pills,
the second phase involved heroin, and the current phase involves
fentanyl. He stated that 15- to 44-year-olds have seen an
increase in overdoses, with 25- to 34-year-olds seeing the
greatest increase. He explained that all public school students
would eventually be in the greatest risk age group. He added
that in 2021 Alaska had the largest jump in drug overdoses in
the nation, with one out of three Alaskans being affected by the
opioid epidemic. He referenced the recent drug arrests at the
airport in Juneau. He stated that 5,000 counterfeit oxycodone
pills were seized, with a street value of $150,000. He stated
the U.S. Drug Enforcement Administration (DEA) released the lab
results which said 6 out of 10 counterfeit pills have a
potential lethal dose. He explained that 2 mg of fentanyl is
fatal, with 1 gram having the potential to kill 500 people. He
stressed the importance of educating youth, because now most
illicit drugs are contaminated with fentanyl. He added that no
drug is safe unless it comes from a doctor or pharmacist. He
stated that because parents are a vital partner in the education
of their children, they also need to learn this.
4:08:24 PM
MR. CARSON stated that there is no current health curriculum
addressing opioids, much less fentanyl. He stated that the last
time the health curriculum had been revised was before the
COVID-19 pandemic, and then no mention of opioid tolerance,
dependence, or addiction had been made. He stated that the
Department of Education and Early Development's (DEED's)
resources for teachers have no updated information on fentanyl,
and the proposed legislation would be requesting curriculum
development. He suggested that in the interim Kellsie's Lesson
could be utilized. He explained this lesson helps students
understand how opioids "hack and whack the brain," and it is
aligned with the national health standards.
MR. CARSON, addressing his qualifications, shared that he taught
school for 35 years in the Matanuska-Susitna Borough School
District. He stated that he has also taught at Mat-Su College,
done postgraduate work in addiction studies, and worked with the
Division of Juvenile Justice. He stated that he has been a
recovery specialist and currently sits on the Mat-Su Opioid Task
Force. He stated that he would welcome any questions on any
drug or Kellsie's Lesson.
4:11:08 PM
REPRESENTATIVE MINA questioned whether any statewide drug
curriculum exists in the country.
MR. CARSON responded that Red Ribbon Week is the last week of
October, and this is a national drug prevention campaign. He
stated that during this week a 30-minute lesson is taught.
However, this would be dependent on individual schools and
districts. He stated this past year he did a presentation on
fentanyl during Red Ribbon Week at Colony Middle School and
Colony High School. He stated that fentanyl is 50 times more
powerful than heroin and 100 times more powerful than morphine.
4:13:42 PM
REPRESENTATIVE MINA, with a follow up, questioned the rates of
opioid abuse and overdoses among youth in Alaska compared with
the national average.
MR. CARSON stated that in 2021 Alaska had the biggest jump in
drug overdoses in the country, with 25- to 34-year-olds having
the greatest increase. He stated that he could follow up with
specific numbers but advised that there is a data lag. He
explained that teenagers would eventually be in the high-risk
group of 25- to 34-year-olds. He said, "I think it is
imperative to move upstream. I am all about pulling people out
of the river of addiction, getting them to detox and treatment,
but there is something to say about moving upstream and cutting
off the flow."
4:15:49 PM
REPRESENTATIVE SADDLER questioned whether a specific curriculum
on opioid addiction should be created, and whether any current
required drug-abuse curriculum exists for Alaska schools.
MR. CARSON expressed uncertainty concerning a mandated drug
curriculum in Alaska. He added that Maryland would be the only
state with this type of school curriculum.
4:17:37 PM
REPRESENTATIVE SADDLER requested that DEED be questioned on this
point. He expressed surprise that mandated education on drug
abuse does not exist and suggested the proposed legislation
could be broadened to include more dangerous drugs.
