Legislature(2017 - 2018)CAPITOL 106

02/28/2017 03:00 PM HEALTH & SOCIAL SERVICES

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Audio Topic
03:04:05 PM Start
03:05:44 PM HB25
03:32:40 PM HB43
04:20:00 PM Presentation: Reducing Use of Emergency Department Services
04:47:03 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
*+ HB 25 INSURANCE COVERAGE FOR CONTRACEPTIVES TELECONFERENCED
Heard & Held
-- Testimony <Invitation Only> --
*+ HB 43 NEW DRUGS FOR THE TERMINALLY ILL TELECONFERENCED
Heard & Held
-- Testimony <Invitation Only> --
+ Presentation: Reducing Use of Emergency Dept. TELECONFERENCED
Services - Follow Up on a Component of SB 74
Medicaid Reform (29th Legislature) by Anne Zink,
MD, AK ACEP President; Ben Zaniello, MD, VP
Collective Medical Technologies & Connie Beemer,
MBA, AK State Hospital & Nursing Home Assoc.
(ASHNHA)
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                       February 28, 2017                                                                                        
                           3:04 p.m.                                                                                            
                                                                                                                                
MEMBERS PRESENT                                                                                                               
                                                                                                                                
Representative Ivy Spohnholz, Chair                                                                                             
Representative Bryce Edgmon, Vice Chair                                                                                         
Representative Sam Kito                                                                                                         
Representative Geran Tarr                                                                                                       
Representative David Eastman                                                                                                    
Representative Jennifer Johnston                                                                                                
Representative Colleen Sullivan-Leonard                                                                                         
                                                                                                                                
MEMBERS ABSENT                                                                                                                
                                                                                                                                
Representative Matt Claman (alternate)                                                                                          
Representative Dan Saddler (alternate)                                                                                          
                                                                                                                                
COMMITTEE CALENDAR                                                                                                            
                                                                                                                                
HOUSE BILL NO. 25                                                                                                               
"An  Act relating  to insurance  coverage  for contraceptives  and                                                              
related  services; relating  to  medical assistance  coverage  for                                                              
contraceptives  and   related  services;  and  providing   for  an                                                              
effective date."                                                                                                                
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
HOUSE BILL NO. 43                                                                                                               
"An  Act relating  to prescribing,  dispensing, and  administering                                                              
an  investigational   drug,  biological  product,   or  device  by                                                              
physicians  for   patients  who  are  terminally   ill;  providing                                                              
immunity  related  to manufacturing,  distributing,  or  providing                                                              
investigational  drugs,  biological   products,  or  devices;  and                                                              
relating to licensed health care facility requirements."                                                                        
                                                                                                                                
     - HEARD & HELD                                                                                                             
                                                                                                                                
PRESENTATION: REDUCING USE OF EMERGENCY DEPARTMENT SERVICES                                                                     
                                                                                                                                
     - HEARD                                                                                                                    
                                                                                                                                
PREVIOUS COMMITTEE ACTION                                                                                                     
                                                                                                                                
BILL: HB 25                                                                                                                   
SHORT TITLE: INSURANCE COVERAGE FOR CONTRACEPTIVES                                                                              
SPONSOR(s): REPRESENTATIVE(s) CLAMAN                                                                                            
                                                                                                                                
01/18/17       (H)       PREFILE RELEASED 1/9/17                                                                                
01/18/17       (H)       READ THE FIRST TIME - REFERRALS                                                                        
01/18/17       (H)       HSS, FIN                                                                                               
02/28/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
BILL: HB 43                                                                                                                   
SHORT TITLE: NEW DRUGS FOR THE TERMINALLY ILL                                                                                   
SPONSOR(s): REPRESENTATIVE(s) GRENN                                                                                             
                                                                                                                                
01/18/17       (H)       PREFILE RELEASED 1/13/17                                                                               
01/18/17       (H)       READ THE FIRST TIME - REFERRALS                                                                        
01/18/17       (H)       HSS, JUD                                                                                               
02/28/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
                                                                                                                                
WITNESS REGISTER                                                                                                              
                                                                                                                                
REPRESENTATIVE MATT CLAMAN                                                                                                      
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 25 as the sponsor of the bill.                                                              
                                                                                                                                
LIZZIE KUBITZ, Staff                                                                                                            
Representative Matt Claman                                                                                                      
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 25 on behalf of the bill                                                                    
sponsor, Representative Claman.                                                                                                 
                                                                                                                                
MARGARET BRODIE, Director                                                                                                       
Director's Office                                                                                                               
Division of Health Care Services                                                                                                
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Answered questions during discussion of HB                                                               
25.                                                                                                                             
                                                                                                                                
REPRESENTATIVE JASON GRENN                                                                                                      
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 43 as the sponsor of the bill.                                                              
                                                                                                                                
BROOKE IVY, Staff                                                                                                               
Representative Jason Grenn                                                                                                      
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:   Presented HB 43 on behalf of  the sponsor of                                                            
the bill, Representative Grenn.                                                                                                 
                                                                                                                                
LINDA BRUCE, Attorney                                                                                                           
Legislative Legal Counsel                                                                                                       
Legislative Legal Services                                                                                                      
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:   Answered questions  during discussion  of HB                                                            
43.                                                                                                                             
                                                                                                                                
STARLEE COLEMAN, Vice President                                                                                                 
Communications                                                                                                                  
Goldwater Institute                                                                                                             
Phoenix, AZ                                                                                                                     
POSITION STATEMENT:  Testified in support of HB 43.                                                                           
                                                                                                                                
CONNIE BEEMER, Director                                                                                                         
Member Services and Operations                                                                                                  
Alaska State Hospital and Nursing Home Association (ASHNHA)                                                                     
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:   Presented  a PowerPoint presentation  of the                                                            
Alaska ED Coordination Project.                                                                                                 
                                                                                                                                
ANN ZINK, MD                                                                                                                    
President                                                                                                                       
Alaska (ACEP) American College of Emergency Physicians                                                                          
Palmer, Alaska                                                                                                                  
POSITION  STATEMENT:   Testified  during the  presentation of  the                                                            
Alaska ED Coordination Project.                                                                                                 
                                                                                                                                
BEN ZANIELLO, MD                                                                                                                
Vice President                                                                                                                  
Chief Medical Officer                                                                                                           
Collective Medical Technologies (CMT)                                                                                           
Sandy, Utah                                                                                                                     
POSITION  STATEMENT:   Testified  during the  presentation of  the                                                            
Alaska ED Coordination Project.                                                                                                 
                                                                                                                                
ACTION NARRATIVE                                                                                                              
                                                                                                                                
3:04:05 PM                                                                                                                    
                                                                                                                                
CHAIR IVY  SPOHNHOLZ called the  House Health and  Social Services                                                            
Standing    Committee   meeting    to   order    at   3:04    p.m.                                                              
Representatives  Spohnholz,  Kito,   Johnston,  and  Eastman  were                                                              
present at the  call to order.  Representatives  Edgmon, Tarr, and                                                              
Sullivan-Leonard arrived as the meeting was in progress.                                                                        
                                                                                                                                
          HB 25-INSURANCE COVERAGE FOR CONTRACEPTIVES                                                                       
                                                                                                                                
3:05:35                                                                                                                         
                                                                                                                                
CHAIR SPOHNHOLZ announced  that the first order  of business would                                                              
be HOUSE BILL NO.  25, "An Act relating to insurance  coverage for                                                              
contraceptives   and  related   services;   relating  to   medical                                                              
assistance coverage  for contraceptives and related  services; and                                                              
providing for an effective date."                                                                                               
                                                                                                                                
