Legislature(2015 - 2016)CAPITOL 106

03/10/2015 03:00 PM HEALTH & SOCIAL SERVICES

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Audio Topic
03:05:45 PM Start
03:06:12 PM HB59
03:11:03 PM Discussion: Medicaid Expansion
04:56:18 PM HB59
04:58:01 PM HB40
05:12:52 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+= HB 59 MARIJUANA CONCENTRATES; LICENSES TELECONFERENCED
Moved CSHB 59(HSS) Out of Committee
*+ HB 40 USE OF ELECTRONIC CIGARETTES AS SMOKING TELECONFERENCED
Heard & Held
-- Public Testimony --
+ Medicaid Follow-up Discussion TELECONFERENCED
-- Testimony <Invitation Only> --
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                         March 10, 2015                                                                                         
                           3:05 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Paul Seaton, Chair                                                                                               
Representative Liz Vazquez, Vice Chair                                                                                          
Representative Neal Foster                                                                                                      
Representative Louise Stutes                                                                                                    
Representative David Talerico                                                                                                   
Representative Geran Tarr                                                                                                       
Representative Adam Wool                                                                                                        
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
All members present                                                                                                             
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE BILL NO. 59                                                                                                               
"An Act relating to marijuana concentrates; and providing for an                                                                
effective date."                                                                                                                
                                                                                                                                
     - MOVED CSHB 59(HSS) OUT OF COMMITTEE                                                                                      
                                                                                                                                
DISCUSSION: MEDICAID EXPANSION                                                                                                  
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
HOUSE BILL NO. 40                                                                                                               
"An Act relating to the use of electronic cigarettes; and                                                                       
providing for an effective date."                                                                                               
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 59                                                                                                                   
SHORT TITLE: MARIJUANA CONCENTRATES; LICENSES                                                                                   
SPONSOR(s): REPRESENTATIVE(s) SEATON                                                                                            
                                                                                                                                
01/21/15       (H)       PREFILE RELEASED 1/16/15                                                                               
01/21/15       (H)       READ THE FIRST TIME - REFERRALS                                                                        
01/21/15       (H)       HSS, JUD                                                                                               
02/03/15       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
02/03/15       (H)       Heard & Held                                                                                           
02/03/15       (H)       MINUTE(HSS)                                                                                            
02/26/15       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
02/26/15       (H)       Heard & Held                                                                                           
02/26/15       (H)       MINUTE(HSS)                                                                                            
03/10/15       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 40                                                                                                                   
SHORT TITLE: USE OF ELECTRONIC CIGARETTES AS SMOKING                                                                            
SPONSOR(s): REPRESENTATIVE(s) HERRON                                                                                            
                                                                                                                                
01/21/15       (H)       PREFILE RELEASED 1/9/15                                                                                
01/21/15       (H)       READ THE FIRST TIME - REFERRALS                                                                        
01/21/15       (H)       HSS, JUD                                                                                               
03/10/15       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
VALERIE DAVIDSON, Commissioner Designee                                                                                         
Office of the Commissioner                                                                                                      
Department of Health and Social Services (DHSS)                                                                                 
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions previously posed to the                                                               
Department of Health and Social Services by the committee.                                                                      
                                                                                                                                
JON SHERWOOD, Deputy Commissioner                                                                                               
Medicaid and Health Care Policy                                                                                                 
Office of the Commissioner                                                                                                      
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions during the DHSS response                                                              
to questions previously posed by the committee.                                                                                 
                                                                                                                                
MARGARET BRODIE, Director                                                                                                       
Director's Office                                                                                                               
Division of Health Care Services                                                                                                
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions during the DHSS response                                                              
to questions previously posed by the committee.                                                                                 
                                                                                                                                
JARED KOSIN, Executive Director                                                                                                 
Rate Review                                                                                                                     
Division of Health Care Services                                                                                                
Department of Health and Social Services                                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Answered questions during the DHSS response                                                              
to questions previously posed by the committee.                                                                                 
                                                                                                                                
MONIQUE MARTIN, Health Care Policy Advisor                                                                                      
Office of the Commissioner                                                                                                      
Department of Health and Social Services                                                                                        
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Answered questions during the DHSS response                                                              
to questions previously posed by the committee.                                                                                 
                                                                                                                                
ALBERT WALL, Director                                                                                                           
Central Office                                                                                                                  
Division of Behavioral Health                                                                                                   
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions during the DHSS response                                                              
to questions previously posed by the committee.                                                                                 
                                                                                                                                
REPRESENTATIVE BOB HERRON                                                                                                       
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 40 as the sponsor of the bill.                                                              
                                                                                                                                
ROB EARL, Staff                                                                                                                 
Representative Bob Herron                                                                                                       
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Explained the changes to HB 40 on behalf of                                                              
the bill sponsor, Representative Herron.                                                                                        
                                                                                                                                
EMILY NENON, Alaska Government Relations Director                                                                               
American Cancer Society Cancer Action Network                                                                                   
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified during discussion of HB 40.                                                                    
                                                                                                                                
CHAR DAY                                                                                                                        
Americans for Non-Smokers' Rights (ANR)                                                                                         
Berkeley, California                                                                                                            
POSITION STATEMENT:  Testified in support of HB 40.                                                                           
                                                                                                                                
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:05:45 PM                                                                                                                    
                                                                                                                                
CHAIR PAUL SEATON called the House Health and Social Services                                                                 
Standing   Committee    meeting   to    order   at    3:05   p.m.                                                               
Representatives  Seaton, Foster,  Tarr,  Wool, Talerico,  Stutes,                                                               
and Vazquez were present at the call to order.                                                                                  
                                                                                                                                
            HB  59-MARIJUANA CONCENTRATES; LICENSES                                                                         
                                                                                                                                
3:06:12 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON announced that the  first order of business would be                                                               
HOUSE BILL  NO. 59, "An  Act relating to  marijuana concentrates;                                                               
and providing for an effective date."                                                                                           
                                                                                                                                
3:08:13 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VAZQUEZ moved  to  adopt  the proposed  committee                                                               
substitute (CS) for HB 59,  labeled 29-LS0257\F, Martin, 2/28/15,                                                               
as  the working  draft.   There  being no  objection,  it was  so                                                               
ordered.                                                                                                                        
                                                                                                                                
3:08:44 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VAZQUEZ  moved to  report  CSHB  59, Version  29-                                                               
LS0257\F,  Martin,  2/28/15,  out of  committee  with  individual                                                               
recommendations and the accompanying fiscal notes.                                                                              
                                                                                                                                
REPRESENTATIVE WOOL objected  for the purpose of  discussion.  He                                                               
stated that he was a license  holder under AS 4, and, as portions                                                               
of the proposed  bill dealt with license holders,  he opined that                                                               
it was more  appropriate for some of the  stipulations and issues                                                               
to be worked out by the regulatory board.                                                                                       
                                                                                                                                
3:09:44 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE WOOL maintained his objection.                                                                                   
                                                                                                                                
A roll  call vote  was taken.   Representatives  Foster, Vazquez,                                                               
Talerico, and Seaton voted in  favor of CSHB 59.  Representatives                                                               
Tarr,  Wool,  and  Stutes  voted against  it.    Therefore,  CSHB                                                               
59(HSS) was reported out of  the House Health and Social Services                                                               
Standing Committee by a vote of 4 yeas - 3 nays.                                                                                
                                                                                                                                
[Further discussion of HB 59 occurred later in this meeting.]                                                                   
                                                                                                                                
^Discussion: Medicaid Expansion                                                                                               
                 Discussion: Medicaid Expansion                                                                             
                                                                                                                                
3:11:03 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON announced  that the next order of  business would be                                                               
a response  by the  Department of Health  and Social  Services to                                                               
the previously asked questions on Medicaid Expansion.                                                                           
                                                                                                                                
VALERIE   DAVIDSON,   Commissioner   Designee,  Office   of   the                                                               
Commissioner, Department  of Health  and Social  Services (DHSS),                                                               
said that the  Healthy Alaska plan, previously  introduced to the                                                               
committee,   and  Medicaid   Expansion  both   offered  benefits,                                                               
improved the  health of Alaskans  and the economy of  Alaska, and                                                               
saved  general fund  dollars.    She declared  that  this was  "a                                                               
really good  investment for Alaska"  as it infused  a significant                                                               
amount of  federal funds into the  Alaska economy at a  time when                                                               
the economy could use the boost.                                                                                                
                                                                                                                                
CHAIR  SEATON  directed  attention  to  the  graph,  titled  "All                                                               
Medicaid   Direct   Services  Beneficiaries   and   Expenditures"                                                               
[Included in members' packets].                                                                                                 
                                                                                                                                
3:13:05 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR asked  for a comparison to the  number of the                                                               
beneficiaries  as a  percentage  of population  in other  states.                                                               
She  questioned   if  Alaska  was   "on  par"  and   had  similar                                                               
percentages.                                                                                                                    
                                                                                                                                
COMMISSIONER  DAVIDSON offered  her belief  that Alaska  did have                                                               
similar  percentages,  but  stated  that she  would  provide  the                                                               
accurate information.                                                                                                           
                                                                                                                                