4:18:11 PM
REPRESENTATIVE SUMNER commented that he remembered the Drug
Abuse Resistance Education (D.A.R.E.) program. He expressed the
understanding that the program was discontinued because of
failure. He stated that while children were being educated
about drug abuse, drug use had increased. He added that
research on this topic would be useful. He expressed the
opinion that something needs to be done; however, he expressed
uncertainty about the proposed legislation. He voiced interest
in learning about drug education programs which have had an
impact.
4:19:13 PM
Representative Rauscher responded that he would research drug
education and follow up with more information for the committee.
4:19:40 PM
REPRESENTATIVE MINA, referring to the proposed legislation,
expressed the understanding that DEED would create the
curriculum for the schools. She questioned the format and the
frequency of the classes.
REPRESENTATIVE RAUSCHER responded that the legislature would not
design the curriculum, timing, or presentation of the material.
He stated that the schools and districts would decide this. He
deferred to Mr. Carson.
MR. CARSON, addressing D.A.R.E., stated that the program did not
produce its targeted benchmarks. Regarding the recommended
frequency of [drug awareness classes], he expressed the opinion
that, because of the ever-changing drug epidemic, classes should
be taught once a year in an assembly or a health class format.
He suggested that classes be taught during Red Ribbon Week. He
concurred with the idea that HB 6 could be expanded to include
other drugs. He stated that because of the ever-changing drug
epidemic Kelsee's Lesson has to be updated every few weeks.
4:23:55 PM
Representative Rauscher pointed out a CBS News article from
March 1, 2023, which described Alaska as fentanyl's "deadliest
frontier."
4:24:23 PM
CHAIR PRAX announced HB 6 was held over.
4:24:43 PM
The committee took an at-ease from 4:24 p.m. to 4:26 p.m.
HB 56-CONTROLLED SUB. DATA: EXEMPT ANIMAL RX
4:26:21 PM
CHAIR PRAX announced that the next order of business would be
HOUSE BILL NO. 56, "An Act exempting controlled substances
prescribed or dispensed by a veterinarian to treat an animal
from the requirements of the controlled substance prescription
database."
4:26:40 PM
REPRESENTATIVE RUFFRIDGE, as prime sponsor, introduced HB 56 via
a PowerPoint presentation [hard copy included in the committee
packet]. He stated that HB 56 would exempt veterinarians from
the Prescription Drug Monitoring Program (PDMP). Beginning on
slide 2, he stated PDMP had been established in Alaska in 2008
to track the dispensing of controlled substance medications. He
added that while every state has a similar program, 33 states
have exempted veterinarians from participating. Currently in
Alaska all prescribing-license types are required to register
with PDMP. He continued that license holders are required to
review PDMP prior to prescribing controlled substances and
report daily on the dispensing of all controlled substances,
even on days the business is closed.
4:29:11 PM
REPRESENTATIVE RUFFRIDGE, referring to slide 3, stated that PDMP
was designed as a dispensing record to aid practitioners,
especially in relation to [Schedule] II narcotics, which are
highly abusable medications. He listed some of the other lower-
class drugs, which also have to be reported. He said pharmacies
have an automatic daily-reporting process, while veterinarians
manually submit their daily reports. He stated that PDMP
monitors prescriptions for legal drugs and would have no control
over illicit-drug use. He stated that the purpose of PDMP is to
help prevent doctor and pharmacy "shopping."
4:32:21 PM
REPRESENTATIVE RUFFRIDGE, moving to the next slide, addressed
the reason for the legislation. He stated that veterinarians
are aware of the importance of PDMP in preventing pharmaceutical
drug abuse; however, they experience unique difficulties with
the program requirements. He added that there are some serious
concerns about the privacy of information in PDMP. On slide 5,
he pointed out that the program is designed to track human
prescriptions, not animal prescriptions. The data gathered by
veterinarians is often not linked to the animal owner, and this
would be required to accurately track data. Veterinarians are
not guided by the Health Insurance Portability and
Accountability Act (HIPAA), nor are they trained in human
medicine. Before dispensing a controlled substance to an
individual with a pet, the veterinarian is required to look up
information on the individual to see if any previous drugs have
been dispensed. He stated that many pet owners are not aware
veterinarians would have access to personal medical information,
and this could be a concern. Animal patients are not well
tracked because they lack the unique PDMP identifiers, and
individuals connected to the pet may not be consistent.