3:05:44 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  MATT CLAMAN, Alaska  State Legislature,  explained                                                              
that  Alaskan women  living and  working  in rural  areas, in  the                                                              
tourism  industry, in  the military,  and on  the North Slope  did                                                              
not  always have  ready  access to  women's  health services,  and                                                              
faced  additional   barriers  for   obtaining  access   to  family                                                              
planning  options.    He  stated that  women  who  currently  used                                                              
hormonal contraceptives  had to return  to a pharmacy  everyone to                                                              
three  months to  refill their  prescriptions.   He reported  that                                                              
proposed HB  25 required  health insurers  to offer consumers  the                                                              
option to  receive a  12-month supply  of hormonal  contraception.                                                              
He declared  that the women in  his family supported  the proposed                                                              
bill as  improved access to  contraceptives meant  huge reductions                                                              
in unintended pregnancies.   He added that  unintended pregnancies                                                              
had  a  profound  effect  on the  overall  well-being  of  Alaskan                                                              
families, as  it was  associated with  adverse maternal  and child                                                              
health  outcomes.     Along   with  health  concerns,   unintended                                                              
pregnancy was  a dramatic cost  driver to public  health programs.                                                              
He pointed out  that it was often time consuming  and inconvenient                                                              
to obtain  a prescription  for contraceptives  every one  to three                                                              
months.    He   offered  his  belief  that,  with   the  financial                                                              
challenges in  the state, there  should be discussion for  ways to                                                              
reduce costs  in both the short  and long term.  He  declared that                                                              
proposed HB  25 offered  these cost reductions,  and that  it made                                                              
sense for Alaska women and families.                                                                                            
                                                                                                                                
3:07:34 PM                                                                                                                    
                                                                                                                                
LIZZIE  KUBITZ, Staff,  Representative Matt  Claman, Alaska  State                                                              
Legislature,  stated  that proposed  HB  25 mandated  that  health                                                              
care  insurers   provide  coverage   for  a  12-month   supply  of                                                              
contraceptives.       She    pointed    out   that    prescriptive                                                              
contraceptives      included       self-administered      hormonal                                                              
contraceptives   which  did   not  require   insertion  or   other                                                              
administration   by   a   medical    professional,   namely   oral                                                              
contraceptives,  noting that this  was discussed  in Section  1 of                                                              
the  proposed  bill.    She moved  on  to  discuss  the  Sectional                                                              
Analysis of  the bill  [included in members'  packets].   She said                                                              
that Section 1  also included a religious exemption  and defined a                                                              
health care  insurer as  including a  self-insured employer,  such                                                              
as the  State of Alaska.   She  moved on to  discuss Section  2 of                                                              
the proposed  bill, which  directed the  Department of  Health and                                                              
Social Services  to pay  for the  12-month supply of  prescription                                                              
contraceptives  for  eligible recipients  of  medical  assistance.                                                              
She  relayed that  Section 3  of  the proposed  bill required  the                                                              
Department of Health  and Social Services to amend  and submit for                                                              
federal  approval a  state plan  for  medical assistance  coverage                                                              
consistent  with  Section  2.     She  explained  that  Section  4                                                              
provided a  conditional effect of Section  2 and Sections  5 and 6                                                              
pertained to the effective dates.                                                                                               
                                                                                                                                
MS.  KUBITZ stated  that  one major  premise  behind the  proposed                                                              
bill was  that when women had  greater access and  availability to                                                              
contraceptives, there  was a reduction of  unintended pregnancies.                                                              
This resulted  in a direct  cost savings  to the state,  which was                                                              
reflected  in  the fiscal  notes  from  Department of  Health  and                                                              
Social  Services  [included in  members'  packets].   She  relayed                                                              
that  one 2010  study  in Alaska  [included  in members'  packets]                                                              
found  that  48   percent  of  all  pregnancies   in  Alaska  were                                                              
unintended.   She added  that an estimated  94.3 percent  of these                                                              
unintended pregnancies  were publicly  funded.  She  reported that                                                              
Alaska spent  $113.7 million on  unintended pregnancies,  of which                                                              
$70.8 million  was paid  for by the  federal government  and $42.9                                                              
million was paid  for by the state.  She pointed  to an additional                                                              
study [included  in members' packets]  which studied  84,000 women                                                              
in California  given 1  month, 3  month, or  12 month supplies  of                                                              
oral contraceptives.   The  researchers of  this study  observed a                                                              
30  percent reduction  in  the odds  of  conceiving an  unintended                                                              
pregnancy  for those  women  given  the 12  month  supply of  oral                                                              
contraceptives.   This  study also  reported  that the  California                                                              
family  planning program  paid  $99 more  annually  for women  who                                                              
received  three cycles  and $44  more for women  who received  one                                                              
cycle  than for  women  who received  a  year-long  supply all  at                                                              
once.  She stated  that this cost "was mostly due  to the costs of                                                              
associated  visits and  the higher  use of  pregnancy tests  among                                                              
women  who received  fewer cycles."   She relayed  that women  who                                                              
received three  cycles were  almost twice as  likely as  women who                                                              
received  the  12  month  supply  to  visit  a  clinic  to  get  a                                                              
pregnancy test.   She noted that the proposed bill  did not change                                                              
who  was eligible  for  coverage, or  the  types of  prescriptions                                                              
covered.    The  bill  merely  allowed   women  already  receiving                                                              
coverage for  prescription contraceptives  to receive, if  they so                                                              
choose, a 12  month prescription.  She addressed  concerns brought                                                              
forward  by   the  Alaska   National  Federation  of   Independent                                                              
Business  (NFIB) and  by America's  Health  Insurance Plan  (AHIP)                                                              
[included  in  members'  packets].    As  NFIB  had  concerns  for                                                              
whether  the  proposed  bill  would  include  the  state  employee                                                              
health  care  plan, a  definition  of  health care  insurer  which                                                              
included  self-insured employers,  such  as the  State of  Alaska,                                                              
had  been included  in the  proposed bill.   She  relayed that  an                                                              
additional  concern voiced  by NFIB  was  for the  cost burden  of                                                              
supplying a  12 month supply  of contraception  at one time.   She                                                              
pointed to  multiple studies  which had  found that  contraceptive                                                              
coverage  did   not  raise  insurance   premiums,  and   that  the                                                              
employers  providing coverage  could  save money  by avoiding  the                                                              
costs  associated with  unintended  pregnancy.   She relayed  that                                                              
the  average  commercial  insurer  payment for  all  maternal  and                                                              
newborn care ranged  from $18,000 to $28,000, whereas  the average                                                              
hormonal birth  control cost  ranged from $100  to $600  per year.                                                              
She  stated that  prevention  of  one unintended  pregnancy  could                                                              
save an  insurer at least  $17,000, enough  savings to pay  for 29                                                              
additional years  of contraception.   She moved on to  discuss the                                                              
concerns   from  AHIP   [included  in   members'  packets]   which                                                              
concluded  that  the  12-month   supply  of  contraceptives  could                                                              
compromise  patient  safety  as  a  result  of  decreased  patient                                                              
visits  to the  prescribing physician.   She  pointed to  research                                                              
which  showed that  birth control  pills  were safe  and could  be                                                              
safely  prescribed based  on  a careful  review  of the  patient's                                                              
medical history and  blood pressure measurement.   For most women,                                                              
no  further   examinations  were   necessary  after   the  initial                                                              
prescription,  unless the  patient asked  for a  follow up  during                                                              
the recommended yearly  examination.  She stated  that the Centers                                                              
for  Disease Control  and Prevention  (CDC) and  the World  Health                                                              
Organization   (WHO)  had   presented  a   study  in  2013   which                                                              
recommended dispensing  a yearly  supply of contraception  with an                                                              
advisement to  return at any time  for discussion of  side effects                                                              
or  other problems,  or  to  change the  method.    The study  had                                                              
declared  that  no routine  follow-up  was  required.   She  added                                                              
that,  although  AHIP  had  concerns  for  the  efficacy  of  oral                                                              
contraceptives  due to  improper storage  for a  12 month  supply,                                                              
CDC had  declared that  oral contraceptives  had  a shelf  life of                                                              
three  to five  years,  dependent  on the  manufacturer,  although                                                              
temperature  and moisture  could diminish  this time  frame.   CDC                                                              
stated that most  women who opted for a 12-month  supply, and were                                                              
regular  users  of  hormonal  contraception,  would  know  how  to                                                              
properly  store  the  medication.    She  addressed  concerns  for                                                              
waste, fraud, and  abuse, and pointed out that  research had found                                                              
that the average  waste of a 12-month supply was  for one cycle of                                                              
prescription  contraceptives,   and  this  was   insignificant  in                                                              
comparison  to the  other  cost savings  for  fewer clinician  and                                                              
pharmacy  visits,   and  the   associated  costs  for   pregnancy.                                                              
Regarding fraud  and abuse, although there were  existing criminal                                                              
statutes  for  sale  of  hormonal  contraceptives,  this  was  not                                                              
anticipated   as  women   would   have  greater   access  to   the                                                              
contraceptives.   She  concluded by  stating that  proposed HB  25                                                              
would offer "huge  advantages for Alaskan women,  from eliminating                                                              
the  inconvenience  of refilling  the  prescription  every one  to                                                              
three months  at a  time, to  the real  inability of some  Alaskan                                                              
women to  make it to the clinic,  hospital, or pharmacy  to refill                                                              
that  prescription at  all."   She  pointed  out that  fisherwomen                                                              
sometimes  spend  three  to  four  months out  on  a  boat,  women                                                              
attending college  often have busy schedules balancing  school and                                                              
a job, and  women in Rural Alaska  often had trouble making  it to                                                              
a clinic or hospital  due to a lack of transportation  and limited                                                              
operating  hours.    She  declared  the HB  25  ensured  that  all                                                              
Alaskan  women  had the  freedom  to  make decisions  about  their                                                              
futures.                                                                                                                        
                                                                                                                                
