Legislature(2017 - 2018)CAPITOL 106

03/07/2017 03:00 PM HEALTH & SOCIAL SERVICES

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Audio Topic
03:07:32 PM Start
03:08:25 PM Presentation: Substance Abuse Treatment System in Ak
04:28:32 PM HB138
04:35:48 PM HB43
04:39:49 PM Adjourn
* first hearing in first committee of referral
+ teleconferenced
= bill was previously heard/scheduled
+ Presentation: Substance Abuse Treatment System TELECONFERENCED
in AK by Kate Burkhart, Exec. Dir., AK Mental
Health Board and AK Board on Alcoholism & Drug
Abuse and Tom Chard, Exec. Dir., AK Behavioral
Health Assoc.
-- Testimony <Invitation Only> --
Heard & Held
-- Testimony <Invitation Only> --
Moved HB 43 Out of Committee
+ Bills Previously Heard/Scheduled TELECONFERENCED
                    ALASKA STATE LEGISLATURE                                                                                  
      HOUSE HEALTH AND SOCIAL SERVICES STANDING COMMITTEE                                                                     
                         March 7, 2017                                                                                          
                           3:07 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                                                                                         
Representative Dan Saddler (alternate)                                                                                          
MEMBERS ABSENT                                                                                                                
Representative Matt Claman (alternate)                                                                                          
COMMITTEE CALENDAR                                                                                                            
PRESENTATION: SUBSTANCE ABUSE TREATMENT SYSTEM IN AK                                                                            
     - HEARD                                                                                                                    
HOUSE BILL NO. 138                                                                                                              
"An Act establishing the month of March as Sobriety Awareness                                                                   
     - 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."                                                                        
     - MOVED HB 43 OUT OF COMMITTEE                                                                                             
PREVIOUS COMMITTEE ACTION                                                                                                     
BILL: HB 138                                                                                                                  
SHORT TITLE: MARCH: SOBRIETY AWARENESS MONTH                                                                                    
SPONSOR(s): REPRESENTATIVE(s) WESTLAKE                                                                                          
02/22/17       (H)       READ THE FIRST TIME - REFERRALS                                                                        
02/22/17       (H)       HSS, CRA                                                                                               
03/07/17       (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                                                                             
02/28/17       (H)       Heard & Held                                                                                           
02/28/17       (H)       MINUTE(HSS)                                                                                            
03/02/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
03/02/17       (H)       Heard & Held                                                                                           
03/02/17       (H)       MINUTE(HSS)                                                                                            
03/07/17       (H)       HSS AT 3:00 PM CAPITOL 106                                                                             
WITNESS REGISTER                                                                                                              
TOM CHARD, Executive Director                                                                                                   
Alaska Behavioral Health Association                                                                                            
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented a PowerPoint about the substance                                                               
abuse treatment system in Alaska.                                                                                               
KATE BURKHART, Executive Director                                                                                               
Advisory Board on Alcoholism & Drug Abuse                                                                                       
Division of Behavioral Health                                                                                                   
Department of Health and Social Services                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented a PowerPoint about the substance                                                               
abuse treatment system in Alaska.                                                                                               
REPRESENTATIVE DEAN WESTLAKE                                                                                                    
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION STATEMENT:  Presented HB 138, as the sponsor of the                                                                  
FORREST WOLFE, Staff                                                                                                            
Representative Dean Westlake                                                                                                    
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:   Explained  HB  38 on  behalf  of the  bill                                                             
sponsor, Representative Westlake.                                                                                               
GREGORY NOTHSTINE, President                                                                                                    
Sobermute Reviving Our Spirit                                                                                                   
Anchorage, Alaska                                                                                                               
POSITION STATEMENT:  Testified in support of HB 138.                                                                          
BROOKE IVY, Staff                                                                                                               
Representative Jason Grenn                                                                                                      
Alaska State Legislature                                                                                                        
Juneau, Alaska                                                                                                                  
POSITION  STATEMENT:   Recapped  HB  43  on  behalf of  the  bill                                                             
sponsor, Representative Grenn.                                                                                                  
ACTION NARRATIVE                                                                                                              
3:07:32 PM                                                                                                                    
CHAIR IVY SPOHNHOLZ  called the House Health  and Social Services                                                             
Standing   Committee    meeting   to    order   at    3:07   p.m.                                                               
Representatives  Spohnholz, Sullivan-Leonard,  Johnston, Eastman,                                                               
Edgmon, Kito,  and Saddler (alternate)  were present at  the call                                                               
to  order.   Representative Tarr  arrived as  the meeting  was in                                                               
^Presentation: Substance Abuse Treatment System in AK                                                                         
      Presentation: Substance Abuse Treatment System in AK                                                                  
3:08:25 PM                                                                                                                    
CHAIR SPOHNHOLZ announced that the  first order of business would                                                               
be  a presentation  on the  substance abuse  treatment system  in                                                               
Alaska.   She noted  that the committee  had recently  focused on                                                               
the  opioid  epidemic   in  Alaska,  which  deserved   a  lot  of                                                               
attention.  She  reminded the committee that the  number one drug                                                               
of choice in  Alaska remained alcohol, and this was  a huge drain                                                               
on the state.  She referenced  a 2012 study by the McDowell Group                                                               
which found that, in 2009,  9.5 percent of the Alaska population,                                                               
ages  12 and  older, were  dependent  on or  abusing alcohol  and                                                               
drugs.   She reported that, in  2010, this cost the  economy $1.2                                                               
billion.   She  pointed  out  that this  was  a  legal, over  the                                                               
counter drug.                                                                                                                   
3:12:12 PM                                                                                                                    
TOM   CHARD,  Executive   Director,   Alaska  Behavioral   Health                                                               
Association,   explained  that   the  Alaska   Behavioral  Health                                                               
Association was "a trade association  of sorts, made up of mental                                                               
health  and drug  and alcohol  [treatment]  providers across  the                                                               
state."  He reported that there  were about 60 members, both for-                                                               
profit,  non-profit, tribal,  and non-tribal  providers, and  the                                                               