4:35:12 PM
REPRESENTATIVE RUFFRIDGE continued to slide 7 and stated that
veterinarians rarely require the use of [Schedule] II narcotics.
In a 2017 study, he said, veterinary clinics accounted for only
0.34 percent of all the opioids dispensed. He added that
veterinary clinics would use opioids only during surgery, and
typically opioid dispensing is reserved for pharmacies, not
veterinarians. In summary, he stated that exempting
veterinarians from PDMP would protect privacy and ensure PDMP
data is clear, usable, and linked only to end users.
4:36:21 PM
BUD SEXTON, Staff, Representative Justin Ruffridge, Alaska State
Legislature, on behalf of Representative Ruffridge, prime
sponsor, provided the sectional analysis of HB 56 [copy included
in the committee packet], which read as follows [original
punctuation provided]:
Section 1. AS 17.30.200(o) is amended to remove "and
the Board of Veterinary Examiners" from the
notification requirement when a practitioner registers
with the database under (n) of this section.
Sec. 2. AS 17.30.200 is amended by adding a new
subsection to read: This section does not apply to a
schedule II, III, or IV controlled substance
prescribed or dispensed by a veterinarian licensed
under AS 08.98 to treat an animal.
Sec. 3. AS 08.98.050(a)(10) is repealed which removes
the requirement for Veterinarians under the controlled
substance prescription database.
4:37:42 PM
TRACY WARD, DVM, Clinic Director/Veterinarian, Juneau Animal
Rescue, provided invited testimony in support of HB 56. She
shared that she recently had been the president of the Alaska
State Veterinary Medical Association (AKVMA). She explained
that Dr. Rachel Berngartt was scheduled to testify on behalf of
the Alaska Board of Veterinary Examiners (BOVE); however, Dr.
Berngartt was detained. She stated that she would be presenting
and answering questions on behalf of both AKVMA and BOVE.
DR. WARD stated for the record that both AKVMA and BOVE strongly
support HB 56. She stated that the Alaska Board of Pharmacy,
which administers PDMP, has recently passed a motion to support
the proposed legislation, as seen on slide 3. She stated that
PDMP had been amended in 2017 to require mandatory participation
by all federal permit holders. As seen in the photo on slide 4,
she stated that representatives from the prescribing boards of
other agencies had been consulted in drafting the amendment;
however, veterinarians had not been consulted. In other words,
advice was not sought from BOVE nor AKVMA, but both
organizations were included in the requirements.
4:40:02 PM
DR. WARD, moving to slide 5, stated that PDMP is not a workable
database for veterinarians because the system is designed for
human data. She said this data is uninterpretable because
veterinarians are not trained in human pharmacology and would
not have the knowledge of appropriate doses, medication
timeframes, and refill requirements. Moving to slide 6, she
expressed the opinion that having access to this data is
intrusive and an invasion of human privacy, because humans are
not the patients - they are the clients. She added that
veterinarians are not protected by HIPAA regulations. She
suggested that committee members consider how personal
medication history is being shared outside of client/patient
privilege. She maintained veterinarians are uncomfortable with
this.
DR. WARD, moving to slide 7, stated, if veterinarians were not
monitored through PDMP in regard to controlled substances, they
would be monitored through record keeping with the DEA. She
stated that every pill of oral medication dispensed and every
drop of injectable medication administered has to be accounted
for. Records would be maintained and made available to DEA or
local law enforcement agencies upon request. She added that
distributors of controlled substances are required to monitor
any pattern in usage by the DEA's Suspicious Orders Report
System, and the vast majority of drug diversions are caught
through this process, not PDMP.