3:13:50 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VAZQUEZ  said  that  she could  not  address  the                                                               
obvious  inconsistencies  with  such short  notice,  offering  an                                                               
example  for  the  stated  enrollment  of  approximately  140,000                                                               
enrollees, even  though the information  that she  had researched                                                               
in her  personal conversations indicated that  there were 165,000                                                               
enrollees.    She reported  that  the  Centers for  Medicare  and                                                               
Medicaid Services  (CMS) had stated that  enrollment was 124,000.                                                               
She asked  which figure was correct.   She said that  there would                                                               
be  other  inconsistencies  and  that she  was  not  prepared  to                                                               
address all the issues given this short notice.                                                                                 
                                                                                                                                
CHAIR SEATON reminded  her that this was a short  follow up and a                                                               
short  response  to  get  all   the  information,  and  that  the                                                               
committee was  not moving the  bill out  of committee today.   He                                                               
suggested that specific  questions could be presented  and that a                                                               
work session,  while sitting around  a table and not  on opposite                                                               
sides of  table, could  be conducted.   He  declared that  it was                                                               
necessary to put the questions on  the table, in order to address                                                               
them in the future.                                                                                                             
                                                                                                                                
3:16:33 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ said that she  would prefer to move on and                                                               
discuss the discrepancies at a later time.                                                                                      
                                                                                                                                
CHAIR  SEATON   explained  that  these  were   responses  to  the                                                               
questions  submitted after  the previous  committee meeting.   He                                                               
declared his desire to ensure  that every member of the committee                                                               
had  the   time  to  analyze   these  responses,  and   that  any                                                               
qualitative responses from the department  could be placed on the                                                               
record.                                                                                                                         
                                                                                                                                
3:17:24 PM                                                                                                                    
                                                                                                                                
JON  SHERWOOD,  Deputy  Commissioner, Medicaid  and  Health  Care                                                               
Policy,  Office of  the Commissioner,  Department  of Health  and                                                               
Social Services, in response  to Representative Vazquez, directed                                                               
attention to the  truncated footnote at the bottom  of the table,                                                               
and  offered to  follow  up  for the  specific  details to  which                                                               
number  was  used for  Medicaid  enrollees.   He  explained  that                                                               
different  reports  generated  different numbers,  as  some  were                                                               
average monthly  enrollment, and others were  quarterly or annual                                                               
unduplicated numbers.   He offered to provide the  source of this                                                               
figure to the committee.                                                                                                        
                                                                                                                                
CHAIR SEATON  said that  he was  unaware of  the various  sets of                                                               
numbers, and that the committee would wait for the information.                                                                 
                                                                                                                                
REPRESENTATIVE  WOOL  pointed to  the  decline  for the  Medicaid                                                               
numbers  in  2014,   and  asked  if  this  was   related  to  the                                                               
implementation  of the  Patient  Protection  and Affordable  Care                                                               
Act.                                                                                                                            
                                                                                                                                
MR.  SHERWOOD replied  that the  expenditure numbers  very likely                                                               
reflected conversion into the  new Enterprise Medicaid Management                                                               
Information  System  (MMIS).    He   said  that  there  was  some                                                               
possibility  that  the  change  in  beneficiaries  reflected  the                                                               
required change  in income  methodology, MAGI  (Modified Adjusted                                                               
Gross Income), a result of  the Patient Protection and Affordable                                                               
Care Act.   He explained  that MAGI  impacted the way  income for                                                               
certain  children,  parents,  caretaker relatives,  and  pregnant                                                               
women was calculated.  He shared  that the department was not yet                                                               
comfortable  with a  definitive  explanation  to the  beneficiary                                                               
changes.                                                                                                                        
                                                                                                                                
3:20:11 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  DAVIDSON  added  that the  Patient  Protection  and                                                               
Affordable Care  Act had  changed the  ways of  qualification for                                                               
Medicaid, subsequently  making it easier.   As asset  testing was                                                               
no longer used, it was now  only based on modified adjusted gross                                                               
income, which she referred to as "the welcome mat effect."                                                                      
                                                                                                                                
CHAIR SEATON asked in which year  on the chart this had come into                                                               
effect.                                                                                                                         
                                                                                                                                
MR. SHERWOOD explained  that the change for  benefits took effect                                                               
on  January 1,  2014,  and that  a provision  for  a three  month                                                               
transition did not allow  a case to be closed as  a result of the                                                               
application of  the new rules.   He noted that some  children had                                                               
been  extended for  another year  if the  changes had  a negative                                                               
impact.  He  allowed that in most circumstances  the changes were                                                               
favorable,  although there  could be  a negative  impact when  it                                                               
required  the  accounting  of  income   from  step  parents  when                                                               
everyone  was  part of  the  same  tax  filing.   He  noted  that                                                               
previously  the department  had  been  prohibited from  including                                                               
step parent income.                                                                                                             
                                                                                                                                
CHAIR  SEATON  asked  that  an explanation  for  the  decline  in                                                               
numbers be presented.                                                                                                           
                                                                                                                                
3:22:14 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR  asked  if  January 1,  2014  had  been  the                                                               
effective  date for  both the  Patient Protection  and Affordable                                                               
Care Act and  Medicaid Expansion, in order to make  it easier for                                                               
qualification and enrollment.                                                                                                   
                                                                                                                                
COMMISSIONER DAVIDSON replied "yes."   She relayed that under the                                                               
original law, Medicaid  Expansion was mandatory for  states.  She                                                               
noted  that the  decision by  the  U. S.  Supreme Court  allowing                                                               
states to opt out of Medicaid  Expansion had created a "new donut                                                               
hole"  in  Medicaid, as  individuals  who  earned less  than  100                                                               
percent of  the federal poverty  level were now not  eligible for                                                               
subsidies on the federally facilitated market place.                                                                            
                                                                                                                                
3:23:38 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ directed attention  to the total funds for                                                               
2014,  at  the  bottom  of  the  spread  sheet  titled  "Medicaid                                                               
Expenditures  by Fund  Source,"  [Included  in members'  packets]                                                               
which totaled  $1,326,503,000.  She  stated that  other budgetary                                                               
documentation  in the  Legislature indicated  that this  would be                                                               
closer to $1.7 billion.  She asked about the discrepancy.                                                                       
                                                                                                                                
3:24:44 PM                                                                                                                    
                                                                                                                                
MARGARET BRODIE, Director, Director's  Office, Division of Health                                                               
Care Services,  Department of Health  and Social  Services, asked                                                               
for clarification to the question.                                                                                              
                                                                                                                                
REPRESENTATIVE   VAZQUEZ  stated   that  she   had  documentation                                                               
elsewhere that indicated the 2014  expenditure was closer to $1.7                                                               
billion.                                                                                                                        
                                                                                                                                
MS.  BRODIE replied  that, although  the Medicaid  projection for                                                               
2014  had been  close to  $1.6 billion,  this chart  was for  the                                                               
actual expenditure.   She reported  that DHSS had  tightened down                                                               
on the waiver programs through  the reassessments, resulting in a                                                               
lot of cost savings.                                                                                                            
                                                                                                                                
3:26:47 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR asked if the  Medicaid reform efforts to this                                                               
point had already resulted in $300 million in savings.                                                                          
                                                                                                                                
MS. BRODIE  replied that the savings  might not be that  high, as                                                               
half  had  been in  cost  savings,  whereas  the other  half  was                                                               
because the system had yet not paid disputed claims.                                                                            
                                                                                                                                
REPRESENTATIVE VAZQUEZ  asked about  the difficulties  with MMIS,                                                               
and whether  this had  resulted in  non-payment for  claims which                                                               
were customarily paid.                                                                                                          
                                                                                                                                
MS.  BRODIE  expressed  her  agreement,   but  pointed  out  that                                                               
currently there had  been correct payment for over  95 percent of                                                               
the claims.                                                                                                                     
                                                                                                                                
REPRESENTATIVE  VAZQUEZ asked  if  claims were  still being  paid                                                               
with paper checks.                                                                                                              
                                                                                                                                
MS. BRODIE  replied that DHSS  paid both electronically  and with                                                               
paper checks.                                                                                                                   
                                                                                                                                
REPRESENTATIVE VAZQUEZ asked for the breakdown.                                                                                 
                                                                                                                                
MS. BRODIE replied that she would research that.                                                                                
                                                                                                                                
3:28:36 PM                                                                                                                    
                                                                                                                                
COMMISSIONER DAVIDSON  asked to  elaborate on a  point previously                                                               
made by  Ms. Brodie.  She  reported that, when MMIS  was delayed,                                                               
Ms. Brodie and her team "worked  really hard with providers to be                                                               
able to  get advance  payments paid," to  enable some  revenue to                                                               
many providers,  a process she  had negotiated with CMS  to allow                                                               
providers  "to keep  their doors  open."   She pointed  out that,                                                               
although the department  had CMS approval to  book those figures,                                                               
a  later  determination   had  been  made  by   the  Division  of                                                               
Legislative  Audit  that  those  figures  had  not  been  claimed                                                               
through the MMIS system, and  consequently needed to be set aside                                                               
and moved  forward to 2015.   She opined that some  of that could                                                               
be reflected  in this  spreadsheet.   She relayed  that, although                                                               
the department had been very  careful to have clearance for these                                                               
advance payments from CMS, the  Division of Legislative Audit had                                                               
required that the payment claims be booked in 2015.                                                                             
                                                                                                                                
3:30:58 PM                                                                                                                    
                                                                                                                                
CHAIR  SEATON expressed  his appreciation  for the  Department of                                                               
Health  and  Social  Services  efforts   to  make  those  advance                                                               
payments,  as   it  otherwise   could  have   created  accounting                                                               
nightmares for years.                                                                                                           
                                                                                                                                
