Legislature(2009 - 2010)CAPITOL 106

03/24/2009 03:00 PM HEALTH & SOCIAL SERVICES


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03:03:52 PM Start
03:04:15 PM HB187
05:06:37 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ HB 187 INS. COVERAGE: AUTISM SPECTRUM DISORDER TELECONFERENCED
Heard & Held
*+ HB 188 TAX ON MOIST SNUFF TELECONFERENCED
<Bill Hearing Rescheduled to 03/26/09>
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                         March 24, 2009                                                                                         
                           3:03 p.m.                                                                                            
                                                                                                                                
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Bob Herron, Co-Chair                                                                                             
Representative Wes Keller, Co-Chair                                                                                             
Representative John Coghill                                                                                                     
Representative Bob Lynn                                                                                                         
Representative Paul Seaton                                                                                                      
Representative Sharon Cissna                                                                                                    
Representative Lindsey Holmes                                                                                                   
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                              
HOUSE BILL NO. 187                                                                                                              
"An  Act   requiring  insurance  coverage  for   autism  spectrum                                                               
disorders,  describing the  method for  establishing a  treatment                                                               
plan  for those  disorders, and  defining the  treatment required                                                               
for those disorders; and providing for an effective date."                                                                      
                                                                                                                              
     - HEARD AND HELD                                                                                                           
                                                                                                                                
HOUSE BILL NO. 188                                                                                                              
"An Act relating to the taxation of moist snuff tobacco, and                                                                    
amending the definition of 'tobacco product' in provisions                                                                      
levying an excise tax on those products."                                                                                       
                                                                                                                              
     - RESCHEDULED TO 3/26/09                                                                                                   
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                              
BILL: HB 187                                                                                                                  
SHORT TITLE: INS. COVERAGE: AUTISM SPECTRUM DISORDER                                                                            
SPONSOR(s): REPRESENTATIVE(s) PETERSEN                                                                                          
                                                                                                                                
03/12/09       (H)       READ THE FIRST TIME - REFERRALS                                                                        
03/12/09       (H)       HSS, L&C                                                                                               
03/24/09       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
REPRESENTATIVE PETE PETERSEN                                                                                                    
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Introduced HB 187 as the prime sponsor,                                                                  
responded to questions, and provided comments.                                                                                  
                                                                                                                                
ASHLEY ROUSSON, Staff                                                                                                           
to Representative Pete Petersen                                                                                                 
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 187 for the prime sponsor,                                                                  
Representative Petersen, and responded to questions.                                                                            
                                                                                                                                
JAMES BOUDER, COO                                                                                                               
The Vista School and The Vista Foundation                                                                                       
Hershey, Pennsylvania                                                                                                           
POSITION STATEMENT:  Presented a Power Point and spoke about the                                                              
cost and benefit of HB 187.                                                                                                     
                                                                                                                                
DR. GINA GREEN                                                                                                                  
Board Certified Behavior Analyst                                                                                                
San Diego, California                                                                                                           
POSITION STATEMENT:  Testified about HB 187.                                                                                  
                                                                                                                                
DENNIS BAILEY, Attorney                                                                                                         
Legislative Legal Counsel                                                                                                       
Legislative Legal and Research Services                                                                                         
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  As the drafter of HB 187, responded to                                                                   
questions about the bill.                                                                                                       
                                                                                                                                
CHRIS SADDLER                                                                                                                   
Eagle River, Alaska                                                                                                             
POSITION STATEMENT:  Testified in support of HB 187.                                                                          
                                                                                                                                
TONJA UPDIKE                                                                                                                    
Soldatna, Alaska                                                                                                                
POSITION STATEMENT:  Testified in support of HB 187.                                                                          
                                                                                                                                
LORI KING                                                                                                                       
POSITION STATEMENT:  Testified in support of HB 187.                                                                          
                                                                                                                                
MILLIE RYAN, Executive Director                                                                                                 
Governor's Council on Disabilities & Special Education                                                                          
Office of the Commissioner                                                                                                      
Department of Health and Social Services (DHSS)                                                                                 
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 187.                                                                          
                                                                                                                                
KATHY FITZGERALD                                                                                                                
POSITION STATEMENT:  Testified in support HB 187.                                                                             
                                                                                                                                
LINDA HALL, Director                                                                                                            
Division of Insurance                                                                                                           
Anchorage Office                                                                                                                
Department  of   Commerce,  Community,  &   Economic  Development                                                               
(DCEED)                                                                                                                         
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Answered questions about HB 187.                                                                         
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:03:52 PM                                                                                                                    
                                                                                                                                
CO-CHAIR WES KELLER  called the House Health  and Social Services                                                             
Standing   Committee    meeting   to    order   at    3:03   p.m.                                                               
Representatives Keller, Herron, Coghill,  Cissna, and Seaton were                                                               
present at  the call to  order.  Representatives Lynn  and Holmes                                                               
arrived as the meeting was in progress.                                                                                         
                                                                                                                                
HB 187-INS. COVERAGE: AUTISM SPECTRUM DISORDER                                                                                
                                                                                                                                
3:04:15 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER announced that the  first order of business would                                                               
be HOUSE BILL  NO. 187, "An Act requiring  insurance coverage for                                                               
autism   spectrum   disorders,    describing   the   method   for                                                               
establishing a  treatment plan for those  disorders, and defining                                                               
the treatment required for those  disorders; and providing for an                                                               
effective date."                                                                                                                
                                                                                                                                