4:44:30 PM
DR. WARD reiterated that a very small amount of total opioid
prescriptions would be dispensed by veterinarians. She stated
that if every one of these prescriptions were misused, it would
be "a tiny, tiny drop in the bucket of the total opioid abuse
problems." She pointed out in the graph on slide 9 that, in
general, veterinarians do not use the drugs of concern, and
synthetic opioids are almost never used. She added that Vicodin
or oxycontin are not used; however, fentanyl is used, but
exclusively in the hospital and would not be sent home with the
pet owner. She added that cocaine or methamphetamine is not
used. She maintained that veterinarians would not be the source
of the drugs of concern in the current drug epidemic.
DR. WARD, moving to slide 10, argued that veterinarians are
pursuing the proposed legislation because of the hardship PDMP
creates. She stated that investigations of veterinarians by the
board of PDMP are mostly because of clerical mistakes. Moving
to slide 11, she stated that since participation became
mandatory, investigative costs have increased threefold. She
explained that this is not because veterinarians are misusing
drugs, but because they are required to use an unwieldy system.
She explained that the board is not funded by the government,
but by licensing fees, so the cost of investigating
veterinarians is borne by the veterinarians. In other words,
veterinarians are charged with investigating themselves. She
added that Alaska already has the highest licensing fees in the
country. Moving to slide 12, she stated that support of HB 56
would allow veterinarians to provide appropriate medical
management, while increasing the efficiency of PDMP for its
intended purpose.
4:48:29 PM
REPRESENTATIVE SADDLER questioned how exempting veterinarians
from PDMP would improve efficiency.
REPRESENTATIVE RUFFRIDGE responded that PDMP was intended to
stop doctor and pharmacy "shopping," which had been a common
practice prior to the implementation of the program. He stated
that the inability to track medications dispensed from multiple
sources led to the overprescribing of controlled substances. He
stated that exempting veterinarians would clean up the data.
For example, a prescription for an animal can be in PDMP
multiple times under different pet names or owners, so this data
is difficult to accurately interpret. In turn the data cannot
be trusted, and the purpose of PDMP is not supported.
REPRESENTATIVE SADDLER, with a follow-up question, requested
additional comments on PDMP's intended use and its
effectiveness.
REPRESENTATIVE RUFFRIDGE responded that the program is
effective. He added that unfortunately the overdose deaths in
Alaska are still increasing, and this causes criticism. He
stated that PDMP is successfully adverting people from doctor
and pharmacy "shopping," but abuse of illicit drugs, such as
heroin, oxycodone, and fentanyl, has not been stopped.
4:52:03 PM
REPRESENTATIVE MINA commented that those in opposition of the
proposed legislation have come to a position of neutrality. She
questioned participation by veterinarians in addressing the drug
epidemic.
DR. WARD expressed the opinion that the education of
veterinarians is more worthwhile than requiring participation in
PDMP. She pointed out that speakers from DEA have been invited
to address [the drug epidemic] at the state veterinarians'
conference. She stated that, even though veterinary clinic
"shopping" is very rare, as part of the larger medical
community, veterinarians should be educated. She stated that
veterinarian clinics have been broken into, and security has
been increased. Within the last five years clinics are more
often calling in prescriptions to pharmacies, as opposed to
dispensing controlled drugs on the premises.
DR. WARD, in response to a follow-up question, expressed the
understanding that currently xylazine is in the process of
becoming a federally controlled substance. She expressed the
opinion that this drug would likely not be a problem in Alaska,
because it is a tranquillizer used on large animals, such as
horses, and Alaska has a small proportion of large animals.
4:55:55 PM
DR. WARD, in response to Representative Sumner, stated that
veterinarians use two opioids. Hydrocodone would be of the
primary concern, but it is used in minor amounts for chronic
coughs in small dogs. She added that accessing enough of this
drug from a clinic to cause a serious issue would be difficult.