CHAIR SEATON  directed attention to the  second question, "Please                                                               
provide the  numbers for Medicaid expansion  at full enrollment."                                                               
[Included in  members' packets]   He  explained that  this should                                                               
include everyone who was eligible  for Medicaid, and he read from                                                               
the attached  table dated July  1, 2015:  Newly  Eligible Adults,                                                               
41,910;  Spending  Per  Enrollee, $7,248;  Federal  Participation                                                               
Rate,   100  percent;   Federal  Spending,   $303,763,680;  State                                                               
Spending,  $1,460,650;  Offsets  to  State  Spending  from  CAMA,                                                               
Department   of  Corrections,   and  Behavioral   Health  Grants,                                                               
(6,100,000); and Savings to State, ($4,639,350).                                                                                
                                                                                                                                
3:33:38 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ  directed attention to  the aforementioned                                                               
table on page  2, and asked about the offsets  to state spending,                                                               
questioning  why  the woodwork  effect,  discussed  in the  Lewin                                                               
Group report, had not been taken into account.                                                                                  
                                                                                                                                
COMMISSIONER   DAVIDSON   replied    that   her   original   DHSS                                                               
presentation  on  Medicaid  Expansion  had  mentioned  the  Lewin                                                               
Report,  as  well  as  the  Urban  Institute  report,  which  she                                                               
referred  to, affectionately,  as "dueling  banjo reports."   She                                                               
stated  that, as  they were  both  dated and  conducted by  firms                                                               
which did  not have  a lot  of experience  with Alaska,  DHSS had                                                               
asked  Evergreen Economics  to analyze  the Medicaid  data.   She                                                               
pointed  out   that  Evergreen  Economics  had   a  long  history                                                               
analyzing Medicaid data  for DHSS.  She stated  that the woodwork                                                               
effect reflected people who had already signed up for Medicaid.                                                                 
                                                                                                                                
3:35:55 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VAZQUEZ said  that the  Lewin report  suggested a                                                               
substantial effect from the woodwork  effect, and as these people                                                               
were already eligible, they would  only have a 50 percent federal                                                               
match.   She stated  that this  report came  out in  April, 2013,                                                               
whereas  the Evergreen  report came  out in  February, 2015,  and                                                               
that  there were  dramatic differences  between the  two reports.                                                               
She  stated  that  she  had  tables that  she  would  share  with                                                               
everyone, and that her research  indicated that there would be an                                                               
effect and an additional expense  to the state from this woodwork                                                               
effect.                                                                                                                         
                                                                                                                                
COMMISSIONER DAVIDSON  replied that it  depended on how  this was                                                               
categorized.  She  stated that the impact  from expanded Medicaid                                                               
coverage would not  include the people on woodwork,  as they were                                                               
already eligible  for the regular  Medicaid program,  hence there                                                               
would not be an additional expense due to expansion.                                                                            
                                                                                                                                
REPRESENTATIVE VAZQUEZ  said that  this would  still be  an added                                                               
cost to  the state.  She  stated that there were  also people who                                                               
would drop private  insurance or drop income in  order to qualify                                                               
for Medicaid.                                                                                                                   
                                                                                                                                
CHAIR  SEATON pointed  out  that  this was  not  included in  the                                                               
second  question  regarding  the  cost effect  for  people  newly                                                               
eligible for Medicaid expansion.  He  stated that he did not want                                                               
to mix apples  and oranges.  He asked  that Commissioner Davidson                                                               
also  provide some  estimates  for this  data  under the  Healthy                                                               
Alaska plan,  as well as  an estimate  if all the  newly eligible                                                               
enrolled, so that  both columns could be included in  a review of                                                               
the parameters.                                                                                                                 
                                                                                                                                
3:39:42 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VAZQUEZ, directing  attention to  the table  with                                                               
question  2,  said that  there  should  be  a second  column  for                                                               
estimated  enrollment  as  there  would not  necessarily  be  100                                                               
percent enrollment of newly eligible adults.                                                                                    
                                                                                                                                
COMMISSIONER DAVIDSON replied  that, as she had  indicated in her                                                               
prior presentation,  the department anticipated about  63 percent                                                               
of  the  eligible  would  enroll.    She  pointed  out  that  the                                                               
committee had  asked for  a table  reflecting enrollment  for 100                                                               
percent of those eligible under Medicaid Expansion.                                                                             
                                                                                                                                
CHAIR  SEATON   expressed  his   agreement,  noting   the  annual                                                               
increases reported in the Healthy Alaska plan.                                                                                  
                                                                                                                                
3:41:34 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR  asked  about  the  spending  per  enrollee,                                                               
noting  the possibility  of  a  "pent up  need"  for services  by                                                               
people  who  had  not  previously  had  access  to  health  care,                                                               
resulting in  higher costs.   She asked  if the average  cost per                                                               
enrollee would go down over time.                                                                                               
                                                                                                                                
COMMISSIONER  DAVIDSON  replied   that  Evergreen  Economics  had                                                               
looked  at the  cost  per enrollee  and found  that  it was  much                                                               
smaller than  a prior report by  the Lewin Group to  the State of                                                               
Alaska.     She  explained  that  the   eligible  population  for                                                               
expansion  were 54  percent male,  with 20  percent of  those men                                                               
between ages 19  - 34.  She reported that,  although the cost per                                                               
enrollee for  this group  had historically  only grown  1 percent                                                               
annually, the  current estimate  for 2016  had been  increased to                                                               
account  for the  initial  pent  up demand  by  those now  having                                                               
access  to care  and trying  to  get caught  up with  care.   She                                                               
pointed  out that  this projected  cost per  enrollee would  also                                                               
address the fact that Medicaid  Expansion would cover some of the                                                               
generally   higher  cost   CAMA   (Chronic   and  Acute   Medical                                                               
Assistance) beneficiaries,  the cost for which  was currently 100                                                               
percent covered by the general fund.   She reported that the cost                                                               
per enrollee  would be about  $7248 in 2016, increasing  to about                                                               
$8433 in 2021.                                                                                                                  
                                                                                                                                
REPRESENTATIVE VAZQUEZ  noted an inconsistency for  the projected                                                               
$6  million  in  administrative  costs  in FY  2016  on  Table  2                                                               
[Included in members' packets] as  the Lewin Report had estimated                                                               
that cost to be about $11 million.                                                                                              
                                                                                                                                
CHAIR SEATON  acknowledged that  different reports  had different                                                               
cost estimates.  He asked if  there had been any further research                                                               
to other states,  beyond the Healthy Alaska plan,  on whether the                                                               
projected  63  percent for  new  enrollees  was "pretty  well  on                                                               
track."   He questioned if  the projection in the  Healthy Alaska                                                               
plan was the current estimate.                                                                                                  
                                                                                                                                
COMMISSIONER  DAVIDSON   replied  that   this  was   the  current                                                               
estimate.                                                                                                                       
                                                                                                                                
3:47:33 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VAZQUEZ  referenced   the  March  5  presentation                                                               
[Healthy Alaska Plan] to the  committee by Commissioner Davidson,                                                               
slide  14, and  said that  the projected  administrative cost  in                                                               
that report had been zero, which  was quite different than the $6                                                               
million estimate.                                                                                                               
                                                                                                                                
COMMISSIONER  DAVIDSON  pointed  to  the  asterisk  next  to  the                                                               
administrative cost in the Healthy  Alaska plan, stating that the                                                               
administrative cost  for the first  year was being funded  by the                                                               
Alaska Mental Health Trust Authority.                                                                                           
                                                                                                                                
REPRESENTATIVE VAZQUEZ  asked if  that estimated amount  had been                                                               
about $1.5 million.                                                                                                             
                                                                                                                                
MR. SHERWOOD  pointed out that  this referenced the  general fund                                                               
savings.      He   explained  that   the   total   administrative                                                               
expenditure,  which  would serve  20,000  Alaskans  in the  first                                                               
year,  in  the Healthy  Alaska  plan  would  have been  about  $3                                                               
million, half of  which was federally funded,  with the remainder                                                               
of  the  state share  paid  by  the  Alaska Mental  Health  Trust                                                               
Authority funds.  He noted that  this would result in a zero cost                                                               
to  the  general fund,  even  though  there  was a  federal  fund                                                               
expenditure.    He added  that  service  for a  projected  41,000                                                               
Alaskans in  FY 2016 would increase  the estimated administrative                                                               
expenses.                                                                                                                       
                                                                                                                                
COMMISSIONER  DAVIDSON  pointed  out   that  50  percent  of  the                                                               
administrative costs were reimbursed by the federal government.                                                                 
                                                                                                                                
CHAIR  SEATON reviewed  that the  $1.5 million  of the  cost from                                                               
general  fund  would  be  covered  by  the  Alaska  Mental  Trust                                                               
Authority  in FY  2016,  with the  remaining  $1.5 million  being                                                               
covered  by  federal  funds,  for   a  total  of  $3  million  in                                                               
administrative costs.                                                                                                           
                                                                                                                                
REPRESENTATIVE VAZQUEZ said  that the Lewin Group  had reported a                                                               
cost of $11,204,000 as the cost  to the state, with an additional                                                               
cost to the federal government.   She stated that there was still                                                               
a  discrepancy between  the  initial estimate  by  DHSS and  this                                                               
report.                                                                                                                         
                                                                                                                                