3:16:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  JOHNSTON  shared  that  a three  month  supply  of                                                              
birth  control pills  for her  daughter was  $800.   She asked  if                                                              
there was a discount for a 12 month supply.                                                                                     
                                                                                                                                
MS. KUBITZ  replied  that her research  had shown  a cost  savings                                                              
for buying in bulk.                                                                                                             
                                                                                                                                
REPRESENTATIVE JOHNSTON suggested more research for this.                                                                       
                                                                                                                                
3:17:40 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE EDGMON pointed to the zero fiscal note.                                                                          
                                                                                                                                
MS.  KUBITZ  replied  that  there   were  two  zero  fiscal  notes                                                              
[included  in members'  packets]  provided  by the  Department  of                                                              
Health and  Social Services [OMB  Component 242 and  OMB Component                                                              
2007].   She relayed  that one fiscal  note projected  anticipated                                                              
costs due  to implementation of  the proposed bill and  the second                                                              
fiscal note detailed the cost savings.                                                                                          
                                                                                                                                
3:18:35 PM                                                                                                                    
                                                                                                                                
MARGARET BRODIE,  Director, Director's Office, Division  of Health                                                              
Care  Services,   Department  of   Health  and  Social   Services,                                                              
addressed  the Department  of Health  and  Social Services  (DHSS)                                                              
fiscal note  labeled OMB Component  2007, and explained  that this                                                              
fiscal note analyzed  7,940 female Medicaid recipients  using oral                                                              
contraceptives.   She estimated that 10 percent,  794 women, would                                                              
require duplication  of services  because  the medication  was not                                                              
effective, it was  lost or stolen, or was not  stored properly and                                                              
could lose its efficacy.   She based the replacement  value at $45                                                              
per month  which was  the national  average drug acquisition  cost                                                              
and  the cost  that the  state used  for its  determination.   She                                                              
shared that DHSS  assumed that 75 percent of the  women planned to                                                              
use oral  contraceptives longer than  12 months, and that,  as the                                                              
CDC  cited  a standard  failure  rate  of  9 percent,  this  would                                                              
result  in 540  unintended  pregnancies.   She  reported that  the                                                              
failure  rate would  decrease  about 30  percent  with a  12-month                                                              
supply of contraceptives,  thereby lowering the failure  rate to 7                                                              
percent.   She pointed out  that about 120 unintended  pregnancies                                                              
could  be  avoided  by using  the  12-month  contraception.    She                                                              
stated  that  the estimated  savings  was  based on  the  Medicaid                                                              
data,  which  reported  that  5.28   births  of  the  120  avoided                                                              
pregnancies  would   have  been   complicated  births,   with  the                                                              
remainder  of births  being non-complicated.    She reported  that                                                              
the  cost factor  for a  complicated birth  was $110,000,  whereas                                                              
the cost  factor for  a non-complicated  birth  was $8,000.   This                                                              
would result  in a  benefit cost savings  to the Medicaid  program                                                              
estimated   to  be  $1,498,000,   of  which   $562,000  would   be                                                              
attributed  to the Medicaid  expansion population.   She  reported                                                              
an annual  projected savings of  $1,355,600.  She added  that this                                                              
was  a conservative  estimate, as  some  complicated births  could                                                              
cost hundreds of thousands of dollars.                                                                                          
                                                                                                                                
MS. BRODIE  addressed the second  fiscal note, OMB  Component 242.                                                              
She offered  her belief  that this fiscal  note could  be removed,                                                              
as there  was no  state or  federal statute  that declared  a need                                                              
for the department to go back and collect from the recipients.                                                                  
                                                                                                                                
3:24:41 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ  expressed  her agreement  with saving the  "money                                                              
in this  particular area."  She  suggested that the  savings would                                                              
be  $1.2  -  $1.3  million  annually  in  overall  Medicaid  costs                                                              
related to contraception and unintended pregnancies.                                                                            
                                                                                                                                
MS. BRODIE expressed her agreement.                                                                                             
                                                                                                                                
3:25:03 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD asked  whether the proposed  bill                                                              
would allow the  state workers' health insurance  program to offer                                                              
this benefit.                                                                                                                   
                                                                                                                                
REPRESENTATIVE  CLAMAN, in  response, relayed  that the intent  of                                                              
the  proposed bill  was for  this benefit  to be  included in  the                                                              
state workers' health insurance plan.                                                                                           
                                                                                                                                
REPRESENTATIVE   SULLIVAN-LEONARD  asked   if  there   were  other                                                              
medications that  could be  prescribed on a  yearly basis,  or was                                                              
this the first proposal for a year-long prescription.                                                                           
                                                                                                                                
MS.  KUBITZ asked  if Representative  Sullivan-Leonard was  asking                                                              
specifically about  contraceptives.  She  stated that she  was not                                                              
aware  of  any  other medications  that  could  have  a  year-long                                                              
prescription, as  often many of these medications  were controlled                                                              
substances.                                                                                                                     
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD asked  if any other  prescription                                                              
drugs could  be included in this  format, pointing out  that a 90-                                                              
day prescription  was because  a physician  wanted to  oversee the                                                              
interaction of the drug for the patient.                                                                                        
                                                                                                                                
REPRESENTATIVE  CLAMAN said  that  his office  had not  researched                                                              
this  specific question.    He  recollected that  certain  mail-in                                                              
drug  programs  allowed  for  longer  prescriptions,  although  it                                                              
depended on the medication.                                                                                                     
                                                                                                                                
CHAIR SPOHNHOLZ  offered her belief  that some other  medications,                                                              
including some  hormonal medications,  were available on  a yearly                                                              
prescription.                                                                                                                   
                                                                                                                                
REPRESENTATIVE CLAMAN replied that he would look into this.                                                                     
                                                                                                                                
3:28:53 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ said that HB 25 would be held over.                                                                             
                                                                                                                                
3:29:18 PM                                                                                                                    
                                                                                                                                
The committee took an at-ease from 3:29 p.m. to 3:32 p.m.                                                                       
                                                                                                                                
             HB 43-NEW DRUGS FOR THE TERMINALLY ILL                                                                         
                                                                                                                                
3:32:40 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ  announced that the  next order of  business would                                                              
be  HOUSE   BILL  NO.  43,   "An  Act  relating   to  prescribing,                                                              
dispensing,   and    administering   an   investigational    drug,                                                              
biological product,  or device by physicians for  patients who are                                                              
terminally  ill;  providing  immunity  related  to  manufacturing,                                                              
distributing,  or  providing  investigational   drugs,  biological                                                              
products,  or  devices;  and  relating  to  licensed  health  care                                                              
facility requirements."                                                                                                         
                                                                                                                                