She stated that buprenorphine would be used in a clinic as a
pain medication. She added that this drug is also used to treat
fentanyl addiction.
4:57:27 PM
REPRESENTATIVE RUFFRIDGE asserted that more work would be done
on HB 56. He stressed the importance of clean data in PDMP and
allowing veterinarians to do their job.
4:58:31 PM
CHAIR PRAX announced that HB 56 was held over.
HB 17-CONTRACEPTIVES COVERAGE:INSURE;MED ASSIST
4:58:56 PM
CHAIR PRAX announced that the final order of business would be
HOUSE BILL NO. 17, "An Act relating to insurance coverage for
contraceptives and related services; relating to medical
assistance coverage for contraceptives and related services; and
providing for an effective date."
4:59:36 PM
REPRESENTATIVE ASHLEY CARRICK, Alaska State Legislature, as
prime sponsor, offered a brief recap on HB 17. She stated that
the proposed legislation would mandate insurance coverage for up
to 12 months for a one-time dispensing of prescription
contraceptives. She stated that the providers would have the
prerogative, as they already can dispense up to a 12 months'
supply of contraceptives. She stated that the proposed
legislation would not change the number of times a doctor is
seen, rather it would change the number of times an individual
would go to the pharmacist. She stated that the response to the
questions from the hearing [on 2/07/23] were sent to the
committee members on 2/14/23. She welcomed any further
questions that members may have.
5:01:37 PM
CHAIR PRAX opened public testimony on HB 17.
5:02:23 PM
BARBARA TYNDALL, representing self, stated that she is in
opposition to HB 17, unless there is an amendment excluding
emergency contraceptives. She related that an article she had
read described the difference between emergency contraception
and the abortion pill. The article explained that in 1959 the
American College of Obstetrics and Gynecologists changed the
definition of pregnancy to the moment of implantation rather
than the moment of fertilization. She expressed the belief that
life begins at conception and a pill which prevents implantation
is abortion. She pointed out the article had related that
emergency contraception's primary function is to prevent
ovulation. She said, "However, the manufacturer's insert for
Plan B admits that the product may prevent the implantation of
an already fertilized human embryo." She asserted that this
possibility is "not acceptable and no insurance policy ...
should be forced to pay for it." She requested that, before a
vote is taken, the bill be amended to exclude emergency
contraception.
5:04:19 PM
PAMELA SAMASH, President, Right to Life - Interior Alaska,
provided testimony in opposition to HB 17. Addressing the first
reason for her opposition, she expressed the opinion that the
government's role should be to protect rights, not control
private enterprises. She continued that insurance companies
should be able to decide what to offer, while the public should
be able to decide what to accept, as this is how capitalism
works. Addressing the second reason for her opposition to the
proposed legislation, she expressed the opinion that the morning
after pill is "killing a child, and that's murder, and the
government is supposed to protect lives, and not kill people."
She continued that the third reason for opposing the bill is the
workforce shortage. The food stamp program in the state has
been affected by this shortage and elderly people are hungry.
She said, "If we keep killing our future generations, who is
going to take care of us?" She expressed the opinion that
anything to do with death or taking away private enterprise
rights needs to be "out of this bill." She described the
workforce shortage as extreme. She said, "We are in a crisis,
and this is why, because we won't let people live beyond the
womb." She requested the proposed legislation be stopped.
5:07:45 PM
MS. SAMASH, in response to Representative Saddler, stated that
she is testifying on behalf of herself and the Right to Life -
Interior Alaska. She stated that she is also a commissioner on
the Alaska Commission on Aging; however, she is not speaking on
behalf of the commission. She stated that the elderly
population is exploding, and there are not enough care givers.
5:09:10 PM
KATHERINE CHRISTENSON, representing self, provided testimony in
opposition to HB 17. She expressed the concern that mandating
insurance companies would put people at risk for not getting the
medical care they need. She shared that she knew some people
who would not buy insurance from a company which covers
contraception. She argued that choices should be available for
individuals and making requirements on insurance companies would
limit this choice.