association served all ages.                                                                                                    
3:12:53 PM                                                                                                                    
KATE BURKHART,  Executive Director, Advisory Board  on Alcoholism                                                               
&  Drug  Abuse,  Division  of Behavioral  Health,  Department  of                                                               
Health and  Social Services,  stated that  they would  provide an                                                               
overview of  the substance  use disorder  treatment system.   She                                                               
said they  would tell  a story based  on information  from people                                                               
who  had  made  the  journey toward  recovery,  and  provided  an                                                               
overview  for  how  the  system worked,  its  strengths  its  and                                                               
weaknesses.   She added that  they would also share  the provider                                                               
perspective.   She estimated that  about 11.5 percent  of Alaskan                                                               
adults  needed substance  use disorder  treatment,  and of  those                                                               
people, more  than one third  had a co-occurring  mental illness,                                                               
which made  treatment that much  more complicated.   She reported                                                               
that mental health disorders and  substance use disorders "travel                                                               
together more often than they travel apart."                                                                                    
REPRESENTATIVE  JOHNSTON asked  about  the  methodology for  this                                                               
MR.  CHARD replied  that  the  National Survey  on  Drug Use  and                                                               
Health contacted individuals and  asked them questions and, based                                                               
on a clinical  approach, determined who might  be substance abuse                                                               
dependent  and might  have a  disorder.   He explained  that this                                                               
statistical study used research to  determine a trend basis and a                                                               
state by state comparison for Alaska.                                                                                           
REPRESENTATIVE  JOHNSTON asked  if  these  were random  telephone                                                               
MR.  CHARD   explained  that   the  surveys   were  statistically                                                               
randomized  and  were  oversampled   to  ensure  that  they  were                                                               
statistically valid.                                                                                                            
REPRESENTATIVE EASTMAN asked how old  the survey results were and                                                               
what the Alaska ranking was among states.                                                                                       
MS.  BURKHART replied  that these  were the  most current  survey                                                               
results and that she would follow up with the state ranking.                                                                    
MR. CHARD offered  his belief that these were  the survey results                                                               
from 2014  and 2015.   He  addressed slides 3  - 4,  "Setting the                                                               
Stage,"  and pointed  out  that the  state  funded programs  only                                                               
provided  treatment to  7,808 people.   He  noted that,  although                                                               
there  were  private practitioners  that  did  not receive  state                                                               
funds,  the  current  discussion  would focus  on  public  source                                                               
REPRESENTATIVE JOHNSTON asked if this included tribal funding.                                                                  
MR. CHARD expressed his agreement.                                                                                              
3:18:09 PM                                                                                                                    
MS. BURKHART  continued with slide  4, and stated that,  based on                                                               
the  Behavioral Risk  Factor  Surveillance  System and  questions                                                               
based on  Adverse Childhood Experiences,  66 percent  of Alaskans                                                               
reported one or more adverse  childhood experience.  She reported                                                               
that these  experiences could range  from the death of  a parent,                                                               
to child  abuse and neglect, or  incarceration of a parent.   She                                                               
reported that 21.4 percent of  Alaskan adults reported growing up                                                               
in  a  household with  one  or  more adults  experiencing  mental                                                               
illness; that 29.7 percent of  Alaskan adults reported growing up                                                               
in a household  with one or more adults abusing  alcohol or other                                                               
drugs;  and, that  19.5 percent  of all  Alaskan adults  reported                                                               
four  or more  adverse  childhood experiences  while growing  up.                                                               
She called  this the dose response,  as the more you  had in your                                                               
life, there was a compounding effect.                                                                                           
MS. BURKHART turned to slide  5, "Martha's Story," and introduced                                                               
Martha,  a fictional  composite  Alaskan, who  is  30 years  old,                                                               
lives  in  a  small  rural   community  in  Western  Alaska,  and                                                               
experiences the consequences of  significant childhood trauma and                                                               
untreated  depression, a  moderate mental  health disorder.   She                                                               
lives with her mother, who is  also dependent on alcohol.  Martha                                                               
was convicted of DUI  five years ago.  She is  a frequent user of                                                               
the  health  clinic,  seeking  relief  for  a  host  of  physical                                                               
ailments and  pain.   She meets  periodically with  the itinerant                                                               
mental health provider.                                                                                                         
MR. CHARD  addressed slide 6, "Missed  Opportunities," and listed                                                               
the  mother's  dependence  on   alcohol,  the  adverse  childhood                                                               
experiences, and the DUI as  examples of missed opportunities for                                                               
early  intervention  and a  much  more  cost effective  treatment                                                               
outcome to mitigate the impact of the problems.                                                                                 
MS.  BURKHART stated  it  was important  to  understand that  the                                                               
current  substance  abuse  disorder   treatment  was  funded  and                                                               
designed to serve  the most acutely addicted, and  that there was                                                               
not a  system designed for early  opportunities for intervention.                                                               
She explained  that this was not  a linear process, but  was more                                                               
"herky-jerky."  She  stated that Martha was  at the pre-readiness                                                               
stage, slide 7, as  she knows that she has a  problem and she was                                                               
scared of  the pain of  opioid withdrawal  and the fact  that she                                                               
was desperate  enough to  consider using street  drugs.   She was                                                               
also scared that,  when she tried to stop using  opioids, she had                                                               
thoughts of suicide, and  she had no one to talk  to.  Martha has                                                               
an appointment at  the health clinic and the  provider, who knows                                                               
Martha well, administered a substance  abuse screening as part of                                                               
the appointment.   Their conversation, supported  by motivational                                                               
interviewing techniques, allowed Martha  to disclose that she was                                                               
dependent on alcohol and other drugs,  and she was scared of what                                                               
might happen if she doesn't get help.                                                                                           
3:24:09 PM                                                                                                                    
MR. CHARD moved on to slide  8, and Martha divulges to her health                                                               
care provider that she might  have a substance abuse problem, the                                                               
moment of  clarity.   Mr. Chard  reiterated that  this was  not a                                                               