3:32:49 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  JASON  GRENN,  Alaska  State  Legislature,  shared                                                              
that the proposed  bill was often referenced nationally  as "Right                                                              
to Try"  legislation.   He stated  that the  goal of the  proposed                                                              
bill was:                                                                                                                       
                                                                                                                                
     to  create  a  legal climate  in  which  terminally  ill                                                                   
     patients  who  have exhausted  all  FDA (U.S.  Food  and                                                                   
     Drug  Administration)  approved  treatment  options  may                                                                   
     work  with  their  doctors  and  drug  manufacturers  to                                                                   
     access  investigational and  safe  treatments that  have                                                                   
     passed Phase I  of the FDA approval process  but are not                                                                   
     yet widely available.                                                                                                      
                                                                                                                                
REPRESENTATIVE GRENN  reported that "Right  to Try" laws  had been                                                              
passed in  33 states,  with this  legislation being considered  in                                                              
another 15  states, now including  Alaska.  Paraphrasing  from the                                                              
Sponsor  Statement  [included  in  members'  packets],  he  stated                                                              
that,  each  year, it  was  estimated  that  more than  1  million                                                              
Americans  died  from  terminal  illness.   "For  those  who  have                                                              
exhausted  all FDA approved  options, clinical  trials become  the                                                              
next step.  However,  of those patients who attempt  to gain entry                                                              
into a clinical  trial, it is found that fewer than  3 percent are                                                              
accepted."    He  declared  that,  although the  FDA  did  have  a                                                              
program in  place for accessing  investigational drugs  outside of                                                              
clinical  trials,  which  was  known  as  the  "Compassionate  Use                                                              
Program," it  was estimated  that only about  1200 people  made it                                                              
through the long,  arduous federal process annually.   He declared                                                              
that  the goal  of  the  proposed bill  was  to provide  the  same                                                              
access as  the existing  program but  on a  shorter timeline.   He                                                              
said  that  by assuring  that  terminally  ill patients  had  more                                                              
timely   access   to   safe,   though   experimental   drugs,   in                                                              
consultation  with their  doctor,  the proposed  bill would  offer                                                              
new hope after all FDA approved options had been exhausted.                                                                     
                                                                                                                                
3:35:02 PM                                                                                                                    
                                                                                                                                
BROOKE  IVY,  Staff,  Representative  Jason  Grenn,  Alaska  State                                                              
Legislature,  presented a  PowerPoint titled  "House Bill  43: The                                                              
Right to Try."   She directed attention to the  sectional analysis                                                              
[included in  members' packets] and  to slide 2, "House  Bill 43."                                                              
She addressed  Section  1 of the  proposed bill,  and stated  that                                                              
this section prohibited  disciplinary action by the  State Medical                                                              
Board  against  physicians  for prescribing  or  administering  an                                                              
investigational drug  to a terminally ill patient  who met certain                                                              
criteria.   She reported  that patients  had  to be ineligible  or                                                              
unable  to   participate  in  an   ongoing  clinical   trial,  had                                                              
considered all  available treatment  options in consultation  with                                                              
their doctor, and  had provided written consent.  She  moved on to                                                              
Section   2  of  the   proposed  bill,   which  established   that                                                              
physicians,  medical team members,  manufacturers, importers,  and                                                              
distributors acting  in good faith and with reasonable  care would                                                              
not  be  held  liable  in  the  case  of  injury  or  death  of  a                                                              
terminally ill  patient from the  use of an investigational  drug,                                                              
provided that the  informed consent was obtained  from the patient                                                              
and notice of immunity  was also given to the patient  in advance.                                                              
She  added  that   the  section  also  established   immunity  for                                                              
physicians and manufacturers  who chose not to  participate in the                                                              
distribution of  investigational drugs.   She addressed  Section 3                                                              
which  amended  AS  17.20.110,   and  would  allow  physicians  to                                                              
prescribe   or   administer  investigational   drugs   under   the                                                              
conditions established  in Section  1 of the  proposed bill.   She                                                              
spoke about  Section 4, which  prevented the Department  of Health                                                              
and  Social  Services  from  requiring   a  licensed  health  care                                                              
facility  to   increase  its   services,  solely  to   accommodate                                                              
physicians who  were prescribing or administering  investigational                                                              
drugs to a patient.                                                                                                             
                                                                                                                                
3:37:37 PM                                                                                                                    
                                                                                                                                
MS.  IVY  directed   attention  to  slide  3,   "FDA  Drug  Review                                                              
Process," and  explained this process.   She reported  that, prior                                                              
to Phase  1, the  sponsors of a  drug were  required to  submit an                                                              
"Investigation  New  Drug"  (IND) application,  and  through  this                                                              
application,  the   FDA  reviewed  the  applicant's   pre-clinical                                                              
testing  results,  and  then  determined   whether  the  drug  was                                                              
reasonably safe for testing in humans.                                                                                          
                                                                                                                                
MS. IVY spoke  about slide 4, "FDA Drug Review  Process (cont'd),"                                                              
and  explained  that  in  Phase 1,  the  studies  occurring  after                                                              
approval of  the IND application,  the studies could  be conducted                                                              
on   healthy  volunteers   dependent   on  the   purpose  of   the                                                              
medication, or on  individuals with specific diseases  or terminal                                                              
illness.    She stated  that  safety  to determine  possible  side                                                              
effects  and  toxicity  levels was  the  goal  of  Phase 1.    She                                                              
addressed slide 5,  "FDA Drug Review Process (cont'd),"  and spoke                                                              
about  the  Phase   2  studies,  which  began  when   a  drug  was                                                              
determined to  be safe,  and was focused  on the effectiveness  of                                                              
the drug.   She  stated that, if  there was  evidence that  a drug                                                              
was effective, it  moved on to Phase 3, slide 6,  "FDA Drug Review                                                              
Process (cont'd)."   In  Phase 3, more  information was  gained on                                                              
safety  and  effectiveness, particularly  in  varying  populations                                                              
and in  different dosages.   After Phase  3, sponsors of  the drug                                                              
have  a  review meeting  with  the  FDA,  and  submit a  new  drug                                                              
application requesting  approval to market the drug  in the United                                                              
States, slide 7,  "FDA Drug Review Process (cont'd)."   After this                                                              
application,  the FDA had  60 days  to decide  whether to  file an                                                              
application  for  review  and  then  applications  were  generally                                                              
processed within 10 months.                                                                                                     
                                                                                                                                
3:39:26 PM                                                                                                                    
                                                                                                                                
MS.  IVY reviewed  slide  8,  and explained  that  investigational                                                              
drugs  had  passed  the  safety  testing  in  Phase  1,  and  were                                                              
currently in  ongoing clinical  trials in Phase  2 and Phase  3 of                                                              
the FDA process.                                                                                                                
                                                                                                                                
3:39:43 PM                                                                                                                    
                                                                                                                                
MS.  IVY directed  attention to  slide 9,  "FDA's Expanded  Access                                                              
Program," and spoke  about the "Compassionate Use"  program, which                                                              
was  designed  for  terminally  ill  patients  without  access  to                                                              
clinical  trials so  they could  apply  for these  investigational                                                              
treatments.   She  explained that  the  patient had  to work  with                                                              
their  doctor to  apply  directly to  the  FDA.   She noted  that,                                                              
until recently,  this application took  more than 100 hours  for a                                                              
doctor  to  complete,  but  it   had  now  been  shortened.    She                                                              
acknowledged  that  this was  still  just the  first  step in  the                                                              
approval  process.   She  added  that  manufacturers also  had  to                                                              
submit lengthy  documentation before the application  went through                                                              
the  internal   FDA  approval  process   and  on  to   a  separate                                                              
institutional review  board, often a lengthy  multi-month process.                                                              
She reported  that approximately  1200 applicants made  it through                                                              
the process annually.   She addressed slide 10, "The  Right to Try                                                              
- A  Nationwide  Effort," and  pointed out  that this  legislation                                                              
had been passed or was under consideration in all but one state.                                                                
                                                                                                                                
3:41:20 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD, referencing  slide 9,  asked how                                                              
many applicants did not make it through the process.                                                                            
                                                                                                                                
MS. IVY said that she did not have that number.                                                                                 
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD offered  her belief  that it  was                                                              
an important component to the proposed bill.                                                                                    
                                                                                                                                