5:11:19 PM
MS. CHRISTENSON, in response to Representative Ruffridge, stated
her reference was an example of a friend who dropped her health
insurance company because it had chosen to cover contraception.
5:12:37 PM
MORGAN LIM, representing self, expressed support for HB 17. He
stated that the proposed legislation would require health
insurance companies to cover a 12-month disbursement of oral
contraceptives from one medical appointment. He stated that
this coverage is extremely important for those who are off the
road system or have limited access to pharmacies. He expressed
hope that the committee would investigate some of the claims
made by individuals and move the bill forward.
5:14:00 PM
CHAIR PRAX, after ascertaining there was no one else who wished
to testify, closed public testimony on HB 17.
5:14:54 PM
REPRESENTATIVE RUFFRIDGE moved to adopt Amendment 1 to HB 17,
labeled 33-LS0222\A.1, Marx, 2/21/23, which read:
Page 1, line 10, following "contraceptives;":
Insert "and"
Page 1, lines 11 - 14:
Delete all material.
Reletter the following subparagraph accordingly.
Page 7, line 2, following "dispensing;":
Insert "and"
Page 7, lines 3 - 6:
Delete all material.
Renumber the following paragraph accordingly.
5:15:03 PM
REPRESENTATIVE MINA objected. Speaking to her objection, she
said that many insurance companies in Alaska cover Plan B, and
Medicaid covers Plan B. She stated that extensive studies have
shown the main course of action for the drug is to delay the
release of an egg, and implantation is not impacted; thus, if an
individual believes that implantation is conception, Plan B
would not impact this.
5:16:02 PM
REPRESENTATIVE RUFFRIDGE stated that Amendment 1 would allow
insurance to cover contraception, which is a valid component of
medical care in the state; however, emergency contraception
continues to be a controversial issue. He stated that emergency
contraception would be available over the counter. He stated
that the mandate of coverage would create an opportunity for a
moral objection to the proposed legislation. He expressed the
opinion that having emergency contraception as a portion of the
bill would be ill advised, and the amendment would remove this.
5:17:21 PM
REPRESENTATIVE CARRICK voiced opposition to Amendment 1.
REPRESENTATIVE MINA removed her objection.
5:17:38 PM
A roll call vote was taken. Representatives Ruffridge, Saddler,
Sumner, and Prax voted in favor of adopting Amendment 1 to HB
17. Representative Mina voted against it. Therefore, Amendment
1 was adopted by a vote of 4-1.
5:18:46 PM
REPRESENTATIVE RUFFRIDGE moved to report HB 17, as amended, out
of committee with individual recommendations. [There was no
mention of fiscal notes in the motion.]
[There was discussion as to whether the original bill version,
as amended, should be considered "33-LS0222\A" or "33-
LS0222\A.1," and another motion was made by Representative
Ruffridge to include "A.1."]
5:19:33 PM
REPRESENTATIVE SADDLER called a point of order to specify the
correct identifier to use to report HB 17, as amended, out of
committee.
5:19:45 PM
The committee took a brief at-ease at 5:19 p.m.
5:19:58 PM
CHAIR PRAX clarified that the intent of the committee had been
to report HB 17, as amended, out of committee.
5:20:37 PM
REPRESENTATIVE RUFFRIDGE surmised that one of his motions had
been correct.
5:20:48 PM
CHAIR PRAX announced that there being no objection, CSHB 17(HHS)
was reported out of the House Health and Social Services
Standing Committee. [The committee addressed HB 17 again on
3/7/23 in order to move a fiscal note with the bill.]