linear path.   This moment of clarity was an  opportunity for the                                                               
treatment system to intervene and to  turn the tide.  The problem                                                               
was that a lot of people  don't recognize their problem.  Some of                                                               
them do recognize,  but don't seek treatment.  Those  who do seek                                                               
treatment  often   face  waitlists,   or  other   challenges  for                                                               
treatment, which  can include  childcare, housing,  or employment                                                               
challenges.  Only about 33  percent recognize they need treatment                                                               
and try to  get treatment, which he acknowledged as  a big issue,                                                               
nationally  and  regionally.   He  reported  that  the  treatment                                                               
provider had to meet the individual  at the moment of clarity, as                                                               
that moment could "pass in a blink of an eye."                                                                                  
MS. BURKHART turned  attention to slide 9,  reporting that Martha                                                               
was ahead of  the game as she already had  a health care provider                                                               
and  she  was receiving  health  care  service in  an  integrated                                                               
health system.   Her clinic provider calls  the behavioral health                                                               
department  at the  larger health  organization,  gets Martha  an                                                               
appointment for  her initial intake assessment,  and then, Martha                                                               
doesn't   go,  which   Ms.  Burkhart   labeled   as  a   standard                                                               
eventuality,  as the  moment  of clarity  was  fleeting.   Martha                                                               
makes another appointment,  but she arrives late.   The counselor                                                               
realized that, based  on Martha's history, she needs  more than a                                                               
basic  substance   abuse  assessment,   and,  as  she   needs  an                                                               
integrated mental health and  substance abuse assessment, another                                                               
appointment was  made with a  mental health  professional through                                                               
MR.  CHARD  shared  slide  10,   and  referenced  the  integrated                                                               
behavioral  health  assessment  [Included in  members'  packets],                                                               
which  was   based  on  the   work  of  trained   counselors  and                                                               
clinicians.    He  referenced  the   ASAM  (American  Society  of                                                               
Addiction Medicine)  criteria as the instrument  to determine the                                                               
level of treatment and care, and  then it was determined what the                                                               
available resources  were for the  best treatment outcome.   When                                                               
the trained  counselor does the exam,  they find a level  of care                                                               
corresponding to  the individual's needs.   He directed attention                                                               
to   slide  11,   the  level   of  care.     He   reported  that,                                                               
unfortunately, the  substance abuse  treatment system  was mostly                                                               
geared for the later end of  the treatment system.  He noted that                                                               
there  were outpatient  treatment service  providers, as  well as                                                               
residential providers,  and a  few withdrawal  management service                                                               
3:31:29 PM                                                                                                                    
MR. CHARD addressed  slide 12, "Levels of Care  in Alaska," which                                                               
included a sobering  center (Bethel) with another due  to open in                                                               
Fairbanks  in  2017;    3  withdrawal  management  centers,  with                                                               
another  due  to  open  in   Soldotna  in  2017;  21  residential                                                               
treatment centers, with another due to  open in Mat-Su in 2017; 2                                                               
non-profit  Medication   Assisted  Treatment  (MAT)   with  state                                                               
grantee methadone programs (Anchorage,  Fairbanks); 2 private for                                                               
profit  MAT   programs  offering  methadone   and  buprenorphine,                                                               
(Anchorage,   Mat-Su);  and   2  OCS-engaged   parents  treatment                                                               
programs  (Anchorage,   Mat-Su).     There  were   45  outpatient                                                               
substance use  disorder treatment  providers, noting that  it was                                                               
rare for multiple providers in  one community to provide the same                                                               
MS.  BURKHART  shared  that  there   was  a  sobering  center  in                                                               
Anchorage which was funded by the  municipality.  She moved on to                                                               
slide 13, and based on  her assessment, the clinicians determined                                                               
that Martha needed intensive treatment  to help her withdraw from                                                               
alcohol and  opioids, a treatment  not available in  her village.                                                               
Martha  was nervous  about going  to  a big  city for  treatment,                                                               
fearing she  would not go  to the treatment facility  and instead                                                               
take advantage  of the  increased access  to alcohol  and opioids                                                               
and go find people  to use with.  This was  an important point in                                                               
Martha's   journey  toward   recovery,  as   she  can   seek  the                                                               
recommended level of treatment in an  urban center or seek a less                                                               
clinically appropriate alternative closer  to home.  Ms. Burkhart                                                               
noted the  importance of the  treatment process, the crux  in the                                                               
road,  and either  go  to  the level  of  care  suggested by  the                                                               
clinical  assessment  treatment  center,   or  stay  and  receive                                                               
services at  a lower level of  care.  Ms. Burkhart  stressed that                                                               
this was a crossroads that many people faced.                                                                                   
3:35:22 PM                                                                                                                    
MS.  BURKHART  directed  attention  to  slide  14.    There  were                                                               
currently  34 withdrawal  management beds  in Alaska,  in Juneau,                                                               
Anchorage, and  Fairbanks, and, with  last year's  funding, there                                                               
will be  additional withdrawal management beds  in Soldotna later                                                               
in the  year.  She declared  that some hospitals were  able to do                                                               
medically  monitored  detoxification   if  absolutely  necessary,                                                               
based on the medical needs.                                                                                                     
MR.  CHARD  emphasized that  the  34  withdrawal management  beds                                                               
served the  entire population of  the state, and  he acknowledged                                                               
that there  were not enough of  these beds.  He  pointed out that                                                               
travel had to be arranged to  get to the treatment and that there                                                               
was a lot of coordination behind the scenes.                                                                                    
REPRESENTATIVE  JOHNSTON   asked  for  clarification   between  a                                                               
management center and a detox center.                                                                                           
MR. CHARD  relayed that the older  term was detox, which  was now                                                               
being  relabeled nationally  as withdrawal  management, partially                                                               
in recognition that this was a much longer process.                                                                             
REPRESENTATIVE  JOHNSTON asked  if this  was for  some drugs  and                                                               
alcohol, not necessarily just for opioids.                                                                                      
Mr. CHARD reiterated that there  were acute problems from alcohol                                                               