3:42:05 PM                                                                                                                    
                                                                                                                                
MS.  IVY pointed  to  the Clinical  Trials  document [included  in                                                              
members'  packets]  which  included  stories  of  Alaskans  facing                                                              
terminal illness  and the benefit  of having access to  the drugs.                                                              
She stated  that, additionally,  there was  a Goldwater  Institute                                                              
policy report  [included  in members' packets]  which delved  into                                                              
greater  detail  for  the  challenges  of  the  Compassionate  Use                                                              
program.                                                                                                                        
                                                                                                                                
REPRESENTATIVE TARR  asked for an  update to the policy  signed by                                                              
President Obama prior  to leaving office, which  had included some                                                              
provisions to expand  drug trials for non-approved  drugs, and for                                                              
its interaction to the proposed bill.                                                                                           
                                                                                                                                
MS. IVY said that she would research the specifics.                                                                             
                                                                                                                                
3:44:18 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KITO  asked  why  the legislation  was  vetoed  in                                                              
Hawaii.                                                                                                                         
                                                                                                                                
MS.  IVY  replied  that,  although   the  legislation  had  passed                                                              
unanimously  from  the legislature  in  Hawaii, the  governor  had                                                              
vetoed  it.   She shared  that Governor  Brown  in California  had                                                              
also  vetoed the  legislation,  but had  since  changed his  mind,                                                              
purportedly  because  of  instances  of benefits  to  patients  in                                                              
Texas.                                                                                                                          
                                                                                                                                
3:46:00 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  KITO  referenced   the  statement  from  the  bill                                                              
sponsor  that this  was an  opportunity for  individuals who  have                                                              
terminal  illnesses  to try  something  that  was not  a  standard                                                              
procedure.     He  offered   his  belief   that  there   might  be                                                              
opportunities  for treatment  benefits  prior to  waiting until  a                                                              
diagnosis of terminal  illness.  He asked why it  was necessary to                                                              
wait to prescribe a potential remedy until a terminal diagnosis.                                                                
                                                                                                                                
MS. IVY  replied that  the national  advisors on this  legislation                                                              
had  suggested to  keep  a narrow  focus,  as  this was  something                                                              
already available  through the FDA.   She pointed out  that taking                                                              
on  preventative care  with all  medications that  go through  the                                                              
FDA approval process  was a much larger federal  policy discussion                                                              
regarding the approval of drugs in the U.S.                                                                                     
                                                                                                                                
3:47:59 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ  added that, as  medications had side  effects, an                                                              
important  part of  the FDA approval  process  was to ensure  that                                                              
the medication  was safe,  did what it  claimed, and  its benefits                                                              
outweighed  the costs.   The FDA  approval process  was set  up to                                                              
protect  consumers.   She  offered  an  example of  aspirin  being                                                              
taken to  prevent heart  problems, whereas  it actually  increased                                                              
gastric  problems  as  a  side  effect.    She  pointed  out  that                                                              
experimental drugs  needed to be proven  safe.  She asked  for the                                                              
definition of terminally ill in the proposed bill.                                                                              
                                                                                                                                
MS. IVY  directed attention  to page  2, line  12 of the  proposed                                                              
bill, and she read:                                                                                                             
                                                                                                                                
     "terminal illness"  means a disease that,  without life-                                                                   
     sustaining  procedures,  will  result  in death  in  the                                                                   
     near  future or  a  state of  permanent  unconsciousness                                                                   
     from which recovery is unlikely.                                                                                           
                                                                                                                                
3:50:43 PM                                                                                                                    
                                                                                                                                
LINDA  BRUCE,  Attorney, Legislative  Legal  Counsel,  Legislative                                                              
Legal Services,  stated that this  was a new definition  which had                                                              
been drafted for this bill.                                                                                                     
                                                                                                                                
MS. IVY  offered her  belief that the  definition came  from model                                                              
legislation in other states.                                                                                                    
                                                                                                                                
3:51:32 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD  asked  whether  the  information                                                              
collected from  terminally ill  patients could  be used  for other                                                              
patients.                                                                                                                       
                                                                                                                                
MS. IVY  replied that  the data  from investigational  drugs, used                                                              
outside a  clinical trial,  was being  collected and that  federal                                                              
law   dictated  that   manufacturers   needed   to  provide   this                                                              
information  to the  FDA.   She  offered her  belief  that it  was                                                              
required that the data be collected.                                                                                            
                                                                                                                                
3:53:16 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR   commented  that  this  was   Rare  Diseases                                                              
Awareness Day.   She shared that, as there was not  a large enough                                                              
population   to  have  statistically   relevant  information   for                                                              
appropriate interventions,  it was often a fight to  get access to                                                              
medication.                                                                                                                     
                                                                                                                                
3:54:50 PM                                                                                                                    
                                                                                                                                
STARLEE   COLEMAN,  Vice   President,  Communications,   Goldwater                                                              
Institute,  reported   that  her  organization  had   crafted  the                                                              
language  on  which  proposed  HB  43  was  based,  although,  she                                                              
acknowledged,  there had  been some  Alaska specific  adjustments.                                                              
She  relayed  that  diagnosis for  a  terminal  illness  currently                                                              
offered  three  paths  of  approved  options  for  the  access  to                                                              
promising  investigational treatments:    the first  path was  for                                                              
the  clinical trials;  the second  path  was for  those who  could                                                              
afford  to  travel overseas  to  access  drugs that  were  already                                                              
available  in countries  other than  the U.S;  the third path  was                                                              
for  the  connected,  the  aforementioned  FDA  "Expanded  Access"                                                              
program.  For  the remainder of  the public, there was  no path to                                                              
access  investigational  treatments,  hence  the  "Right  to  Try"                                                              
program.   She stated  that it  was important  to understand  that                                                              
this  program was  the  opposite  of the  right  to die  movement,                                                              
which was  for people ready  to end their  own lives.   The "Right                                                              
to Try"  program allows patients  with terminal illnesses  who had                                                              
tried existing  treatments with no  success, and could  not enroll                                                              
with  a  clinical  trial, to  access  promising  treatments  being                                                              
safely used in  government approved clinical trials.   She pointed                                                              
out  that it  was not  a question  for  whether or  not trying  an                                                              
investigational treatment  was too risky,  as the risk  from these                                                              
treatments  was  exactly  the  same  as  for  those  entered  into                                                              
government clinical  trials.  She  emphasized that it was  hard to                                                              
be  selected for  a clinical  trial.   She offered  an example  of                                                              
clinical  trials  for  children  diagnosed  with  spinal  muscular                                                              
atrophy (SMA).   She reported that  97 percent of  cancer patients                                                              
had to rely  on drugs already on  the market, even if a  drug in a                                                              
clinical  trial was being  developed specifically  for their  type                                                              
of  cancer, and  had  already been  approved  in other  countries.                                                              
She reiterated that,  although about 1200 people  annually made it                                                              
through  the  application  process,  it  was not  known  how  many                                                              
people were  declined as FDA did  not keep records.   She reported                                                              
that, although the  FDA declared that its approval  rate was about                                                              
99  percent,  she  had  questioned  this rate.    She  offered  an                                                              
example of  a cancer trial center  in Houston, the largest  in the                                                              
world,  which claimed  that  it  had only  been  able  to get  one                                                              
person through  the FDA "Expanded  Access" process annually.   She                                                              
surmised that many  doctors spoke to the FDA in  advance and would                                                              
not  apply   if  the  FDA  stated   they  would  not   accept  the                                                              
application.    She pointed  out  the  difficulty for  doctors  in                                                              
Alaska who  were not familiar with  the FDA process  or hierarchy.                                                              
She compared  the FDA  program with  a similar  program in  France                                                              
which  treated 25,000  people annually,  and  declared that  there                                                              
was a problem with the FDA program.                                                                                             
                                                                                                                                