5:21:23 PM
ADJOURNMENT
There being no further business before the committee, the House
Health and Social Services Standing Committee meeting was
adjourned at 5:21 p.m.
| Document Name | Date/Time | Subjects |
|---|---|---|
| HB 6 Sectional Analysis .pdf |
HHSS 3/2/2023 3:00:00 PM |
HB 6 |
| HB 6 Sponsor Statement.pdf |
HHSS 3/2/2023 3:00:00 PM |
HB 6 |
| HB0006A.PDF |
HHSS 3/2/2023 3:00:00 PM |
HB 6 |
| HB 52 - v.A.PDF |
HHSS 3/2/2023 3:00:00 PM HHSS 3/16/2023 3:00:00 PM |
HB 52 |
| HB 52 - Sponsor Statement.pdf |
HHSS 3/2/2023 3:00:00 PM HHSS 3/16/2023 3:00:00 PM |
HB 52 |
| HB 52 - Sectional Analysis.pdf |
HHSS 3/2/2023 3:00:00 PM HHSS 3/16/2023 3:00:00 PM |
HB 52 |
| HB0056A.PDF |
HHSS 3/2/2023 3:00:00 PM HHSS 3/11/2023 3:00:00 PM |
HB 56 |
| HB56 Sectional Analysis.pdf |
HHSS 3/2/2023 3:00:00 PM HHSS 3/11/2023 3:00:00 PM |
HB 56 |
| HB56 Support Letter.pdf |
HHSS 3/2/2023 3:00:00 PM HHSS 3/11/2023 3:00:00 PM |
HB 56 |
| House Bill 56 Sponsor Statement.pdf |
HHSS 3/2/2023 3:00:00 PM HHSS 3/11/2023 3:00:00 PM |
HB 56 |
| HB 56 Fiscal Note.pdf |
HHSS 3/2/2023 3:00:00 PM |
HB 56 |
| HB56 Rep.Ruffridge Presentation.pdf |
HHSS 3/2/2023 3:00:00 PM HHSS 3/11/2023 3:00:00 PM |
HB 56 |
| HB 56 Hearing Slides 2023 (002).pdf |
HHSS 3/2/2023 3:00:00 PM HHSS 3/11/2023 3:00:00 PM |
HB 56 |
| Geiger HB56 Support Ltr - Feb 26 2023 - 7-15 PM.pdf |
HHSS 3/2/2023 3:00:00 PM HHSS 3/11/2023 3:00:00 PM |
HB 56 |
| HB56 Delker Support.pdf |
HHSS 3/2/2023 3:00:00 PM HHSS 3/11/2023 3:00:00 PM |
HB 56 |
| HB56 letter removing opposition vets PDMP.pdf |
HHSS 3/2/2023 3:00:00 PM HHSS 3/11/2023 3:00:00 PM |
HB 56 |
| PDMPFlyer.pdf |
HHSS 3/2/2023 3:00:00 PM |
HB 56 |
| HB 56 2023AVKMA-PDMPWhitePaper.pdf |
HHSS 3/2/2023 3:00:00 PM |
HB 56 |
| HB56 VerSteeg Support Letter.pdf |
HHSS 3/2/2023 3:00:00 PM |
HB 56 |
| HB 6 Kellsie's Lesson Example.pdf |
HHSS 3/2/2023 3:00:00 PM |
HB 6 |
| HB 17 Support Document - Public Costs From Unintended Pregnancies February 2015.pdf |
HHSS 2/7/2023 3:00:00 PM HHSS 2/18/2023 3:00:00 PM HHSS 3/2/2023 3:00:00 PM |
HB 17 |
| HB 17 Support Document - Unintended Pregnancies Study March 2011.pdf |
HHSS 2/7/2023 3:00:00 PM HHSS 2/18/2023 3:00:00 PM HHSS 3/2/2023 3:00:00 PM |
HB 17 |
| HB 17 Support Document - UCSF Study Newspaper Article 2.22.2011.pdf |