in Alaska, and  that many of the withdrawal  management beds were                                                               
set up  for alcohol, as  people could die from  detoxification of                                                               
alcohol, whereas detox from many drugs  was not as dangerous.  He                                                               
reported that,  because of the emergence  of complicated clients,                                                               
there  were a  lot of  new detox  beds opening,  particularly for                                                               
opioid detoxification.   He stated that these  were all medically                                                               
monitored services to maintain safety for the patient.                                                                          
MS.  BURKHART, in  response  to Representative  Sullivan-Leonard,                                                               
said  that  Nugens  Ranch  was   a  residential  program,  not  a                                                               
withdrawal management  program.  She returned  attention to slide                                                               
14, and stated  that the system was prioritized  by these federal                                                               
guidelines:  1) pregnant injecting  drug users; 2) other pregnant                                                               
drug users;  and 3) other injecting  drug users.  She  added that                                                               
there was  additional state guidance, which  prioritized families                                                               
engaged  with the  Office of  Children's Services.   She  relayed                                                               
that  it  was  a  common   occurrence  for  these  priorities  to                                                               
supersede others  on the  wait list.   As a  bed was  expected to                                                               
become  available in  three weeks  in Anchorage,  Martha and  her                                                               
clinician worked together to develop  a plan to help her maintain                                                               
her  treatment  readiness while  she  waited  for the  withdrawal                                                               
management bed.   Ms.  Burkhart declared that  three weeks  was a                                                               
very long time to "remember that you want to get treatment."                                                                    
3:41:19 PM                                                                                                                    
MS. BURKHART  moved on to  slide 15,  and shared that,  as Martha                                                               
had identified  a risk  that she would  divert from  treatment on                                                               
the way, the treatment team  arranged to have family members take                                                               
and wait with her  at the village and hub airports.   It was also                                                               
arranged  for  the provider  to  pick  her  up at  the  Anchorage                                                               
airport.   Despite  all the  precautions and  preparation, Martha                                                               
showed  up  at the  airport  severely  intoxicated, and  was  not                                                               
allowed  to  board the  flight  to  Anchorage.   Martha's  family                                                               
member called the  local treatment provider, who  worked with the                                                               
withdrawal  management treatment  team in  Anchorage to  hold the                                                               
bed.   Martha  stayed with  a  family member  overnight, and  was                                                               
taken to the  airport the next day.  Martha  arrived in Anchorage                                                               
and  was  met at  the  airport  by  someone from  the  withdrawal                                                               
management center.                                                                                                              
MR.  CHARD directed  attention to  slide 16.   Martha  spends the                                                               
next  seven  days in  Anchorage  in  a medically  monitored  high                                                               
intensity  inpatient setting,  a  withdrawal management  setting.                                                               
The treatment  team explored whether  placement at  a residential                                                               
treatment  setting  closer  to   home  following  discharge  from                                                               
withdrawal management  was available  and was the  best treatment                                                               
option.   This was  another important  point in  Martha's journey                                                               
toward  recovery,  as the  discharge  and  placement process  can                                                               
either support or divert Martha's  progress.  He stated that this                                                               
was one challenge  of the treatment providers,  getting ready for                                                               
the  next  service  setting,  finding  a  new  availability,  and                                                               
finding travel.                                                                                                                 
MS. BURKHART stated  that it was important to  recognize that for                                                               
Martha to stay all seven days  was a huge victory, as many people                                                               
just walked out.   She emphasized that  maintaining the treatment                                                               
readiness was very  difficult, especially in the  most acute time                                                               
MR.  CHARD added  that,  as these  were  all voluntary  treatment                                                               
programs, the individual would go  through the necessary level of                                                               
treatment, feel better, and then  leave the program with the idea                                                               
of doing it by themselves.                                                                                                      
MS. BURKHART shared slide 17, and  said that Martha was ready for                                                               
an  intensive   residential  program.    There   were  about  315                                                               
residential treatment  beds in Alaska  today, which  included the                                                               
aforementioned  Nugens   Ranch.     She  pointed  out   that  the                                                               
residential treatment  programs were  not one  size fits  all, as                                                               
some were  for males  only, some  were for  women only,  and some                                                               
were co-ed.   Some were for  women with children.   Some programs                                                               
were 30-90  days long, some were  6-12 months long, and  each one                                                               
had  unique  features  for  specific  client  populations.    She                                                               
pointed out  that there  would be  additional capacity  for women                                                               
with  children in  the Matanuska-Susitna  Valley thanks  to three                                                               
years of funding appropriated by the Legislature last year.                                                                     
MR. CHARD pointed  out that the Institutions  for Mental Diseases                                                               
(IMD)  exclusion, slide  18,  dated  back to  the  60s, early  in                                                               
Medicaid,  to prevent  tearing down  state psychiatric  hospitals                                                               
just  to  build community  psychiatric  hospitals.   One  of  the                                                               
challenges faced by residential  substance use disorder treatment                                                               
providers was  for this IMD  Exclusion, which prohibited  the use                                                               
of  Medicaid for  care provided  to people  in mental  health and                                                               
substance  use disorder  residential treatment  facilities larger                                                               
than 16 beds.   Flat funding and funding cuts  in both grants and                                                               
Medicaid  have  resulted  in  staffing  shortages  that  make  it                                                               
difficult  to  fully  utilize  the   residential  beds  that  are                                                               
available.     As  funding  has   been  cut,   facilities  cannot                                                               
adequately  staff  all   the  beds,  and  this   has  created  an                                                               
opportunity, as not all the beds are being fully utilized.                                                                      
MS. BURKHART addressed  slide 19, and asked "What if  there is no                                                               
residential treatment  bed available or  what if there's  not one                                                               
available  on a  realistic time  horizon."   She stated  that one                                                               
option was for Medication Assisted  Treatment (MAT), which was an                                                               
evidence-based  treatment for  opioid and/or  alcohol dependence.                                                               
It combined  medication with behavioral health  treatment to help                                                               
the person achieve and maintain  recovery.  Opioid dependence MAT                                                               