4:04:00 PM                                                                                                                    
                                                                                                                                
MS.  COLEMAN stated  that, although  no one  expected a  guarantee                                                              
that  an  investigational  drug  would offer  a  cure,  they  just                                                              
wanted an  opportunity to try  the medications already  being used                                                              
in clinical  trials.   She declared  that dying  people and  their                                                              
families were  owed that opportunity.   She stated that  "Right to                                                              
Try"  was  already working  and  saving  lives.   She  offered  an                                                              
example of  terminal pancreatic  cancer patients.   She emphasized                                                              
that states  were able to do  this to complement the  federal drug                                                              
approval  process, and  not compete  with it.   She declared  that                                                              
the right  to save your  own life was a  human right, and  that it                                                              
should not be necessary to also fight government red tape.                                                                      
                                                                                                                                
4:05:49 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   JOHNSTON  asked   for   clarification  that   the                                                              
proposed  bill  was for  the  right to  try  drugs  that had  gone                                                              
through the first, second, and third steps toward FDA approval.                                                                 
                                                                                                                                
MS. IVY  replied that all  of these drugs  had passed Phase  1 for                                                              
safety testing and were currently in Phase 2 or Phase 3.                                                                        
                                                                                                                                
REPRESENTATIVE  JOHNSTON  asked if  drugs  allowed  in Europe  had                                                              
already passed  Phase 1 by  the FDA, and were  also in Phase  2 or                                                              
Phase 3.                                                                                                                        
                                                                                                                                
MS.  IVY replied  that  was  correct.   She  stated  that in  some                                                              
countries  medications  or treatments  were  in general  use,  and                                                              
considered  safe  and effective,  but  had  not yet  gone  through                                                              
Phase  1 of the  FDA process  in order  to be  eligible under  the                                                              
"Right  to Try"  program.   She pointed  out that  a person  could                                                              
travel to  that country and utilize  the medication, but  that was                                                              
outside this process.                                                                                                           
                                                                                                                                
MS.  COLEMAN  offered  an example  for  five  FDA  investigational                                                              
treatment  drugs for  breast  cancer which  had  been approved  in                                                              
other  countries.   She stated  that  "Right to  Try" would  allow                                                              
those treatments  already in use  to become available  to American                                                              
women.                                                                                                                          
                                                                                                                                
4:07:59 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ asked  how many people had taken  advantage of the                                                              
access to "Right to Try."                                                                                                       
                                                                                                                                
MS.  COLEMAN replied  that there  was  not a  complete record  for                                                              
that  information, as  there was  not a  state specific  reporting                                                              
requirement  for the  use of  drugs in  a state with  a "Right  to                                                              
Try"  law.   She noted  that  this would  be  duplicative of  drug                                                              
company  reports to  the FDA,  adding that  the FDA  did not  make                                                              
this information available under public records laws.                                                                           
                                                                                                                                
4:09:27 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE JOHNSTON  asked if a  drug would qualify if  it was                                                              
used  for  one   treatment,  even  though  its   purpose  was  for                                                              
something  else.    She  pointed  out that  it  had  already  gone                                                              
through  the  Phase  1  safety test,  but  not  through  the  next                                                              
phases.                                                                                                                         
                                                                                                                                
MS. COLEMAN  said that  she would  need more  specifics about  the                                                              
drug's placement  in the trial process.   She reiterated  that the                                                              
goal  of  "Right  to  Try" was  to  provide  access  for  terminal                                                              
patients to  any drug which had  passed the initial  safety trial,                                                              
and was  in on-going trials and  under active investigation.   She                                                              
said that it was  legal for drugs to be used  for another purpose,                                                              
which she termed "off label use."                                                                                               
                                                                                                                                
4:11:28 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR  expressed   concern  for  the  provision  of                                                              
immunity, noting  that medical  malpractice provisions  were still                                                              
in  place, and  asked  if this  had  been an  issue  in any  other                                                              
states.  She asked  if there was protection for  an individual who                                                              
felt pressured or coerced into taking a drug.                                                                                   
                                                                                                                                
MS.  COLEMAN shared  this  concern  that patients  were  protected                                                              
from  any undue  pressure to  try  something they  were not  fully                                                              
comfortable  with and to  protect them  from medical  malpractice.                                                              
She shared  that the  proposed bill  had two patient  protections:                                                              
(1)  that  a  patient  must  voluntarily   sign  a  comprehensive,                                                              
informed  consent   document,  and  (2)  that  this   was  totally                                                              
voluntary  with no  incentive for  the  pharmaceutical company  to                                                              
participate.   She  said that  medical malpractice  laws were  not                                                              
impacted  by the proposed  bill,  and these laws  would remain  in                                                              
place.  She declared  that a point of the liability  shield was to                                                              
ensure  that  doctors,  hospitals,  and  pharmaceutical  companies                                                              
understand  that should  a  patient in  a  terminal situation  die                                                              
while  taking  an  investigational  treatment,  that,  in  and  of                                                              
itself, was not a reason to be sued.                                                                                            
                                                                                                                                
4:15:05 PM                                                                                                                    
                                                                                                                                
MS. IVY  added that there were  other protections in  the proposed                                                              
bill, as  it included  investigational drugs  in on-going  trials.                                                              
She  offered her  belief that,  under  federal law,  manufacturers                                                              
cannot engage in  the marketing and sale of unapproved  drugs, and                                                              
were  not legally  permitted  to  sell investigational  drugs  for                                                              
more than the production  cost.  She stated that  this removed the                                                              
cost benefit for manufacturers to participate.                                                                                  
                                                                                                                                
CHAIR SPOHNHOLZ  asked whether the  informed consent  described in                                                              
the proposed bill  included a verbal discussion for  the risks and                                                              
benefits.                                                                                                                       
                                                                                                                                
MS. IVY, in  response to Chair Spohnholz, expressed  her agreement                                                              
and added  that discussion would  include all available  treatment                                                              
options currently approved by the FDA.                                                                                          
                                                                                                                                
CHAIR SPOHNHOLZ  directed attention to  page 2, lines 26  - 27, as                                                              
the guarantee of  a verbal conversation with the  doctor regarding                                                              
the  risks  and  benefits  of  a  potential  treatment,  and  that                                                              
writing was a codification of that consent.                                                                                     
                                                                                                                                
MS. IVY expressed  her agreement that  this was the intent  of the                                                              
proposed  bill,  and  expressed   her  support  of  any  necessary                                                              
amendment to clarify the requirement for a verbal conversation.                                                                 
                                                                                                                                
4:18:24 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ  said that  HB 43  would be  held over  and public                                                              
testimony would be opened at that time.                                                                                         
                                                                                                                                
4:18:51 PM                                                                                                                    
                                                                                                                                
The committee took a brief at ease.                                                                                             
                                                                                                                                
^Presentation: Reducing Use of Emergency Department Services                                                                  
  Presentation: Reducing Use of Emergency Department Services                                                               
                                                                                                                                
4:20:00 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ announced  that the final order  of business would                                                              
be a  presentation titled  "Reducing Use  of Emergency  Department                                                              
Services."                                                                                                                      
                                                                                                                                
4:20:20 PM                                                                                                                    
                                                                                                                                
CONNIE BEEMER,  Director, Member  Services and Operations,  Alaska                                                              
State  Hospital and  Nursing Home  Association (ASHNHA),  directed                                                              
attention  to  the  PowerPoint   titled  "Alaska  ED  Coordination                                                              
Project,"  and  stated  that  the  project was  a  result  of  the                                                              
Medicaid Redesign  efforts initially proposed in 2015.   She noted                                                              
that  rising  health care  costs  and  the  decline in  the  state                                                              
budget had  been a reason for  this project in  collaboration with                                                              
the  Alaska   Chapter  of  the   American  College   of  Emergency                                                              
Physicians.   She stated that the  project was not  solely focused                                                              
on Medicaid patients,  but for all patients, as they  wanted to do                                                              
the  right  things for  their  patients.   She  acknowledged  that                                                              
emergency  rooms were  a great place  if there  was an  emergency,                                                              
but that  it was not  the best place  to provide for  re-occurring                                                              
primary  care and  behavioral health  issues.   She reported  that                                                              
this  project was  based on  the  State of  Washington seven  best                                                              
practices  model, slide  3.   She  shared  that  Alaska saw  these                                                              
successes  and "we  wanted  to steal  them  so  that's what  we're                                                              
working  on."    She  reported  that  Washington  was  also  under                                                              
financial  pressures,  similar  to  Alaska,  and  was  faced  with                                                              
threats  from the  governor  to  limit emergency  department  (ED)                                                              
visits for  Medicaid patients.   She addressed slide  4, "Learning                                                              
from  Others," which  listed  the  reductions for  ED  use in  the                                                              
first year, and  included a 10.7 percent reduction  among frequent                                                              
utilizers and  a 24 percent  reduction for narcotic  prescriptions                                                              
from the ED.                                                                                                                    
                                                                                                                                