HHSS 2/7/2023 3:00:00 PM HHSS 2/18/2023 3:00:00 PM HHSS 3/2/2023 3:00:00 PM |
HB 17 |
| HB 17 Support Document - HRSA Women's Preventive Services Guidelines.pdf |
HHSS 2/7/2023 3:00:00 PM HHSS 2/18/2023 3:00:00 PM HHSS 3/2/2023 3:00:00 PM |
HB 17 |
| HB 17 Support Document - Insurance Coverage of Contraceptives 4.01.2021.pdf |
HHSS 2/7/2023 3:00:00 PM HHSS 2/18/2023 3:00:00 PM HHSS 3/2/2023 3:00:00 PM |
HB 17 |
| HB 17 Support Document - Guttmacher Alaska Statistics 2016.pdf |
HHSS 2/7/2023 3:00:00 PM HHSS 2/18/2023 3:00:00 PM HHSS 3/2/2023 3:00:00 PM |
HB 17 |
| HB 17 v. A Sponsor Statement.pdf |
HHSS 2/7/2023 3:00:00 PM HHSS 2/18/2023 3:00:00 PM HHSS 3/2/2023 3:00:00 PM |
HB 17 |
| HB17 Version A.PDF |
HHSS 2/7/2023 3:00:00 PM HHSS 2/18/2023 3:00:00 PM HHSS 3/2/2023 3:00:00 PM |
HB 17 |
| HB 17 v. A Sectional Analysis.pdf |
HHSS 2/7/2023 3:00:00 PM HHSS 2/18/2023 3:00:00 PM HHSS 3/2/2023 3:00:00 PM |
HB 17 |
| HB 17 Support Letter.pdf |
HHSS 2/18/2023 3:00:00 PM HHSS 3/2/2023 3:00:00 PM |
HB 17 |
| Opposition Letter for HB 17 Redacted.pdf |
HHSS 2/18/2023 3:00:00 PM HHSS 3/2/2023 3:00:00 PM |
HB 17 |
| ACOGFactsAreImportantEC.pdf |
HHSS 2/18/2023 3:00:00 PM HHSS 3/2/2023 3:00:00 PM |
HB 17 |
| FDA Decisional Memorandum 12.23.2022.pdf |
HHSS 2/18/2023 3:00:00 PM HHSS 3/2/2023 3:00:00 PM |
HB 17 |
| HB 17 Opposition Letter Redacted 3.pdf |
HHSS 2/18/2023 3:00:00 PM HHSS 3/2/2023 3:00:00 PM |
HB 17 |
| HB 17 opposition letters 4 Redacted.pdf |
HHSS 2/18/2023 3:00:00 PM HHSS 3/2/2023 3:00:00 PM |
HB 17 |
| ALPHA Policy Comm Letter of Support HB17 2-10-23.pdf |
HHSS 3/2/2023 3:00:00 PM |
HB 17 |
| HB17.SB27 LOS 2.23 ANDVSA.pdf |
HHSS 3/2/2023 3:00:00 PM |
HB 17 SB 27 |
| A.1--amendment to HB 17 Contraceptives.pdf |
HHSS 3/2/2023 3:00:00 PM |
HB 17 |
| HB 17 Opposition Letters Redacted 2.pdf |
HHSS 3/2/2023 3:00:00 PM |
HB 17 |
| HB 52 - Slideshow Presentation (03-01-23).pdf |
HHSS 3/2/2023 3:00:00 PM HHSS 3/16/2023 3:00:00 PM |
HB 52 |
| HB 17 Fiscal Note DCCED.pdf |
HHSS 3/2/2023 3:00:00 PM HHSS 3/7/2023 3:00:00 PM |
HB 17 |
| HB 17 Fiscal Note DOA-DRB.pdf |
HHSS 3/2/2023 3:00:00 PM HHSS 3/7/2023 3:00:00 PM |
HB 17 |
| HB 17 Fiscal Note DOH.pdf |
HHSS 3/2/2023 3:00:00 PM HHSS 3/7/2023 3:00:00 PM |
HB 17 |