and alcohol dependence  MAT had been shown  to increase retention                                                               
in treatment, decrease illicit opiate  use and criminal activity,                                                               
increase  employability, improve  birth  outcomes among  pregnant                                                               
addicted women, and lower risk  of contracting HIV or Hepatitis C                                                               
by  reducing  the potential  for  relapse.   Medication  Assisted                                                               
Treatment was  available through  some community  health centers,                                                               
community  behavioral  health  centers, and  private  physicians'                                                               
offices,  slide  20.    Methadone   treatment  was  available  in                                                               
Fairbanks,  Anchorage, and  Wasilla,  and MAT  capacity had  been                                                               
actively expanded thanks  to a federal grant  from the Department                                                               
of Health and  Social Services, focusing on  building capacity in                                                               
Anchorage and Juneau.                                                                                                           
REPRESENTATIVE   TARR  asked   about   federal  restrictions   to                                                               
expanding MAT.                                                                                                                  
MS. BURKHART replied  that not anyone can  provide MAT treatment.                                                               
If  a  physician  or  a  nurse  practitioner  wanted  to  provide                                                               
treatment,  licensing  was  required  by the  state  and  federal                                                               
governments,  and there  was a  limit  to the  number of  clients                                                               
served.   She stated  that the methadone  programs were  the most                                                               
rigorously  regulated.     Many   other  medications   were  also                                                               
effective for  pain management, and  there were no limits  on the                                                               
pain  management practices.    She  declared: "same  medications,                                                               
different regulatory structures."                                                                                               
3:52:10 PM                                                                                                                    
MS. BURKHART  moved on to slide  21, and said that  Martha wanted                                                               
to  find a  residential  program closer  to  her home  community.                                                               
There  was  a  culturally relevant,  appropriate  clinical  level                                                               
program in her  region, which would have an opening  in about two                                                               
weeks.  Martha can't stay  at the withdrawal management treatment                                                               
center for  the two weeks while  she has to wait  for the opening                                                               
in  residential  treatment,  which  creates  a  warning  for  the                                                               
opportunity to divert  off the recovery journey.   She works with                                                               
the  treatment  team at  the  withdrawal  management center,  her                                                               
behavioral health  provider at home,  and a case manager  to come                                                               
up with a  plan for those two  weeks.  Martha can go  back to the                                                               
hub community  and stay  with a  family friend  who is  sober and                                                               
willing to  help her  stay sober during  those two  weeks. Martha                                                               
can  also   attend  the  nightly   AA  meetings  hosted   at  the                                                               
residential treatment center where she  was planning to go.  This                                                               
would  also  help  her  to  establish  a  relationship  with  the                                                               
treatment provider.                                                                                                             
MR.  CHARD directed  attention to  slide 22.   Martha  spends six                                                               
weeks  in  the residential  treatment  program,  and then,  after                                                               
residential treatment, Martha  needs to move to a  lower level of                                                               
outpatient treatment to  build on the progress she has  made.  At                                                               
each of these steps there is  risk for diversion from the road to                                                               
recovery.  Martha was able  to transition to outpatient treatment                                                               
in the  hub community, staying  with family.   Transitioning from                                                               
the structure  of residential  treatment to  outpatient treatment                                                               
was  another   critical  point  in  Martha's   recovery  journey.                                                               
Martha's  social   and  familial  networks  contributed   to  and                                                               
supported her alcohol and drug use.                                                                                             
MS. BURKHART discussed  the opportunity for relapse  and the need                                                               
for a relapse  prevention plan, slide 23.  Martha  was invited to                                                               
a family  birthday party, and  although she really wanted  to go,                                                               
she  knows  that  it's  a  risk  to her  sobriety.    She  has  a                                                               
safety/relapse  prevention  plan  that   she  and  her  clinician                                                               
developed as  part of her  outpatient treatment plan.   There was                                                               
alcohol at  the party, and  everyone was drinking.   Martha makes                                                               
it through most of the evening,  but then decides "one beer won't                                                               
hurt,and    she drinks until she  passes out.  The  next day, she                                                               
is  very hung  over and  someone offers  her prescription  opioid                                                               
pain pills to  "take the edge off."  Martha  takes her usual dose                                                               
of pills,  but because she's been  sober for almost 60  days, she                                                               
doesn't  have  the  same  tolerance,  and  she  overdoses.    Ms.                                                               
Burkhart  stated  that  this happens  with  great  frequency  for                                                               
people  who don't  realize  how their  tolerance  has waned  with                                                               
prolonged sobriety.                                                                                                             
MR. CHARD shared  slide 24, and relays that  the first responders                                                               
had Narcan  onboard, so they were  able to save Martha  when they                                                               
responded  to  her  overdose.     Martha's  outpatient  treatment                                                               
provider  talks to  Martha about  going back  into a  residential                                                               
program  to help  her  avoid  a long-term  relapse.   Martha  was                                                               
worried  that  she won't  be  able  to  stay  sober in  her  home                                                               
community.  She  works with her clinicians to  find a residential                                                               
treatment  program that  includes aftercare,  transitional living                                                               
and recovery  support services.   He added that,  although Narcan                                                               
can save a life, it was not treatment.                                                                                          
MS. BURKHART addressed  slide 25, and shares  that Martha decides                                                               
to go to  another residential program because  she was struggling                                                               
to stay  on her chosen  road.  Martha moves  successfully through                                                               
the levels  of treatment  offered by  the substance  use disorder                                                               
treatment provider.   During that  time, she connects  with other                                                               
people  in recovery  and starts  to build  a support  network for                                                               
healthy and  stable social  networks to  maintain recovery.   She                                                               
was homesick, but she was also  afraid of relapse.  Martha worked                                                               
with a  case manager  to address barriers  to her  recovery: find                                                               
stable  housing;  connect   with  vocational  rehabilitation  for                                                               
employment; work with the primary  care provider regarding actual                                                               