3:04:37 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  PETE  PETERSEN,  Alaska State  Legislature,  read                                                               
from the  Sponsor Statement [Included  in the  members' packets.]                                                               
and said  that many  children diagnosed  with an  Autism Spectrum                                                               
Disorder  (ASD)   would  not   receive  treatment,   even  though                                                               
treatment had  been shown  to improve  the symptoms  of ASD.   He                                                               
confirmed   the  exorbitant   costs  which   families  paid   for                                                               
treatment, and  the incremental societal  costs for  not treating                                                               
autism.    He explained  that  "HB  187 would  require  insurance                                                               
coverage for  autism spectrum  disorders, including  the behavior                                                               
therapies that after 30 years of  study have shown to be the only                                                               
effective treatment of  these disorders."  He  confirmed that the                                                               
cost  savings from  the  treatments far  outweighed  the cost  of                                                               
treatment  or  the incremental  societal  cost  of no  treatment,                                                               
which  he observed  would be  "steep."   He reported  significant                                                               
savings  to the  state and  local governments  with HB  187.   He                                                               
pointed out  that the required  insurance coverage for  ASD would                                                               
bring qualified ASD professionals to Alaska to meet these needs.                                                                
                                                                                                                                
3:07:32 PM                                                                                                                    
                                                                                                                                
ASHLEY  ROUSSON, Staff  to Representative  Pete Petersen,  Alaska                                                               
State Legislature, explained the  sectional analysis [Included in                                                               
the  members' packets.]  and highlighted  that Section  1 amended                                                               
the  current insurance  statute  to include  coverage for  autism                                                               
spectrum  disorders.    She  detailed  that  treatment  would  be                                                               
covered as  prescribed by a  licensed physician  or psychologist;                                                               
treatment  would  be  provided  by an  autism  service  provider;                                                               
treatment would  be outlined in  a treatment plan,  prescribed by                                                               
the physician  or psychologist, and  followed by  a comprehensive                                                               
evaluation; and that treatment  would include medically necessary                                                               
pharmacy    care,   psychiatric    care,   psychological    care,                                                               
rehabilitative  care, and  therapeutic care.   She  reported that                                                               
the coverage would  include people under the age of  21, and that                                                               
there  would be  a maximum  annual  benefit of  $36,000, with  an                                                               
annual inflation  adjustment.  She  continued and  explained that                                                               
Section 2  of HB 187  stated that  the coverage would  be applied                                                               
for policies issued on or after January 1, 2010.                                                                                
                                                                                                                                
3:09:44 PM                                                                                                                    
                                                                                                                                
MS. ROUSSON informed the committee  that experts were prepared to                                                               
testify.                                                                                                                        
                                                                                                                                
3:10:29 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 3:10 p.m. to 3:12 p.m.                                                                       
                                                                                                                                
3:12:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  referred to  Section 1(a)(2) and  asked if                                                               
the rehabilitative  care was for  care until there was  no longer                                                               
progress,  or was  ongoing  "as  long as  the  person needs  some                                                               
help."                                                                                                                          
                                                                                                                                
3:13:43 PM                                                                                                                    
                                                                                                                                
MS. ROUSSON  referred to the definition  of "medically necessary"                                                               
in Section  1(a)(1) which explained  that the treatment  and care                                                               
was described in subparagraphs (A), (B),  and (C).  She said that                                                               
the  treatment would  include prevention  and amelioration  for a                                                               
condition  or  disability, as  well  as  assistance in  achieving                                                               
maximum functional capacity with daily activities.                                                                              
                                                                                                                                
3:14:16 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  asked to  clarify that  treatment services                                                               
would not  have a termination  date, if the medical  analysis was                                                               
for progression of the condition.                                                                                               
                                                                                                                                
3:15:04 PM                                                                                                                    
                                                                                                                                
MS.  ROUSSON  agreed, but  she  pointed  out the  limitations  to                                                               
coverage contained in the bill.                                                                                                 
                                                                                                                                
3:17:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE PETERSEN said that HB  187 was to help people with                                                               
the  disorder, that  there had  been significant  improvements in                                                               
the   treatments,  and   that  there   were  greater   successes,                                                               
especially when treatment was received at an early age.                                                                         
                                                                                                                                
3:18:59 PM                                                                                                                    
                                                                                                                                
JAMES BOUDER,  COO, The  Vista School  and The  Vista Foundation,                                                               
explained that he was the COO  of a private school in Hershey, PA                                                               
which provided  services to  children with  autism.   He detailed                                                               
that  he  had  provided  cost   analysis  testimony  for  similar                                                               
legislation in  many other  states.  He  presented a  Power Point                                                               
titled  "The Cost  and  Benefit of  HB 187."    [Included in  the                                                               
members' packets.]                                                                                                              
                                                                                                                                
MR.  BOUDER referred  to slide  2, "Cost  Benefit Analysis,"  and                                                               
said he  would discuss the  effect that mandating  coverage would                                                               
have on commercial  insurance rates and state  employee claims if                                                               
the  benefit were  extended to  dependents.   He spoke  about the                                                               
long-term  savings  considerations  and he  summarized  the  cost                                                               
effect to other states.                                                                                                         
                                                                                                                                