COMMISSIONER DAVIDSON expressed agreement.                                                                                      
                                                                                                                                
REPRESENTATIVE   TARR   asked   for   any   characterization   of                                                               
differences  since  the  activation   of  Medicaid  Expansion  on                                                               
January  1,  2014 between  the  Lewin  report and  the  Evergreen                                                               
report, as there was now some data for comparison.                                                                              
                                                                                                                                
COMMISSIONER  DAVIDSON replied  that an  unfortunate result  from                                                               
the decision  by the State  of Alaska  to not expand  Medicaid in                                                               
the first year was that many  Alaskans now do not have any health                                                               
coverage when there  could have been improvement  to their health                                                               
care while the state received  federal funding.  She relayed that                                                               
a benefit of  this delay had been the opportunity  to look at the                                                               
experience of other  states in 2014 for reform  of their Medicaid                                                               
programs,  thus  providing  more   information  to  compare  with                                                               
Alaska's experience for Medicaid trends.                                                                                        
                                                                                                                                
CHAIR SEATON expressed the need  to recognize that there were two                                                               
different  reports  covering  two  different  time  periods  with                                                               
different analyses.   He stated that the committee  would need to                                                               
"figure out  what numbers make the  most sense."  He  pointed out                                                               
that the  Healthy Alaska plan from  DHSS was its synopsis  of the                                                               
different  reports with  the  most  reasonable assumptions  going                                                               
forward.    He  allowed  that  it  was  not  necessary  that  the                                                               
committee agree  with that  plan, but  rather that  the committee                                                               
decide  which report  to  use most  critically,  and then  decide                                                               
whether DHSS  had done an adequate  job with its analyses  of the                                                               
different reports  for its Healthy  Alaska plan.  He  stated that                                                               
the committee  was not chastising  but was working  to understand                                                               
the difference  between each of  these reports and  the resulting                                                               
numbers.                                                                                                                        
                                                                                                                                
3:54:53 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR asked  about  the  expected enrollment  from                                                               
Medicaid  Expansion, noting  that  fewer enrollees  could mean  a                                                               
significant reduction of spending by the state.                                                                                 
                                                                                                                                
MR. SHERWOOD replied that the  aforementioned presentation on the                                                               
Healthy Alaska  plan showed  that state  expenditures in  FY16 at                                                               
the  regular rate  would be  zero, and  that, in  addition, there                                                               
would be  offsets to  other programs resulting  in a  net general                                                               
fund  reduction.   He  expressed  agreement  that, although  full                                                               
enrollment  without additional  funding  from  the Alaska  Mental                                                               
Health   Trust   Authority   would  incur   state   expenses   of                                                               
approximately  $1.4  million,  there  would  be  substantial  net                                                               
reductions  in general  funds in  excess of  $4 million  with the                                                               
offsets.                                                                                                                        
                                                                                                                                
3:56:32 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON moved  on to question number 3,  "Please provide the                                                               
incomes  of  the  hospitals  that reported  the  $90  million  in                                                               
uncompensated  care," and  he directed  attention to  the handout                                                               
and  table  of  the  same  title in  response  to  this  question                                                               
[Included  in members'  packets].   He  summarized that  Medicaid                                                               
Expansion  would attempt  a  reduction in  that  care with  fully                                                               
compensated care.                                                                                                               
                                                                                                                                
MR. SHERWOOD stated  that the Office of Rate  Review had supplied                                                               
the  information  on the  included  table,  noting that  the  net                                                               
income  listed included  all sources  of  revenue, including  one                                                               
time payments, against expenses  as opposed to operating revenue.                                                               
He offered an  example of capital appropriations  in the revenue,                                                               
and reported  that this net  income did not  inherently represent                                                               
profit, as  a case  by case  analysis of  each facility  would be                                                               
necessary.                                                                                                                      
                                                                                                                                
CHAIR SEATON noted  that grants appeared as  net income, although                                                               
it was  only the facility  receiving a  capital grant.   He added                                                               
that bond issues could also be represented as net income.                                                                       
                                                                                                                                
3:59:32 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TALERICO  offered his  belief  that  it would  be                                                               
important  to  have   a  discussion  for  this   $91  million  in                                                               
uncompensated care  by the non-tribal facilities.   He questioned                                                               
whether  it was  possible  to  use these  net  income numbers  to                                                               
figure this out.                                                                                                                
                                                                                                                                
CHAIR SEATON  expressed his agreement  that the  capital projects                                                               
did make it  difficult, and said that he was  unsure if there was                                                               
a way to get to the requested information.                                                                                      
                                                                                                                                
4:01:36 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR directed  attention  to the  listing on  the                                                               
aforementioned table  for Providence Alaska Medical  Center, with                                                               
a  net  income  of  about   $88  million,  and  asked  about  the                                                               
corresponding 13 percent of revenue.                                                                                            
                                                                                                                                
4:02:17 PM                                                                                                                    
                                                                                                                                
JARED KOSIN, Executive Director,  Rate Review, Division of Health                                                               
Care  Services,   Department  of  Health  and   Social  Services,                                                               
explained that  after they  take total  revenue and  deduct total                                                               
expenses, the  remaining net  income reflected  the corresponding                                                               
percentage, listed on the same line, of total revenue.                                                                          
                                                                                                                                
REPRESENTATIVE TARR  asked how the  amount of  uncompensated care                                                               
would be  applied to  the listed  information for  each facility.                                                               
She asked if it had already  been figured as an expense, or would                                                               
it be subtracted from the listed net income.                                                                                    
                                                                                                                                
MR. KOSIN  replied that uncompensated care  costs were considered                                                               
in the  total expenses that  had been  deducted to arrive  at the                                                               
net  income.   He  said  that the  only  way  hospitals could  be                                                               
reimbursed for  uncompensated care by  the state was  through the                                                               
disproportionate   share   of   hospital  payments,   which   was                                                               
distributed  through the  federal  government as  a  part of  the                                                               
Patient Protection  and Affordable Care  Act, and this  money was                                                               
being  phased out  over  the upcoming  seven to  ten  years.   He                                                               
stated that it was considered  in the reported expenses for total                                                               
net  income,  but  was  reimbursed  through  a  separate  revenue                                                               
stream, and not through Medicaid.                                                                                               
                                                                                                                                
CHAIR  SEATON  asked  if  that separate  revenue  stream  to  the                                                               
hospital was part of its net income.                                                                                            
                                                                                                                                
MR. KOSIN replied that it was.                                                                                                  
                                                                                                                                
REPRESENTATIVE TARR asked if there  was an industry standard that                                                               
the  net income  should be  above  a specific  percentage of  the                                                               
total revenue.                                                                                                                  
                                                                                                                                
MR. KOSIN explained that the  staff accountants in his office had                                                               
cautioned that  this global  scale for total  net income  did not                                                               
allow for any  way to draw the conclusions  that financial health                                                               
could be  assessed based on  any percentage.   He stated  that it                                                               
was necessary to draw down  on each individual revenue stream and                                                               
each  individual  expense on  each  line  in order  to  determine                                                               
whether there was  a healthy margin.  He reported  that with this                                                               
information this analysis would be inconclusive.                                                                                
                                                                                                                                
REPRESENTATIVE VAZQUEZ asked if he  had any determination for the                                                               
disproportionate share hospital payments.                                                                                       
                                                                                                                                
MR.  KOSIN replied  that the  federal  government determined  the                                                               
aggregate  amount of  money  allowed  for disproportionate  share                                                               
hospital payments,  and then regulations specified  how the funds                                                               
were  to be  distributed.   He said  that his  office did  figure                                                               
facility  specific   limits  for  each  hospital   that  reported                                                               
uncompensated  care, and  then determined  the  relevant caps  to                                                               
payments for each of these hospitals.                                                                                           
                                                                                                                                
CHAIR SEATON  asked for a  broad explanation  of disproportionate                                                               
care payment.                                                                                                                   
                                                                                                                                
MR. KOSIN  explained that  these disproportionate  share hospital                                                               
payments   were   designed   to    help   hospitals   serving   a                                                               
disproportionate  share  of  uncompensated  care  patients.    He                                                               
stated that, as patients with  no payer source were still treated                                                               
even though there was not  any reimbursement for those costs, the                                                               
federal  government had  created  a means  to  help offset  those                                                               
costs by  annually publishing a  state by state  aggregate amount                                                               
they would fund.   From this fund, each state  could draw down at                                                               
a 50:50 match  to distribute payments to  identified hospitals in                                                               
order to offset the uncompensated care.   He pointed out that the                                                               
Patient  Protection  and  Affordable  Care  Act,  since  Medicaid                                                               
Expansion  was  originally  mandatory,   had  made  this  program                                                               
irrelevant;  however,  when  Medicaid  Expansion  was  ruled  not                                                               
mandatory,  the  reductions  in Disproportionate  Share  Hospital                                                               
payments were delayed and are supposed to start this year.                                                                      
                                                                                                                                
4:08:18 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE VAZQUEZ  asked if uncompensated hospital  care was                                                               
considered in the cost reports submitted to his office.                                                                         
                                                                                                                                
MR. KOSIN replied that uncompensated  care was not considered for                                                               
the reimbursement  calculation, although  it was reported  in the                                                               
cost  report.   He  clarified that  it was  not  in the  Medicaid                                                               
reimbursement for hospitals, and it was not compensated.                                                                        
                                                                                                                                