health  conditions;   and  find   healthy  alternatives   in  the                                                               
community which  did not include  drinking.  She points  to slide                                                               
26, and  declares that Martha  celebrated 12 months  of sobriety.                                                               
She  was  working  full-time  and sharing  an  apartment  with  a                                                               
friend.   She went to  the 12-step  meetings 3-4 times  each week                                                               
for support.   Martha was seeing a mental  health professional to                                                               
address the underlying mental health  issues that had been masked                                                               
by drug and  alcohol use.  The coping skills  she was learning in                                                               
therapy helped her  navigate the triggers that might  lead her to                                                               
drink or  want to use  again.  Martha  felt strong enough  in her                                                               
recovery to go home to visit her  mother.  They had a good visit.                                                               
She reported that for those working  to achieve recovery in a new                                                               
environment,  going home  was  a  big deal,  as  it  could be  an                                                               
opportunity to address many triggers.                                                                                           
MR. CHARD  shared slide 27,  and noted that several  points along                                                               
the  journey to  recovery hinted  at problems  the substance  use                                                               
disorder  treatment  providers  had  that  were  hampering  their                                                               
ability  to  provide  the  support  she  needs.    Providers  and                                                               
policymakers  were   working  together  to  address   the  larger                                                               
challenge that  was affecting healthcare delivery  systems across                                                               
the country:  Access; Quality; and Cost.                                                                                        
4:00:59 PM                                                                                                                    
MS. BURKHART  turned to  slide 29,  "Patient &  Provider Stigma."                                                               
She spoke about an earlier  presentation regarding the science of                                                               
addiction,  and  noted  that individuals  with  a  substance  use                                                               
disorder  were not  treated the  same as  individuals with  other                                                               
disorders  and  diseases.     Substance  use  disorder  treatment                                                               
providers  were   not  treated  the  same   as  other  healthcare                                                               
practitioners,  as there  was a  stigma attached,  in how  we pay                                                               
them, the  documentation that we  require of them  for oversight,                                                               
and how  we credential them.   The  stigma was beyond  the person                                                               
needing  help, and  affected everyone  involved  in helping  that                                                               
MR. CHARD  spoke about  slide 30,  reporting that  the Behavioral                                                               
Health providers  in Alaska  were required  by regulation  (7 AAC                                                               
70.150) to  be accredited by  a national accrediting  body (Joint                                                               
Commission, CARF, COA, or other).   Accrediting bodies maintained                                                               
strict standards that ensured adequate  oversight of clinical and                                                               
business  practices,  treatment   effectiveness,  and  continuous                                                               
quality   improvement.      There  was   duplicative   reporting,                                                               
documentation,   and   oversight   requirements   that   diverted                                                               
resources from  treatment.  The 2014  Streamlining Initiative was                                                               
a successful  public/ private partnership  to help  address these                                                               
MR.  CHARD reported  that Alaska  was  constantly recruiting  for                                                               
more qualified  people in the  substance use  disorder workforce,                                                               
as it  was an area  of job growth in  the economy, with  good pay                                                               
and benefits in communities across the state, slide 31.                                                                         
MS.  BURKHART moved  on to  slide 32,  and spoke  about The  Peer                                                               
Support workforce,  a relatively untapped opportunity  that had a                                                               
lot  of potential  to fill  vacancies with  individuals who  have                                                               
lived  experience that  could help  inform treatment  and improve                                                               
outcomes.   The  way  a person's  criminal  background check  was                                                               
conducted was still  a major hurdle, as people  in recovery could                                                               
have  a felony,  which was  a disqualifier  for many  health care                                                               
professions.     Peer  Support   providers  were   not  currently                                                               
credentialed, and  it would  be necessary  to expand  the ability                                                               
for reimbursement.   She relayed  that telehealth was  a critical                                                               
component to the behavioral health  system, and was often used by                                                               
substance use  disorder treatment  providers to tap  into outside                                                               
MR.  CHARD said  that  substance abuse  treatment providers  were                                                               
predominantly  funded  by  unrestricted grant  funding,  although                                                               
there was some designated grant  funding from the current alcohol                                                               
tax.    He   said  that  Medicaid  Expansion   would  allow  more                                                               
individuals to  qualify.   He noted that  this was  also changing                                                               
the  treatment  system  with  a   transition  toward  a  Medicaid                                                               
reimbursement, even though Medicaid  rates did not actually cover                                                               
the cost of care.  He said  that rates had not been changed since                                                               
2006, slide 34.  He stressed  that there were still some services                                                               
which Medicaid would not pay for.                                                                                               
4:09:45 PM                                                                                                                    
MS.  BURKHART stated  that, as  it  was not  possible to  provide                                                               
every  service in  every community,  it was  necessary to  ensure                                                               
that publicly  funded substance use disorder  treatment providers                                                               
operated  in  concert across  the  State  of  Alaska, each  as  a                                                               
critical component  in a larger system  of care.  That  system of                                                               
care strives  to meet  every individual where  they are  on their                                                               
journey  and help  them achieve  recovery.   It was  a customized                                                               
approach, operating in a system  that seeks uniformity for policy                                                               
and funding purposes.  It  was challenging for trained clinicians                                                               
to find  the best resources  available to assist people  in their                                                               
journey to  recovery.   It was  extremely difficult  for someone,                                                               
especially in  crisis, to  navigate the  system themselves.   She                                                               
relayed that enrollment in Alaska  211 had been encouraged to all                                                               
the service providers, slide 35.                                                                                                
MS.  BURKHART   reported  that   substance  use   disorders  were                                                               
incredibly  complex, and  the people  who  experienced them  have                                                               
many behavioral, physical,  and social needs.   The substance use                                                               
disorder treatment  system was difficult  to navigate,  and there                                                               
were multiple  transition points  where a recovery  process could                                                               
be derailed.   Just  as teams of  health care  professionals work                                                               
together  to  serve  clients, Department  of  Health  and  Social                                                               