3:23:20 PM                                                                                                                    
                                                                                                                                
MR.  BOUDER pointed  to  slide 3,  "Summary of  HB  187," and  he                                                               
stated  that  HB  187 required  private  insurance  coverage  for                                                               
autism, and provided  coverage for a list  of medically necessary                                                               
services.                                                                                                                       
                                                                                                                                
3:23:49 PM                                                                                                                    
                                                                                                                                
MR.  BOUDER   explained  slide  4,  "Commercial   Insurance  Cost                                                               
Estimates."  He estimated that  more than 48,000 Alaskans between                                                               
the ages  of 2  and 20  had insurance under  plans subject  to HB
187.    He  explained  the "treated  prevalence  rates"  used  to                                                               
establish low,  mid, and high  range estimates for the  number of                                                               
children  seeking  treatment.    He explained  that  the  highest                                                               
expenses  would be  during the  early childhood  years.   He said                                                               
that applied behavior analysis (ABA)  was the most effective, and                                                               
the  most  expensive,  treatment;   and  that  this  was  usually                                                               
provided at younger ages.                                                                                                       
                                                                                                                                
3:25:56 PM                                                                                                                    
                                                                                                                                
MR. BOUDER considered slide 5,  also titled "Commercial Insurance                                                               
Cost  Estimates," which  continued the  assumptions discussed  on                                                               
slide 4.   He declared that the assumption of  85 percent Medical                                                               
Loss Ratio was  the industry standard, and described  this as the                                                               
percentage of premiums  collected that were spent on  claims.  He                                                               
directed attention  to the  estimated premium  base of  more than                                                               
$345  million in  2009, and  he explained  how he  collected this                                                               
information.   He declared that  the final assumption was  for an                                                               
adequate provider network  to be in place by  the effective date.                                                               
He  noted  that  there  was  not  an  adequate  provider  network                                                               
currently available  in Alaska,  and that it  would take  time to                                                               
recruit, train, and deploy trained providers.                                                                                   
                                                                                                                                
3:28:32 PM                                                                                                                    
                                                                                                                                
MR.   BOUDER    discussed   slide   6,   "How    Many?   Eligible                                                               
Beneficiaries."      He   explained   the   table   of   eligible                                                               
beneficiaries,  and announced  that there  would be  about 48,000                                                               
eligible children  in Alaska.  He  continued on to slide  7, "How                                                               
Many?  Treated   Prevalence  Assumptions,"  and  he   noted  that                                                               
community prevalence was not an  assumption to use for autism, as                                                               
it  had  a range  of  severity.    He  referred instead  to  four                                                               
different  studies  that  found  about 1  in  500  children  with                                                               
autism.   He noted that  his assumption  was for a  more frequent                                                               
occurrence.   He  explained that  an  adequate treatment  program                                                               
would bring more people to utilize these services.                                                                              
                                                                                                                                
3:31:59 PM                                                                                                                    
                                                                                                                                
MR.  BOUDER showed  slide  8, "How  Much?  Low Estimate  (Treated                                                               
Prevalence 1  in 400)," and  said that  he used an  estimate from                                                               
the actuarial firm, Mercer.  He  estimated the cost per person to                                                               
be $2.24 per member per month.                                                                                                  
                                                                                                                                
3:34:02 PM                                                                                                                    
                                                                                                                                
MR.  BOUDER continued  on to  slide  9, "How  Much? Mid  Estimate                                                               
(Treated Prevalence  1 in 325)."   He  said that this  table used                                                               
the  same actuarial  estimates  for this  mid  range estimate  of                                                               
prevalence,  and that  the cost  would  be $3.60  per member  per                                                               
month.                                                                                                                          
                                                                                                                                
3:34:20 PM                                                                                                                    
                                                                                                                                
MR. BOUDER presented slide 10,  "How Much? High Estimate (Treated                                                               
Prevalence 1  in 250)."   He noted that  the cost would  be $5.81                                                               
per  month.    He  reminded  the  committee  that  all  of  these                                                               
estimates  assumed  that an  adequate  network  of providers  was                                                               
available.                                                                                                                      
                                                                                                                                
3:35:00 PM                                                                                                                    
                                                                                                                                
MR. BOUDER  moved on  to slide  11, "Short-Term  Cost Estimates."                                                               
He explained the likely scenarios  for cost increases over a four                                                               
year period with low, mid, and high prevalence rates.                                                                           
                                                                                                                                
3:36:26 PM                                                                                                                    
                                                                                                                                
MR. BOUDER  noted on  slide 12, "State  Fiscal Impact,"  that the                                                               
likely  cost  per state  employee  per  month  with a  mid  range                                                               
prevalence would be $3.02 per month.                                                                                            
                                                                                                                                
3:37:15 PM                                                                                                                    
                                                                                                                                
MR. BOUDER assessed slide 13,  "Future Savings," and compared the                                                               
lack of  investment in autism  treatment to  deferred maintenance                                                               
on a  home.  He explained  that, according to the  Jacobson study                                                               
in 1999,  there was a  $2 million  savings per person  with early                                                               
treatment.   He  noted that  the Ganz  study in  2007 showed  the                                                               
incremental societal  cost for  not treating  autism to  be about                                                               
$3.2 million  per person.   He explained  that this  included the                                                               
care and  lost productivity for  the person with autism,  as well                                                               
as the lost productivity for the parents or primary caregivers.                                                                 
                                                                                                                                