4:23:16 PM                                                                                                                    
                                                                                                                                
ANN  ZINK,  MD,  President,  Alaska  (ACEP)  American  College  of                                                              
Emergency  Physicians,  offered  her  belief  that  "what  you  do                                                              
really matters."   She said that  a lot of great things  can build                                                              
off this  project.  She directed  attention to slide  5, "Alaska's                                                              
ED  Coordination  Project,"  and  reported that  this  was  actual                                                              
language from  Senate Bill  74, emphasizing  that this  was Alaska                                                              
specific.   She shared that ideas  had been taken from  the States                                                              
of Washington  and Oregon,  as well as  others, for what  had been                                                              
done well,  what could have been  done differently, what  would be                                                              
recommended, and  what made sense for  Alaska.  She read  from the                                                              
list  on slide  5, which  included  creating an  interdisciplinary                                                              
process for  defining, identifying,  and minimizing the  number of                                                              
frequent  visitors of  emergency department  services, creating  a                                                              
real-time   electronic   information  exchange   mechanism   which                                                              
crossed  all   IT  platforms   for  electronic  medical   records,                                                              
educating  patients, and  providing  primary  care and  behavioral                                                              
health  follow-up within  96 hours.   They also  reviewed  ways to                                                              
create   statewide   narcotics   guidelines  for   the   emergency                                                              
departments, and  ways to review  the successes and  challenges of                                                              
this  program when  moving forward.    She relayed  that they  had                                                              
been receiving input  from other hospitals, as well  as working on                                                              
the  statewide opiate  guidelines;  however, the  big project  was                                                              
research  for an  IT system  that  would cross  the platforms,  be                                                              
easy to  use, be interface  friendly, and  have the  potential for                                                              
future expansion.   She lauded Collective Medical  Technologies as                                                              
an ideal partner.                                                                                                               
                                                                                                                                
4:25:31 PM                                                                                                                    
                                                                                                                                
BEN  ZANIELLO,   MD,  Vice   President,  Chief  Medical   Officer,                                                              
Collective Medical  Technologies (CMT), shared that he  was also a                                                              
practicing  physician  at  Providence  Hospital in  the  State  of                                                              
Washington.   He shared some  background about Collective  Medical                                                              
Technologies  (CMT),  slide  7,  stating  that  it  was  a  small,                                                              
mission driven  company started by  an Emergency Room  (ER) social                                                              
worker  in   Idaho,  and   that  CMT  was   focused  on   ER  care                                                              
coordination  and the  sharing of  information between  hospitals.                                                              
He  said that  the focus  of CMT  was  to create  a national  care                                                              
coordination  network around  the concept  of medical  uncertainty                                                              
versus medical  necessity.   He pointed out  that there was  a lot                                                              
of  information asymmetry  in the  emergency  department (ED),  as                                                              
decisions  had  to be  made  quickly.    He  stated that  the  CMT                                                              
software  would  provide the  information  to reduce  the  medical                                                              
uncertainty,  and  they were  now  working  with more  than  1,000                                                              
hospitals.    He   directed  attention  to  slide   8,  "PreManage                                                              
Platform," and  said that the  program was called  EDIE, Emergency                                                              
Department Information  Exchange.  He explained that,  in order to                                                              
focus  on  the  emergency  department,  it was  necessary  to  get                                                              
information from  outside the  ER, from all  aspects of  the "care                                                              
ecosystem."  He pointed  to slide 9, as an example  of the type of                                                              
data shared.                                                                                                                    
                                                                                                                                
4:30:01 PM                                                                                                                    
                                                                                                                                
DR. ZINK  moved on  to slide  10, "ED  Narcotic Guidelines."   She                                                              
reported  that  there  was  a  coordinated   effort  with  the  ED                                                              
departments  to  implement  statewide guidelines  to  reduce  drug                                                              
seeking  and drug  dispensing to  frequent  emergency room  users.                                                              
She  shared that  the State  of  Washington had  reported "a  huge                                                              
difference  in  their  overall  narcotic  dispensing  out  of  the                                                              
emergency  department."    She directed  attention  to  slide  12,                                                              
"Ultimate Goal," and  stated that, since the IT  platform had been                                                              
determined,  there  was work  to  get  the  platform in  place  in                                                              
hospitals.  She  shared that support was widespread.   She pointed                                                              
to slide 13,  "Participating Organizations," which  listed many of                                                              
the collaborating  organizations.  She  declared that this  was an                                                              
opportunity  to put patients  first, and  reduce restrictions  and                                                              
decrease silos between  different providers.  She  stated the need                                                              
for tools to reduce costs and improve care.                                                                                     
                                                                                                                                
4:33:09 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE   JOHNSTON  asked  if   she  would  encourage   her                                                              
facility to use this platform for all patients.                                                                                 
                                                                                                                                
DR. ZINK  explained that this  was emergency department  specific,                                                              
as it was different  than for someone with chronic  pain, and that                                                              
it  had  100   percent  support  from  the   emergency  department                                                              
physicians, as well as support from the urgent cares.                                                                           
                                                                                                                                
REPRESENTATIVE  JOHNSTON asked it  the IT  platform could  be used                                                              
for all emergencies, and not just Medicaid.                                                                                     
                                                                                                                                
DR.  ZINK  replied that  this  was  correct.    She said  that  it                                                              
crossed  all platforms  and  patients, and  it  could access  data                                                              
from the other states that had the CMT platform.                                                                                
                                                                                                                                
REPRESENTATIVE   JOHNSTON   asked    whether   any   hospital   or                                                              
organization  which  used  this   IT  platform  could  interchange                                                              
throughout the system.                                                                                                          
                                                                                                                                
DR. ZINK said, "Correct."                                                                                                       
                                                                                                                                
4:34:31 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  SULLIVAN-LEONARD asked if  there were  forms which                                                              
were  clearly  highlighted  for   sharing  this  information  with                                                              
another facility  for an emergency  room patient.   She questioned                                                              
the Health  Insurance Portability  and Accountability  Act (HIPAA)                                                              
information.                                                                                                                    
                                                                                                                                
DR.  ZINK   replied  that   different  hospitals   could   set  up                                                              
individual  criteria  and  this was  on  a  tracking board.    She                                                              
reported  that when  a  patient checked  into  an emergency  room,                                                              
they agreed  to be  treated via  the Health Insurance  Portability                                                              
and   Accountability  Act,   hence   there  was   access  to   the                                                              
information, and  then their information  could be accessed.   She                                                              
offered some  examples for the  information, including  any recent                                                              
violent  actions by  the patient,  an  important care  plan, or  a                                                              
notice of frequent visitations to emergency departments.                                                                        
                                                                                                                                
4:35:53 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE SULLIVAN-LEONARD  reiterated her question  that the                                                              
patient  would  need   to  sign  an  agreement   for  the  medical                                                              
facilities to share their personal information.                                                                                 
                                                                                                                                
DR.  ZINK   said  that,   when  checking   in  to  the   emergency                                                              
department,  the  patient basically  agrees  to allow  access  for                                                              
anything  to  do with  their  medical  emergency at  that  moment,                                                              
which is in compliance  with HIPAA.  She added  that any follow-up                                                              
in an  outpatient clinic  does not  automatically allow  access to                                                              
that patient  information.   She explained  that all the  patients                                                              
in the mental  health court signed a full information  release for                                                              
willingness to share their information.                                                                                         
                                                                                                                                
4:37:14 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE TARR asked  if this was a tool which  fed into each                                                              
EMR  system, and,  as  a result,  there  was  not any  unnecessary                                                              
information, although this was governed by HIPAA.                                                                               
                                                                                                                                