Services,  the Alaska  Behavioral Health  Association, and  other                                                               
stakeholders  were working  together to  maintain and  strengthen                                                               
the  system.    She  stated   that  this  was  "a  pretty  strong                                                               
relationship," slide 36.                                                                                                        
REPRESENTATIVE JOHNSTON  asked about the possibility  for an 1115                                                               
MS. BURKHART said  that she had participated on  the writing team                                                               
and the  policy team  for the  concept paper.   She  had positive                                                               
conversations  with   the  Centers  for  Medicare   and  Medicaid                                                               
Services,  regarding  the  concept paper  [Included  in  members'                                                               
packets].    She  stated  that   federal  healthcare  policy  was                                                               
currently up  in the air.   She emphasized that they  were moving                                                               
forward  with the  process,  and that  the  application would  be                                                               
submitted this summer.                                                                                                          
REPRESENTATIVE  JOHNSTON stated  that while  she was  reading the                                                               
grant  book,  she  had  found  duplication  and  intertwining  of                                                               
grants, and she opined that it  was not a very clear system, even                                                               
as she could  see legislative intent in some of  the grants.  She                                                               
said that a lot of these  were not federal pass through, and that                                                               
there  was  a need  to  readdress  some  of  these grants.    She                                                               
declared   that  she   was  in   total   support  of   non-profit                                                               
organizations.    She lamented  that  lack  of benchmarks.    She                                                               
offered her belief  that speaking of the stigma was  not fair, as                                                               
no one had the answers.                                                                                                         
MS. BURKHART replied that she had  looked at all the FY16 grants.                                                               
She  explained that  you had  to be  a grantee  in order  to bill                                                               
Medicaid, hence the very small grants.                                                                                          
REPRESENTATIVE EDGMON  said that the narrative  helped illustrate                                                               
that Martha  could have  had kids,  she could  have been  an FASD                                                               
baby, and there  could have been domestic violence  involved.  He                                                               
declared that it was an inherently complicated issue.                                                                           
REPRESENTATIVE  TARR  offered  her   belief  that  the  need  far                                                               
exceeded the  amount of service  available, hence  the appearance                                                               
of  overlap for  the grants.    She opined  that an  organization                                                               
could not get  too big without losing the personal  touch and the                                                               
intensive  management  support  toward recovery,  and  that  this                                                               
could be the reason for the appearance of similar services.                                                                     
4:19:49 PM                                                                                                                    
MR. CHARD acknowledged  that the capacity for  services could not                                                               
meet the  demand.  He pointed  out that there were  34 withdrawal                                                               
management beds  for 740,000 people.   He  said that each  of the                                                               
treatment providers  worked to  employ evidence  based practices,                                                               
and some  of these models  were in  smaller settings.   He stated                                                               
that  it  depended on  the  client's  needs, and  what  treatment                                                               
program would  work best.   He asked  that the  committee mention                                                               
any  programs that  appeared duplicative,  as he  may be  able to                                                               
explain any differences.  He pointed  out that some serve the kid                                                               
population, and some serve the adult population.                                                                                
REPRESENTATIVE SULLIVAN-LEONARD  stated that  Martha was  a clear                                                               
description of anyone in Alaska.   She mentioned that she had not                                                               
noticed any  treatment component  for faith  based groups  in the                                                               
state.  She said that  the Department of Corrections had declared                                                               
that the faith based treatments  within the correctional facility                                                               
were successful.                                                                                                                
MS. BURKHART replied  that some state programs  were faith based,                                                               
and they  were often part  of the system.   She relayed  that the                                                               
clinical and accreditation requirements to  be part of the system                                                               
were the same  for everyone.  She allowed that  having the choice                                                               
to pursue was good, but there were not always many options.                                                                     
CHAIR  SPOHNHOLZ  stated  that  addiction treatment  was  a  very                                                               
personal  experience  and  that  it   was  necessary  to  find  a                                                               
treatment  experience  that  aligned   with  your  values.    She                                                               
reflected on  the pauses  necessary for  treatment, and  that the                                                               
challenge was  when someone  would show  up ready  for treatment,                                                               
but without  immediate availability,  and the person  would often                                                               
relapse.  She asked if there  had been any research for solutions                                                               
to this problem.                                                                                                                
MR. CHARD  expressed his agreement that,  although elasticity for                                                               
the  system  was  important,  there  were  not  enough  treatment                                                               
programs  and  providers  for  the  need.    He  emphasized  that                                                               
services cost money,  and resources were necessary.   He declared                                                               
that innovations in peer support  and telemedicine, among others,                                                               
were helping to address this question.                                                                                          
MS.  BURKHART added  that one  area which  had not  been explored                                                               
enough  were  the  natural  helpers in  the  community,  and  the                                                               
resources  available from  tribal  or extended  families.   As  a                                                               
system,  she asked  how  the community  would  keep someone  safe                                                               
until there were openings.                                                                                                      
4:27:09 PM                                                                                                                    
The committee took a brief at ease.                                                                                             
             HB 138-MARCH: SOBRIETY AWARENESS MONTH                                                                         
4:28:32 PM                                                                                                                    
CHAIR SPOHNHOLZ announced  that the next order  of business would                                                               
be HOUSE  BILL NO. 138, "An  Act establishing the month  of March                                                               
as Sobriety Awareness Month."                                                                                                   
4:28:42 PM                                                                                                                    
REPRESENTATIVE  DEAN WESTLAKE,  Alaska State  Legislature, stated                                                               
that proposed  HB 138 designated  the month of March,  each year,                                                               
as Sobriety  Awareness Month.  He  relayed that this was  to help                                                               
and support  all those people  who have struggled.   The proposed                                                               