3:41:25 PM                                                                                                                    
                                                                                                                                
MR. BOUDER directed  attention to Attachment A.  [Included in the                                                               
members' packets.]   He explained that the first  page showed the                                                               
completed cost analyses for autism  legislation which has already                                                               
been  enacted.    He  pointed  out  that  the  estimated  premium                                                               
increase was between .33 and 1 percent.                                                                                         
                                                                                                                                
3:43:34 PM                                                                                                                    
                                                                                                                                
MR. BOUDER mentioned that page  2 of Attachment A listed national                                                               
actuarial firms hired  to find the costs of  the legislation, and                                                               
that  all of  the firms  had agreed  that the  cost increase  for                                                               
premiums would  be one percent  or less.   He concluded  that the                                                               
costs in Alaska would be similar to that of these other states.                                                                 
                                                                                                                                
3:44:54 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON asked  about the  estimated percentage  of                                                               
increase for premiums on slide 11.                                                                                              
                                                                                                                                
3:45:38 PM                                                                                                                    
                                                                                                                                
MR. BOUDER explained that the  likely total claims impact in year                                                               
one  would be  25 percent  of  year four;  year two  would be  50                                                               
percent of year four; and year  three would be 75 percent of year                                                               
four.                                                                                                                           
                                                                                                                                
3:46:23 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON  asked  if  transportation  costs  to  the                                                               
facilities would  be required  should coverage  be mandated.   He                                                               
noted  that there  were not  any transportation  expenses in  the                                                               
estimates which Mr. Bouder presented.                                                                                           
                                                                                                                                
3:47:39 PM                                                                                                                    
                                                                                                                                
MR.  BOUDER  replied  that  other  states  had  limited  provider                                                               
networks within the state.  He  noted that the $36,000 cap in the                                                               
bill would limit the fiscal impact.   He explained that the types                                                               
of  services  for  applied   behavior  analysis  were  ordinarily                                                               
provided in a home setting.                                                                                                     
                                                                                                                                
3:48:49 PM                                                                                                                    
                                                                                                                                
DR.  GINA GREEN,  Board Certified  Behavior  Analyst, offered  to                                                               
answer any questions about autism.                                                                                              
                                                                                                                                
3:49:41 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON   asked  that  as  treatment   was  to  be                                                               
prescribed by  a licensed physician or  psychologist, would their                                                               
general  knowledge be  sufficient to  determine whether  the best                                                               
treatment was or was not the most expensive treatment.                                                                          
                                                                                                                                
3:50:49 PM                                                                                                                    
                                                                                                                                
DR.  GREEN  responded that  the  American  Academy of  Pediatrics                                                               
endorsed  applied behavior  analysis as  the preferred  treatment                                                               
for autism.                                                                                                                     
                                                                                                                                
3:53:23 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON pointed  to  Section 1(e)(2)  of the  bill                                                               
which listed disorders that were  all defined as "autism spectrum                                                               
disorders."    He asked  if  there  were different  levels  which                                                               
required different treatments.                                                                                                  
                                                                                                                                
3:54:10 PM                                                                                                                    
                                                                                                                                
DR. GREEN acknowledged  that the treatment and the  needs for all                                                               
these  disorders  were  similar.    She  explained  that  applied                                                               
behavior  analysis  treatment  was   very  individualized.    She                                                               
commented that there were all degrees of severity.                                                                              
                                                                                                                                
3:57:01 PM                                                                                                                    
                                                                                                                                
DR.  GREEN  began her  presentation  and  explained that  applied                                                               
behavior analysis was a natural  science approach to behavior and                                                               
that  autism was  just  one of  the areas  of  application.   She                                                               
suggested  looking  at the  skill  deficits  and then  developing                                                               
procedures  to   reduce  the   problem  behaviors   and  increase                                                               
independent functions:  self care, communication,  social skills,                                                               
and general  awareness.   She explained  that this  procedure was                                                               
highly  individualized.   She  shared that  the  training of  the                                                               
parent  was also  important to  make available  the opportunities                                                               
for the child to regularly  practice these skills.  She specified                                                               
that  there was  constant evaluation,  so that  if there  was not                                                               
progress,  the  procedures  and techniques  were  changed.    She                                                               
expressed that  there were many studies  which evaluated specific                                                               
methods  for reducing  some of  the problem  behaviors, as  these                                                               
were contributors to  health care costs.  She  explained that the                                                               
most  effective result  for applied  behavior analysis  (ABA) was                                                               
for early, comprehensive, and intensive intervention.                                                                           
                                                                                                                                
4:01:29 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE COGHILL  asked to clarify  at what age  ABA worked                                                               
best.                                                                                                                           
                                                                                                                                
4:02:11 PM                                                                                                                    
                                                                                                                                
DR GREEN said that the brain is  more able to absorb at a younger                                                               
age  before behavioral  patterns  become established.   She  said                                                               
that older children would often have slower progress.                                                                           
                                                                                                                                