DR.  ZANIELLO explained  that, when  a patient  registered in  the                                                              
ER, the  IT system was  fed a narrow  slice of patient  data which                                                              
was matched  against  their larger  data base.   He reported  that                                                              
the  CMT system  would  report on  recent  patient activities  and                                                              
actions.    He stated  that  each  emergency room  maintained  its                                                              
"deep clinical repository on each patient."                                                                                     
                                                                                                                                
4:39:05 PM                                                                                                                    
                                                                                                                                
REPRESENTATIVE  TARR asked about  any issues  of privacy,  as each                                                              
use  of electronic  records  allowed  an  opportunity  for a  data                                                              
breach.                                                                                                                         
                                                                                                                                
DR.  ZANIELLO  replied  that a  lot  of  his  work was  with  data                                                              
privacy  concerns.     He  reminded  that  committee   that  HIPAA                                                              
referenced  portability, not privacy.   He  reported that  CMT had                                                              
not had any data breach or HIPAA violation.                                                                                     
                                                                                                                                
CHAIR  SPOHNHOLZ   asked  about   the  projected  time   line  for                                                              
implementation of the CMT platform.                                                                                             
                                                                                                                                
MS. BEEMER  said that the bulk  of the CMT implementation  was for                                                              
the legal  review, projected  to be a  3 - 4  month process.   She                                                              
allowed  that the  actual IT  implementation was  "a fairly  light                                                              
lift."  She pointed  out that the program had been  implemented at                                                              
Providence  Hospital   in  Anchorage,  as  it  had   already  been                                                              
implemented   in  other   Providence  Hospitals   in  Oregon   and                                                              
Washington.     She   reported   that  her   team  was   currently                                                              
demonstrating the  CMT program to  the mid and large  hospitals in                                                              
Alaska.                                                                                                                         
                                                                                                                                
4:41:52 PM                                                                                                                    
                                                                                                                                
CHAIR SPOHNHOLZ offered  her belief that it was  important to have                                                              
as  many  hospitals  involved  as  possible.    She  mentioned  an                                                              
earlier reference  to prescription  drug monitoring  programs, and                                                              
asked about the timing for integrating that information.                                                                        
                                                                                                                                
MS. BEEMER  offered her  belief that the  language in  Senate Bill                                                              
74  regarding the  prescription  drug monitoring  program  allowed                                                              
for some  regulations which  were due to  go into effect  in July.                                                              
She  expressed  the desire  to  soon  have discussions  with  that                                                              
program.                                                                                                                        
                                                                                                                                
CHAIR SPOHNHOLZ  asked whether regulations were necessary  to take                                                              
effect prior to integration with the prescription drug database.                                                                
                                                                                                                                
MS.  BEEMER  offered  her  understanding  that  this  was  already                                                              
underway.                                                                                                                       
                                                                                                                                
CHAIR SPOHNHOLZ  asked for  the end date  goal to have  a complete                                                              
rollout of integration with EDIE.                                                                                               
                                                                                                                                
MS. BEEMER opined  that the hospitals needed six months  to have a                                                              
legal  review before  signing  the contract.    She reported  that                                                              
phase  2 would  be  access by  the  communities  and primary  care                                                              
through  the  portal.    She  added   that  discussion  was  still                                                              
necessary with the  rural critical access hospitals.   She allowed                                                              
that there  was still a  lot of work,  although there was  hope to                                                              
have  this in  all the  large and  mid-size emergency  departments                                                              
within six months.                                                                                                              
                                                                                                                                
4:44:30 PM                                                                                                                    
                                                                                                                                
DR. ZINK pointed  out that the IT was only one  component, and the                                                              
prescription  drug database  regulation  component  was now  being                                                              
finished.   She  stated that  there was  a lot  of opportunity  to                                                              
build  on care  coordination, end  of  life care,  and other  cost                                                              
savings issues for improvement for patient health.                                                                              
                                                                                                                                
REPRESENTATIVE TARR  asked about participation with  Indian Health                                                              
Services or Tri Care.                                                                                                           
                                                                                                                                
DR.  ZINK  replied  that  there was  extensive  work  with  Indian                                                              
Health Services.   She reported  that there was ongoing  work with                                                              
the leaders  within the  VA (Veterans  Administration) system  for                                                              
changes to  regulations, with  a desire to  bring this  program to                                                              
the federal  level.  She surmised  that this was just  a temporary                                                              
barrier in the work toward integrating these systems.                                                                           
                                                                                                                                
4:47:03 PM                                                                                                                    
                                                                                                                                
ADJOURNMENT                                                                                                                   
                                                                                                                                
There being  no further business  before the committee,  the House                                                              
Health  and  Social   Services  Standing  Committee   meeting  was                                                              
adjourned at 4:47 p.m.                                                                                                          

Document Name Date/Time Subjects
HB025 ver A 2.16.17.PDF HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Sponsor Statement 2.16.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Sectional Analysis ver A 2.16.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Cost Savings Study 2.16.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-ADN Commentary 2.16.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Guttmacher Alaska Statistics 2.16.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Guttmacher Public Costs from Unintended Pregnancies 2.16.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Letter Kachemak Bay Family Planning Clinic 2.23.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Letter League of Women Voters Alaska 2.24.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Unintended Pregnancies Study 2.16.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Letter Planned Parenthood Votes Northwest & Hawaii 2.16.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-UCSF Study Newspaper Article 2.16.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Letter Dr. Tina Tomsen 2.27.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Supporting Document-Support Emails 2.27.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Opposing Document-America's Health Insurance Plans 2.27.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Opposing Document-Letter NFIB 2.16.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Fiscal Note DHSS-Medicaid Services 2.28.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Fiscal Note DHSS-DHCS 2.28.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB025 Fiscal Note DCCED-DIO 2.28.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/9/2017 3:00:00 PM
HHSS 4/6/2017 3:00:00 PM
HHSS 4/11/2017 3:00:00 PM
HB 25
HB043 ver D 2.22.17.PDF HHSS 2/28/2017 3:00:00 PM
HHSS 3/2/2017 3:00:00 PM
HHSS 3/7/2017 3:00:00 PM
HB 43
HB043 Sponsor Statement 2.22.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/2/2017 3:00:00 PM
HHSS 3/7/2017 3:00:00 PM
HB 43
HB043 Sectional Analysis ver D 2.22.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/2/2017 3:00:00 PM
HHSS 3/7/2017 3:00:00 PM
HB 43
HB043 Supporting Document - Legislative Map 2.22.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/2/2017 3:00:00 PM
HHSS 3/7/2017 3:00:00 PM
HB 43
HB043 Supporting Document - FDA Drug Review Process 2.22.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/2/2017 3:00:00 PM
HHSS 3/7/2017 3:00:00 PM
HB 43
HB043 Supporting Document - Clinical Trials in Alaska.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/2/2017 3:00:00 PM
HHSS 3/7/2017 3:00:00 PM
HB 43
HB043 Supporting Document - Goldwater Institute Fact Sheet 2.22.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/2/2017 3:00:00 PM
HHSS 3/7/2017 3:00:00 PM
HB 43
HB043 Supporting Document - Goldwater Institute Patient Stories 2.22.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/2/2017 3:00:00 PM
HHSS 3/7/2017 3:00:00 PM
HB 43
HB043 Supporting Document - Goldwater Institute Policy Report Summary 2.22.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/2/2017 3:00:00 PM
HHSS 3/7/2017 3:00:00 PM
HB 43
HB43 Supporting Document - Letters of Support 2.27.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/2/2017 3:00:00 PM
HHSS 3/7/2017 3:00:00 PM
HB 43
HB043 Fiscal Note DCCED--DCBPL 2.28.17.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/2/2017 3:00:00 PM
HHSS 3/7/2017 3:00:00 PM
HB 43
HB 43 Powerpoint Presentation.pdf HHSS 2/28/2017 3:00:00 PM
HHSS 3/2/2017 3:00:00 PM
HHSS 3/7/2017 3:00:00 PM
HB 43
AK ED Coordination Project from SB 74 to H HSS.pdf HHSS 2/28/2017 3:00:00 PM