REPRESENTATIVE VAZQUEZ asked why it was reported.                                                                               
                                                                                                                                
MR.  KOSIN replied  that  the  Medicare cost  report  was a  very                                                               
thorough report in mechanism, as Medicare  took a look at all the                                                               
financials for  a hospital, including  the requirement  to submit                                                               
its annual  audit.  He  stated that  DHSS required that  the same                                                               
data,  along  with  some  additional  financial  information,  be                                                               
submitted  for Medicaid  calculations.   He  reported that  these                                                               
reports allowed  the department to  isolate allowable  costs, and                                                               
then reimburse for those costs.                                                                                                 
                                                                                                                                
REPRESENTATIVE  VAZQUEZ   asked  about  the   difference  between                                                               
Medicare and Medicaid, and which program his office handled.                                                                    
                                                                                                                                
MR.  KOSIN  spoke  about  the  reimbursement  programs  for  both                                                               
Medicaid and Medicare.  He  said that Medicaid served a different                                                               
population  as it  was state  based, and  Medicare was  a federal                                                               
program.   He said that  with Medicaid, states had  the authority                                                               
to set  the way to  reimburse for Medicaid services;  however, as                                                               
Medicare covered the  same or similar services,  dependent on the                                                               
population,  the Medicaid  programs  would  mirror those  payment                                                               
methodologies  and would  adjust them  based  on the  state.   He                                                               
stated that  the Office of  Rate Review  and the State  of Alaska                                                               
were Medicaid.                                                                                                                  
                                                                                                                                
MR. SHERWOOD, in response to  Representative Vazquez, stated that                                                               
Medicare  was a  federal  program providing  health coverage  for                                                               
individuals  over  65 years  of  age,  and for  individuals  with                                                               
disabilities.   He  said  that  it was  more  closely modeled  to                                                               
conventional  insurance, as  it  was paid  into through  employer                                                               
withheld  taxes,   was  administered  directly  by   the  federal                                                               
government, and provided  a wide range of primary  and acute care                                                               
services, although it did not  provide substantial long term care                                                               
services.   He  reported  that  it was  not  based  on assets  or                                                               
income, as the  criteria was only for age or  disability, and for                                                               
the  required  payment participation.    He  explained that  most                                                               
people  qualified   for  hospital   coverage,  Part   A,  without                                                               
premiums, and that almost everyone  paid for Medicare Part B, the                                                               
outpatient,  primary  care.    He   noted  that  there  was  also                                                               
prescription drug coverage,  Part D.  He  explained that Medicare                                                               
Advantage was for the managed care  program, Part C.  He declared                                                               
that it was not a needs  based program and the policies were made                                                               
at the federal level.                                                                                                           
                                                                                                                                
MR. SHERWOOD  said that  Medicaid was a  needs based  program for                                                               
individuals  with low  incomes,  and, in  some categories,  asset                                                               
tests  did  apply.   He  stated  that  it had  historically  been                                                               
dependent  on certain  categorical requirements,  including aged,                                                               
blind,  disabled, pregnant  women, and  children.   He said  that                                                               
childless  adults between  the  ages of  21 -  64,  who were  not                                                               
parents  or care  taker  relatives, did  not  have a  substantial                                                               
disability, and were not pregnant,  did not qualify regardless of                                                               
income.  He  explained that it was a  state administered program,                                                               
under  federal rules,  although  states had  certain options  for                                                               
what they  could offer,  how they  administer their  program, and                                                               
who  they  can  cover.    He  noted  that  the  state  worked  in                                                               
partnership  with  the  federal  government.   He  reported  that                                                               
states paid  a share of the  costs of Medicaid.   He allowed that                                                               
some  people, including  the aged,  and those  with disabilities,                                                               
low  incomes  and  few  assets, were  dually  eligible  for  both                                                               
programs.                                                                                                                       
                                                                                                                                
4:15:33 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VAZQUEZ  summarized  that Medicare  was  for  the                                                               
elderly,  over  65  years  of  age, and  the  disabled  and  that                                                               
Medicaid  was for  individuals  with  certain disabilities,  long                                                               
term care, and low income.                                                                                                      
                                                                                                                                
COMMISSIONER DAVIDSON said that asset  testing was still in place                                                               
for people receiving certain long term care services.                                                                           
                                                                                                                                
REPRESENTATIVE VAZQUEZ asked whether  this was no longer relevant                                                               
as of the last year.                                                                                                            
                                                                                                                                
MR. SHERWOOD explained that assets  for children, pregnant women,                                                               
and parents or care taker relatives  were not subject to an asset                                                               
test.  He said that  older Alaskans and individuals who qualified                                                               
through disabilities were subject to asset tests.                                                                               
                                                                                                                                
REPRESENTATIVE  VAZQUEZ asked  for clarification  that the  TEFRA                                                               
(Tax Equity and  Fiscal Responsibility Act) program  did not have                                                               
any  asset  tests,  as  the  child was  considered  as  a  single                                                               
household.                                                                                                                      
                                                                                                                                
MR. SHERWOOD replied that TEFRA  did have an asset test, although                                                               
it only pertained  to the child's assets and not  to the parent's                                                               
assets.   He  explained that  for qualification,  the child  must                                                               
meet an institutional  level of care, and if the  child was in an                                                               
institution, the parent's assets were not counted.                                                                              
                                                                                                                                
MR. SHERWOOD, in response to  Representative Tarr, clarified that                                                               
TEFRA, the Tax Equity and  Fiscal Responsibility Act, was a broad                                                               
legislation  which  included  the  option  for  states  to  cover                                                               
individuals.                                                                                                                    
                                                                                                                                
4:18:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  WOOL  referenced  the aforementioned  question  3                                                               
regarding  the  $90 million  in  uncompensated  care.   He  asked                                                               
whether this question stemmed from  the amount each hospital paid                                                               
in uncompensated  care, and what  percentage that was of  its net                                                               
income.  He opined that this  information was not included on the                                                               
table.                                                                                                                          
                                                                                                                                
MR. SHERWOOD expressed agreement that  the table did not have any                                                               
information for uncompensated care.                                                                                             
                                                                                                                                
REPRESENTATIVE  WOOL surmised  that  hospitals were  in favor  of                                                               
Medicaid Expansion as it would reduce uncompensated care.                                                                       
                                                                                                                                
COMMISSIONER DAVIDSON expressed her agreement.                                                                                  
                                                                                                                                
REPRESENTATIVE  WOOL asked  if  uncompensated  care received  any                                                               
reimbursement from the federal government.                                                                                      
                                                                                                                                
COMMISSIONER  DAVIDSON  asked  whether  he  was  referencing  the                                                               
disproportionate  share  payments,  and she  explained  that,  as                                                               
initially  the Patient  Protection  and Affordable  Care Act  had                                                               
included mandatory  Medicaid Expansion,  it was planned  to phase                                                               
out the  disproportionate share  payments over time  as a  way to                                                               
help fund the  expansion.  When the  mandatory Medicaid Expansion                                                               
provision  was  disallowed  by  the U.  S.  Supreme  Court,  many                                                               
hospitals across the country took  "the requisite hits to be able                                                               
to  pay for  the increases  and  resources that  would come  with                                                               
Medicaid Expansion, but  Medicaid Expansion was off  the table in                                                               
terms of being a mandatory service."                                                                                            
                                                                                                                                
4:22:11 PM                                                                                                                    
                                                                                                                                
MR.   KOSIN  explained   that  disproportionate   share  hospital                                                               
payments were partly  funded by the federal  government, with the                                                               
remaining 50  percent funded by the  state.  He pointed  out that                                                               
these can  "get complicated very  quickly," as they appear  to be                                                               
designed  to  reimburse  for  uncompensated  care,  although  the                                                               
payments  are  structured  so that  only  certain  services  were                                                               
eligible.    As  the  majority  of  the  eligible  services  were                                                               
behavioral health services, the  predominant amount of funds went                                                               
to  the  Alaska  Psychiatric  Institute,   as  it  was  the  only                                                               
institution  for mental  disease in  the state.   He  pointed out                                                               
that  the state  had  to pay  half  of the  payment  in order  to                                                               
receive the federal  match, so that drawing down  these funds was                                                               
not a  given and could  not be  counted on while  determining the                                                               
budget.   He reported that only  two or three other  hospitals in                                                               
Alaska received  any of  this funding, as  it was  for behavioral                                                               
health services.   He shared  that, "at  best, it only  offsets a                                                               
little uncompensated care  and per the Affordable  Care Act, it's                                                               
set to phase out anyways over the next seven to ten years."                                                                     
                                                                                                                                
4:24:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE WOOL  reflected that, as Medicaid  eligibility was                                                               
based on  income, not assets,  it had been suggested  that people                                                               
would  choose  to  lower  their income  intentionally  to  be  on                                                               
Medicaid.   He  opined that,  if people  had any  experience with                                                               
receiving care through  the Medicaid system, this would  not be a                                                               
choice for anyone with a lot of  assets.  He asked if the Patient                                                               
Protection  and Affordable  Care Act  subsidy structure  was also                                                               
based on assets.                                                                                                                
                                                                                                                                