4:03:17 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE COGHILL asked how  a medical model could determine                                                               
the  need to  intervene  early when  the problem  may  be that  a                                                               
developmental stage had not yet matured.                                                                                        
                                                                                                                                
4:03:55 PM                                                                                                                    
                                                                                                                                
DR.  GREEN asked  what Representative  Coghill meant  by "medical                                                               
model."                                                                                                                         
                                                                                                                                
4:04:03 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  COGHILL responded  that the  ABA was  a technical                                                               
screening tool.                                                                                                                 
                                                                                                                                
4:04:29 PM                                                                                                                    
                                                                                                                                
DR  GREEN clarified  that ABA  was a  treatment, not  a screening                                                               
tool.                                                                                                                           
                                                                                                                                
REPRESENTATIVE   COGHILL   asked   if  every   child   could   be                                                               
behaviorally suspect enough to be considered for the ABA.                                                                       
                                                                                                                                
DR. GREEN  specified that the child's  developmental difficulties                                                               
needed to meet  the diagnostic criteria for autism.   She pointed                                                               
out  that  trained  professionals were  good  at  differentiating                                                               
autism spectrum  disorder from other  developmental disabilities.                                                               
She shared  that there  was no evidence  that people  with autism                                                               
got  better with  maturity.   She stated  that without  effective                                                               
intervention,  people  with  autism would  remain  impaired,  and                                                               
costly to care for.                                                                                                             
                                                                                                                                
4:05:46 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE COGHILL  referred to the subjective  nature of the                                                               
diagnostics,  and  posed the  question  for  finding and  helping                                                               
people with  a legitimate  need, as opposed  to paying  people to                                                               
find a need.                                                                                                                    
                                                                                                                                
4:06:14 PM                                                                                                                    
                                                                                                                                
DR.  GREEN agreed  that  there were  not  biological markers  for                                                               
autism  spectrum  disorder.   She  declared  that the  behavioral                                                               
characteristics were  clearly defined,  and that  experience with                                                               
these disorders allowed for differentiation.   She explained some                                                               
of the behaviors distinctive to autism spectrum disorder.                                                                       
                                                                                                                                
4:07:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE COGHILL  said that  he would  maintain this  as an                                                               
ongoing question.                                                                                                               
                                                                                                                                
4:07:43 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  referred to page  5 of Dr.  Green's letter                                                               
to  the U.S  Assistant Secretary  of Defense  for Health  Affairs                                                               
[Included in the members' packets.]  and he read: "With effective                                                               
treatment,  military  children  and  youths  with  ASD  can  lead                                                               
happier  and healthier  lives  than they  would  otherwise."   He                                                               
asked about  the connection between  military children  and youth                                                               
with ASD.                                                                                                                       
                                                                                                                                
4:08:11 PM                                                                                                                    
                                                                                                                                
DR. GREEN  responded that military  health care covered  ABA, and                                                               
that  this   letter  explained  the  medical   necessity  of  ABA                                                               
treatment for autism.                                                                                                           
                                                                                                                                
4:09:12 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON asked  how  much ABA  takes  place in  the                                                               
school environment.                                                                                                             
                                                                                                                                
4:09:52 PM                                                                                                                    
                                                                                                                                
DR. GREEN  explained that  most public schools  did not  have the                                                               
expertise or the resources.   She reported that the interventions                                                               
needed to  be provided in the  homes and communities, as  well as                                                               
the schools, to address the needs of children with autism.                                                                      
                                                                                                                                
4:11:47 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  referred to  Section 1(b)(5) of  the bill,                                                               
which  stated  that  coverage  "must   cover  treatment  that  is                                                               
coordinated with an education program,  but may not be contingent                                                               
on the coordination of treatment with an education program."                                                                    
                                                                                                                                
4:12:06 PM                                                                                                                    
                                                                                                                                
DR. GREEN,  in response  to Representative  Seaton, said  that it                                                               
worked best  for children  with autism  to coordinate  the school                                                               
and the out-of-school programming to provide consistency.                                                                       
                                                                                                                                
4:12:49 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON   asked  who  would  finance   the  school                                                               
programs, as this was a mandated coverage.                                                                                      
                                                                                                                                
4:13:27 PM                                                                                                                    
                                                                                                                                
DR.  GREEN, in  response  to Representative  Seaton, opined  that                                                               
financing was determined on a state  by state basis.  She pointed                                                               
out  that  all states  were  required  to provide  special  needs                                                               
children with  "a free  and appropriate  public education."   She                                                               
reminded  the committee  that the  early intervention  treatments                                                               
started  before school  age, as  it  was necessary  to teach  the                                                               
child all the  basic skills for success in  a school environment.                                                               
She  shared that  the  coordination of  programs  only became  an                                                               
issue when children were capable of school participation.                                                                       
                                                                                                                                
4:15:01 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE LYNN  referred to  TRICARE military  insurance and                                                               
asked how many  children of retired military  were diagnosed with                                                               
autism spectrum disorder.                                                                                                       
                                                                                                                                
4:15:35 PM                                                                                                                    
                                                                                                                                
DR. GREEN  replied that TRICARE  had a program for  special needs                                                               
children of military  families.  She offered her  belief that the                                                               
retired  military   insurance  package   did  not   include  this                                                               
treatment benefit, but that it was being discussed.                                                                             
                                                                                                                                