bill  would  provide  the   opportunity  for  schools,  community                                                               
groups,  and   other  entities   to  recognize,   appreciate  and                                                               
celebrate those Alaskans that choose  to live a life of sobriety.                                                               
Individuals that lead sober lives are  an asset to Alaska in that                                                               
they can  help reduce  the incidence of  alcohol or  drug related                                                               
social ills  such as crime, recidivism,  domestic violence, child                                                               
abuse and  neglect.   He relayed  an experience  with a  group of                                                               
empowering stories of sobriety at a gathering.                                                                                  
4:30:22 PM                                                                                                                    
FORREST WOLFE, Staff, Representative  Dean Westlake, Alaska State                                                               
Legislature, read  from the  Uniform Alcoholism  and Intoxication                                                               
Treatment Act [Included in members' packets]:                                                                                   
     It   is  the   policy  of   the  state   to  recognize,                                                                    
     appreciate,  and  reinforce  the  example  set  by  its                                                                    
     citizens who  lead, believe in,  and support a  life of                                                                    
MR.  WOLFE offered  his belief  that a  permanent designation  of                                                               
March as Sobriety Awareness Month  would help the State of Alaska                                                               
meet this declaration of policy.                                                                                                
4:31:27 PM                                                                                                                    
GREGORY  NOTHSTINE,  President,  Sobermute Reviving  Our  Spirit,                                                               
said  that he  was aware  the  Alaska State  Legislature was  the                                                               
first in  the nation to  pass a statute  recognizing appreciation                                                               
and reinforcement of citizens for living  a life of sobriety.  He                                                               
said  that there  were elders  and senior  citizens who  were not                                                               
recognized  for contributions  and efforts  for building  a safer                                                               
community.  He  offered his belief that millions  of dollars were                                                               
spent  on  treatment centers,  whereas,  this  proposed bill  was                                                               
reinforcing  appreciation  of its  citizens.    He expressed  his                                                               
support of the proposed bill.                                                                                                   
REPRESENTATIVE JOHNSTON stated that she  was glad this was March,                                                               
as,  she opined,  spring could  be  a very  stressful time,  when                                                               
alcohol "rears  its ugly head  and suicide."  She  suggested that                                                               
celebrations and festivals  in March were great.   She stated her                                                               
support for the proposed bill.                                                                                                  
REPRESENTATIVE EDGMON  offered his belief that  "tribes" could be                                                               
added to the wording in the proposed bill.                                                                                      
4:34:48 PM                                                                                                                    
REPRESENTATIVE SPOHNHOLZ  shared that she  had been sober  for 14                                                               
years,  and  that celebrating  sobriety  as  a healthy  lifestyle                                                               
choice for  Alaskans was a  step in  the right direction  for our                                                               
community to come together in March  every year.  She stated that                                                               
making  it dedicated  forever showed  commitment from  the state.                                                               
She stated her support for the proposed bill.                                                                                   
[HB 138 was held over.]                                                                                                         
             HB 43-NEW DRUGS FOR THE TERMINALLY ILL                                                                         
4:35:48 PM                                                                                                                    
CHAIR SPOHNHOLZ announced that the  final 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."                                                                                                         
4:36:12 PM                                                                                                                    
BROOKE  IVY,  Staff,  Representative Jason  Grenn,  Alaska  State                                                               
Legislature,  recapped  the proposed  bill,  and  stated that  it                                                               
would streamline  an existing process  through the U.S.  Food and                                                               
Drug  Administration,   the  Compassionate  Use   Program,  which                                                               
allowed  for   those  diagnosed  as  terminally   ill  to  access                                                               
investigational  medications outside  the clinical  trial process                                                               
in an  effort to save their  own lives.  The  proposed bill would                                                               
allow terminally ill patients to  work directly with their doctor                                                               
and  the drug  manufacturer,  given informed  consent, to  access                                                               
those treatments.                                                                                                               
4:37:13 PM                                                                                                                    
CHAIR SPOHNHOLZ  opened public testimony  on HB 43.   There being                                                               
no one to testify, she closed public testimony.                                                                                 
4:37:59 PM                                                                                                                    
REPRESENTATIVE  EDGMON moved  to report  HB 43  out of  committee                                                               
with  individual  recommendations  and  the  accompanying  fiscal                                                               
4:38:09 PM                                                                                                                    
REPRESENTAIVE  EASTMAN objected.   He  stated there  was "a  very                                                               
wide gap between the purposes for  which a drug is tested and the                                                               
actual uses that  we are now giving physicians  immunity for, and                                                               
that's concerning to me."                                                                                                       
4:38:45 PM                                                                                                                    
A roll  call vote  was taken.   Representatives  Spohnholz, Tarr,                                                               
Sullivan-Leonard, Johnston,  Eastman, Edgmon,  and Kito  voted in                                                               
favor of HB 43.   Therefore, HB 43 was reported  out of the House                                                               
Health  and Social  Services Standing  Committee by  a vote  of 7                                                               
yeas - 0 nays.                                                                                                                  
4:39:49 PM                                                                                                                    
There being no  further business before the  committee, the House                                                               
Health  and  Social  Services   Standing  Committee  meeting  was                                                               
adjourned at 4:39 p.m.                                                                                                          

Document Name Date/Time Subjects
ABADA ABHA Substance Use Disorder Treatment in Alaska Presentation 3.7.....pdf HHSS 3/7/2017 3:00:00 PM
Substance Use Treatment in Alaska
ABADA ABHA Back Up Materials.pdf HHSS 3/7/2017 3:00:00 PM
HB138 ver D.PDF HCRA 4/4/2017 8:00:00 AM
HHSS 3/7/2017 3:00:00 PM
HHSS 3/23/2017 3:00:00 PM
HB 138
HB138 Sponsor Statement.pdf HCRA 4/4/2017 8:00:00 AM
HHSS 3/7/2017 3:00:00 PM
HHSS 3/23/2017 3:00:00 PM
HB 138
HB138 Fiscal Note DHSS-BHA-3.3.17.pdf HCRA 4/4/2017 8:00:00 AM
HHSS 3/7/2017 3:00:00 PM
HHSS 3/23/2017 3:00:00 PM
HB 138
HB138 Support Document-Alcoholism and Intoxication Treatment Act.pdf HCRA 4/4/2017 8:00:00 AM
HHSS 3/7/2017 3:00:00 PM
HHSS 3/23/2017 3:00:00 PM
HB 138
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 - 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 - 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 - 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
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 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
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
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
HB043 Supporting Document - Letters of Support 3.2.17.pdf 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.pdf HHSS 3/2/2017 3:00:00 PM
HHSS 3/7/2017 3:00:00 PM
HB 43