COMMISSIONER   DAVIDSON  explained   that,   under  the   Patient                                                               
Protection and  Affordable Care Act,  to qualify, in  Alaska this                                                               
was a  federally facilitated market place,  individuals were only                                                               
eligible  for these  market place  subsidies if  they had  income                                                               
between  100  percent and  400  percent  of the  federal  poverty                                                               
level.  She stated that anyone  with income less than 100 percent                                                               
of the  federal poverty level was  not eligible for a  subsidy on                                                               
the  market place.   She  relayed that  Medicaid Expansion  would                                                               
cover individuals with  incomes up to 138 percent  of the federal                                                               
poverty level.                                                                                                                  
                                                                                                                                
REPRESENTATIVE   WOOL  asked   if  there   was  an   overlap  for                                                               
individuals with incomes between 100  percent and 138 percent [of                                                               
the federal  poverty level] for eligibility  from either Medicaid                                                               
or  subsidies from  the Patient  Protection  and Affordable  Care                                                               
Act.                                                                                                                            
                                                                                                                                
MR. SHERWOOD  offered his belief  that, as the process  was based                                                               
on  income, an  individual with  income  in this  range would  be                                                               
directed  to  Medicaid in  a  state  that had  accepted  Medicaid                                                               
Expansion, or to  the [market place] exchange  dependent on their                                                               
income.   He explained that  the subsidy from the  exchange could                                                               
be accepted down to 100 percent [of the federal poverty level.]                                                                 
                                                                                                                                
4:28:18 PM                                                                                                                    
                                                                                                                                
MONIQUE  MARTIN,  Health  Care  Policy  Advisor,  Office  of  the                                                               
Commissioner,   Department  of   Health   and  Social   Services,                                                               
explained  that  an  individual  with an  income  less  than  138                                                               
percent of  the federal poverty  level residing in a  state which                                                               
had expanded  Medicaid coverage would receive  a determination or                                                               
an  assessment suggesting  the person  was eligible  for Medicaid                                                               
and  that  this information  would  then  be transmitted  to  the                                                               
state.    If  a  person   was  determined  eligible  for  minimum                                                               
essential coverage  under the  Patient Protection  and Affordable                                                               
Care Act,  they would not  be able to sign  up for a  subsidy and                                                               
would only be eligible for Medicaid.                                                                                            
                                                                                                                                
4:30:10 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   TALERICO  asked   about   other  categories   in                                                               
accounting, such as operating income, which could include non-                                                                  
operating  expenses.   He  suggested  that  any other  accounting                                                               
information would be good to share with the committee.                                                                          
                                                                                                                                
CHAIR SEATON suggested  that he discuss this  with the department                                                               
and determine whether the information  was meaningful within this                                                               
context.                                                                                                                        
                                                                                                                                
REPRESENTATIVE TALERICO expressed his agreement.                                                                                
                                                                                                                                
CHAIR SEATON  reiterated that any  member of the  committee could                                                               
directly contact the department through the legislative liaison.                                                                
                                                                                                                                
4:32:05 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON moved on to  question 5, "Please provide information                                                               
on  how   Medicaid  and  Medicaid   expansion  might   help  with                                                               
behavioral  health  medicine  compliance  issues."  [Included  in                                                               
members' packets]  In response  to Representative Tarr, he stated                                                               
that he would temporarily bypass  question 4, in order to discuss                                                               
expansion before moving on to reforms.                                                                                          
                                                                                                                                
REPRESENTATIVE TARR  asked about  the unintended  consequences to                                                               
behavioral  health and  mental health  from stopping  medication,                                                               
noting that there could be correctional issues, as well.                                                                        
                                                                                                                                
CHAIR  SEATON  paraphrased  from   the  second  bullet  point  in                                                               
question 5, which read:                                                                                                         
                                                                                                                                
     for  individuals transitioning  from  hospital care  or                                                                    
     releases   from    correctional   facilities,   because                                                                    
     individuals  leaving  these  facilities will  not  only                                                                    
     have prescriptions  in hand  for their  medications but                                                                    
     also the coverage  to pay for them as long  as they are                                                                    
     medically necessary.                                                                                                       
                                                                                                                                
CHAIR SEATON opined  that the key point to her  question was that                                                               
Medicaid Expansion would provide this to those populations.                                                                     
                                                                                                                                
4:35:04 PM                                                                                                                    
                                                                                                                                
COMMISSIONER DAVIDSON,  in response to Representative  Tarr, said                                                               
that there  were definite benefits  in a variety of  settings, as                                                               
experience had shown  that continuity of care,  assurance for the                                                               
right  care, at  the right  time, in  the right  place, including                                                               
medications,  would   also  help   individuals  to   continue  to                                                               
contribute  to a  healthy, productive  lifestyle.   She expressed                                                               
agreement that  this could also  lead to opportunities  to reduce                                                               
recidivism,  offering  Texas  as  an example  for  investment  in                                                               
health instead of  prisons.  She reported that the  offering of a                                                               
variety of  behavioral health and  treatment services was  one of                                                               
the biggest  opportunities to change  the dynamic  of recidivism.                                                               
She pointed out that a  high percentage of the prison population,                                                               
as they were  there awaiting trial and not because  they had been                                                               
convicted, could  be, instead, placed in  treatment programs paid                                                               
for through Medicaid Expansion.                                                                                                 
                                                                                                                                
REPRESENTATIVE   TARR  stated   that,   as   the  Department   of                                                               
Corrections  was  the largest  mental  health  care provider  [in                                                               
Alaska], it would be better to  have care for an individual prior                                                               
to their criminal behavior.                                                                                                     
                                                                                                                                
COMMISSIONER  DAVIDSON  added  that,  in  addition  to  treatment                                                               
facilities  being better  than incarceration  in the  prisons, it                                                               
was  necessary to  have continuity  of care  for medications  and                                                               
follow  up  behavioral health  services  for  an individual  upon                                                               
return to their community.   She pointed out that these community                                                               
health  provider   programs  after  release   from  incarceration                                                               
already existed in other states.                                                                                                
                                                                                                                                
4:39:52 PM                                                                                                                    
                                                                                                                                
ALBERT  WALL, Director,  Central Office,  Division of  Behavioral                                                               
Health, Department of Health and  Social Services, reported that,                                                               
for  the  population  with  serious   mental  illness,  the  most                                                               
important  thing for  stability  was access  to consistent  care,                                                               
with  medication, on  an ongoing  basis.   He declared  that this                                                               
ongoing access was available through  the Medicaid Expansion, and                                                               
would  allow  these  people  to   rise  to  the  greatest  extent                                                               
possible.                                                                                                                       
                                                                                                                                
REPRESENTATIVE  WOOL  expressed  recognition  for  the  potential                                                               
realized  savings from  Medicaid Expansion  as medical  treatment                                                               
outside the  prison facility  for prisoners  would be  covered by                                                               
Medicaid.  He noted that,  as mental health treatments would also                                                               
be  covered through  this expansion,  it could  potentially lower                                                               
the prison  population.   He asked if  any of  these calculations                                                               
for reduced recidivism or a reduction  in the need for use of the                                                               
state corrections system had been  put into the projected savings                                                               
for Medicaid expansion.                                                                                                         
                                                                                                                                
COMMISSIONER  DAVIDSON replied  that the  only part  of the  cost                                                               
savings  used in  the projections  was  for the  out of  facility                                                               
overnight  medical  care, which  she  described  as contract  in-                                                               
patient care.   She stated  that it  did not include  the savings                                                               
from  anti-recidivism  efforts,  behavioral health  services,  or                                                               
substance and  alcohol abuse  services.   She declared  that DHSS                                                               
did expect to realize those savings.                                                                                            
                                                                                                                                
4:43:13 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON paraphrased question  number 6 [Included in members'                                                               
packets], which read:                                                                                                           
                                                                                                                                
     Representative Seaton  would like  to hear  our opinion                                                                    
     on whether  expansion legislation could  include reform                                                                    
     requirements with a  delayed implementation timeline to                                                                    
     provide a level of  accountability and assurance to the                                                                    
     legislature.                                                                                                               
                                                                                                                                
CHAIR SEATON  noted that  there would also  be discussion  on the                                                               
response  from  DHSS on  reform  efforts.  [Included in  members'                                                               
packets]  He  offered his belief that there were  two things that                                                               
did  not  meet in  time:  expansion  that  occurred when  it  was                                                               
expanded,  and reforms  that could  take time  to implement.   He                                                               
offered an  example of an  HMO (health  maintenance organization)                                                               
model  that was  not instantaneous,  as it  would entail  a shift                                                               
from the  current fee for service  model.  He asked  if DHSS felt                                                               
that something could be done  in legislation to move forward with                                                               
Medicaid  Expansion  while  there  were  definite  timelines  for                                                               
itemized reforms to be accomplished.                                                                                            
                                                                                                                                