4:17:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON referred  to  Section 1(a)  and asked  the                                                               
reason for exclusion of a "fraternal benefit society."                                                                          
                                                                                                                                
4:18:01 PM                                                                                                                    
                                                                                                                                
DENNIS BAILEY,  Attorney, Legislative Legal  Counsel, Legislative                                                               
Legal  and  Research  Services,  explained  that  with  fraternal                                                               
benefit societies, such  as the Benevolent &  Protective Order of                                                               
Elks or the  Loyal Order of Moose, the  members provided benefits                                                               
for themselves  which were not  considered an  insurance program.                                                               
He  explained  that  this  exception   was  common  for  mandated                                                               
coverages.                                                                                                                      
                                                                                                                                
4:18:32 PM                                                                                                                    
                                                                                                                                
CHRIS SADDLER  said that she  had a 10  yr. old son  with autism.                                                               
She said that  autism was a "huge health issue"  in Alaska, as it                                                               
affected  more kids  than aids,  diabetes,  and cancer  combined.                                                               
She shared that the Anchorage  School District reported that 1 in                                                               
80 kids were on the autism  spectrum.  She reminded the committee                                                               
that  autism was  treatable, and  that with  early diagnosis  and                                                               
intensive behavior treatment,  a majority of the  kids would lead                                                               
"productive, independent  lives."  She  continued on to  say that                                                               
without effective  intervention, 80 percent of  the kids required                                                               
more costly, life-long support services,  at public expense.  She                                                               
opined that it was  a lot easier to deal with  a toddler having a                                                               
tantrum,  than an  adolescent or  adult  having a  tantrum.   She                                                               
related  that  there were  no  intensive  treatment programs  for                                                               
autism in  Alaska.  She recounted  that they were able  to find a                                                               
private  provider  to  set  up a  volunteer  based  home  program                                                               
patterned after  a University of Alaska  Anchorage (UAA) research                                                               
project.     She   revealed  that   her  son's   early  education                                                               
experiences lead to  his extreme frustration and  that there were                                                               
no  programs for  support.   She said  that the  Anchorage School                                                               
District  declined to  provide the  intensive behavioral  program                                                               
that her  son required.   She relayed  that she was  directed, by                                                               
another parent, to Dr. John  McEachin's Autism Partnership clinic                                                               
in  Seal Beach,  California.   She stated  that the  clinic staff                                                               
determined  her   son's  needs,  and  outlined   an  intervention                                                               
program.   She shared  that it  took several  months to  hire and                                                               
train a volunteer  staff member to provide the 30  hours per week                                                               
of  one-on-one interaction.   She  emphasized that  none of  this                                                               
intervention was covered  by either her federal  or her husband's                                                               
State of Alaska  insurance.  She disclosed that, after  a year of                                                               
documented  improvement  and  tens  of thousands  of  dollars  of                                                               
expenses,  they were  able  to submit  a plan  of  care that  was                                                               
approved by  Medicaid, only  because her  son was  also diagnosed                                                               
with an  anxiety disorder.   She said that this  Medicaid funding                                                               
paid for the  staffing, but did not pay for  any of the oversight                                                               
and direction from  Autism Partnership.  She said  that they were                                                               
finally  able  to  file  a successful  due  process  against  the                                                               
Anchorage School District.  She  shared that, at this point, they                                                               
had  incurred  a  debt  from  the autism  program  of  more  than                                                               
$100,000.  She  said that the school district was  now paying for                                                               
the  current costs,  but had  declined  to reimburse  any of  the                                                               
previous  expenses.   She shared  that the  resulting legal  fees                                                               
were  an   additional  $100,000.    She   summarized  that  early                                                               
effective treatment  for children with autism  reduced costs, but                                                               
that no  single service  system would  bear the  entire financial                                                               
responsibility  for  payment.   She  suggested  that  coordinated                                                               
support from  education funding, Medicaid, and  private insurance                                                               
was necessary.  She stated that  HB 187 would ensure that private                                                               
insurance  carriers  provided  coverage   of  vital  health  care                                                               
services for  children with autism.   She opined that  this would                                                               
save millions  of dollars for the  state of Alaska over  the life                                                               
of  each child.    She  appealed to  the  National Federation  of                                                               
Independent  Businesses (NFIB)  to remove  its opposition  to any                                                               
new mandates  on insurance  coverage.  She  asked that  autism be                                                               
given  the  same  considerations  for  treatment  as  for  polio,                                                               
cancer, or diabetes.  She offered her strong support for HB 187.                                                                
                                                                                                                                
4:25:22 PM                                                                                                                    
                                                                                                                                
TONJA UPDIKE shared  that her child was diagnosed  with autism at                                                               
18 months.  She declared  that he began speech, occupational, and                                                               
physical  therapies which  all "helped  tremendously."   She said                                                               
that  her husband's  insurance  did not  cover  everything.   She                                                               
pointed out that this early  intervention would save money in the                                                               
long term.  She expressed that  autism was a growing problem, but                                                               
that   it  was   treatable.     She  emotionally   described  the                                                               
frustration  and concern  of  trying  to meet  all  of her  son's                                                               
needs, without  also having the  insurance coverage.   She voiced                                                               
her support for HB 187.                                                                                                         
                                                                                                                                