COMMISSIONER  DAVIDSON  replied  that  a lot  of  the  identified                                                               
reform  efforts were  "not  things  that you  can  flip a  switch                                                               
with,"   or   they  would   have   taken   place  over   previous                                                               
administrations.  She  declared that a lot of  the reform efforts                                                               
took  time.   She  stated  that  the  current challenge  was  for                                                               
smaller budgets  and smaller revenues.   She noted that  DHSS had                                                               
identified some reform efforts that  had already been undertaken.                                                               
She  declared  that  DHSS  had already  commenced  working  on  a                                                               
timeline  for reform  efforts.   She  directed  attention to  the                                                               
handout  titled "March  5, 2015  Meeting  - Follow-up  Questions"                                                               
[Included  in  members'  packets]   which  she  explained  was  a                                                               
document of the efforts for  savings opportunities and timelines.                                                               
She offered  her belief  that DHSS  was "happy  to work  with the                                                               
Legislature  on reform  ideas," and  that DHSS  had identified  a                                                               
path forward to this end.   She pointed out that savings had been                                                               
identified  through  the  budget  process,  some  of  which  were                                                               
included  in  the handout.    She  offered  her belief  that  any                                                               
further delay to Medicaid Expansion  was a missed opportunity for                                                               
taking advantage  of the $145  million in federal funds  in 2016,                                                               
which  "would really  go a  long way  to be  able to  improve the                                                               
health of Alaskans and quite  frankly boost the economy of Alaska                                                               
for a considerable savings to our state general fund budget."                                                                   
                                                                                                                                
REPRESENTATIVE STUTES  expressed her concern that  reform efforts                                                               
would take time,  as, otherwise, they would  have occurred during                                                               
the past  several administrations.   She expressed her  hope that                                                               
changes and  reforms would not  take many  future administrations                                                               
for  completion.   She  expressed  her belief  that  it would  be                                                               
difficult  for reform  adjustments and  controlled spending  when                                                               
the money was  coming in, and that it was  imperative that reform                                                               
go  hand in  hand [with  expansion].   She  declared that  reform                                                               
needed to be  as much of a priority as  Medicaid Expansion, or it                                                               
would not be successful.                                                                                                        
                                                                                                                                
COMMISSIONER DAVIDSON  expressed her agreement, noting  that this                                                               
was   a  very   different  budget   environment  than   in  prior                                                               
administrations.   She shared that the  governor had expectations                                                               
for  the department  commissioners  to  review each  departmental                                                               
budget  and to  plan  for  25 percent  reductions  over the  next                                                               
several years.   She reported that DHSS had taken  $76 million in                                                               
budget cuts  from the House  and it  was rumored that  the Senate                                                               
would make further  cuts of $4 million.  She  relayed that reform                                                               
efforts  with  opportunities  and   timelines  for  savings  were                                                               
already  underway because  "nobody is  more incentivized  to hold                                                               
ourselves accountable  than we are.   We recognize  that Medicaid                                                               
is a  significant portion of  our department's budget, and  if we                                                               
are  going to  cut our  budget  by 25  percent in  the next  four                                                               
years, and our biggest budget  item is Medicaid, reform really is                                                               
our opportunity to be able to meet the governor's expectation."                                                                 
                                                                                                                                
4:50:29 PM                                                                                                                    
                                                                                                                                
CHAIR  SEATON referenced  the  aforementioned  three pages  which                                                               
itemized  the  reform  efforts,   stating  that  the  purpose  of                                                               
question  6  was  to determine  whether  the  administration  was                                                               
willing  to have  delayed implementation,  in statute,  to assure                                                               
that there were variable time lines for reform.                                                                                 
                                                                                                                                
4:51:36 PM                                                                                                                    
                                                                                                                                
COMMISSIONER  DAVIDSON, referencing  the reform  efforts handout,                                                               
noted  that  the  underlined  sections  referred  back  to  those                                                               
numbered slides  in the original  PowerPoint presentation  to the                                                               
committee.                                                                                                                      
                                                                                                                                
4:52:21 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE WOOL offered an analogy  to the injection of cash,                                                               
jobs, and the  stimulation of the economy from  the proposed F-35                                                               
fighter jets  being stationed  on a  military base  in Fairbanks,                                                               
although it  was argued that the  military was in need  of reform                                                               
and the F-35 project needed more  testing.  He opined that all of                                                               
this could  go on  in parallel,  even though  the military  was a                                                               
big,  complex  institution  that  most  likely  had  waste.    He                                                               
suggested that this was analogous  to the discussion for Medicaid                                                               
Expansion.                                                                                                                      
                                                                                                                                
COMMISSIONER  DAVIDSON  offered her  belief  that  this was  very                                                               
similar, noting  that when  the military had  come to  Alaska, it                                                               
had  asked for  various departments  of the  state government  to                                                               
provide information  for the benefits to  military personnel from                                                               
Alaska.    She   reported  that  a  lot   of  military  personnel                                                               
qualified,  because of  income and  children,  for Medicaid,  and                                                               
could  potentially  qualify under  the  expansion.   She  relayed                                                               
that,   after  the   military  had   studied   many  states   and                                                               
communities, they had reported back  that the military population                                                               
in Alaska benefitted from a  great partnership with the community                                                               
and the services it provided.                                                                                                   
                                                                                                                                
             HB 59-MARIJUANA CONCENTRATES; LICENSES                                                                         
                                                                                                                                
4:56:18 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON,  upon request from Representative  Stutes, returned                                                               
the  committee's attention  to HB  59.   In  further response  to                                                               
Representative  Stutes,  Chair  Seaton confirmed  that  the  next                                                               
committee of referral  for HB 59 is the  House Judiciary Standing                                                               
Committee.                                                                                                                      
                                                                                                                                
REPRESENTATIVE STUTES moved to reconsider  her vote on the motion                                                               
to  report CSHB  59, Version  29-LS0257\F, Martin,  2/28/15, from                                                               
committee.  She  stated she wanted to change her  vote from a nay                                                               
to a  yea vote.  There  being no objection, Version  F was before                                                               
the committee.                                                                                                                  
                                                                                                                                
REPRESENTATIVE  VAZQUEZ  moved to  report  CSHB  59, Version  29-                                                               
LS0257\F,  Martin,  2/28/15,  out of  committee  with  individual                                                               
recommendations and  the accompanying fiscal notes.   There being                                                               
no objection,  CSHB 59(HSS) was  moved from the House  Health and                                                               
Social Services Standing Committee.                                                                                             
                                                                                                                                
         HB  40-USE OF ELECTRONIC CIGARETTES AS SMOKING                                                                     
                                                                                                                                
4:58:01 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON announced that the  final order of business would be                                                               
HOUSE BILL  NO. 40,  "An Act  relating to  the use  of electronic                                                               
cigarettes; and providing for an effective date."                                                                               
                                                                                                                                
4:58:33 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  BOB  HERRON,  Alaska State  Legislature,  relayed                                                               
that  the  genesis of  the  proposed  bill  was  a result  of  e-                                                               
cigarette  use in  the  Anchorage  Airport.   When  he asked  the                                                               
Department  of Transportation  & Public  Facilities, he  was told                                                               
there was not any policy, law,  or regulation limiting the use of                                                               
electronic  cigarettes.   He  stated  that  although he  was  not                                                               
against  e-cigarette devices,  the  exhaled  aerosol did  contain                                                               
particulates.  He asked that the  use of these devices be limited                                                               
to  those  areas  where  cigars  and  cigarettes  were  currently                                                               
allowed.                                                                                                                        
                                                                                                                                
5:00:23 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  VAZQUEZ moved  to  adopt  the proposed  committee                                                               
substitute (CS)  for HB 40, labeled  29-LS0232\W, Martin, 3/7/15,                                                               
as  the working  draft.   There  being no  objection,  it was  so                                                               
ordered.                                                                                                                        
                                                                                                                                
5:01:03 PM                                                                                                                    
                                                                                                                                
ROB  EARL,   Staff,  Representative  Bob  Herron,   Alaska  State                                                               
Legislature, explained  that the committee substitute  added "and                                                               
other  oral smoking  devices," on  page 1,  line 8,  in order  to                                                               
capture the next  generation of vaporizers.   The American Cancer                                                               
Society had  made the suggestion  to expand this definition.   He                                                               
stated that the proposed bill  expanded the definition of smoking                                                               
in  AS 18  to include  e-cigarettes,  and the  bill also  defined                                                               
electronic cigarettes,  lines 4 -  7.  He reported  that proposed                                                               
HB  40 would  prohibit e-cigarette  use statewide  in any  public                                                               
places  where  smoking  tobacco  was  currently  not  allowed  as                                                               
spelled   out   in   AS    18.35.300,   which   included   public                                                               
transportation  vehicles,  facilities,  state  office  buildings,                                                               
other buildings  operated by the  state, nursing homes, etc.   He                                                               
said  that state  law  was  currently a  bit  unclear whether  e-                                                               
cigarette use would be prohibited  in public places where tobacco                                                               
was  currently  banned because  there  was  not a  definition  of                                                               
smoking in AS 18.  The  proposed bill would clarify that issue by                                                               
defining  smoking to  include e-cigarettes.   He  said that  some                                                               
local Alaska  jurisdictions had enacted comprehensive  smoke free                                                               
workplace  ordinances   that  included  bans  on   smoking  which                                                               
included e-cigarettes.   He listed  these communities  to include                                                               
Nome, Juneau,  Palmer, Haines  Borough, Petersburg,  and Skagway,                                                               
although the  Anchorage law, passed  in 2006, did not  mention e-                                                               
cigarettes.                                                                                                                     
                                                                                                                                
5:02:57 PM                                                                                                                    
                                                                                                                                
CHAIR SEATON asked  for clarification that the  proposed bill was                                                               
for e-cigarettes  to be banned  from areas where  cigarettes were                                                               
currently banned.                                                                                                               
                                                                                                                                
REPRESENTATIVE STUTES  asked about  the advice from  the American                                                               
Cancer Society to equate these devices the same as tobacco.                                                                     
                                                                                                                                