4:29:30 PM                                                                                                                    
                                                                                                                                
LORI  KING spoke  about her  daughter  and pointed  out the  very                                                               
specific early  signs of  autism that  doctors looked  for, which                                                               
included  aggressive behavior,  tantrums, and  early walking  and                                                               
talking  developmental  signs.    She shared  that  her  daughter                                                               
required  significant clinical  treatment.   She noted  that when                                                               
her daughter,  now 18  years of  age, was  young, there  were not                                                               
many  services  available.    She   described  a  number  of  her                                                               
daughter's early indicators.  She  said that her insurance policy                                                               
at the time  covered about 50 percent of  mental health services,                                                               
which  was the  category  for  autism.   She  disclosed that  the                                                               
problem was with the wait lists  for the services.  She explained                                                               
that  most services  were provided  by non-profits,  which needed                                                               
full payment  from as  many patients as  possible.   She reported                                                               
that as  she was  working, she  did not  qualify for  Medicaid or                                                               
Denali Kid  Care for her  daughter's treatment.  She  stated that                                                               
not  having "quite  enough insurance"  resulted in  a three  year                                                               
wait  for services.    She compared  the HB  187  funding cap  of                                                               
$36,000  per year  to  the  actual costs  of  $70,000 for  funded                                                               
services.    She expressed  her  frustration  at not  having  the                                                               
services  available  for  those  crucial  first  5  years.    She                                                               
described the necessity for early  learning of the social skills.                                                               
She said that she supported HB 187.                                                                                             
                                                                                                                                
4:39:23 PM                                                                                                                    
                                                                                                                                
MILLIE   RYAN,   Executive   Director,  Governor's   Council   on                                                               
Disabilities  & Special  Education, Office  of the  Commissioner,                                                               
Department of Health  and Social Services, said  that the Council                                                               
was comprised  of family members  and representatives  from state                                                               
agencies.   She relayed that the  Council had convened an  ad hoc                                                               
committee  on autism  to improve  the quality  of services.   She                                                               
shared  that  good  progress  was  being  made  to  increase  the                                                               
availability of  services.   She said that  the Council  was very                                                               
supportive of HB 187.                                                                                                           
                                                                                                                                
4:41:07 PM                                                                                                                    
                                                                                                                                
KATHY FITZGERALD shared that her  daughter was severely autistic,                                                               
but that  her behaviors were  not recognized  26 years ago.   She                                                               
reported that her husband's insurance  with IBM included coverage                                                               
for families  with special needs  children, which paid for  a lot                                                               
of  the   therapies.    She   described  some  of   the  problems                                                               
encountered  with a  severely autistic  child.   She offered  her                                                               
belief that the  insurance mandate would bring  more providers to                                                               
Alaska and  would have  a "positive and  wonderful impact  on the                                                               
state of Alaska."   She stated that Medicaid was  a payer of last                                                               
resort,  and that  any  of  the services  paid  for with  private                                                               
insurance would  help.  She described  that this was an  issue of                                                               
parity  to ensure  that services  for autism  were included,  and                                                               
that this was a wise investment for Alaska.                                                                                     
                                                                                                                                
4:45:58 PM                                                                                                                    
                                                                                                                                
LINDA HALL,  Director, Division  of Insurance,  Anchorage Office,                                                               
Department  of   Commerce,  Community,  &   Economic  Development                                                               
(DCEED), said, in  response to Co-Chair Keller, that  she did not                                                               
have detailed cost estimates.  She  said that about 40 percent of                                                               
the people covered  by private insurance plans in  Alaska were in                                                               
plans regulated by the Division of  Insurance.  She said that the                                                               
rest were  pre-empted by Employee Retirement  Income Security Act                                                               
of  1974  (ERISA),  and  therefore not  required  to  follow  any                                                               
mandates.  She said that mandates  in state statute had no impact                                                               
on  self  insured plans.    She  listed  the types  of  insurance                                                               
coverage that  would not be  impacted by  legislation, regardless                                                               
of being good public policy.                                                                                                    
                                                                                                                                
4:48:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  COGHILL  requested  a   pie  chart  to  show  the                                                               
insurance  market,  including  ERISA.   He  opined  that  it  was                                                               
necessary to  review the  money being  paid toward  the services,                                                               
and to determine  if there was enough money to  support a service                                                               
delivery system.                                                                                                                
                                                                                                                                
4:51:22 PM                                                                                                                    
                                                                                                                                
MS.  HALL explained  that ERISA  programs were  private employers                                                               
who self funded the health care.                                                                                                
                                                                                                                                
4:51:36 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  COGHILL listed  some  of the  ERISA employers  to                                                               
include  ConocoPhillips, and  Alyeska  Pipeline Service  Company.                                                               
He  asked if  it  was realistic  for this  group  to support  the                                                               
industry base needed to supply the benefit.                                                                                     
                                                                                                                                
4:52:08 PM                                                                                                                    
                                                                                                                                
MS.  HALL  referred  to  a  prior  hearing  for  application  for                                                               
conversion from a "not for profit"  to a "for profit" for Premera                                                               
Blue Cross.   She  mentioned that the  studies from  that hearing                                                               
were still available and could be transferred to a pie chart.                                                                   
                                                                                                                                