MR. EARL  explained that  the American  Cancer Society  (ACS) had                                                               
helped  expand  the  definition  for  smoking  in  the  committee                                                               
substitute.  He  referenced slide 11 of  the PowerPoint [Included                                                               
in members' packets],  and clarified that proposed HB  40 did not                                                               
define e-cigarettes as a tobacco  product, as there would then be                                                               
taxation and other implications.                                                                                                
                                                                                                                                
REPRESENTATIVE STUTES, asking about the  advice from ACS to treat                                                               
e-cigarettes similar  to products containing  tobacco, questioned                                                               
what substantiated that advice.                                                                                                 
                                                                                                                                
MR. EARL deferred to a representative from ACS.                                                                                 
                                                                                                                                
5:05:36 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR  asked if there was  testimony available from                                                               
Legislative Legal Services.                                                                                                     
                                                                                                                                
CHAIR SEATON pointed out that the bill would be held over.                                                                      
                                                                                                                                
5:06:03 PM                                                                                                                    
                                                                                                                                
EMILY  NENON,  Alaska  Government  Relations  Director,  American                                                               
Cancer  Society Cancer  Action Network,  said that  she would  be                                                               
available at the  next House Health and  Social Services Standing                                                               
Committee meeting, and that she was available for any questions.                                                                
                                                                                                                                
5:06:40 PM                                                                                                                    
                                                                                                                                
CHAR  DAY, Americans  for  Non-Smokers'  Rights (ANR),  explained                                                               
that  the   organization  was  a  national   member  based  group                                                               
committed to clear  the air of second hand  smoke, including "the                                                               
smoke that comes off of the end  of an e-cigarette and out of the                                                               
breath of  those who use e-cigarettes."   She said the  group was                                                               
also working to prevent another  generation addicted to nicotine.                                                               
She encouraged  support for HB 40,  as it would prohibit  the use                                                               
of e-cigarettes  and other electronic  smoking devices  in places                                                               
that  were required  to be  smoke free.   She  declared that  ANR                                                               
supported prohibiting  the use of electronic  cigarettes in smoke                                                               
free environments  at all times  without exception.   She offered                                                               
her belief that this was a  worker health and safety issue, given                                                               
the  growing body  of science  for what  was in  the second  hand                                                               
aerosol, also known  as vapor, emitted from an  e-cigarette.  She                                                               
allowed that, although there was not  as much science on what was                                                               
in  the  second  hand  aerosol from  an  e-cigarette  as  tobacco                                                               
cigarettes, there was  plenty to cause concern.   She stated that                                                               
second hand aerosol contained  volatile organic compounds, ultra-                                                               
fine particles, lead, chromium, nicotine,  and other toxins.  She                                                               
stated that  legislators were  choosing to not  allow the  use of                                                               
electronic  smoking devices  in smoke  free environments  so that                                                               
workers and  patrons do  not have  to breathe  the aerosol.   She                                                               
relayed  that there  were currently  at least  274 municipalities                                                               
and 3 states which had  included e-cigarettes as items prohibited                                                               
from use in smoke free environments.   She clarified that ANR was                                                               
not  proposing an  outright prohibition  or ban  on e-cigarettes,                                                               
but  were only  concerned  with exposure  to  non-users from  the                                                               
emitted  aerosol.   She stated  that e-cigarettes  should not  be                                                               
used  indoors or  inside public  places  that would  then pose  a                                                               
health hazard  to non-users.   She pointed out  that e-cigarettes                                                               
could be  used to vape  other substances, including hemp  oil and                                                               
marijuana.    She declared  that  there  was  a growing  body  of                                                               
science research which  showed that the aerosol was  a new source                                                               
of  air pollution  that contained  ultra-fine particles  with low                                                               
levels  of  toxins  known to  cause  cancer,  including  benzene,                                                               
formaldehyde, and lead.   She urged support of HB  40 to prohibit                                                               
the use of  e-cigarettes and other electronic  smoking devices in                                                               
places that are supposed to be smoke free.                                                                                      
                                                                                                                                
REPRESENTATIVE STUTES noted  that there was not a  lot of history                                                               
or studies that  it may potentially cause health  issues, and she                                                               
asked for  verifiable research  that these  were as  hazardous to                                                               
health as cigarettes.                                                                                                           
                                                                                                                                
MS. DAY  replied that there  were new studies  about e-cigarettes                                                               
being  released  monthly.   She  listed  a  recent study  by  the                                                               
American Society  for Heating  and Air  Conditioning Regulations,                                                               
the  standard setting  body for  indoor air,  which had  added e-                                                               
cigarettes to  the list  for things  not to  have in  indoor air.                                                               
She  noted  that the  World  Health  Organization had  written  a                                                               
background  paper  on  e-cigarettes,  which  stated  that  people                                                               
exposed  to e-cigarette  vapor absorb  nicotine,  with one  study                                                               
comparing  this to  the levels  comparative  to passive  smokers.                                                               
She  stated  that  a recently  published  environmental  research                                                               
journal  addressed  the cotinine  of  non-smokers  exposed to  e-                                                               
cigarettes.    She reiterated  that  new  studies were  published                                                               
monthly about the dangers of e-cigarettes.                                                                                      
                                                                                                                                
CHAIR SEATON asked that copies of  the studies be provided to the                                                               
committee.                                                                                                                      
                                                                                                                                
5:12:44 PM                                                                                                                    
                                                                                                                                
[HB 40 was held over]                                                                                                           
                                                                                                                                
5:12:52 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being no  further business before the  committee, the House                                                               
Health  and  Social  Services   Standing  Committee  meeting  was                                                               
adjourned at 5:12 p.m.                                                                                                          

Document Name Date/Time Subjects
HB40 - Version A.PDF HHSS 3/10/2015 3:00:00 PM
HB 40
HB40 Sponsor Statement.pdf HHSS 3/10/2015 3:00:00 PM
HHSS 4/2/2015 3:00:00 PM
HB 40
HB40 - Supporting Document - CDC Testimony on Secondhand Smoke and ENDS Aerosol Alaska February 2015.pdf HHSS 3/10/2015 3:00:00 PM
HHSS 4/2/2015 3:00:00 PM
HB 40
HB40 - Supporting Document - Electronic Smoking Devices and Secondhand Aerosol (FS-39) 11-2014.pdf HHSS 3/10/2015 3:00:00 PM
HHSS 4/2/2015 3:00:00 PM
HB 40
HB40 - Letter of Support - American Cancer Society Cancer Action Network.pdf HHSS 3/10/2015 3:00:00 PM
HHSS 4/2/2015 3:00:00 PM
HB 40
HB40 - Supporting Document - Alaska E-cigarette Fact Sheet.pdf HHSS 3/10/2015 3:00:00 PM
HHSS 4/2/2015 3:00:00 PM
HB 40
HB40 - Letter of Support - AK LOS HB40 030315.pdf HHSS 3/10/2015 3:00:00 PM
HHSS 4/2/2015 3:00:00 PM
HB 40
HB40- letter of opposition-assorted form letters.pdf HHSS 3/10/2015 3:00:00 PM
HB40- Fiscal note-DEC.pdf HHSS 3/10/2015 3:00:00 PM
HHSS 4/2/2015 3:00:00 PM
HB 40
HB40 - powerpoint overview of e-cigarettes.pdf HHSS 3/10/2015 3:00:00 PM
HHSS 4/2/2015 3:00:00 PM
HB 40
HB40 - Proposed CS version W.pdf HHSS 3/10/2015 3:00:00 PM
HHSS 4/2/2015 3:00:00 PM
HB 40
HB 59 Version F.pdf HHSS 3/10/2015 3:00:00 PM
HB 59
HB 59 Sectional Analysis_Version F.pdf HHSS 3/10/2015 3:00:00 PM
HB 59
HB 59 Legal opinion_constitutionality 03.02.2015.pdf HHSS 3/10/2015 3:00:00 PM
HB 59
Rep Vazquez_ final questions regarding expansion.pdf HHSS 3/10/2015 3:00:00 PM
Medicaid expansion
HB 59 Support_AK Chiefs of Police.pdf HHSS 3/10/2015 3:00:00 PM
HB 59
H-HSS Expansion Presentation Committee Questions Round 1.pdf HHSS 3/10/2015 3:00:00 PM
DHSS reponses
HB 59_Fiscal Note_DOA-OPA.pdf HHSS 3/10/2015 3:00:00 PM
HB 59
Impact of Medicare Cuts 2015_ASHNHA.pdf HHSS 3/10/2015 3:00:00 PM
Medicaid-Responses by DHSS
Hospital Reported Total Net Incomes_RE 3-5 meeting.pdf HHSS 3/10/2015 3:00:00 PM
Medicaid-Responses by DHSS
H-HSS Expansion Presentation Committee Questions Round 1.pdf HHSS 3/10/2015 3:00:00 PM
Medicaid-Responses by DHSS
DHSS Reply to Question on Reforms & reform numbers_RE 3-5-2015.pdf HHSS 3/10/2015 3:00:00 PM
Medicaid-Responses by DHSS
Questions and Responses from DHSS on Medicaid_Follow-up on 3-5 meeting_v 2.pdf HHSS 3/10/2015 3:00:00 PM
Medicaid-Responses by DHSS
Medicaid-Responses fby DHSS
HB40-Opposition-assorted form emails.pdf HHSS 3/10/2015 3:00:00 PM
HHSS 4/2/2015 3:00:00 PM
HB 40