4:53:19 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE COGHILL said that the  pie chart would help gain a                                                               
realistic  look of  whether a  smaller insurance  group generated                                                               
enough pay-out to support the service industry.                                                                                 
                                                                                                                                
4:53:55 PM                                                                                                                    
                                                                                                                                
MS. HALL said that she would supply that data.                                                                                  
                                                                                                                                
4:54:13 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  CISSNA referred  to  an Institute  of Social  and                                                               
Economic Research (ISER)  study and the Department  of Health and                                                               
Social Services  investigation of  the uninsured.   She mentioned                                                               
that an ISER report was also studying the "under-insured."                                                                      
                                                                                                                                
4:54:54 PM                                                                                                                    
                                                                                                                                
MS. HALL replied that she had  worked with both of them, and that                                                               
she would utilize those resources.                                                                                              
                                                                                                                                
4:55:09 PM                                                                                                                    
                                                                                                                                
CO-CHAIR  HERRON asked  Ms. Hall  for  her written  opinion of  a                                                               
mandate in HB 187 as opposed to a mandated offering.                                                                            
                                                                                                                                
4:55:42 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SEATON asked  if  there was  any  restraint on  a                                                               
mandate for  a condition  when a patient  claimed there  were not                                                               
services within the state.                                                                                                      
                                                                                                                                
MS. HALL said that there was not any restriction.                                                                               
                                                                                                                                
4:56:32 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON asked to clarify  that the mandate required                                                               
that  available services  be  made available,  even  if it  meant                                                               
travel to another state.                                                                                                        
                                                                                                                                
4:56:54 PM                                                                                                                    
                                                                                                                                
MS. HALL agreed.                                                                                                                
                                                                                                                                
4:57:05 PM                                                                                                                    
                                                                                                                                
[HB 188 was rescheduled for Thursday, March 26, 2009.]                                                                          
                                                                                                                                
4:57:49 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON asked that  if coverage was mandated, would                                                               
that affect funding under Medicaid.                                                                                             
                                                                                                                                
4:58:12 PM                                                                                                                    
                                                                                                                                
MS. HALL, in  response to Representative Seaton, said  that for a                                                               
benefit  to  be mandated,  it  would  be  need  to be  placed  in                                                               
legislation.                                                                                                                    
                                                                                                                                
4:58:32 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON noted that  the ABA utilization dropped off                                                               
after early  childhood intervention,  and he  asked why  the bill                                                               
included coverage through the age 21.                                                                                           
                                                                                                                                
5:00:12 PM                                                                                                                    
                                                                                                                                
MS.  ROUSSON  said  that  ABA  was  one  of  the  most  effective                                                               
treatments for  autism spectrum disorders (ASD),  especially with                                                               
intensive treatment  at an early  age.   She listed a  variety of                                                               
other  treatments,  and  noted  that  the  severity  of  the  ASD                                                               
determined a  case by case  review for treatment.   She explained                                                               
that the  cost analysis reflected  necessary care, but  that this                                                               
care varied  for each diagnosis.   She observed that the  ABA was                                                               
also extremely  stressful on  the family, and  that they  did not                                                               
want the treatment to continue any longer than was necessary.                                                                   
                                                                                                                                
5:04:13 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SEATON  asked again about the  reason for mandated                                                               
coverage to continue until age 21.                                                                                              
                                                                                                                                
5:04:42 PM                                                                                                                    
                                                                                                                                
MS.  ROUSSON said  that the  age  limitation was  based on  other                                                               
similar states' legislation.                                                                                                    
                                                                                                                                
5:05:50 PM                                                                                                                    
                                                                                                                                
CO-CHAIR KELLER closed public testimony.                                                                                        
                                                                                                                                
5:06:07 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE PETERSEN said  that HB 187 was a  good basic bill,                                                               
and that any additional questions could be answered.                                                                            
                                                                                                                                
5:06:37 PM                                                                                                                    
                                                                                                                                
[HB 187 was held over.]                                                                                                         
                                                                                                                                
                                                                                                                                
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.                                                                                                          
                                                                                                                                

Document Name Date/Time Subjects
Background - Autism Speaks.PDF HHSS 3/24/2009 3:00:00 PM
HB 187
Backup - Actuarial Cost Estimate.PDF HHSS 3/24/2009 3:00:00 PM
HB 187
Sectional Analysis.PDF HHSS 3/24/2009 3:00:00 PM
HB 187
Backup - table of contents & Cost Analysis.PDF HHSS 3/24/2009 3:00:00 PM
HB 187
Backup - Autism Definitions.PDF HHSS 3/24/2009 3:00:00 PM
HB 187
Backup - Gina Green letter.PDF HHSS 3/24/2009 3:00:00 PM
HB 187
Backup - Gina Green powerpoint.PDF HHSS 3/24/2009 3:00:00 PM
HB 187
State Initiatives, Map.PDF HHSS 3/24/2009 3:00:00 PM
HB 187
Support letter.PDF HHSS 3/24/2009 3:00:00 PM
HB 187
Backup - Newspaper article.PDF HHSS 3/24/2009 3:00:00 PM
HB 187